Hit with $7,146 for two hospital bills, a family sought health care in Mexico : Shots

Claudia and Jesús Fierro of Yuma, Ariz., review their medical bills. They pay $1,000 a month for health insurance yet still owed more than $7,000 after two episodes of care at the local hospital.

Lisa Hornak for Kaiser Health News


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Lisa Hornak for Kaiser Health News


Claudia and Jesús Fierro of Yuma, Ariz., review their medical bills. They pay $1,000 a month for health insurance yet still owed more than $7,000 after two episodes of care at the local hospital.

Lisa Hornak for Kaiser Health News

The Fierro family of Yuma, Ariz., had a string of bad medical luck that started in December 2020.

That’s when Jesús Fierro Sr. was admitted to the hospital with a serious case of COVID-19. He spent 18 days at Yuma Regional Medical Center, where he lost 60 pounds. He came home weak and dependent on an oxygen tank.

Then, in June 2021, his wife, Claudia Fierro, fainted while waiting for a table at the local Olive Garden restaurant. She felt dizzy one minute and was in an ambulance on her way to the same medical center the next. She was told her magnesium levels were low and was sent home within 24 hours.

The family has health insurance through Jesús Sr.’s job, but it didn’t protect the Fierros from owing thousands of dollars. So when their son Jesús Fierro Jr. dislocated his shoulder, the Fierros — who hadn’t yet paid the bills for their own care — opted out of U.S. health care and headed south to the U.S.-Mexico border.

And no other bills came for at least one member of the family.

The patients: Jesús Fierro Sr., 48; Claudia Fierro, 51; and Jesús Fierro Jr., 17. The family has Blue Cross and Blue Shield of Texas health insurance through Jesús Sr.’s employment with NOV, formerly National Oilwell Varco, an American multinational oil company based in Houston.

Medical services: For Jesús Sr., 18 days of inpatient care for a severe case of COVID-19. For Claudia, fewer than 24 hours of emergency care after fainting. For Jesús Jr., a walk-in appointment for a dislocated shoulder.

Total bills: Jesús Sr. was charged $3,894.86. The total bill was $107,905.80 for COVID-19 treatment. Claudia was charged $3,252.74, including $202.36 for treatment from an out-of-network physician. The total bill was $13,429.50 for less than one day of treatment. Jesús Jr. was charged $5 (70 pesos) for an outpatient visit that the family paid in cash.

Service providers: Yuma Regional Medical Center, a 406-bed nonprofit hospital in Yuma, Ariz. It’s in the Fierros’ insurance network. And a private doctor’s office in Mexicali, Mexico, which is not.

What gives: The Fierros were trapped in a situation in which more and more Americans find themselves. They are what some experts term “functionally uninsured.” They have insurance — in this case, through Jesús Sr.’s job, which pays $72,000 a year. But their health plan is expensive, and they don’t have the liquid savings to pay their share of

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Never-ending costs: When resolved medical bills keep popping up : Shots

Suzanne and Jim Rybak, inside the craft room where their son, Jameson, would encourage Suzanne to make colorful beach bags, received a $4,928 medical bill months after it was supposedly resolved.

By Gavin McIntyre/Kaiser Health News


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Suzanne and Jim Rybak, inside the craft room where their son, Jameson, would encourage Suzanne to make colorful beach bags, received a $4,928 medical bill months after it was supposedly resolved.

By Gavin McIntyre/Kaiser Health News

Every now and then, Suzanne Rybak and her husband, Jim, receive pieces of mail addressed to their deceased son, Jameson. Typically, it’s junk mail that requires little thought, Suzanne said.

But on March 5, an envelope for Jameson came from McLeod Health.

Jim saw it first. He turned to his wife and asked, “Have you taken your blood pressure medication today?”

He knew showing her the envelope would resurface the pain and anger their family had experienced since taking Jameson to McLeod Regional Medical Center in Florence, S.C., two years ago.

As KHN previously reported, Jameson was experiencing withdrawal symptoms from quitting opioids. Suzanne feared for her son’s life and took him to McLeod’s emergency room on March 11, 2020.

There, they encountered a paucity of addiction treatment and the potential for high medical costs — two problems that plague many families affected by the opioid crisis and often lead to missed opportunities to save lives.

Jameson was not offered medications to treat opioid use disorder in the ER, nor was he given referrals to other treatment facilities, Suzanne said. The hospital wanted to admit him, but, being uninsured, Jameson feared a high bill. The hospital didn’t inform him of its financial assistance policy, Suzanne said. And he decided to leave.

Three months later, Jameson, 30, died of an overdose in his childhood bedroom.

Months of red tape

In the following months, the Rybaks received bills from McLeod Health addressed to Jameson. He owed $4,928, the bills said. Suzanne called and wrote to hospital administrators until September 2020, when the bill was resolved under the health system’s financial assistance program.

That was the last they had heard from McLeod Health until the new envelope arrived March 5 — one week before the two-year anniversary of Jameson’s ER visit. That visit was what Suzanne calls “the beginning of the end for my son.”

When the Rybaks opened the envelope, they found a strikingly familiar bill for $4,928.

“I can’t even describe my anger and sadness,” Suzanne said. “It’s always present, but when we received that statement, we were just stunned.”

There’s no national data to indicate how often patients or their families receive medical bills that were previously paid or forgiven, but hospital billing experts say they frequently see it happen. Patients might receive bills for claims their insurers already paid. A reminder statement may arrive even after a patient has submitted payment.

Unlike “surprise bills,” which often result from policy gaps when a provider is out

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A nurse’s death becomes a rallying cry for health workers’ mental health : Shots

Close friends Joshua Paredes, Michael Walujo and John LeBlanc are working together to set up a crisis help line for nurses following the suicide of their friend Michael Odell in January.

Rachel Bujalski for NPR


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Rachel Bujalski for NPR


Close friends Joshua Paredes, Michael Walujo and John LeBlanc are working together to set up a crisis help line for nurses following the suicide of their friend Michael Odell in January.

Rachel Bujalski for NPR

On the morning of January 18, Joshua Paredes came home to an empty apartment. His roommate and good friend Michael Odell wasn’t there, but there was a giant bag of Skittles, Odell’s favorite snack, on the dog bed.

Paredes, who has two dogs, texted his friend. “I was like, ‘Oh my gosh, how many Skittles were in here? Just so I know what’s going on with the dogs.'”

They were both working as nurses – Paredes at the University of California, San Francisco hospital and Odell at Stanford Health Care – and initially, Paredes didn’t think much of his friend’s absence, since he typically came home a little later.

When he didn’t hear back, and Odell didn’t answer his call either, Paredes looked for his friend’s location on his phone – they shared locations with each other. It showed him on a highway that he never took to come home.

“So I kind of realized something was weird,” says Paredes.

He then called his friend’s workplace and learned that Odell had left work around 4:30 a.m. to get something from his car. But he never came back.

Paredes started calling Odell’s other friends to raise the alert.

“When I found out that he left mid-shift, my first thought was he’s in crisis,” says John LeBlanc, a nurse at UCSF, and a good friend of Paredes and Odell. “Because it’s totally, completely out of character for him.”

Two days later, after a search by friends, volunteers and the police, the authorities found Odell’s body. While the investigation into his death is still ongoing, the evidence points to suicide. He was 27 years old.

Michael Odell, a critical care nurse, had spent the past two years traveling between assignments in California and Minnesota. In December, he started a stint with Stanford in the midst of the Omicron surge.

Joshua Paredes


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Joshua Paredes


Michael Odell, a critical care nurse, had spent the past two years traveling between assignments in California and Minnesota. In December, he started a stint with Stanford in the midst of the Omicron surge.

Joshua Paredes

If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.

A wake-up call

For Odell’s group of close friends, his death was crushing.

“It’s been hard,” says Michael Walujo, a critical care nurse at Stanford, and a close friend who traveled with Odell for several

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Why early COVID treatments like Paxlovid are going unused : Shots

Treatments like monoclonal antibody infusions and antiviral pills can prevent a case of COVID-19 from becoming life-threatening. But many of the available drugs are not being used.

Emily Elconin/Bloomberg via Getty Images


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Emily Elconin/Bloomberg via Getty Images


Treatments like monoclonal antibody infusions and antiviral pills can prevent a case of COVID-19 from becoming life-threatening. But many of the available drugs are not being used.

Emily Elconin/Bloomberg via Getty Images

Even as this winter’s omicron surge recedes, more than 2,000 people in the U.S. still get hospitalized with COVID-19 each day. This population is largely unvaccinated, with medical conditions that increase their risks. Some of these hospitalizations could have been prevented with early COVID treatments, such as pills and monoclonal antibodies, purchased and distributed for free by the government.

But data on COVID treatment utilization, shared with NPR by the U.S. Department of Health and Human Services, indicates that millions of COVID treatments are sitting on shelves unused.

“We are still in a public health emergency,” said Dr. Derek Eisnor, who leads the government’s distribution of COVID drugs, on a call with national health organizations on March 16. He urged health leaders to try to get the drugs to communities that have a demand for them, rather than let them go to waste.

“There’s an assumption that there’s not enough of [these drugs] around but it does seem when you look at the numbers that there is a lot around — it’s just not being used,” says Dr. Amesh Adalja, an infectious disease physician and senior scholar at the Johns Hopkins Center for Health Security. “They clearly are not getting to people at high enough rates to have their maximum impact.”

Currently, the federal government distributes four outpatient COVID treatments that can help stop the progression of COVID infections if taken within five to seven days of symptom onset, and one prevention therapy for immunocompromised people. State health departments and certain providers can order these drugs, and they are now available at pharmacies, infusion centers and health clinics across the country.

But states and health care providers report that less than half of the supply of treatments that they’ve ordered starting October 2021 has been used.

Health experts initially expected the drugs to fly off the shelves. “I thought [utilization] would be much higher,” says Dr. Phyllis Tien, an infectious disease physician at University of California, San Francisco who serves on the NIH COVID-19 treatment guidelines panel. At first, doctors were prioritizing who would get them, she says, to help preserve access for those with the greatest medical need.

The reported utilization rates may underestimate the total doses used; sites are supposed to report daily or weekly usage numbers to the government, but not all do. Still, the rates are used by the government to make decisions on distribution policies, and Tien says they track with what she’s seeing on the ground.

“When a patient comes to us and they’re COVID positive and

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How to reboot from unhealthy pandemic habits : Shots

Scheduling time on the calendar for a workout and setting small, achievable goals are just a couple of ways we can focus on rebuilding healthy habits.

Michael Driver for NPR


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Michael Driver for NPR

The early days of lockdown restrictions had a profound effect on people’s daily lives. Alcohol sales skyrocketed, physical activity dropped off sharply, and “comfort eating” led to weight gain, too.

So, what’s happened since March of 2020? After two years of pandemic life, many of these effects persist. The strategies we used to adapt and cope have cemented into habits for many of us. And this is not a surprise to scientists who study behavior change.

“We know when a shock arises and forces a change in our behavior for an extended period of time, there tend to be carryover effects because we’re sticky in our behaviors,” says Katy Milkman of the University of Pennsylvania, and author of the book How To Change. In other words, our pandemic habits may be hard to break.

Take, for example, alcohol consumption. During the first week of stay-at-home restrictions in March 2020, Nielsen tracked a 54% increase in national sales of alcohol. This came as bars and restaurants closed. A study from Rand documented a 41% increase in heavy drinking among women in the months that followed. (Heavy drinking was defined as four or more drinks for women within a few hours.)

“Of concern is the fact that increases in drinking are linked to stress and coping,” says Dr. Aaron White of the National Institute on Alcohol Abuse and Alcoholism. He points to a study that found a 50% increase in the number of people who said they drank to cope in the months right after COVID began compared to before the pandemic.

After a spike in sales in the spring of 2020, alcohol sales dipped.

But the most recent data from Nielsen show sales of beer, wine and spirits at the start of 2022 remain higher than they were in 2019. That trend is also reflected yearly: In 2019, spirit sales totaled about $16.3 billion, compared with $21 billion in 2021. Bottom line: Alcohol sales have remained higher than they were before the pandemic, even after adjusted for inflation.

Changes in physical activity have followed a similar pattern. Scientists at UC San Francisco analyzed data from a wellness smartphone app, Argus, which tracks daily step counts among users in countries around the globe. One month after stay-at-home restrictions were initiated in the spring of 2020, people took about 27% fewer steps a day, on average. That’s 1,432 fewer steps.

And what’s happened since? “The first decrease in activity was really the most drastic,” explains study author Geoff Tison, a cardiologist at UCSF who continues to track the smartphone data. In the U.S., physical activity picked up during spring and summer months (both in 2020 and 2021), when cases retreated and there was more daylight, but declined again amid fall

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Postal provider reform bill would shift retirees health treatment expenses to Medicare : Shots

A US Postal assistance staff unloads mail at a facility on February 10, 2022 in Houston, Texas. On February 8, the Property of Reps passed the Postal Assistance Reform Act of 2022 (H.R. 3076). The laws will tackle operational and monetary concerns that the agency has been grappling with for years.

Brandon Bell/Getty Illustrations or photos


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Brandon Bell/Getty Illustrations or photos


A US Postal company staff unloads mail at a facility on February 10, 2022 in Houston, Texas. On February 8, the Property of Associates handed the Postal Company Reform Act of 2022 (H.R. 3076). The laws will tackle operational and financial challenges that the agency has been grappling with for years.

Brandon Bell/Getty Pictures

A very long-awaited invoice to correct the nation’s deteriorating mail provider is on the verge of passage in the Senate, but it could occur at the cost of an even even larger and a lot more difficult trouble: Medicare solvency.

The Postal Support Reform Act of 2022 would aid shore up article workplace finances by ending the abnormal and onerous lawful prerequisite to fund 75 a long time of retirement health and fitness benefits in advance. In return, it would require long term Postal Provider retirees to enroll in Medicare.

In accordance to the Congressional Spending plan Office, the shift could save the postal retirement and well being programs about $5.6 billion as a result of 2031 whilst adding $5.5 billion in costs to Medicare through that span, and possibly significantly a lot more in later on many years.

Taking into consideration the large dimensions of Medicare — it put in $926 billion in 2020 — the expenditures never sum to considerably. That small money effect, and the ongoing immediate crises with mail supply, in all probability account for the robust bipartisan assistance the postal monthly bill has been given in Congress, with 120 Republicans joining Democrats to go the invoice in the Household on Feb. 8.

But late in the process, some lawmakers are elevating alarms around the shift, arguing that possibly Congress must glimpse additional carefully at the fiscal effect to Medicare’s belief fund, which is envisioned to run dry in 2026.

“This invoice simply shifts possibility to Medicare recipients by incorporating billions of new expenses to Medicare,” Sen. Rick Scott, R-Fla., claimed Feb. 14 in blocking requests on the Senate flooring to expedite passage of the invoice. Scott’s objection delayed consideration of the invoice till early March, following the Senate returns from its Presidents Working day split.

Presently, Postal Support staff members are coated by strategies presented in the Federal Employees Wellbeing Added benefits plan. When they retire they have a number of decisions for wellbeing treatment, including staying in their initial plan or switching to Medicare as their major protection and owning an FEHB strategy serve as supplementary protection. About 20% of postal retirees do not indication up for Medicare, preferring their latest federal plan. Below this legislation, they would have to change to Medicare, but

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