Self-pay patients are by no means a homogenous group – some are uninsured, others have high-deductible health insurance or even more comprehensive coverage that covers most costs (so long as they stay in-network and the insurer decides covers the treatment, of course). Some of the uninsured don’t have coverage by choice, while others would like to have coverage but just can’t afford conventional health insurance, or even alternative coverage types in some cases.
And some of them are immigrants, legal or illegal. Estimates vary, but one recent report pegged the number of immigrants in the U.S. at about 40 million, about 29 million legal and 11 million illegal. About 22 million of these immigrants come from just eight countries: Mexico, China, India, Philippines, Vietnam, Cuba, El Salvador, and Korea.
Just about everything that I’ve written about at The Self-Pay Patient blog is of use to America’s immigrant communities, both legal and illegal, such as visiting cash-only doctors, going to surgery centers that offer up-front ‘all inclusive’ pricing, joining health care sharing ministries, and using prescription drug discount cards.
That said, it did occur to me that there were a few things, some of which I’ve written about here before, that might stand out as options for immigrants when it comes to paying directly for health care (I should probably note here that I’m not a fan of the assumption many seem to have that immigrants, legal or illegal, rely primarily on government-provided care or use emergency rooms for ‘free’ treatment).
The first option I wanted to mention is something I’ve read about that seems to primarily be in the Los Angele, Miami, and Phoenix areas, which have large Spanish-speaking immigrant communities. The New York Times wrote about what are known as bodega clinicas in early 2013:
The “bodega clinicas” that line the bustling commercial streets of immigrant neighborhoods around Los Angeles are wedged between money order kiosks and pawnshops. These storefront offices, staffed with Spanish-speaking medical providers, treat ailments for cash: a doctor’s visit is $20 to $40; a cardiology exam is $120; and at one bustling clinic, a colonoscopy is advertised on an erasable board for $700.
County health officials describe the clinics as a parallel health care system, serving a vast number of uninsured Latino residents. Yet they say they have little understanding of who owns and operates them, how they are regulated and what quality of medical care they provide. Few of these low-rent corner clinics accept private insurance or participate in Medicaid managed care plans…
Visits to more than two dozen clinics in South Los Angeles and the San Fernando Valley found Latino women in brightly colored scrubs handing out cards and coupons that promised a range of services like pregnancy tests and endoscopies. Others advertised evening and weekend hours, and some were open around the clock.
Such all-hours access and upfront pricing are critical, Latino health experts say, to a population that often works around the clock for low wages.
Also important, officials say, is that new immigrants from Mexico and Central America are more accustomed to corner clinics, which are common in their home countries, than to the sprawling medical complexes or large community health centers found in the United States…
The article was informative about this option catering to self-pay immigrants, but unfortunately it focused on what I have to say is an irrational concern that because bodega clinicas are cash-only and affordable, they somehow must be inferior and are in desperate need of regulation.
One doctor from a local university hospital was quoted saying about this affordable option “Someone has to figure out if there’s a basic level of competence,” while the director of a local nonprofit that runs 13 health clinics said “They are off the radar screen… and it’s unclear what they’re doing.” One think tank even referred to them as “underground,” suggesting that there’s something shady and even illegal about self-pay health care. I’m going to go out on a limb here and say they wouldn’t be saying these things about a cash-only practice that didn’t cater primarily to immigrants.
Another option that might appeal to self-pay immigrants who are Spanish-speakers and in need of surgery is Surgery Without Medical Insurance/Cirugia Sin Frontieres, in Bakersfield, California. Unlike other surgery centers that cater to self-pay patients, SWMI/CSF performs operations at local hospitals using doctors that have agreed to accept a discounted cash fee. Their services aren’t only for immigrants of course, but they do offer a Spanish-language web site and seem to be an ideal fit for this community.
Unfortunately SWMI/CSF doesn’t post their prices, which would obviously be a big help. I’d assume potential patients can call and get pricing information after a conversation with someone at the organization.
Not every immigrant is a Spanish-speaker or lives in California of course. Another self-pay option that seems custom-fit for immigrants is medical tourism, which typically offers prices for treatment that are much less than what it costs in the U.S., often 75% – 90% less.
While many native-born Americans may be reluctant to travel overseas for care, where they may have no local family to support their recovery, immigrants with roots and families in the country they plan to get their treatment are likely to feel far more comfortable.
MedRetreat, for example, offers medical tourism destinations in countries around the globe, including Argentina, Brazil, Costa Rica, El Salvador, India, Malaysia, Mexico, South Africa, Thailand, and Turkey. That doesn’t cover every country that sends immigrants to the U.S. course, but it does cover a lot of regions, and other medical tourism facilitators offer even more countries.
This is an option that is likely to work best for legal immigrants, who presumably have little trouble getting to their destination and returning to the U.S. after their treatment (that said, I believe there are some restrictions on legal immigrants leaving and returning to the country, and if you are a non-citizen legal resident you might want to talk with an immigration attorney before planning to travel overseas for treatment). For illegal immigrants, getting back into the U.S. is an obvious hurdle to traveling overseas for medical care.
Finally, finding coverage in the event of a catastrophic medical expense can be a challenge for illegal immigrants. They are prohibited from purchasing insurance on the exchanges, and obtaining conventional insurance in the individual market outside of the exchange can be difficult as well because of documentation requirements.
There is an option that may be suitable for illegal immigrants however, and that is the health care sharing ministries. It’s my understanding that Samaritan Ministries, Christian Healthcare Ministries, and Liberty Healthshare are open to anybody who otherwise qualifies regardless of citizenship/residency status. Christian Care Ministry requires members to be U.S. citizens, and Altrua is ambiguous – the membership requirements don’t state that only legal U.S. residents are eligible, but the application does ask about citizenship status as well as social security numbers.
As I’ve mentioned in the past, membership in a health care sharing ministry can provide financial protection against catastrophic medical expenses as well as help with paying for more routine treatments, similar to conventional and high-deductible insurance. And because illegal immigrants are already exempt from Obamacare’s tax on the uninsured, the current uncertainty over whether members of Liberty and Altrua get the same exemption as the other three ministries is a moot point.
To the best of my knowledge, none of the ministries currently operate programs that are aimed primarily at immigrant communities, but I will not be surprised if that changes in the next few years.
Like I said earlier, these aren’t the only self-pay options available to immigrants, and just about all the options I regularly discuss here that are available to native-born Americans are just as helpful to those born elsewhere. With luck these options and others will continue to develop over time to expand access to healthcare for everybody in the country, whatever their national origin or citizenship status.