Blue Shield agrees to cover some treatment in Mexico

SAN DIEGO - She drives north across the border to work in the United States each day, but Enedina Franco wouldn't think of going to an American doctor.

"I wouldn't know how to say in English what hurts, or how I feel," says Franco, 54, a janitor who has legal U.S. residency but chooses to live in Tijuana, Mexico.

Franco's reluctance to use U.S. doctors is shared by enough workers in the San Diego-Tijuana area that it has attracted the interest of California's second-largest health maintenance organization. Blue Shield of California last week said it would offer the first U.S. health plan that covers medical care provided in Mexico.

Beginning Aug. 1, Blue Shield will cover routine medical care at three Tijuana hospitals for subscribers living in Tijuana and in the San Diego area up to 40 miles north of the border.

The plan makes Blue Shield the first major U.S. health insurer to enter the cross-border market.

Earlier this year, Mexican insurer Sistemas Medicos Nacionales won approval from California officials to offer a similar plan, which covers Mexican health care for Mexican citizens employed on the U.S. side in the San Diego area.

The Blue Shield plan doesn't need approval from Mexican insurance regulators because it will be sold only to U.S. employers, said Jim Arriola, Blue Shield's district manager for cross-border development.

The cross-border market is large: An estimated 50,000 people travel from Tijuana each day to work legally in the United States, about 25 percent of whom are U.S. citizens who live in Mexico, according to San Diego Dialogue, a public policy organization. Blue Shield hopes to tap that market and have 20,000 subscribers to its new plan within five years.

If the plan catches on in the San Diego area, Blue Cross may expand it, first to workers in Calexico, about 120 miles to the east, then to dental and vision coverage, and possibly to workers in Los Angeles, Arriola said.

"We are going to carefully evaluate how things are going before we take the next step," he said.

Dr. George Flores, the public-health officer for San Diego County, said thousands of U.S. citizens, many Spanish-speaking, use doctors in Mexico because it's cheaper and they are less likely to encounter a language barrier.

He cautioned, however, that doctors in Mexico generally have less training than their U.S. counterparts and less oversight from the government and professional organizations.

"There is perhaps a greater need for caution about getting care in Mexico," he said.

Blue Shield of California spent 18 months evaluating the three Tijuana hospitals in its program, Arriola said. He said the three - Centro Medico Excel, Hospital Notre Dame and Hospital Nova - are the only private hospitals in Tijuana certified by Mexico's health ministry.

Blue Shield of California and its counterparts in Texas and Arizona also are forming a subsidiary in Mexico that would serve the Mexican domestic market, Arriola said.

Eventually, he said, they hope to allow Mexican nationals who work anywhere in the United States to include their families back in Mexico in their Blue Shield plans through that subsidiary.