I don't know their individual circumstances.........but I imagine they got the appointment the same way anyone would, by phoning and asking for one.
These caravans across the border aren't spontaneous....they're planned.
As for who pays, they would.
Either in cash/debit/credit or through their American insurer if applicable.
That's perfectly legal.
Foreigners here have to get medical care too.
Depending on your circumstances. [[ie. if you're a student here or employed here legally vs being a tourist) you may buy into the public system here, or buy private insurance, or you may just pay cash etc.)
Just as they paid the drugstore for the insulin.
No different.
Doctors here also accept cash from Canadians for non-insured services. Everything from a doctor's note, to cosmetic work, to an employment related physical/certificate etc.
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