Interesting medical reimbursement policy

[Evelyn Kendall]

This post is going to be a lot more polite than what I am feeling.

Today I went to our well known hospital to pick up a check for the reimbursement of lab tests.  Previously, I had to resubmit the pink lab coupon because the physician had not written a diagnosis on it.  The physician (who I consider to be one of the best) did not seem to be aware of this necessity, but he gladly went over my records in fine detail and then very carefully considered a diagnosis for all the tests. He wrote it on the coupon.  I resubmitted it and waited my thirty days, only to be presented with a check that did not cover at least a third of the lab work.  I asked to be shown the original bill for the labs and saw various tests with stars written next to them to indicate that they did not fit the diagnosis.  I guess a highly respected physician with decades of experience is not qualified to order tests he thinks are pertinent to his patient?  Some upstairs paper pusher gets to decide? (ok, now I'm getting angry all over again!)  Now I have to go back to the physician and ask him to put down three more diagnoses that will justify the labs.  Silly me!  And I thought labwork was used to MAKE a diagnosis.

I have complained before about this hospital - that it is becoming more and more like what I left the US to get away from. Inflated charges (the $102 I paid for a basic sonogram is ridiculously high for Panama) and the game playing with reimbursements is very distressing to me.  OK I'm done ranting.

[Bonnie Williams]

Thanks. Does anyone know the whereabouts of an online brochure particular to the Chiriqui plan? Is the upper limit the only difference between the two?

[Samantha]

For what its worth,  you can find info here..

 

http://www.mschiriqui.com/

 

My advice would be to RUN FOR THE HILLS! lol

[Judith Bernstein]

I am trying to get a handle on the medical care in Panama and from reading all the posts, have arrived at the following which may not be correct so please correct if wrong: routine outpatient care is available at affordable cost from doctorsin boquete and david. However, if you have an accident or an illness that requires hospitalization, you need insurance coverage unless you go to the public hospital. If you get health insurance, you still must lay out the money for all treatment and medicine and then try to get reiumbursed and this is not an easy process. Well even if I could afford $4600 per year with BUPA of Canada or the $600 per year at the Chiriqui Hospital, I don't have enough money to layout if I had a serious illness. If I understand this correctly, even though I am in good health at age 69, who knows what next year might bring and that makes me reconsider coming to Panama for a year or more as I had planned. Judith

[Bonnie Williams]

You don't have to have insurance to get into a private hospital. But if you don't have insurance, you have to make a deposit by cash or credit card prior to treatment. The deposit will depend on the type of care contemplated. Surgery generally will require a deposit equal to the anticipated costs of the operating room; in my experience this is generally $500. If your stay becomes extended, another deposit may be required. A hospital room is less than $100 a day, and routine tests are inexpensive.

[Judith Bernstein]

Bonnie: I Think you may have answered the question below but if you can add ore, please do. From what you said, I could afford the $500, but not the suregon's fee, as a layout. Also, hospital room for a while, but then not and read about one man who was in the hospital for three months! Do you have do be discharged to have the reimbursement process kick in?  See below and thanks. This is the one issue holding up my move to Boquete. I feel now I would be playing Russian roulette with my health!

 

 am trying to get a handle on the medical care in Panama and from reading all the posts, have arrived at the following which may not be correct so please correct if wrong: routine outpatient care is available at affordable cost from doctorsin boquete and david. However, if you have an accident or an illness that requires hospitalization, you need insurance coverage unless you go to the public hospital. If you get health insurance, you still must lay out the money for all treatment and medicine and then try to get reiumbursed and this is not an easy process. Well even if I could afford $4600 per year with BUPA of Canada or the $600 per year at the Chiriqui Hospital, I don't have enough money to layout if I had a serious illness. If I understand this correctly, even though I am in good health at age 69, who knows what next year might bring and that makes me reconsider coming to Panama for a year or more as I had planned.

[Bonnie Williams]

Judy's reply is correct. I would add, however, that the $600 a year the Hospital Chiriqui plan costs is not really insurance; it's a 70/30 co-pay with an $18,000 limit. This would certainly help with most illnesses, but it would be a drop in the bucket if you were facing something very serious which required long-term expensive care.  I am of the view that if you cannot afford international heath insurance or do not have a sizable cash reserve, you will not have peace of mind, but others disagree and/or are willing to take the risk that they will not require expensive care.

I posted the following recently in the yahoo expat health forum as an example of a "perfect storm":

My husband shattered his foot and ankle in an accident back in March, requiring
complicated orthopedic surgery with pins and plates and a week's stay in
Hospital Chiriqui. He subsequently contracted an infection in the wound which
required another hospital stay of one week with round the clock IV antibiotics.
A few weeks later the foot again was infected with an antibiotic-resistant
bacteria. This required another surgery to remove the pins and plates and a
month of hospitalization on a variety of IV antibiotics. After his release, he
required IV antibiotics three times a day for 10 days. The wound was too deep to
heal properly, so he underwent yet another surgery to remove part of his calf to
graft over the wound. He still is on a variety of medications and is visiting
the surgeon every few days for cleansing of the wound and checkups. Total number
of doctors involved: 8. Total cost to date: $45,000 mas or menos--and that's
with two of the surgeons discounting their work and with our pensionado
discount. (I would point out that had he enrolled in the Hospital Chiriqui plan,
the maximum paid would have been $18,000.) I have no doubt that he would have
lost his leg and maybe his life had we been forced, because of lack of money or
insurance, to go to the social security hospital because the antibiotics (we
went through many before finding one that killed the bacteria) were extremely
expensive and therefore not available there. He was cured only through the
efforts of a team of doctors working over a period of several months.

[Judith Bernstein]

Is the split 30% copay from patient, and 70% hospital insurance pays-- under the Hospital Chiriqui plan? And does anyone have an email or telephone # for their billing dept? I'd like to get clarification about what $ I would have to lay out were I hospitalized there, assuming that reimbursement is for their share of the expenses that you paid-- still not clear how this works, so if anyone can clarify, it would be most helpful. Judith B.

[Bonnie Williams]

Go to http://groups.yahoo.com/group/expathealth/ and click on the Files tab on the lefthand side. Look for the brochure on "MS Panama". I think it will answer your questions.( I note that the limit has been raised from $18,000 to $20,000.) Be aware, however, that there are many exclusions, as has been discussed here in previous posts.

[Judith Bernstein]

Thanks, Bonnie I did go there. The policy still say $15,000 limit on the website. I contacted the department to ask about how much money I might have to lay out if I had an emergency hospital stay-- the entire cost? As I cannot afford to do this and wait for re-imbursement, it  would be a difficult situation to say the least. If they send a satisfactory answer, it will make the move to Boquete possible.

Do you know if you can buy the insurance from the USA so that you are covered from Day 1??

Judith

[Bonnie Williams]

By the way, if you contacted them by e-mail, don't expect a reply. Panamanian businesses seldom respond to e-mails.

I'm glad your mind is more at rest, but mine wouldn't be. As I and others have pointed out, what the plan does not pay for can add up to a sizable amount. Without cash reserves, you could find yourself in a bind. You write that you are in good health, but even persons in good health have accidents that could result in costly hospitalization. (See the above report of my husband's accident which resulted in about $45,000 in medical bills.) If you have a credit card with a high limit, you probably would be all right. But without that or money in the bank, you need to realize that you would be taking a risk.

I'm not trying to frighten you or discourage you, but you appear to want to truly understand the situation, so I am responding as honestly as I can.