half price drinks for ladies

health insurance

Staying healthy in Puerto Vallarta and finding help when you're not.

Moderator: freeeye

Re: health insurance

Postby waltandjean » Thu Sep 21, 2017 11:00 am

OK, this comes from the Chapala web board. I do not vouch for it's accuracy but this member's wife is mexican and she is retired from IMSS as an admin. person so they do have a certain amount of knowledge. Every Mexican office of every agency runs things "their own way" so it may not be exactly like this in PV:

This pertains to SP (Seguro Popular)

" 21 hours ago, cedros said:
What a bout for first time application-not renewal?

"Procedure for affiliation:
• The holder of the families eligible for incorporation will attend an MAO (Affiliation and Orientation Module) to express their willingness to join the System, which may also be carried out before the brigades of affiliation and re-affiliation that for the purpose are constituted.
• The MAO's staff will ask the interested party to provide the necessary information to request the CECASOEH (Certificate of Socio-Economic Characteristics of the Home). [This is done verbably]
• The MAO staff or the affiliation employees will apply the CECASOEH. Once signed by the holder of the family, it will be considered as the request of affiliation of the families to the System.
• The holder must provide a simple copy of the following documents:

• Official ID (Elector's credential, current driver's license, Military Ticket, valid passport, INM card).
◦CURP (Single Code of Population Register) of each of the members.
◦ Domicile Proof (Receipt of water or RECENT light).

• The information obtained in CECASOEH and the documentation indicated in the previous point will be handled in a confidential way.
• Cover the family quota, except for families that due to their socio-economic status enter the non-contributory regime.
• The MAO or staff will provide the Letter of Rights and Obligations and will issue the Affiliation Policy indicating the holder, the beneficiaries of the family, the validity of their rights, the annual family fee and the medical unit Health) that corresponds to them."

"To join the Seguro Popular you need to be a legal resident of Mexico. [the passport mentioned above is for Mexican citizens, not foreigners] They ask you questions about your living conditions and property you own. If you rent or do not own a vehicle it is feee and if you have a certain amount of assets and own a house and vehicle they might charge you and your family a yearly fee to join on a scale according to the amount of assets you have. If you qualify for free the contract is for 3 years and if you need to pay a fee the contract is for 1 year. Upon renewing you will be asked the same questions to evaluate your current circumstances. Only about 2% of Seguro Popular members and their families pay an annual fee. After waiting your turn and bringing in the originals and copies of what they ask for you will have a contract in about 25 to 30 minutes."

" 3 hours ago, cedros said:
One more question if I may. Once you have done the paperwork at the SP hospital in El Chante do you need to register with a Doctor at a clinic near you. (In my case it would be San Juan Cosala probably).

All large clinics and all Seguro Popular hospitals have Affiliation and Orientation Modules and when you get your contract they print out the location of the nearest clinic to you to go to to get your appointment booklet and there between 8AM and 10AM Mon. to Fri. you make an appointment to see a GP Doctor usually the next day or 2. Before you go in to see the Dr. you go to the nurse´s station or in some clinics a desk in the waiting área where they open your file and ask you questions about your previous operations, list off about 25 to 30 medical questions you answer yes or no to [examples: did any of your family have cáncer or heart attacks, if yes who, did you ever have mumps, did you ever have tuberculosis, etc.] , and what your current medical conditions are, what medications you are on, your vitals, weight and height and if you didn´t eat anything take your blood sugar level. Take all your prescriptions and medicines if you want to continue getting them without being diagnosed by Seguro Popular specialists to the Dr..

I helped my buddy get his enrollment changed from SLP to Puerto Vallarta in June. They gave him a new 3 year contract instead of changing his address. We got him an appointmet the next morning and we had him set up and the GP gave him prescriptions for all his medicines [prescriptions from a US Doctor and in vials with the doses and instructions on them from the US] at that first appointment without requiring him to be diagnosed by SP specialists. She only carefully looked at the vials and wrote prescriptions based on that information. Once she entered al this information in his file she will be able to continue writing his perscriptions every month by looking at that information. If you need to be diagnosed by a SP specialist it might take 3 months or more before it is over and he sends a letter authorizing your GP to write perscriptions that he gave you.

I have done this for 7 people in the last 7 years at the SP and 3 times at IMSS. I belong to the ISSSTE. I take my wife´s ageing relatives and some of our friends family to their specialists appointments at all 3 of these socialized medicine hospitals as I am now noted for getting them in and out fast and have a car.

The SP is much more lenient, IMSS is not as much and ISSSTE is hard a**ed when following rules. I don´t even think ISSSTE would give prescritions without their specialists diagnosing you all over again and filing their paperwork into their system.


You may be asked to provide a Constancia de Residencia, proof of residence. This is a letter that you will obtain from the Presidencia in Jocotepec on the plaza. You will need to bring your visa, CFE bill, Curp, passport, and a photo (infantil ?) to get the letter. About 38 pesos. Then you take that to the hospital in El Chante. YMMV, sometimes they ask for this and sometimes not, depende."

Hope this helps.
waltandjean
 
Posts: 650
Joined: Sun Aug 25, 2013 3:21 pm
Location: Puerto Vallarta

Re: health insurance

Postby km1972 » Thu Sep 21, 2017 1:27 pm

Also dlockesf----It may "cover" you, but the Mexican hospital system will not process your insurance claims. You ARE required to pay the Mexican hospital in full, then you file for reimbursement to your US insurance. With Mexican hospitalization insurance the hospital and insurance company work together, your insurance company monitors your charges so you are not paying Gringo prices; and you have to pay a copay and deductable if you have not met it yet.

My husband and I are in our 60's, we paid @2k each for our insurance (still cheaper than US premiums 400 a month in the US). As with any insurance; you may need it, you may not. After 2 of my friends were hospitalized 1 in an emergency the other with a heart problem and they were held by the hospitals until their 30 & 50k medical bills were paid (by running up the credit cards), we figured FOR US, we would not risk it.

I should make it clear, I do not work for the insurance company, I get nothing. I only want to relate that there is good insurance available here in Mexico for ex pats, and as I stated I did speak with Pam about it and have introduced her to Andre by email so she knows there are a few options out there.

:)
km1972
 
Posts: 18
Joined: Fri May 30, 2014 2:39 pm

Re: health insurance

Postby waltandjean » Thu Sep 21, 2017 2:04 pm

km1972 is correct that any "foreign" insurance you have will be for reimbursement only, you pay up front and then file your claim. No pay, no leave hospital although I think an attorney could get you out of that one. Kidnapping is still kidnapping. My wife is retired from a major oil company and our insurance is through them with a $300 ded., 80/20, with $2000 max out of pocket. Our combined premium is only $305/Mo and is one of the main reasons we are able to live in Mexico. We are currently involved with Aetna on a claim for my cataract surgery. They just can't fathom the lack of super itemized operative reports. Don't they realize how much that adds to the costs? On the other hand, there is a lot of fraud involved, especially with foreign claims. I know, I used to work for one of the big companies and Tijuana was one place I used to have to go to investigate. That probably is the biggest reason we will never see Medicare coverage outside the US.
waltandjean
 
Posts: 650
Joined: Sun Aug 25, 2013 3:21 pm
Location: Puerto Vallarta

Re: health insurance

Postby deepcove » Fri Sep 22, 2017 11:00 am

Andre's email does not work = anyone have a different one?
deepcove
 
Posts: 176
Joined: Sun Sep 28, 2008 5:42 pm

Re: health insurance

Postby Marcos » Sat Sep 23, 2017 8:43 am

waltandjean wrote:Anyone who has health insurance in the US, whether Obamacare, Medicare or something else and who knows they have a pre-existing condition is not real smart to move to a foreign country unless A: The coverage is good worldwide (which Obamacare and Medicare are not) or B: They have a lot of money that they can use to pay out of pocket. Or, sign up for SP and accept that you go to their doctors and hospitals at their time schedule and receive what they consider appropriate treatment considering your age and physical condition. It's called triage in the med field. If Pam said no options she usually knows of what she speaks. SP is better than nothing if you can't afford out of pocket. SP is only free for people at the very lowest income range and you cannot have ANY other insurance.


The other option, depending upon the type of "pre-existing condition", is to bite the bullet and simply assume that if the PEC reoccurs you are gonna die.

I had a triple bypass 16 years ago. I have had zero complications so far but rather than bankrupt the wife, I'll simply fade away.
Two Wrongs Don't Make A Right ... But Three Lefts Do!
Marcos
 
Posts: 261
Joined: Fri Apr 22, 2005 11:23 am
Location: PV

Re: health insurance

Postby waltandjean » Sat Sep 23, 2017 4:29 pm

Marcos wrote:
waltandjean wrote:Anyone who has health insurance in the US, whether Obamacare, Medicare or something else and who knows they have a pre-existing condition is not real smart to move to a foreign country unless A: The coverage is good worldwide (which Obamacare and Medicare are not) or B: They have a lot of money that they can use to pay out of pocket. Or, sign up for SP and accept that you go to their doctors and hospitals at their time schedule and receive what they consider appropriate treatment considering your age and physical condition. It's called triage in the med field. If Pam said no options she usually knows of what she speaks. SP is better than nothing if you can't afford out of pocket. SP is only free for people at the very lowest income range and you cannot have ANY other insurance.


The other option, depending upon the type of "pre-existing condition", is to bite the bullet and simply assume that if the PEC reoccurs you are gonna die.

I had a triple bypass 16 years ago. I have had zero complications so far but rather than bankrupt the wife, I'll simply fade away.


That's the other option for sure! They will usually keep someone comfortable until the end for not much cash.
waltandjean
 
Posts: 650
Joined: Sun Aug 25, 2013 3:21 pm
Location: Puerto Vallarta

Re: health insurance

Postby km1972 » Sun Sep 24, 2017 8:14 am

deepcove wrote:Andre's email does not work = anyone have a different one?


Opps! Correct address is:

andre@bellon.com.mx

Cell phone number: 333-662-6915
km1972
 
Posts: 18
Joined: Fri May 30, 2014 2:39 pm

PreviousNext

Return to Health | Medical | Dental

Who is online

Users browsing this forum: No registered users and 2 guests