Health Insurance

[gzeniou]

Hi,

We have been working with an insurance agent in CR. I was told there are basically 3 plans the INS offers, I am assuming this is not the Caja. One is an international plan, will over you even in the USA, then there is the regional plan, will just cover CR and Central America and the high deductible plans. These plans require you to reside in CR 6 months out of the year. All you need is a lawyer to sign off saying you live in CR 6 months out of the year. I guess they can check your passport to confirm this. In any event, I’m curious do see what the forum members use. The international plan seems to be a great deal compared to what we are paying in the US. Its about 40% of the cost with what seems to be better benefits. Has anyone ever try to use this insurance in the US? and if so was payment seemless?

My neighbors in Atens all seem to belong to the Caja but they don’t travel much back to the US, they also pay a small monthly fee to a private ambulance service (25-$50 per month per household), this pays for Ambulance service as well as minor injuries and sickness at the Ambulance service clinic.

Thanks

[DavidCMurray]

With all the INS plans, do take a careful look at the actual rates of reimbursement and at the limitations on service providers — who is in and out of network and what the implications are for using each.

It was my understanding that INS’ international plan, which affords coverage worldwide, reimburses based upon their reimbursement rates for the same services [u]rendered in Costa Rica[/u]. If that’s right, while the premiums are attractive, the coverage is not. You won’t get much care in the U.S. for Costa Rican rates.

Look, too, at the implications for having pre-existing conditions. As a diabetic, they would not cover any condition directly related to my diabetes. What’s more, since most diabetics actually die of heart disease, they surcharged me 60% of my premium (but not my wife’s) to cover heart-related care. They also flatly denied any coverage for conditions related to my mild high blood pressure and high cholesterol (both in excellent control) and any other pre-existing conditions Marcia or I declared on the application form.

We had our INS in-country policy for a couple of years and decided that the high premiums and relatively low reimbursement rates made it unattractive enough that we decided to drop it. Now, we’re enrolled in the CAJA, as we must be, and keep our Blue Cross/Blue Shield which covers only services in the U.S. as a backup. When we turn 65, we’ll enroll in Medicare.

[gzeniou]

We are lucky enough that we don’t have any preexisting conditions. Looking at the policy there is a difference in reimbursement rates for the US and CR. For example a standard hospital room is paid at $150 a day/ $300 a day for ICU bed in CR but in the US they allocate $500 a day/ $1000 a day for the same beds. The average cost according to the web for a standard us bed in a hospital is $240. The way I understand it in the USA if you are in network (have no idea what in network is) it pays 80% for the first 20,000 and 100% after, meaning the most you will be out of pocket is 4000. out of network is the same thing but paid at 70%. There seems the be only a few things that they limit payments on; Organ transplant is one at $250,000.

We are trying to stay away from the CAJA as we have heard there are long waits and the hospital are good but not quite as good as the private ones.

By the way, we do have BCBS currently and they do pay for all emergency service in CR and they also pay for all services at CIMA.

[gzeniou]

In CR the plan cover 90% for the first 5000 then 100% for in network, there is also a 1 day hospital room deductible.

for out of network in CR its 70% for the first 20,000 with the room deductible, (actually the same as out of network for USA with the exception in the USA no room deductible…who would guess that)

[DavidCMurray]

Boy, I don’t know . . .

If I had BC/BS that would pay for all services at CIMA Hospital (our preferred source for service), and if I lived anywhere close to CIMA at all, I would be very tempted to enroll in the CAJA (as you must if you’re to be a legal resident) and rely on the BC/BS to cover those services rendered at CIMA. For us, we found that we could buy a lot of medical care for cash for the cost of INS’ premiums.

Now, if you live in some remote corner of Costa Rica, that would be a different matter.

[gzeniou]

Thanks David,

I guess the assumption to make is that the CIMA doesn’t accept the CAJA insurance. I send CIMA an email to see if they have their own private insurance plan. I know some local private clinics do. I did see the price list on CIMA website for some common procedures, I was actually shocked to see how inexpensive they were. but these didn’t include Doctor fees, but still seemed very reasonable.

[DavidCMurray]

You are correct that CIMA Hospital is not part of the CAJA network, so CAJA enrollment won’t do you any good there.

If you learn something interesting about an insurance plan offered by CIMA, would you please post the basics?

Thanks!

[gzeniou]

[quote=”DavidCMurray”]You are correct that CIMA Hospital is not part of the CAJA network, so CAJA enrollment won’t do you any good there.

If you learn something interesting about an insurance plan offered by CIMA, would you please post the basics?

Thanks![/quote]

Hi David….
We didn’t get a response via email from CIMA, thus my wife whose Spanish is a lot better then mine called. CIMA does not have its own insurance plan. They accept the INS international and regional plan, with all other international plans, assuming your insurance carrier will pay in Costa Rica, if you are hospitalized for more then one day CIMA will bill your insurance company and you don’t have to front the money. For outpatient procedures and rehabilitation (PT), they will bill your insurance company for you but you have to pay out of pocket and then if your insurance company accepts the claim, your insurance company will reimburse you directly. My wife will be getting some PT starting in July, our BCBS plan states they will cover it, thus we will pay out of pocket and hopefully will get reimbursed for it.

…..To bad CIMA doesn’t have their own plan. I would think that those living on just SS of $1,000 per month couldn’t afford the INS plan, I suspect that it would take too much of a bite for them. Maybe that’s why I haven’t heard of anyone with the INS plan.

[DavidCMurray]

I think most folks in the $1,000 per month income bracket are enrolled in the CAJA, if they’re eligible. INS’ policies are priced by age and sex, with some surcharges for related pre-conditions. No individual living on $1,000 per month could possibly devote that much to health insurance.

Your wife is going to CIMA for physical therapy? Have you considered going to one of the freestanding practitioners instead, unless she needs something specialized? My guess is that CIMA will be much more expensive.

[gzeniou]

[quote=”DavidCMurray”]
Your wife is going to CIMA for physical therapy? Have you considered going to one of the freestanding practitioners instead, unless she needs something specialized? My guess is that CIMA will be much more expensive.[/quote]

My wife had a rotator cuff tear…mountain biking and is currently getting PT after surgery in the states, we go back to CR in a couple of weeks, thus we need to continue it.
It would be great if we knew of a freestanding clinic in Atenas but BCBS only has 2 in network places…CIMA and another hospital in San Jose (can’t remember the name) for us as we met our deductible and have no Copay in theory it should not cost us anything if we go to CIMA. But of course BCBS like all usa insurance companies always seems to find was not to fully pay even when they tell you that your covered.

In any event the more I think about it and read your posts it seems that the only real way to go is to get residency and get the CAJA, as the CAJA won’t deny treatment. I wonder if your willing to pay your own doe combined with the CAJA if you would get better service, like having a private room, you can just pay the difference or paying a little more and getting that MRI quicker, etc.

[waggoner41]

[quote=”gzeniou”] In any event the more I think about it and read your posts it seems that the only real way to go is to get residency and get the CAJA, as the CAJA won’t deny treatment. I wonder if your willing to pay your own doe combined with the CAJA if you would get better service, like having a private room, you can just pay the difference or paying a little more and getting that MRI quicker, etc.[/quote]
[b]The CAJA hospitals [/b]aren’t able to offer amenities like private rooms due to the number of patients that they serve.
My wife had breast cancer surgery at San Juan de Dios and was in an 8 bed dorm. Upside is that she made some friends while there.
[b]For a long term stay [/b](week or more) you also have to consider that the limitations of socialized medicine means that you supply much of your own needs. Pillows, blankets, toilet paper, bottled water, fan, cup, bath soap, wash cloth, towel. There are no TVs or other entertainment so might want TV or music.
They always provide a spoon when they serve your meals so you might want a fork.

[b]We did find the care to be very good[/b].

[DavidCMurray]

I think what waggoner wrote very accurately reflects what you can expect in a CAJA facility. In Grecia, only volunteer donations pay for things like diapers for newborns, etc.

The CAJA will, indeed, provide physical therapy, but facilities may be limited, the therapists themselves may be spread very thin, and there may be a wait to be admitted.

I think that if we can avoid making demands on the CAJA system it’s better for everyone, so if your BC/BS will eventually pay the bills at CIMA or elsewhere, that’s the route I’d take.

[waggoner41]

[quote=”DavidCMurray”]
I think that if we can avoid making demands on the CAJA system it’s better for everyone, so if your BC/BS will eventually pay the bills at CIMA or elsewhere, that’s the route I’d take.[/quote]

David is right. Simple testa are handled at the local clinics but appointments for things such as X-rays and other major tests ars done only in the hospitals and can be a long wait. Emergencies are handled immediately but non-emergency service takes a back seat usually by appointment within a day.

The doctors and staff are very good.

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