BajaNomad

U.S. medical insurance

vandenberg - 12-6-2006 at 11:16 AM

How do you Nomads, that live in Baja ( especially BCS ), deal with your medical needs.when treatment in California is wanted?? I live in Loreto permanently, have medicare plus blueshield supplemental, and need carpal tunnel treatment badly. No more residency in Sacramento, only some friends and family. As everyone knows, getting appointments and treatment takes time. Lots of it. And staying with people you know gets old quick. Remember company and fish after 3 days...? So, the alternative is getting treatment ( operation ) in Baja, meaning La Paz.. Don't doubt the competency of their physicians, but doesn't this imply that your , very costly, insurance is only good for life or death situations ?
I know that I can't be the only one with this dilemma, so please let's hear from Nomads that have experienced this kind of situation and how they dealt with it.
Your input will surely be appreciated. :?::?:

fishbuck - 12-6-2006 at 01:57 PM

This is a great question. I don't know the answer but as someone who plans to retire in Baja I am also interested.
Wouldn't San Diego be the logical choice for medical treatment. Why would that be so difficult. You could schedule the surgery and either drive or fly. It may require a stay in a motel but shouldn't be more than a week. I would imagine that SD has the very finest medical treatment. If the surgery goes okay then any follow up visits could be handled locally.
Is that too simple?

[Edited on 12-6-2006 by fishbuck]

jerry - 12-6-2006 at 02:08 PM

i too am intresten in medical info in bcs as im too younge to get medicar ill be footing my own bill witch i havent choosen yet my problem is the us insurance isnt any good in mexico the mexican insurence isnt any good in the us?? or so i hear any heads up??

vandenberg - 12-6-2006 at 02:13 PM

Schedule surgery ? How, without being present. Doctors won't do anything without seeing you first. Loreto, being over 700 miles below the border, is no picnic to drive. Stay in a motel for a week or so, plus staying for follow up visits ? No idea where you're from fishbuck, but most motels in that area run in the 70 to 100 dollar a night range, a little beyond my budget for any extended stay, which is unavoidable for any kind of medical treatment, surgery or not. Had some medical work done in Sacramento last summer. Took almost 2 months to get everything done and that was with the doctors giving me priority for living in Mexico. For some procedures it takes months to get an appointment. Luckely have friends there that let me use their cabin in Tahoe. And nowadays, flying back and forth at close to $ 500.00r/t is out of the question for most folks.

bajabound2005 - 12-6-2006 at 02:17 PM

Medicare will cover no expenses outside the country. Your supplement MAY cover emergency treament. I'm not sure if all supplement plans do so, but Plan J seems to cover emergency treatment. You'll still have to pay the hospital here and then get reimbursement for covered charges from the insurance company. Our neighbor fell on Thanksgiving Day and broke her hip. After surgery and several days in the hospital the bill was about $8000 total. They had to pay it but the Supplement plan will reimburse 80% of the bill.

Read your policies carefully. Some may say they only cover emergency treatment if you've been out of the country less than 90 days...in which case, you just arrived a couple weeks ago!

Medicare suppliment

modhatter - 12-6-2006 at 02:27 PM

I am unclear as to why you would continue to carry and pay for a supplimental policy if you didn't have some ideas how to use it if you became ill. I would suggest that staying with friends and or relatives would be your only avenue.

However, this is not a life threatning condition. I am not clear on the theray needed, but you might want to consider the cost of having the proceedure done in Mexico, and then compare the costs (travel and convenience) There are competent doctors in Mexico.

Personally, my own plan as with many other gringo's is to use Mexican doctors for all non-life threatning conditions, and keep US insurance in case anything really major occurs and you do not have faith in treatment in Mexico or they do not have treatment or equipment avail. that you might need.

fishbuck - 12-6-2006 at 02:51 PM

Quote:
Originally posted by vandenberg
Schedule surgery ? How, without being present. Doctors won't do anything without seeing you first. Loreto, being over 700 miles below the border, is no picnic to drive. Stay in a motel for a week or so, plus staying for follow up visits ? No idea where you're from fishbuck, but most motels in that area run in the 70 to 100 dollar a night range, a little beyond my budget for any extended stay, which is unavoidable for any kind of medical treatment, surgery or not. Had some medical work done in Sacramento last summer. Took almost 2 months to get everything done and that was with the doctors giving me priority for living in Mexico. For some procedures it takes months to get an appointment. Luckely have friends there that let me use their cabin in Tahoe. And nowadays, flying back and forth at close to $ 500.00r/t is out of the question for most folks.

Okay I booked you a room at the Motel 6 in Chula Vista for $40 a night. Jump in your car and drive to GN. Use your good hand. Stay one night for about $30 . Get up early and drive to San Quintin. Stay one night for about $30. Show up the next day at the doctor in San Diego after lunch. I assume you have a telephone so you should be able to schedule an intial visit. While you're there schedule the surgery. Stay in SD for a day and rest and then drive yourself home. Repeat the trip in a month or so as required to return for surgery.
Total trip cost not including doctor about $300.

Pescador - 12-6-2006 at 03:08 PM

I am a blue Cross blue shield Agent in Colorado (when I am home) and you should have world wide coverage, but some different deductible options. check with the insurance company and ask if you are covered. Then check with medicare. I think that is where you run into the snag. Blues will cover you probably but medicare is the first payee so they may not cover out of the US. Start with the benefit of descriptions on the Medicare website and see. I have used my individual insurance and it covered things that I had done in Mexico but it was a seperate deductible. I paid the bill and worked on reimbursement when I presented the bills.

Capt. George - 12-6-2006 at 06:23 PM

does anyone have knowledge of Mexican medical insurance??

gp

bajabound2005 - 12-6-2006 at 07:04 PM

we just met with an agent for mexican health insurance -- pre-existing conditions are not covered. Por ejemplo, my husband has a pacemaker - anything regarding the heart was automatically eliminated. Age is also a consideration. Over a certain age (I think 75) they won't cover you. You still have to undergo a physical exam to get the coverage. The rates are very inexpensive compared to the US, but know what you are getting.

I second Pescador's suggestion, talk to your supplement company (forget Medicare - they won't cover it out of the USA). Go to them with the US price and the Mexico price - they may agree to pay for (part) if you have it done in Mexico since I'm sure the price differential would be to the insurance company's favor! Remember though that in the US there is an agreed upon fee between Medicare/Insurance Supplement Co and the medical provider so you have to compare apples to apples.

fishbuck - 12-6-2006 at 07:15 PM

Quote:
Originally posted by bajabound2005
we just met with an agent for mexican health insurance -- pre-existing conditions are not covered. Por ejemplo, my husband has a pacemaker - anything regarding the heart was automatically eliminated. Age is also a consideration. Over a certain age (I think 75) they won't cover you. You still have to undergo a physical exam to get the coverage. The rates are very inexpensive compared to the US, but know what you are getting.

I second Pescador's suggestion, talk to your supplement company (forget Medicare - they won't cover it out of the USA). Go to them with the US price and the Mexico price - they may agree to pay for (part) if you have it done in Mexico since I'm sure the price differential would be to the insurance company's favor! Remember though that in the US there is an agreed upon fee between Medicare/Insurance Supplement Co and the medical provider so you have to compare apples to apples.

Why the reluctance to just go to San Diego and take advantage of Medicare? Aren't you retired? What else do you have to do with your time?

greybaby - 12-6-2006 at 11:15 PM

I will probably ruffle some feathers here but have to jump in. Having worked in the medical field all of my adult life AND having lived in Mexico for 6 years and witnessed first-hand the availability (or lack thereof) of quality medical care, think seriously about the ramifications of retiring outside of the U.S. when probably most of us, as we age, will need more medical care on a yearly basis. My husband and I lost both of our mothers while living in Ensenada and decided then we could not subject our own sons to dealing with our care as we aged in a country where neither one of us trusted the health care system (our friends who are nationals feel the same).

We have returned to Idaho and I now work in a large community health center and though our medical system is flawed it is still far superior to what most of the world has to offer. It is important to be established with a physician or clinic that will continue to treat us as we reach Medicare age.

As much as I love Mexico and the people there, I think it is very important to think logically about health care needs as we approach retirement. My theme when we lived there was if I looked like I was slipping, drive North fast!!

Diver - 12-6-2006 at 11:24 PM

Why not keep a US policy active with a US address ie your children or sibling ? If you have a serious immediate need for medical care, the binational evacuation insurance would get you back to the US and bill your insurance company. Otherwise, you could take care of non-emergency needs when you visit your relatives.
Who ever knows how long you have been in Baja at any given time anyway? You were just there on a short vacation, right ?

.

comitan - 12-7-2006 at 07:58 AM

Vandenburg

It seems nobody has really addressed this problem. A solution would be for 20 or more people to go in together and buy a condo in TJ they can be had for around $100,000 and everyone who invested would have an investment and a place to stay. With the number of people that are now living in the BCS don't think it would be difficult to find that many people.

bajalou - 12-7-2006 at 08:39 AM

Quote:
Originally posted by fishbuck
Why the reluctance to just go to San Diego and take advantage of Medicare? Aren't you retired? What else do you have to do with your time?


Often for retired folks, it isn't the time that's a problem, it's the money for traveling and staying somewhere.

bajabound2005 - 12-7-2006 at 08:55 AM

Quote:
Originally posted by fishbuck
Why the reluctance to just go to San Diego and take advantage of Medicare? Aren't you retired? What else do you have to do with your time?


For routine medical care, driving 6 hours (round trip) and sitting at the border for 2 hours, and paying the tolls - it just isn't worth it. We are trying to do routine things in Baja. For the major stuff (pace maker checks - it's an ICD so it can't be done over the phone) we do make the trip. Lab work we do get done here (it's cheap) and fax the report or call in the results to the US doctors.

I do like that idea of a co-op condo though!

We're all Going to Die.

MrBillM - 12-7-2006 at 08:58 AM

My attitude is to roll the dice and simply accept whatever happens. Most of the people who are so worried about the Medical situation are well into Geezerhood like I am. Life has been mostly good and I've gotten my share. It won't be any big deal when I finally go Face Down and it'll make so many other people happy.

The Clinics that are sprouting up in all of the Tourist areas seem to do a pretty good job with the mundane Medical tasks. One thing that would be a good investment is the Air Evac Insurance since that mode of transport is obscenely expensive. I had a neighbor who paid over $25K to be flown to San Diego when he had a Heart Attack. When I had some trouble in that regard, I closed up the house and drove for the border so that , if I croaked, I'd be back in the U.S. and my wife wouldn't have to go through the Hellish process of getting the body out.

greybaby - 12-7-2006 at 09:09 AM

Mr. BillM, You've got the right attitude about it and that's why you can successfully live out your days in Baja. I applaud you.

Don Alley - 12-7-2006 at 09:15 AM

My wife and I have both had some minor diagnostic and consulting done at the Virginia Mason clinic in Seattle. They have a nice attached hotal at reasonable rates, and a comprehensive hospital staff that can do pretty complete overhauls. You can consolidate a lot of medical work there, and schedule several appointments with different specialists in a couple of days.

I believe there is a similar clinic in San Diego.

Not cheap, but insurance may cover expenses. Places like Virginia Mason commonly help patients from out-of-town, such as people from small towns with limited health care options. I found them very good at scheduling to minimize time away from home.

Other than perhaps distance and air fares, is your problem different from the problems facing someone living in Turtle Falls, Wyoming?

We've kept a place in Kalispell. We just downsized to a smaller place this summer, but we did keep a place to hang out there. Medical work was one reason.

bajalou - 12-7-2006 at 09:37 AM

From areas line San Felipe, you can often be driven to the border, or use a local ambulance in much less time than getting a plane in for air-evac. The local ambulance's make arrangements to be met by US ambulances at the border and avoid the long wait lines.

Like MrBill, dying ain't no big deal, it'll happen when it does and today I have nothing left undone with my life/relationships so I'm at peace to go when it's my time. But I ain't volunteering.

vandenberg - 12-7-2006 at 12:20 PM

Quote:
Originally posted by comitan
Vandenburg

It seems nobody has really addressed this problem. A solution would be for 20 or more people to go in together and buy a condo in TJ they can be had for around $100,000 and everyone who invested would have an investment and a place to stay. With the number of people that are now living in the BCS don't think it would be difficult to find that many people.


Comitan.
Thus far your comment and attempt at a solution is the only sensible one.
Like to hear some more comments on this from other retirees in BCS.

toneart - 12-7-2006 at 06:11 PM

I'm not sure there is a standardized solution that everyone could utilize. There have been suggestions here that may work for some people; the best being, stay with relatives and/or friends in a U.S. location with good hospitals and medical facilities. I question the motel idea. Whenever I have had to have any procedure as an out-patient, the facility would not release me on my own. Not wanting to inconvenience anyone, I had wanted to take a taxi to a hotel room, but no...they would allow it.

In Mulege last spring there was a medical emergency that required evacuation to the U.S. Apparently his medical insurance had lapsed. He did have AAA Plus, which supposedly covers emergency evacuation. They couldn't get them to OK it. He was transported by ambulance to La Paz where he had to take a commercial flight. About 12 hours elapsed before he could get on the plane. Fortunately he was accompanied by his wife. Even though the condition was serious, (stroke), he survived and it worked out. But it could easily have not turned out well. The result was that our community researched thoroughly, emergency phone numbers, closest facilities, What to do, how, etc. This has been passed around to everybody or emailed.

The point of this story is to urge everyone to pre-plan what you would do in an emergency. Know your coverage. If your insurance will not cover air transport ecacuation, buy it now. Know where is the nearest Baja medical facility that can handle serious emergencies. Organize your community. Know where you would go in the U.S. and who could assist you there. Pre-arrange with a primary care physician. Join Bi-National Emergency Organization ($30 ) and set them up with all your information.Make the one phone call to them (24/7) and let them coordinate everything.

Finally, Comitan's TJ condo coop suggestion sounds good in theory. The only time I have ever been able to mobilize 20 people for anything was when I was buying the beer.:rolleyes:

bajabound2005 - 12-7-2006 at 07:46 PM

keep that aspirin at hand, benedryl and as suggested many times on this forum, an epipen... do look into all options for how to get out in an emergency and HAVE YOUR CURRENT PASSPORT handy. Trying to cross over that line, even in an emergency, could result in disaster without the proper docs! I don't know if it's been adopted all over the Baja but the equivalent of 911 in the USA in the Ensenada area is 066; you can get an English speaking person on the other end, if needed, and get directly to the Red Cross (Cruz Roja) ambulance service...

[Edited on 12-8-2006 by bajabound2005]

comitan - 12-7-2006 at 08:04 PM

http://64.233.179.104/translate_c?hl=en&u=http://www.moranrealteam.com/&prev=/search%3Fq%3Dbienes%2Braices%2BTijuana%26hl%3Den%26lr%3D%26sa%3D X

The above is a TJ real estate site a 2 bedroom could be has as low as $25,000. It looks like the above site will have to be copied and pasted

[Edited on 12-8-2006 by comitan]

oladulce - 12-8-2006 at 01:16 AM

Vandenberg-

Our situation will be different than yours when we retire in 2 years (15 years too young for Medicare) so our plan to get "Expatriate international insurance" that covers you outside and in the US wouldn't help you much. But here's some Carpal tunnel info that may sway your decision.

There are 2 ways to do a carpal tunnel release:

(1). "Open" technique requires a 3½" incision on your palm and wrist .
Pros:
- Surgery can be done by most orthopedic surgeons. Most likely only the "Open carpal tunnel" will be offered in Mexico.
- Outpatient surgery.

Cons: -
- Your hand and wrist need to be immobilized for at least a week to prevent stress on the long incision. This is usually in the form of a plaster splint. Anytime you immobilize an extremity after surgery there's increased stiffness, and delay in recovery due to the loss in range of motion.
- You'll return to the Dr. for suture and splint removal in about a week.
- Larger incision and more invasive the surgery, the greater the chance for infection.
- Usually requires general anesthesia.

(2). "Endoscopic" Carpal tunnel release is done using a scope and 3, ½" incisions are made on your wrist . This is the technique that's usually used by orthopedic "Hand" specialists.

Pros:
- Outpatient surgery. Frequently done under IV sedation anesthesia.
- Usually only a stitch is needed in each of the small wounds and sometimes just steri-strips ( like butterflies) are needed to hold the wound edges together. Hand is wrapped with a soft bandage and you're encouraged to start gently bending your fingers after surgery to prevent stiffness.
- Small incisions=less chance of infection, less pain.
- Your surgeon may agree to schedule your post-op appt. in a few days so you could return to Baja sooner.

Cons:
- Usually only "Hand" specialists are proficient in this technique. It would be unlikely to have the Endoscopic method done in Baja Sur.

I was trying to present this info objectively, but it's probably obvious that I'm biased towards the scope method. People have less pain, less swelling, and faster healing, plus it would require a shorter stay in the U.S. for you.

I don't think you'll be able to get around the need to make a couple of trips if you have your surgery in the US. You'll need you initial evaluation by the surgeon and then probably return for the surgery. Often the dr's. office will want you to come in for a pre-op visit a few days before surgery but just tell them it's too inconvenient since you live out of the country and they should be able to accommodate you.

Capt. George - 12-8-2006 at 06:14 AM

Mr Bill

You are my new hero.

Exactly right, we all gonna go. Wanna stay around longer, suffer, pay the doctors, cause undue pain and suffering to your family and go anyway?

Frankly I'd rather eat a bullet. Watched my psuedo father die from the ravages of Alzheimers, including severe Parkinsons. After 2 years in a nursing facility, and most of his (and wife's life savings) he died (anyway).

Just prior to dying he could no longer eat, the suggestion made to his wife was, "we can take care of that with a feeding tube!". How very callous and money hungry can our medical profession get?

I'll live my life to the fullest, go naturally if I'm so lucky or simply say all my good-byes, be thankful for all I've had and be on my way in a way "I" choose.

Capt. George

Mr Bill, if you go first, I'll get ya body out. Sit ya in my passenger seat with sunglasses and a fake cigarette, slip right through the border crossing. Plus, at that point, you won't be so hard to talk to!!

Capt. George - 12-8-2006 at 10:46 AM

Where did this thread go????

comitan - 12-8-2006 at 11:08 AM

Vandenburg there is another option, Hostels in the area you want to stay San Diego has 3-4.

toneart - 12-8-2006 at 12:06 PM

Quote:
Originally posted by Capt. George


I'll live my life to the fullest, go naturally if I'm so lucky or simply say all my good-byes, be thankful for all I've had and be on my way in a way "I" choose.

Capt. George


Capitan,
Be sure you leave a legal directive so that your wish will be honored. Otherwise you will babble and drool and need a bib while the medical profession plunders your and your family's resources.

Capt. George - 12-8-2006 at 12:24 PM

thanks toneart, but I'll bail out before I start chitting in my pants!

I do have a living will...only good though if you have it tatooed to yer ass!

the captain