BajaNomad - What will U.S. Health Insurance cover in Mexico?

What will U.S. Health Insurance cover in Mexico?

pauldavidmena - 2-9-2014 at 10:06 AM

My wife and I are thinking of retiring in Baja, but until then, our home in MA will be our primary location, and our health insurance is covered by my workplace. It's Blue Cross / Blue Shield, which I've heard will reimburse for health-related expenses incurred overseas. I'm assuming this means that one must still pay for these expenses out of pocket? Will showing my insurance card just result in blank stares?

The part of Baja we've been focusing on is Todos Santos. I know there is one private hospital in town (St. Luke's), but know nothing else about what is available. I've heard good things about some of the hospitals and doctors in La Paz, about an hour away. Fortunately I haven't had to put the system to the test, but it would be good to know what my options are.

I echo the gratitude of others who are thrilled to see a separate forum for this important topic. :cool:

woody with a view - 2-9-2014 at 10:10 AM

you pay, BCBS repays you. i bet it is only for emergencies, not checkups.

EnsenadaDr - 2-9-2014 at 10:22 AM

Here is the link for the medical center I believe you are talking about and I would contact Hector at the email specified for contacts. I know you have started threads in the past concerning coverage for health care in Mexico. I would encourage you to research the information on those threads and continue the topic of conversation on the same thread to keep repetition to a minimum, but in this case there doesn't seem to be a way of transferring these threads to the new topic Health and Wellness. I did check your member information, and read a little about your bio on your blog page. Very interesting. Brings back memories of riding the subways and trains from Grand Central Station in New York City to Connecticut, thank the Lord I don't have to deal with that weather anymore.

Nomad Pescador has some very good insurance information, and I am going to start a new topic thread for all of those that offer or know of Insurances and what they cover in Mexico so we have this info in the Health and Wellness topic area of the forum.

Contact Hector and ask him what insurances he accepts, that is always the best way to go before you visit a hospital.

http://www.todossantos.cc/shops-and-business/st-lukes-clinic

Bob H - 2-9-2014 at 10:28 AM

There are so many levels of coverage under any medical plan. I would check directly with your plan contacts to find out exactly what you have.

Bajajorge - 2-9-2014 at 10:48 AM

I guess like any other health insurance coverage, it varies from policy to policy. Last year I needed treatment while SOB, I was quite surprised that one of my US policies paid half my ambulance cost, and part of the Mexican Urgent Care cost.

pauldavidmena - 2-9-2014 at 10:53 AM

Quote:

Originally posted by EnsenadaDr
Here is the link for the medical center I believe you are talking about and I would contact Hector at the email specified for contacts. I know you have started threads in the past concerning coverage for health care in Mexico. I would encourage you to research the information on those threads and continue the topic of conversation on the same thread to keep repetition to a minimum, but in this case there doesn't seem to be a way of transferring these threads to the new topic Health and Wellness.

@EnsenadaDr - Thank you for the link! I thought twice about recycling a thread instead of replying to an older one, and apologize if I'm duplicating effort. Hopefully there will be a way to transfer existing threads to this new topic to give it better visibility (and to proactively answer questions like mine).

Quote:

I did check your member information, and read a little about your bio on your blog page. Very interesting. Brings back memories of riding the subways and trains from Grand Central Station in New York City to Connecticut, thank the Lord I don't have to deal with that weather anymore.

Yes, I grew up on Long Island and lived there until the late 80s, and then bounced around a little bit before settling in the Boston area. With the exception of 6 months in SC and 4 years in AL, it's been nothing but snow and ice in the winter time. No wonder I spend so much time thinking about Baja!

Quote:

Nomad Pescador has some very good insurance information, and I am going to start a new topic thread for all of those that offer or know of Insurances and what they cover in Mexico so we have this info in the Health and Wellness topic area of the forum.

I suspect this will be a very popular topic indeed, and I already have future questions in mind. I'll wait on those until I see whether or not existing threads can be moved over.

Quote:

Contact Hector and ask him what insurances he accepts, that is always the best way to go before you visit a hospital.

http://www.todossantos.cc/shops-and-business/st-lukes-clinic

I've emailed Hector and will update this thread with his reply. Thanks again!

[Edited on 2-9-2014 by pauldavidmena]

RnR - 2-9-2014 at 12:25 PM

Check your BCBS plan website.

Our BCBS plan has a tab for "Overseas Providers". There are several specialties and one hospital in the Cabo area listed as preferred providers.

pauldavidmena - 2-9-2014 at 03:18 PM

Quote:

Originally posted by EnsenadaDr
Here is the link for the medical center I believe you are talking about and I would contact Hector at the email specified for contacts.

http://www.todossantos.cc/shops-and-business/st-lukes-clinic

Quote:

Originally posted by pauldavidmena
I've emailed Hector and will update this thread with his reply. Thanks again!

Here is Hector's reply:

Hello sir my name is hector and i speak english,we take most insurance companys ! So welcome to todos santos
Email me your number and ill call you on monday for more info !

My guess is that he believes I'm in Todos Santos and need this information right away. If only that were true! In any case I'll reply to him via email in further detail and see what he has to say.

Hook - 2-9-2014 at 03:34 PM

Just because a medical center/clinic says they take most insurance companies doesnt mean that the insurance company takes them. The insurance company is holding the cards; the clinic is hoping to be dealt in. If you go to that clinic and are treated, they know they can go after you, even if the ins. co. backs away.

Really, the bottom line is what Bob H mentioned. All that matters is what YOUR insurance policy says.

And even then, they often fight you, tooth and nail.............. :rolleyes:

pauldavidmena - 2-9-2014 at 03:58 PM

Quote:

Originally posted by Hook
Just because a medical center/clinic says they take most insurance companies doesn't mean that the insurance company takes them. The insurance company is holding the cards; the clinic is hoping to be dealt in. If you go to that clinic and are treated, they know they can go after you, even if the ins. co. backs away.

Really, the bottom line is what Bob H mentioned. All that matters is what YOUR insurance policy says.

And even then, they often fight you, tooth and nail.............. :rolleyes:

I've gotten the runaround from insurance providers before, and that's while being fortunate enough to have avoided a major health expense thus far. But eventually, if I visit for long enough - and often enough - I'm going to need to test the system. It will be interesting to see what happens.

In the mean time, I took a look at my BCBS website and couldn't find anything about what to do when needing health care overseas. I've emailed them and will report what I find out here.

EnsenadaDr - 2-9-2014 at 04:53 PM

With Seguro Popular or IMSS, you will be covered at their hospitals for sure in Mexico. Like you have been advised here, check your overseas coverage with BCBS, and with any other coverage you have, and still, as Hook mentions, they will fight you tooth and nail.

Quik question

captkw - 2-10-2014 at 10:46 AM

Why is it that we never hear of these insure companys going out of biz or needing a bailout ???

Majorcynik - 2-10-2014 at 01:58 PM

Have a friend from Idaho who broke his hip in San Sebastian about 5 years ago. Long, painful story with NO KIND of pain meds except Excedrin!!
Loaded him onto a sheet of plywood (at the time he was 67, 6'5" and 280+#'s), put him across the bow of a panga (accident happened around the north side of San Sebastian cove), shuttled him into the cove in San Sebastian, loaded him into the back of a pick up truck, 1 1/2 hours to Mex 1, another 1 hour+ to Loreto where the X-Ray tech had quit!!!. Ambulance took him from Loreto to Constitucion where he was hospitalized and waited for 4 days for the doctor to arrive from La Paz!!!!
He was covered by Humana Health in the USA and, although he had to shell out the $4500+ dollars for the ambulance ride (from Loreto to Constitucion and, after the surgery, from Constitucion back to Mulege), the hospital stay and the surgery, Humana reimbursed him to the tune of $5000!!!
Naturally, the Mexican doctors work was sub-par and he has had to have several surgeries in the past 4 years to correct the problems caused by the
doctors work. He does manage to get around OK but has about a 1 1/2" lift in his shoe to compensate for the shortening of his leg.
Worst of it was he caught NO fish on his trip to San Sebastian!!!

El Jefe - 2-10-2014 at 06:14 PM

There will always be horror stories about peoples' medical care down here, especially when they are injured way out in the boonies. That is a problem anywhere, but here there is no "Lifeflight" helicopter to whisk you to the closest trauma center.

Todos Santos is not far from fine medical care in Los Cabos or La Paz and the St. Lukes is highly regarded with clinics in Cabo and San Jose as well.

Here is what we have done for the past eight years. We maintain our insurance state side and have our annual check ups done up there as well as any medical procedures that come up. We usually fly up quarterly to see family anyway. As far as Blue Cross is concerned we live in our forwarding post office box in San Ysidro California. We have kept all our doctors and regular providers up there. We get our meds via the mail on a 90 day program and have friends or relatives bring them down if we are not going to be up there in time.

When there is a problem down here that takes nothing more than an office visit we just pay cash. Something more serious like when I busted my head, the insurance reimburses for my accident away from "home." Really serious stuff like heart problems etc. you get stabilized here and go north for getting fixed. You would do well to have a few credit cards with high limits so the hospital can "charge" it until your insurance comes through.

We pay dearly for our coverage, over $1,000 per month, but that we consider a cost of doing business. We are not medicare age yet and will cross that bridge when we come to it. I imagine there are supplemental programs that will cover out of country emergencies.

Don't let the horror stories scare you away from retiring down here. Of course you have to consider that some of the things we take for granted in the states are not available here. Like 911. But there is a whole, happy country-full of people living and thriving here. They seem to get along just fine. And so do we.

pauldavidmena - 2-11-2014 at 07:05 AM

Quote:

Originally posted by El Jefe
There will always be horror stories about peoples' medical care down here, especially when they are injured way out in the boonies. That is a problem anywhere, but here there is no "Lifeflight" helicopter to whisk you to the closest trauma center.

Todos Santos is not far from fine medical care in Los Cabos or La Paz and the St. Lukes is highly regarded with clinics in Cabo and San Jose as well.

Here is what we have done for the past eight years. We maintain our insurance state side and have our annual check ups done up there as well as any medical procedures that come up. We usually fly up quarterly to see family anyway. As far as Blue Cross is concerned we live in our forwarding post office box in San Ysidro California. We have kept all our doctors and regular providers up there. We get our meds via the mail on a 90 day program and have friends or relatives bring them down if we are not going to be up there in time.

When there is a problem down here that takes nothing more than an office visit we just pay cash. Something more serious like when I busted my head, the insurance reimburses for my accident away from "home." Really serious stuff like heart problems etc. you get stabilized here and go north for getting fixed. You would do well to have a few credit cards with high limits so the hospital can "charge" it until your insurance comes through.

We pay dearly for our coverage, over $1,000 per month, but that we consider a cost of doing business. We are not medicare age yet and will cross that bridge when we come to it. I imagine there are supplemental programs that will cover out of country emergencies.

Don't let the horror stories scare you away from retiring down here. Of course you have to consider that some of the things we take for granted in the states are not available here. Like 911. But there is a whole, happy country-full of people living and thriving here. They seem to get along just fine. And so do we.

@El Jefe - thank you for the wise and reassuring words. I have heard good things about St. Luke's as well as some of the providers in La Paz and San Jose de Los Cabos. Right now our plan is to split our time between Baja and the U.S. when we retire, but that's still a few years away. Even then, it seems prudent to maintain Health Insurance stateside for anything that might happen "away from home".

Bomberro - 2-11-2014 at 07:31 AM

I was taken by ambulance from Los Barriles to Los Cabos. Ten days in Hospital there. We had to pay in advance for all of the services, doctors. They would ask for the payment before any more work was done. Blue Cross repaid 80% to me. There are caps on out of Country benefits I am not sure the amounts. A friend of ours was taken to the same hospital the same way, she spent about 30 days there and their insurance company we were told would not pay until the patient paid hospital. It was limited to about 20K I think. They had to sell their home in Mexico to pay the bill, amount paid to the hospital was over 300K. The hospital had filed a law suit and wanted the house as payment. We and other friends pooled resources and paid to have her flown to San Diego by a medflight. Best to check with your insurance provider and find out payment limits in Mexico. I have never heard of anyone being able to get medical care in Mexico and not have to pay up front or sign an agreement to the hospital to be fully responsible for the entire bill. The hospital can and will sue under Mexican law to take your home or possessions for repayment.

bajaguy - 2-11-2014 at 07:46 AM

Get stabilized then transported/evacuated back to the US.

Have a "hole card" high limit credit card that is for emergency medical use only.

Check out a Mexican hospital and service providers where you live, then have an evacuation insurance program that gets you back to the US and your hospital of choice

Have a written medical directive that spells out what YOU want, how and who you want to do it

Develop a "support network" of friends and neighbors that check up on each other.

Have a "contact plan" so your friends/neighbors can communicate with relatives/friends in the US if you are unable

[Edited on 2-11-2014 by bajaguy]

DENNIS - 2-11-2014 at 08:11 AM

Quote:

Originally posted by El Jefe

Don't let the horror stories scare you away from retiring down here. Of course you have to consider that some of the things we take for granted in the states are not available here. Like 911. But there is a whole, happy country-full of people living and thriving here. They seem to get along just fine. And so do we.

Great advice....especially for the young and healthy who have that mindset that nothing will ever happen to them. Others should seriously consider the horror stories........especially the scenario of lying on a gurney being milked like a cash-cow, and the heartless lack of care when you run dry.

Pescador - 2-11-2014 at 08:45 AM

Because I was an insurance agent with a very large list of clients, I am totally aware of the "problems" people used to have with the insurance companies. Most of the time it was because they had never bothered to read the policy and then never bothered to read it again when they had a need for coverage. I used to have an annual review with each policy holder to see what they might want to change and what problems they had experienced. The idea that the companies did not pay as contracted is a silly notion and is usually a result of "low information enrolees".
Most policies offere "Emergency Medical Services" when you are traveling which means they will stabilize you, treat you for life or limb threatening situations. They may or may not include transportation to a hospital. When in Mexico, I know of no insurance companies that have the ability or desire to pay a hospital or medical service directly. The drill is that you pay the bill and then submit it when you return home. Again, read the policy and it will spell out how that is taken care of.

Now, if you are going to retire here then it behooves you to check out the medical facilities that you would use if you needed them. I was on a board of directors for the local hospital in Santa Rosalia and got to spend quite a bit of time there. I have no misunderstandings about the rather sparse and questionable services available there. I have a medical directive that indicates that I am to be transported to the hospital in La Paz if necessary.
You also need to know how you would be transported in the event that became needed.

We are spoiled with hospital services and medical treatment in most areas in the United States and most assume the medical treatment here is "Just Like in the United States" on cheaper. There are some things I find exlemparary about medical treatment here and that is a doctor and medical staff will take the time to do their very best and treat you as well as they can with limits of equipment and diagnostic. But make no mistake, the level of care is not the same as NOB.

So spend a little time evaluating the medical facilities and providers and decide what you are comfortable with. If you cannot handle the idea of treatment in the hospitals and such, then keep a valid evacuation policy paid up and ready to go. If on the other hand you are comfortable with what you find and you decide that you are satisfied with services available then be satisfied with that decision as well. But don't be a dupe who waits till you are in that situation and find yourself a victim of a system that may see you as a bearer of needed funds.

pauldavidmena - 2-11-2014 at 10:34 AM

@Pescador - thank you for the wise response. We need to put St. Luke's hospital on our list of places to visit the next time we're in Todos Santos. It would be far better to visit proactively than otherwise!

pauldavidmena - 2-11-2014 at 11:03 AM

Just got a reply from my inquiry to Blue Cross / Blue Shield. Basically they asked me to call an 800 number to locate a "participating provider" where I will be traveling, and that "the plan pays for covered emergency services at the In-Network benefit level of coverage and all other covered non-emergency services at the Out-of-Network benefit level. Show your ID card to the participating provider and they will coordinate your care and claim submission. You will be responsible for any out-of-pocket expenses (non-covered services, deductible, copayment and coinsurance) that you would normally pay for in the United States."

Based upon what I'm reading on this forum and elsewhere, it might be too good to be true.

Pescador - 2-11-2014 at 01:43 PM

Okay, Blue Cross Blue Shield pays a percentage of what is set on Medicare reirmbursement. If you travel outside of the US, all of the Blue plans that I sold had you pay for the service and then submit a bill when you returned. Emergency services mean that whatever is needed to keep you alive and not losing life or limb. I had a client that was in Cabo who had an appedix rupture and the Blues were only to happy to pay for the emergency surgery since it was less than it would have been in-network.
Once you go out of network, they normally pay with a higher deductible and pay only reasonable and customary.

I have never seen a hospital, except for a few on the border in Tijuana who would directly bill Blue Cross.

pauldavidmena - 2-12-2014 at 06:42 AM

I decided to call the 800 number, and as expected, got a friendly but unconvincing response. It seems prudent to have a credit card with a deep credit limit in the event of an emergency, and to file with BCBS after the fact and hope for at least partial reimbursement. My "BLUE CARE ELECT PREFERRED VALUE PLUS" plan should reimburse for emergency care overseas - if the full-color brochures are to be believed.

Alm - 2-19-2014 at 02:40 PM

You are worried about coverage now - you should better worry about getting a proper treatment on time. 2-3 hours for local Red Cross to arrive, even when you are 15 miles from their base. Then God knows how long to get to a real hospital - not a small clinic nearby.

Evac plan requires you to go to some medical facility first, and only then they will airlift you to a big city in Baja or NOB, and it may take hours to get to the airport where this evac service is flying from. Few more expensive services are "evac and rescue", meaning they will pick you up the place of accident.

Border formalities at the airport take precious time, and if you go to Mexican hospital don't expect them to speak English. More and more of them do, as time goes by, but don't count on it, especially in public hospitals and small towns.

FYI, you get irreversible brain damage after stroke if not treated within 4 hours.

EnsenadaDr - 2-19-2014 at 03:35 PM

I totally agree with Baja Guy, have an emergency exit plan, medjet seems like a good alternative!!

pauldavidmena - 2-19-2014 at 05:38 PM

Quote:

Originally posted by EnsenadaDr
I totally agree with Baja Guy, have an emergency exit plan, medjet seems like a good alternative!!

There seem to be a number of companies competing in this space, and I think it's a good idea to have this type of contingency plan in one's pocket just in case. Perhaps it's worthy of its own topic?

I've heard of a good medical plan...

Pompano - 2-19-2014 at 05:54 PM

Tongue in cheek naturally, but this might just happen with the present state of affairs.

CaboMagic - 2-23-2014 at 09:15 PM

With his experience in the industry, Pescador is one to listen to ..
There are so many variables ..
Not to put any sort of damper in your plans or enthusiasm pauldavidmena but keep in mind that Cabo is still part of Mexico, even tho it does create, or follow, its own rules/laws .. Might want to check if (your) insurance provider considers Mexico 'abroad' ..
20 yrs ago, living in Cabo, required emergency medical attention - Kaiser Permanente did reimburse, but advised it was because it was emergency medical attention, or it would have been refused.
Many friends/clients/acquaintences from BajaSouth do not live there year round, and travel NOB for health issues .. not to say there aren't those whose dedication to health and their studies thereof are not admirable .. nor is it a 'sure thing' that care provided NOB would be "perfekt"
Wish you the best in all you do, Lori