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Author: Subject: Mexican Health Insurance 101
Alm
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[*] posted on 9-22-2013 at 10:51 PM


There are no pre-existing conditions in SP, yes, but there are exceptions, kind of. There is a list of covered procedures, pretty long list.

OTH, IMSS does not cover - not supposed to cover - pre-existing conditions. How IMSS could accept somebody with a recently diagnosed condition, is beyond understanding. Oh, land of wonders...

Btw, did anybody notice that the OP never specified whether he/she was interested in a Mex social healthcare at all. Or whether he/she was a resident or somebody with a visitor status. The question was "Plans, costs, deductibles", and where to buy in La Paz/Cabo area.
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Mulegena
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[*] posted on 9-23-2013 at 07:34 AM


Again, to point out the inequalities of Seguro Popular/SP vs. Seguro Social/IMSS coverages:

Another relative has a condition that has become potentially life-threatening, an aortic hernia that's been present from birth; the lady is now in her 30s.

She has Seguro Popular (and cannot change to IMSS, btw, for whatever reason). She was sent to La Paz for a current exam which included x-rays and an endoscopy. SP did not cover the endoscopy, nor of course will it pay for any medications or the necessary surgery to save her life. She was sent home and told to come back when she had the money. Kinda cold. The family is raising payment at the moment by selling tamales door to door.

This brings up another point: Fundraisers.
Each little village helps to look after their own. When someone is sick they have fundraisers, usually a planned collective lunch sale with tickets available by advance sale or "at the door". All proceeds are put into a bank account for that beneficiary's health care. Fundraisers are an essential part of community life down here and are an excellent way tourists can help. When someone approaches you, buy a ticket. Ask who in town is in charge of the Association (for example, in Mulege see Saul Davis). Go to that person and ask how you can help. Make a donation. Save a life.




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[*] posted on 9-23-2013 at 10:45 AM


Quote:
Originally posted by Mulegena
Again, to point out the inequalities of Seguro Popular/SP vs. Seguro Social/IMSS coverages:

Another relative has a condition that has become potentially life-threatening, an aortic hernia that's been present from birth; the lady is now in her 30s.

She has Seguro Popular (and cannot change to IMSS, btw, for whatever reason). She was sent to La Paz for a current exam which included x-rays and an endoscopy. SP did not cover the endoscopy, nor of course will it pay for any medications or the necessary surgery to save her life. She was sent home and told to come back when she had the money. Kinda cold. The family is raising payment at the moment by selling tamales door to door.

This brings up another point: Fundraisers.
Each little village helps to look after their own. When someone is sick they have fundraisers, usually a planned collective lunch sale with tickets available by advance sale or "at the door". All proceeds are put into a bank account for that beneficiary's health care. Fundraisers are an essential part of community life down here and are an excellent way tourists can help. When someone approaches you, buy a ticket. Ask who in town is in charge of the Association (for example, in Mulege see Saul Davis). Go to that person and ask how you can help. Make a donation. Save a life.


Mulegena, that is excellent advice. The problem with the fundraisers is that a lot of tourists never know who the sick person is because they have very little interaction with the people who live in the village. We had a guy who was working over San Lucas Trailer Park, Dos Amigos, Punta Chivato, and as far as the campgrounds at Concepcion. He had a Fonatur shirt and a typed up and signed sheet of paper. On closer examination the guy who was supposed to be needing surgery had died 4 years prior and this guy was using this fundraising as an excuse to obtain money. Checking with Saul would have brought that to a stop for sure. I knew the person who had died so I was not vulnerable. He also changed the amounts donated to reflect a higher amount. So if you gave 20 pesos, by the time your neighbors read the sheet, it looked like you gave 200 or 2,000 so you upped your amount to reflect what he showed the others as having given.




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EnsenadaDr
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[*] posted on 9-23-2013 at 11:02 AM


Wow I am sending this to the boss at Maneadero in Ensenada for his comment, this is crazy. He speaks good English. I will ask him what he thinks. But between us, the Internal medicine guy probably decided he didn't want to take any further action on this because of the risks involved. But he should say that not deny funding.
Quote:
Originally posted by Mulegena
Again, to point out the inequalities of Seguro Popular/SP vs. Seguro Social/IMSS coverages:

Another relative has a condition that has become potentially life-threatening, an aortic hernia that's been present from birth; the lady is now in her 30s.

She has Seguro Popular (and cannot change to IMSS, btw, for whatever reason). She was sent to La Paz for a current exam which included x-rays and an endoscopy. SP did not cover the endoscopy, nor of course will it pay for any medications or the necessary surgery to save her life. She was sent home and told to come back when she had the money. Kinda cold. The family is raising payment at the moment by selling tamales door to door.

This brings up another point: Fundraisers.
Each little village helps to look after their own. When someone is sick they have fundraisers, usually a planned collective lunch sale with tickets available by advance sale or "at the door". All proceeds are put into a bank account for that beneficiary's health care. Fundraisers are an essential part of community life down here and are an excellent way tourists can help. When someone approaches you, buy a ticket. Ask who in town is in charge of the Association (for example, in Mulege see Saul Davis). Go to that person and ask how you can help. Make a donation. Save a life.
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EnsenadaDr
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[*] posted on 9-23-2013 at 12:55 PM


I just got a response from the head boss over at Maneadero and wants to know more information. Name, and address. He said he could help her with Seguro Popular in La Paz. If you don't want to make it public please U2U me.
Quote:
Originally posted by Mulegena
Now what I came on to share before I read Alm's last paragraph.

This is about how Mexico's public insurance plans can be flexed at the discretion of the people in charge, which corroborates statements made by DrEnsenada:

My mother-in-law is in-hospital at this moment. She had an inactive Seguro Popular which was easily verified and updated when she became an in-patient in Sta. Rosalia Seguro Popular Hospital two weeks ago. No worries.

Last week she was transferred to the Seguro Popular hospital Salvatierra in La Paz for specialist(s) care. She was again evaluated as to her qualifications, a simple matter of a short verbal chat with a social worker.

When a diagnosis was determined it was found that the treatment coverage (read, "paid for by") Seguro Popular was not available for her illness. Not at all. 0% coverage. Zip.

She has a son in La Paz who has Seguro Social coverage, IMSS. He signed her up on his policy as a dependent living with him. She was transferred out of the Seguro Popular hospital and directly into the Seguro Social/IMSS hospital. Her medical treatment is covered by the insurance, 100%.

I think it's great that the two public insurance providers will coordinate and work together, and that one of her sons is employed by a Mexican company.


[Edited on 9-23-2013 by EnsenadaDr]
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Alm
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[*] posted on 9-23-2013 at 01:15 PM


Have forgotten about Rolly Brook site, in case if the OP is still reading: http://rollybrook.com/health.htm

Kind of 101 on the subject. With links to private insurers as well, that Pescador and Mula mentioned.
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pauldavidmena
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[*] posted on 9-23-2013 at 04:05 PM


Quote:
Originally posted by Alm
Have forgotten about Rolly Brook site, in case if the OP is still reading: http://rollybrook.com/health.htm

Kind of 101 on the subject. With links to private insurers as well, that Pescador and Mula mentioned.


the Rolly Brook site, as well as the book he co-authored is definitely a good primer on not just Mexican Health Insurance, but on the ex-pat life in general. Of course the continued experiences of people on this forum is even more informative.
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