bajalearner
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Location: Tijuana
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Do US health insurance companies pay MX Dr.'s claims
Do companies such as Blue Cross pay claims from a Mexican Dr. or hospital for treatment by their insured people? My Delta dental pays MX DDS's but I
have not inquired about health plans.
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EnsenadaDr
Banned
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Registered: 9-12-2011
Location: Baja California
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In most cases, NO! Neither does Medicare part B. I have heard to the contrary as in an emergency that some people do get reimbursed, but it would
have to be a hospital that was the closest hospital available on both sides of the border to the person that had the emergency living in the US.
There are some plans that do but please, do NOT wait till the emergency arises. Do NOT wait till after you have spent considerable amount of money at
a Dr.'s office in Mexico. Pick up the phone and call the claims department at your insurance company and ask beforehand. Most likely, they will say
"NO".
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durrelllrobert
Elite Nomad
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Location: Punta Banda BC
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Kaiser reimbursed me for emergency treatments in Mexico (paid 80% of bills in USD vs. pesos = 800% reimbursed) and Canada (paid 96% of bills). Got pre
approval from them via phone call in both cases.
Bob Durrell
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EnsenadaDr
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Location: Baja California
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Yes Bob but you were probably covered under Kaiser's policy. i remember 14 years ago I had my cesarean section tear open in Rosarito and I was
preauthorized by Kaiser as well for my ambulance ride, but that is not the norm. And many people make the mistake of saying they live in Mexico more
than half time which pretty much cuts out any assistance from the US Federal government plans like medicare.
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El Jefe
Super Nomad
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Registered: 10-27-2003
Location: South East Cape
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I've had two emergency visits to hospital here in los cabos. Both times Anthem Blue Cross paid 100%. One bill was 10K dollars.
No b-tchin\' in the Baja.
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ncampion
Super Nomad
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Location: Loreto
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Generally speaking most insurance policies cover emergency treatment no matter where they occur. They do usually ask for the treating facility to
call a toll free number for authorization but it is just a rubber stamp. Ask your agent to be sure.
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TMW
Select Nomad
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Registered: 9-1-2003
Location: Bakersfield, CA
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| Quote: | Originally posted by El Jefe
I've had two emergency visits to hospital here in los cabos. Both times Anthem Blue Cross paid 100%. One bill was 10K dollars.
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Thats good to know as I too have Anthem Blue Cross.
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RnR
Senior Nomad
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Registered: 5-1-2010
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Check Anthem Blue Cross's website for your plan.
Our Anthem plan has a page for international benefits and service providers. There are actually preferred providers listed in many places in Mexico.
If you choose another provider, they pay according to the benefits section of your plan.
Payments have always been at the 100% level. Usually because the Mexican prices are lower than the "usual and customary" prices on Anthem's US
schedules for the same services.
The biggest hassle has been the itemization/coding of the services provided. They won't accept a lump sum.
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rts551
Elite Nomad
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Healthnet payed for our sons arm surgery when he broke it in Loreto.
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EnsenadaDr
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Location: Baja California
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Mood: Move on. It is just a chapter in the past, but don't close the book- just turn the page
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Well that is good to hear, but I hear a whole lot of horror stories about not being reimbursed. And the key to Mexican healthcare is pay your bills
first, and ask the insurance company for reimbursement later.
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Pescador
Ultra Nomad
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Registered: 10-17-2002
Location: Baja California Sur
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Almost all health plans have a provision for emergency care which means care that you need on an emergency basis for accident or illness. Since they
are not connected with hospitals in the rest of the world, it is normal procedure to pay for what you receive and unless something is excluded, you
will be reimbursed when you present a bill.
Normal and regular care is a different story with some plans covering treatment while traveling others not covering at all.
The best way to find out is like I told all my clients, "Read the Policy" or at least call your agent.
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durrelllrobert
Elite Nomad
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Registered: 11-22-2007
Location: Punta Banda BC
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Mood: thriving in Baja
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My reimbursement by Kaiser for Canadian hospitalization
Earlier I stated that Kaiser had reimbursed me for my hospital stay in Canada. Since I'm a member of the Senior Advantage plan they first had to get
authorization from Medicare which meant that I had to show proof that I hadn't just traveled there for treatment but was passing through without an
"unreasonable delay" when the emergency occurred (see #2 below). Since I did not fly there I didn't have airline ticket but they accepted my Visa
bills for gas purchased in route 
www.medicare.gov/Pubs/pdf/11037.pdf
There are three situations when Medicare may pay for certain types of health care services you get in a foreign hospital (a hospital outside the
U.S.): 1.You’re in the U.S. when you have a medical emergency, and the foreign hospital is closer than the nearest U.S. hospital that can treat your
illness or injury.
2.You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency
occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat your illness or injury. Medicare determines what qualifies
as “without unreasonable delay” on a case-by-case basis.
3.You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition,
regardless of whether it’s an emergency. Remember, in these situations, Medicare will pay only for the Medicare-covered services you get in a foreign
hospital.
[Edited on 1-12-2014 by durrelllrobert]
Bob Durrell
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EnsenadaDr
Banned
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Location: Baja California
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Mood: Move on. It is just a chapter in the past, but don't close the book- just turn the page
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In any case Bob, most expats in Mexico don't fit that description and they will need to pay their bills up front. That is why I urge them to join
Seguro Popular.
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