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Pescador
Ultra Nomad
Posts: 3587
Registered: 10-17-2002
Location: Baja California Sur
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| Quote: | Originally posted by Hook
We are in the midst of renewing our health insurance policy. It is a high deductible policy, 5k dollars, that is catastrophic coverage. It is through
Best Doctors. We have also had plans through Bupa. These are worldwide plans for persons living outside the US. You can get treated in the US IF you
are traveling there but it is not intended for simply going to the US for treatment.
But it seems like Seguro Popular might be a good thing to have for needs below 5k.
So, where are we at in whether there is a charge for Popular? I see conflicting info.
What are the annual limits or deductibles? |
Hook, it was set up so that the average person in Mexico who did not have coverage would have some type of coverage. It does a good job of covering
lab and exams, not so good with surgeries and more serious treatments. Like the old days where they covered everyone in the US but the poor people
went to county hospitals and clinics. Here, they have to provide the coverage, but you can sit a long time waiting for a doctor to see you and then
it is somewhat difficult to get referrals to a specialist.
Google the Seguros Popular website and you can find the Guaymas office. They are supposed to do a financial intake and a health intake but some
offices like Ensenada just do away with that and sign up everyone for free. It was designed to be done on a sliding scale according to your income.
We have people in Santa Rosalia who pay nothing and some who pay the max amount. Until you visit your office, you will have no idea because there is
a wide difference in how the various offices are run.
Deductibles and annual coverage is not a consideration because some things are simply not covered. You must go to a hospital that is affiliated with
your office. For example, if I get sick, I have to go to Santa Rosalia and if the doctor decides to make a referral to La Paz then it is up to him or
her to do that. I had a good friend who got Nitrogen Narcosis from diving and could not get a referral to the decompression chamber in Asuncion, so
we just had a fund raiser and paid for it. If you wanted to go to Hermosillo, you would need to go there first and claim that you got sick while
traveling through.
The website is a well developed site and answers most questions and will probably be a better source for more accurate information that you will get
here due to individual perceptions of what the program entails. I have helped a large number of my friends get signed up and work with the services
but this is typical of things in Mexico where it varies according to location.
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Mula
Super Nomad
Posts: 1655
Registered: 8-16-2011
Location: San Nicolas y Lopez Mateos
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What we do with our Seguro Popular in Lopez Mateos on Mag. Bay:
If we have something the local clinic can not address, we get a referral for a specialist in Constitucion or LaPaz - and that gets us in the door at
the bigger medical facilities in Baja for specific larger problems.
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EnsenadaDr
Banned
Posts: 5027
Registered: 9-12-2011
Location: Baja California
Member Is Offline
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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The website is a well developed site and answers most questions and will probably be a better source for more accurate information that you will get
here due to individual perceptions of what the program entails. - (Comment by Pescador).
Pescador, you just gave your opinion, and I am entitled to give mine as I worked for Seguro Popular for a year as a clinic physician. May I say that
the inconsistencies vary from doctor to doctor and if you don't get what you want or need you must return for a second opinion, just like in the US.
I had patients come to me because of months of no resolution of their problem where I promptly referred them and at times re-referred them to the
appropriate specialists until they got the satisfaction they wanted and/or needed. I believe first hand information is accurate, now don't you? And
I don't believe Ensenada would be doing something that wasn't accepted by the higher ups, and risk losing their jobs.
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Hook
Elite Nomad
Posts: 9009
Registered: 3-13-2004
Location: Sonora
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Mood: Inquisitive
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Jim, thanks for all that good info on SP. I think I'll just stick to my existing plan and pay the piper for the small stuff. It's not like we cant
afford it.
In checking with the specialists we have used in the past, they dont recommend going to the places that will take Seguro Popular for anything but the
most basic ailments. But maybe they wouldnt. Still, they havent paid them through insurance so they arent dissing SP cause they know they wont pay as
much as they expect. Our specialists realize the type of insurance we carry and that we have to pay them out of pocket. Just not good facilities, in
their opinion. They specifically mentioned the State Hospital of Sonora in Hermosillo.
I am confused as to why both Seguro Popular and IMSS heath care exist? Arent they basically the same thing? The IMSS facilities over here are scary!
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Pescador
Ultra Nomad
Posts: 3587
Registered: 10-17-2002
Location: Baja California Sur
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No, IMSS was the government employee program and they decided it made sense to sell coverage to those who did not have it. It is your worst case
scenario of HMO like conditions where the doctors, staff, and facility are owned and operated by the government. A lot of the doctors are fulfilling
their responsibility before going out into practice. It is run very much like Public Health services that I encountered when I was a teacher on the
Indian Reservation.
Seguros has contracts with the general hospital in any given area or the health clinics in the smaller towns and villages. I have heard of people
paying a little extra when they see the doctor to get better referrals. That seems to become kind of standard practice where the government puts in a
program that they think will be adequate for the people but rely on the social conscience of the medical people who get paid a pittance for the people
they see. If they do not take in enough money, especially with all of the free coverage, then obviously they do not have enough money to correctly
fund the utilization of the program.
I still think it is a great program but my biggest fear is that people will come to equate it with coverage they have had in the United States. It
obviously does not cover the same things as Medicare, which is a government run and administered coverage.
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Bill Collector
Nomad
Posts: 374
Registered: 1-13-2004
Location: Buena Vista, BCS
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Seguro Insurance
Ensenada Dr
Just want to say that because of you almost 75% of Americans/Candians here in Los Barriles/Buena Vista BCS have gotten Seguro Insurance. I've used it
twice now with postive results each time. We also carry private Mexican Insurance, we just paid the premium its $2,500 US dollars a year for one
person with a $1,500 US dollar deductabe.
Thanks again for all the great information you give out. Always positive
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EnsenadaDr
Banned
Posts: 5027
Registered: 9-12-2011
Location: Baja California
Member Is Offline
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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Thanks so much. I am here to help, and only help.
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Nan&D
Nomad
Posts: 137
Registered: 2-28-2010
Location: Bahia Asuncion
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Thanks for all this Ensenadadr!
We live in Asuncion where the only hospital is IMSS. Should we apply for both Seguro Popular and IMSS?
Nan
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EnsenadaDr
Banned
Posts: 5027
Registered: 9-12-2011
Location: Baja California
Member Is Offline
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, if the closest hospital is IMSS, and there are no other facilities around, then I would apply just for IMSS for now. IMSS is going to cost you
a few hundred dollars a year, and from what I understand, has an exclusion policy on emergency services up to the first year, but if it's the only
game in town, I would go for it. Do they have a private hospital around there? Let us know if you do sign up as to what the first year exclusions
are and how much it costs to join. There are some other private insurance programs available, but they are not cheap. In fact, IMSS will actually
turn you away if you don't have their insurance unless it is a life or death situation, but will promptly get you out of their hospital as they did
with Ron Hoff and his wife who were initially treated by them in San Quintin.
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Nan&D
Nomad
Posts: 137
Registered: 2-28-2010
Location: Bahia Asuncion
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I believe it's a private hospital for the co-ops. Non co-op people pay for visits. Also we have gone to the hospital in the past for an emergency,
and just given a donation. Is IMSS accepted at Seguro Popular hospitals? I will let you know how this evolves, and thanks again. N
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EnsenadaDr
Banned
Posts: 5027
Registered: 9-12-2011
Location: Baja California
Member Is Offline
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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What do you mean by co-ops? What is the name of the co-ops hospital? No, Seguro Popular is not accepted by IMSS. Like I said, Mexico has an
observance of the "EMTALA" law as in the US, that is critical patients must be stabilized before transport to their accepting facility, but rest
assured they will get you out of there as soon as you are stabilized, to your insurance covered facility.
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Nan&D
Nomad
Posts: 137
Registered: 2-28-2010
Location: Bahia Asuncion
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The fishing co-operativas. I don't know the name...
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EnsenadaDr
Banned
Posts: 5027
Registered: 9-12-2011
Location: Baja California
Member Is Offline
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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Hmmm, so the fishing co-ops have another hospital besides IMSS? Very interesting. Can you find out the name of it when you get a chance? | Quote: | Originally posted by Nan&
The fishing co-operativas. I don't know the name... |
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Nan&D
Nomad
Posts: 137
Registered: 2-28-2010
Location: Bahia Asuncion
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Sorry for the confusion, it is IMSS. Unidad Medica Familiar #15. We can apply here, starting with the physical. They gave me a list of other necessary
documentation and the annual cost list.
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DENNIS
Platinum Nomad
Posts: 29510
Registered: 9-2-2006
Location: Punta Banda
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I thought IMSS was Social Security?
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EnsenadaDr
Banned
Posts: 5027
Registered: 9-12-2011
Location: Baja California
Member Is Offline
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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IMSS is for the common working man in Mexico, so that is probably why the fishing co-ops belong to that hospital.
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Bill Collector
Nomad
Posts: 374
Registered: 1-13-2004
Location: Buena Vista, BCS
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A friend went last Friday to sign up here is his report
Friday we devoted the day to an adventure in La Paz to register with Seguro Popular. First step was Immigration where we presented our Passports
along with our new Temporary Resident Cards and obtained our CURP numbers. Next stop was the old hospital on Nicolas Bravo. We found the office on
the second floor of the new wing. Look for the door on the right. We had a nice chat with the young gal under the window who spoke perfect English.
That office will determine an "economic means test"; how much you will be charged for the Seguro Popular medical insurance. Their policies range from
3 months to years. A wife may apply under the husbands name. If you are indigent, its free but if you have "means", there will be a charge. You will
be asked a variety of questions to make that determination including "do you have a refrigerator?" At the Seguro Popular office, you will need copies
of the CURP form, Passport, FM3 - we included copies of utility bills, etc. I did not include any prices since they will vary depending on their
assessment.
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EnsenadaDr
Banned
Posts: 5027
Registered: 9-12-2011
Location: Baja California
Member Is Offline
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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Thank you Bill Collector. Are you aware that SEGURO POPULAR and IMSS are two different healthcare plans?
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Bill Collector
Nomad
Posts: 374
Registered: 1-13-2004
Location: Buena Vista, BCS
Member Is Offline
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Yes we are, we have Seguro popular thanks to you..this was in La Paz..
Most of all our friends have signed up.. Thanks for letting us know, it's important for all that make Baja their home.
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durrelllrobert
Elite Nomad
Posts: 7393
Registered: 11-22-2007
Location: Punta Banda BC
Member Is Offline
Mood: thriving in Baja
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What can you say about the new RUMOR (out of PV) that the new president is going to restrict Seguro Popular coverage To Mexican Nationals ONLY?
Bob Durrell
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