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pauldavidmena
Super Nomad
Posts: 1734
Registered: 5-23-2013
Location: Centerville, MA, USA
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What will U.S. Health Insurance cover in Mexico?
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. 
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woody with a view
PITA Nomad
Posts: 15939
Registered: 11-8-2004
Location: Looking at the Coronado Islands
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Mood: Everchangin'
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you pay, BCBS repays you. i bet it is only for emergencies, not checkups.
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EnsenadaDr
Banned
Posts: 5027
Registered: 9-12-2011
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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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
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Bob H
Elite Nomad
Posts: 5867
Registered: 8-19-2003
Location: San Diego
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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.
The SAME boiling water that softens the potato hardens the egg. It's about what you are made of NOT the circumstance.
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Bajajorge
Ultra Nomad
Posts: 2604
Registered: 10-13-2005
Location: Topaz Lake, NV/San Felipe
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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.
Why do Liberals insist and demand that achievers pay the way for nonachievers who are to lazy to succeed, or are just failures by their own choice?
Criminals prefer unarmed victims, dictators prefer unarmed subjects.
Why do ignorant people continue their blabbering when it only proves to others how stupid they are.
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pauldavidmena
Super Nomad
Posts: 1734
Registered: 5-23-2013
Location: Centerville, MA, USA
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| 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.
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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.
I've emailed Hector and will update this thread with his reply. Thanks again!
[Edited on 2-9-2014 by pauldavidmena]
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RnR
Senior Nomad
Posts: 839
Registered: 5-1-2010
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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.
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pauldavidmena
Super Nomad
Posts: 1734
Registered: 5-23-2013
Location: Centerville, MA, USA
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| 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!
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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.
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Hook
Elite Nomad
Posts: 9011
Registered: 3-13-2004
Location: Sonora
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Mood: Inquisitive
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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..............
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pauldavidmena
Super Nomad
Posts: 1734
Registered: 5-23-2013
Location: Centerville, MA, USA
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| 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..............
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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.
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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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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.
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captkw
Ultra Nomad
Posts: 3850
Registered: 10-19-2010
Location: el charro b.c.s.
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Mood: new dog/missing the old 1
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Quik question
Why is it that we never hear of these insure companys going out of biz or needing a bailout ???
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Majorcynik
Newbie
Posts: 16
Registered: 1-9-2014
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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!!! 
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El Jefe
Super Nomad
Posts: 1027
Registered: 10-27-2003
Location: South East Cape
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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.
No b-tchin\' in the Baja.
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pauldavidmena
Super Nomad
Posts: 1734
Registered: 5-23-2013
Location: Centerville, MA, USA
Member Is Offline
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| 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".
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Bomberro
Nomad
Posts: 157
Registered: 7-19-2006
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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.
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bajaguy
Elite Nomad
Posts: 9247
Registered: 9-16-2003
Location: Carson City, NV/Ensenada - Baja Country Club
Member Is Offline
Mood: must be 5 O'clock somewhere in Baja
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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]
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DENNIS
Platinum Nomad
Posts: 29510
Registered: 9-2-2006
Location: Punta Banda
Member Is Offline
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| 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.
"YOU CAN'T LITTER ALUMINUM"
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Pescador
Ultra Nomad
Posts: 3587
Registered: 10-17-2002
Location: Baja California Sur
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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.
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pauldavidmena
Super Nomad
Posts: 1734
Registered: 5-23-2013
Location: Centerville, MA, USA
Member Is Offline
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@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!
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