Tag: caja

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My First Government Doctor Visit

Yesterday I went to see my assigned government doctor (Dr. Zuniga) for my initial visit and he was not there but his substitute was a beautiful young lady evidently just out of medical school (Dr. Arias) and she spoke good English. So it made the first visit easy. No one else spoke English at the clinic. We discussed my medical history and what I am being treated for now and postponed the physical lab work until I finish my current round of heart medicine prescribed by a private heart doctor in San Jose. Then (September) they will evaluate with their own diagnosis and prescription if any. Not all doctors use medication for arrhythmia, even in the states where medicine tends to be overused.

My whole time at the clinic including the nurse weighing, blood pressure, etc. visiting with a doctor, waiting at lab for appointment was only about one hour. One perceived problem with government health programs like this is that you have longer waits. Not so this time! All went efficiently and quickly and I was quite happy with the service! I’m now in a health plan like Bernie proposed for you guys in the states. It is great! Sorry no photos this time. Didn’t think of it at the time.

Ticos just call it “Caja” which is part of the name in Spanish. Here is a summary definition from Wikipedia:

The Costa Rican Department of Social Insurance or Caja Costarricense de Seguro Social (as it is known in Spanish) is in charge of most of the nation’s public health sector. Its role in public health (as the administrator of health institutions) is key in Costa Rica, playing an important part in the state’s national health policy making.
Its services are available to all citizens and permanent legal residents. This governmental entity’s functions encompass both the administrative and functional aspects. It has the obligation (as a public institution) to formulate and execute health programs that are both preventive (such as: vaccination, informational,fumigation, etc.) and healing (such as: surgery, radiation therapy, pharmacy, clinical, etc.) in nature.[2] 

Note that this service includes all medical needs including prescriptions, dental, eye care, etc. with no 
co-pay or additional charge after my $114 a month fee for medical services. This is where I really save 
money over living in the states. 
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After Much Effort – I’m Insured Again

My Carné card is what will get me all needed medical service;
including prescriptions, doctor visits, hospital, surgery, tests, etc.
at no extra cost to me above the $114 a month coverage fee based
on my U.S. Social Security income check deposited in a bank here. 
The instructions said bring the original of each needed document and
one copy. In my usual overkill I made 3 copies of all and took it with me.
He didn’t even want one copy beyond the originals, BUT . . .
He did not like the digital printed receipt of my electric bill and made be go for a
traditional paper bill mailed to houses with no email. Very difficult to get!
But with help of my amigo Jason Quesada & landlord, we finally got it in time.

I still have to go back to Immigration 28 July for my Cedula or residential ID card, but I am legally a resident now with full medical coverage. An American Tico? Well, more secure anyway! 🙂  

Next week I will schedule my initial appointment with the Caja doctor assigned to me, getting a physical and giving him my medical history. It will be interesting to see what they do with my Sleep Apnea and the recently discovered heart arrhythmia. For some specialists I may have to go to Alajuela or San Jose, just like with the more expensive private doctors. 

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Waiting Patiently . . .

. . . for the sun to bring out their new leaves. Two trees seen from my terrace.
The fog always passes. The leaves always return.

Patience is not simply the ability to wait – it’s how we behave while we’re waiting. 
~Joyce Meyer


And I’m working on patience as I do the paperwork and legwork to get my CAJA health insurance applied for. Wednesday week I go to the U.S. Embassy SS Department to get my proof of SS income. Then I take it and all my other paperwork and filled in form to the other side of San Jose and Jose Pablo Carter, my attorney, to collect my residency card and make sure I have all my paperwork correct in preparation for my July 8 CAJA appointment. Then I will see what else is needed!  🙂  It has not been easy but it will be worth it to have 100% health care coverage through my new government. Then all I will lack is a CR Driver License to get a rental car occasionally. Then no more new tourist visas every 90 days! But I am doing it at least one more time the end of June. 
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The Lehning’s Passed Through Today

Tim & Joan Lehning and all three kids passed through the San Jose International Airport today where I welcomed them and immediately said goodbye as they got on van transportation to the Pacific Coast beach town of Tamarindo where they will participate in a surfing school for the next four days. They return Tuesday afternoon for two nights in my tranquil little farming town of Atenas before returning to Nashville. They came here from Peru where they hiked up Machu Pichu as the first part of their Latin America trip. They’ve seen coffee farms before, about our only tourist attraction here, so I will just walk them through our little small town life and feed them well! And show off my little rent house and garden and visit! They are staying at Eden Atenas Tuesday & Wednesday nights.

More on Wednesday about their visit in Atenas.

And more things are happening on my CAJA application than I can explain now, but bureaucracy is hard at work in this government health insurance thing but my attorney is back in the middle of it. And I really need it! The Rx cream for my finger to help skin grow (Sufrexal) cost me about $48! 

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Sharp Knife, Dusty Volcano & Red Tape!

SLICING THE TIP OF MY FINGER OFF
Whoever told me that a sharp knife is safer than a dull knife . . . I might want to challenge you. I got a new kitchen knife the other day that looked really sharp like the one I have that is usually dirty from slicing veggies, meaning I needed another. Last night I used it the first time slicing some onions and peppers for my guacamole and I sliced the tip end of my finger off and never found the little flap of skin. (I probably ate it in the guac!) A painful, bloody mess! The Doc and EMT this morning fixed it sort of, but she cannot easily do stitches over an open hole. (A last resort.) I cringe just writing about it. Sometimes I do stupid things like slicing the tip of my finger off! It hurts!

So now I have a complicated cleaning and bandaging process every day for awhile. She prescribed a cream or ointment that is suppose to encourage skin to grow over the wound. Hope it heals fast! I’m allergic to pain! A big baby!

VOLCANO TURRIALBA STILL ERUPTING
All that means to us in the Central Valley is more gray dust blowing in, which is a nuisance at times.  See it erupting on YouTube  The big explosion is more than 30 seconds into the video. 

COLLECTING DOCUMENTS FOR JULY 8 APPOINTMENT
I’ve got a month to hopefully get everything right for my CAJA appointment that will get me in the more affordable government health program, but bureaucratic red tape comes first!  🙂 And filling out the form in Spanish has become a Spanish Class project we will possibly finish tomorrow.  🙂  They are another support group! And I contacted the embassy today for proof of my SS income. ¡Poco a poco!

So yes, Pura Vida includes this messy stuff too! But I will survive!  🙂 And I’m enjoying another day with high of 79 and low of 65 with late afternoon shower! Sweet!

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Private Health Insurance, Public Health Coverage and Residential Papers

Boring Stuff for the Few Readers Anticipating a Move Here

That title just means some details only concern the persons actually moving here or retiring here and I don’t want family or friends back in the states worrying about my healthcare. I’m fine! Don’t worry! In a different country, culture or situation some things take longer than you expect and you just work them out the best way you can, sometimes one day at a time.

RESIDENCY & PUBLIC HEALTHCARE
It has been 15 months since I filed my application with Immigration and I am still not approved yet. I now know people who have gotten it in 6 or 8 months and another in 3 years, so the bureaucratic government office is always slow and it often depends on which agent’s desk your application ends up on or what is happening in his/her life at the time. So mine is not that unusual, but I talked with my attorney  by phone this afternoon and here is the update on my application or what is in his control: I am now his oldest application file, so I’m his number one priority now. Good! He has made an appointment with Immigration for May 13 to request “a resolution” on my application. That is between him and the government office, I’m not allowed to go then, but he is planning for approval on that date and has even made a June 1 appointment with the CAJA Office (government health plan) for me to get my healthcare card (Caja Card) which is separate from my residency card (Cedula) and I think that same day we may apply for the “Gold Card” which is for us old people to get discounted or free services like buses, etc. That means we have to do some paperwork and Social Security Office visits between May 13 and June 1. I will try to stay available though I do have a May 20-23 birding club trip. SO I’M HOPING FOR RESIDENCY BY MAY AND CAJA BY JUNE OR JULY. I will not hold my breath! Everything here usually takes longer than suggested!

The primary reason I’m in a hurry to get this residency and public healthcare coverage is because I really can’t afford to keep private healthcare insurance! For a reasonable amount per month I will be on something like medicaid or medicare in the states (only much better!). There will be no co-pay or charges for any doctor visit, surgery, hospital visits, prescription drugs, etc.! I will pay a monthly charge based on a percent of my SS income. I need this kind of “socialized medicine” as some Americans like to call it. Read on to see why.

PRIVATE MEDICAL CARE AND PRIVATE HEALTHCARE INSURANCE
I’m thankful I’ve had no big health issue like cancer or needed surgery, injury, etc.! But private doctors, hospitals and other medical services are so much less expensive here than in the states that for my usual medical needs so far in my life I could afford to have no insurance and just pay cash out of pocket for doc visits, x-rays, EKGs, prescriptions, etc. But prudence makes you plan for the worst and have insurance when you are not on the government health plan yet, as has been my case for the last year.

When I first came, I was could tell my Medicare Supplement Insurance that I was on an extended vacation and be covered for I think it was up to 4 or 6 months. When that expired, I cancelled that policy and purchased a Costa Rica Private Healthcare Insurance Policy which covered 80 to 90% of everything including prescriptions with a few restrictions I won’t get into here. But like in the states it was based on age and for someone turning 75 it was $3,000 paid up front for the whole year. It expires the end of this month and I just sent in my claims for the whole year, so waiting on a check!

Since I still don’t have my residency and thus the almost free government healthcare plan, I figured I probably should go ahead and renew for one more year “just in case.” Well, they do everything at the last minute here and I just got my renewal notice with the shocker that I this year move into the next age bracket of 76-80 years old and thus my renewal cost would now be over $6,000 for the year! NO WAY! That precipitated the above-mentioned call to my attorney and my push to get residency and the government healthcare plan expedited if at all possible.

It is close but the timing of my May residency and June healthcare plan may be just right! Though I may have a couple of months without insurance, so just don’t get sick! Private insurance companies here are about as bad as the states for high costs, but the government plan is certainly a lot better! And I hope to be on that soon!

If anyone considering a move here wants more details, just email and I will be glad to discuss it further and keep you posted on what happens, though I will do that here on the blog too once I’m approved and probably have stories of government bureaucracy to share.  🙂

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The Autopista del Sol to San Jose

Well, I splurged today and hired a private driver to drive me to San Jose for my residential paperwork appointment and to sign up for medical insurance. Part of the way we drove on the Autopista del Sol (official site), or the newest, access-controlled highway from San Jose to the Pacific Beaches. See also a Nosara Surfer’s Report on the Highway. Here’s three phone photos, then I’ll tell you about the experience in the big city.

Out our way is beautiful scenery driving up the central valley.
Further from the city is only 2 or 3 lanes, but . . .
In and near the city are 6 and 8 lanes, toll plazas, and bumper to bumper in rush hour.

I have a wonderful attorney, Jose Pablo Carter Herrera, the son of another attorney with the Association of Residents of Costa Rica, a service organization for expats living in the country. I’m still waiting for an Apostille on my proof of income which Social Security in the states refused to help me with. The embassy here is supposed to do it easily, but it didn’t happen today! The only unfriendly, unhelpful place I’ve been in Costa Rica is the U.S. Embassy. I wasn’t too surprised that they wanted me to make an appointment but they would not let me make it even though I was there standing at the guard station. The correct procedure is to do it over a certain phone number between 8 AM and 11:30 AM, no exceptions! So me and my driver wasted time there. (The embassy in The Gambia was just as haughty and difficult to work with, but you have to work with them!)

The good thing I did not expect was I got my application for health insurance started and within the next week or so I will receive a call from the doctor to schedule my physical for the insurance company. I’m covered by my Medigap Policy for the first 90 days or until March 24. My Pricose agent, Juan Colero, says I will easily have it secured by or before then. It usually takes about 5 weeks after the physical. So I wait for the doc’s call on this. Then pay a whole year’s premium at once, then after a $300 deductible, 90% of everything is paid. It costs less than my Medigap and Rx insurance in the states. But when my residency is finalized I get the even cheaper government medical service if I wish. 
Tomorrow I will dutifully call the correct embassy number during the correct hours and hopefully get an appointment fairly soon. Jose can’t file my residency application until I get this last legal document. Then it will take from 5 months to more than a year, depending on which bureaucrat is assigned my application in the Immigration Office. It is all part of the laid back life of Tico-land and I will not worry about it after I have done my part. The private insurance can go on indefinitely and I could decide I like it better than the Caja or government health plan – we will wait and see. But government medicine and a long-term Visa are the reasons I’m applying for residency.

After back around 1:00 I had lunch at a new place for me, La Trilla Restaurante. I compared their Casado con Pollo with La Carretta’s and it was very similar, though they add a piece of cheese and some black bean dip and chips. I also drank another Guanabana drink, this time con leche. Muy bien! Now back to my birds!  🙂 And my study of Spanish!

P.S.
Someone asked about the inside of the apartments. During the first two weeks I linked to a photo gallery of the downstairs apartment #4. I have a smaller gallery of my upstairs apartment, since much is the same, all built-ins, granite counters in kitchen, carved doors etc. But anyway, here are the links to the Inside Apartments Galleries:

I’ll figure out how to photograph the balconies soon. They are not super grand inside, but more than adequate for me. When my boxes get here, they might get clutter or crowded.  🙂
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Focusing Day

Hotel Autentico, My Home Base for Two Weeks

First thing after breakfast this morning was walking the 5 blocks to the ARCR office and meeting with my new Costa Rican lawyer, Jose Pablo Carter. He helped me put together the important items from the seminar and create a checklist of what I need to do to gain residency and get moved to Costa Rica. I will include it below. I walked back to my hotel (above) where they know me by name now and the waiters are trying to teach me Spanish. Fun! I did a review of it on TripAdvisor last night. Worked on list and had a sandwich.

In the afternoon I walked down the street again to two banks and only one of them had English as a choice on their ATM for the cash withdrawal I needed to make. Got to learn Spanish!  Then at 3:00 my two-day driver came to show me the city and learn of my housing interests for our all day trip tomorrow to look at apartments and rental houses. I’m not renting now, but I want to see what they look like in different areas and get a feel for what I will try to nail down in 4-6 months maybe. Howard’s tour only showed expensive houses and tourist condos which was my biggest disappointment with his tour. We stopped for afternoon tea at a little neighborhood Soda, a small Tico cafe. Before and after this I typed up my checklist of things to do and had a bowl of mushroom soup and Tres Leches for dinner. Here is timeline:
Step by Step Timeline for Costa Rica Residency
As I understand it from ARCR Seminar and personal conference with Jose Pablo Carter, Lawyer
At Association of Residents of Costa Rica, September 1, 2014
COLLECT NEEDED DOCUMENTS
Send to Jose. I must then arrive within 6 months of earliest date on any of the following documents.
1. Authenticated Birth Certificate with Apostille from State of Arkansas
2. Apostille letter from Social Security proving lifetime pension over $1,000 a month
3. Police Report on me with Apostille and if possible fingerprints
4. U.S. Embassy/State Department Online: Do a Consular Registration for Costa Rica, then save as a PDF file. Print one for this packet of documents & email the file to Jose.
JOSE & ARCR WILL DO ALL THIS WORK IN COSTA RICA FOR ME:
1. Provide Spanish translations of all the above documents as required
2. File my application with the Caja Office
JOSE/ARCR WILL DO AFTER I MOVE:
1. Review my rental contract
2. Get my fingerprints and physical exam that can be turned in after the Caja application is filed
3. Help me open a local bank account
4. Prepare a Costa Rica Will and powers of attorney from copy of my U.S. Wills, etc.
OTHER THINGS I CAN DO BEFORE MOVING
1. Contact Juan C. Calero of Pricose to start INS insurance policy by day I arrive
2. Contact the young doctor from Metropolitano about my sleep apnea and meds
3. Get budget worked out
4. Contact mover, Charlie Zeller
5. Learn more Spanish
6. Get online business settled before the move and ask lots of questions about doing it from Costa Rica
7. See if X or X will let me establish a U.S. physical address with them for my TN Driver License, maybe mail forwarding, and maybe something else.
8. Renew TN Driver License which now expires in 2015
9. Rent PO Boxes from ARCR in San Jose & Miami before I move.
P.S.
NOTE: I ended up not getting an address with ARCR but signed up for Aeropost.com and got a Miami address directly with them and use it now for all shipping and internet orders. I use postal service for most letters but new credit cards can be sent to the Miami address.