Tag: health insurance

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Cardiólogo hoy

Cardiologist today (cardiólogo hoy) for the appointment (1 pm) I started making 4 months ago.

10:15 – Left the house walking to bus station
11:00 – Bus to Alajuela then taxi to Hospital Alajuela
12:15 – In line to check in on 4th floor Cardiology Department (cardiólogia)
12:30 – Behind the gray screen for weight and blood pressure
12:35 – Wait in front of Door 8
1:00 – Called into Door 8 where she asked questions in español of course. Then created an EKG (ecg) and then sent me to Door 4
2:00 – Dr. Hernandez calls me in behind Door 4. My first and only person of the day who spoke English. We mixed it up, Spanish/English, as he created a little heart-related medical history of me to begin my cardiology file. At one point he had me both sit and lay down on the examining table where he listened to my chest and back and then felt around in my abdomen. He read and wrote notes on the reports I brought from the private cardiologist I had seen earlier and the medication she had prescribed. He told me he would have be back for an ecocardiogram along with blood and urine workup to give him a total picture of my health to help him better monitor my heart. I feel very good about making this young (30-something) cardiologist my primary heart doctor with the government healthcare program generally called CAJA here.
2:50 – I go back to the front desk with really nice young adults who only speak Spanish to make my appointments (citas). The young man had to use his phone to translate to tell me I must first go to the first floor to a desk and have them make a file on me, mi experiencia, which took a while to find the right desk where I took a number and waited.
3:20 – I took my beautifully created large folder for all my medical records there back to 4th floor where the young man called me past the line and put everything in the folder except my two appointments for March 24 & 25 and multiple copies of my prescription for a different but similar treatment of my arrhythmia.
3:30 – Got a taxi to bus station
4:00 – Bus to Atenas
5:15 – I’m eating one of Chef Dan’s Meatloaf Dinners before watching ABC news.

Now all of this cost me exactly $0. The prescription is good until my March visit and it too is FREE! While the prescription from the private doctor even in generic form costs me between $40 and $50 per month.

Yeah, this first visit cost me most of the day and I had to wait a few months for it, but my heart will be monitored and cared for until I die at no other cost than the required $100 a month CAJA cost which is required if I live in Costa Rica, use it or not. I’m going to use it! Save money! And I like most of it even if rather slow! 🙂 Later I will explain how I plan to work the free government system with some limited private system healthcare and a great little local insurance for a private hospital if or when ever needed for just $12 USD per month! Later!

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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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Getting Reimbursed for Medical Expenses

The private medical services insurance here is mostly through a government program called INS, a Spanish language acrostic. I finally completed the piles of paperwork with doctor signatures and original receipts (No photo copies! One of my claims was disqualified for this reason.) I mailed them to my insurance agent who got them to INS and I received an email pretty quickly telling me what was accepted and how much they would pay me with an electronic deposit in my local bank account when they received the account number. (I added to the time here by at first sending the wrong number dummy me!) When I finally got that right they informed me that since I still don’t have official residency yet, they could not auto deposit but I could come to an INS office or my agent. My agent requires 15 days, so I opted to go to INS somewhere close other than in San Jose. Alajuela is the closest and I went today and even with one problem, I completed the task within two hours! That is could! The problem was that my agent gave me the wrong address or directions to the office in Alajuela and I wasted one taxi fare ($2) in the wrong place. When I got to the right office, a typical government office with guards and take a number and wait until they call it to be served. It was surprisingly quick with only three employees needed to complete my task and they paid me in cash!

That is likely the last/only time I will do that since I canceled my expensive policy. I’m waiting to receive the government coverage after my residency is approved. Hoping that will start happening this Friday the 13th when my attorney appeals! Ironic? Probably! But I’m not superstitious!

And by the way, this experience today continues to strengthen the motivation to learn to speak AND understand Spanish. It is necessary to live here! 

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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.  🙂