Health & Beauty
|General Health Care Information Part 3: Insurance Coverage - Inpatient Services|
Pamela Thompson - healthcareresourcespv.com
July 14, 2010
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|For all of your Puerto Vallarta medical needs, please contact Pamela Thompson at (322) 222-9638, 044-322-107-7007, Nextel 145-6912 or send an email to pamela(at)healthcareresourcespv.com.|
Choosing & Communicating with a Personal Physician
Insurance Coverage - Outpatient Services
Banderas Bay Area Emergency Services
Having basic information on how health care services work in the Banderas Bay area is vitally important. In Part 3 of her General Health Care Information series, HealthCare Resources Puerto Vallarta's Pamela Thompson talks about insurance coverage for inpatient services.
Having insurance for "major medical," for inpatient services is the one that people especially need to consider and have. True, medical services here are much less expensive than in the US, BUT there is no such thing as free medical care in Puerto Vallarta!
Insurance as a form of payment for inpatient services will only be considered with a Minimum of a 24 hour admission.
Upon admission to any private hospital in the area, the patient will be required to put down a deposit. This is like opening a tab at a bar. It doesn't matter if they have insurance or not. Minimal deposit is $10,000 pesos. If it is an admission to the Intensive Care Unit, a surgery, anything major, then a larger amount will be required. This can be done with a credit card.
At the time of admission, the patient's insurance card should be presented to the admitting department. They will then contact the insurance company and open a case. Until the insurance company sends a confirmation and a guarantee of payment, the patient is 100% responsible for all fees. It is surprising how many people have insurance but do not carry their insurance card with them. Without the card, the hospital will not be able to open your case.
When the insurance company sends the confirmation/approval to the hospital, they will include any co-pay and/or deductible which the patient will be responsible for.
There are three parts to an inpatient hospital bill. 1) Hospital fees 2) Physician fees 3) Lab fees. Not all physicians are keen to accept insurance. Remember that it normally takes many months for an insurance company to pay. That means all involved must wait a substantial amount of time for payment. If the patient has insurance, it is important to discuss this with the attending physician. HealthCare Resources is happy to assist with all of these arrangements.
There are a plethora of insurance companies that are accepted here. There are also many that are not. It's best to check with your insurance company to see if they will send a payment out of country. And as well, check with us. Just because your insurance company says that they will, does not necessarily mean that private hospitals in the Banderas Bay area will accept them.
Of course, Medicare is not accepted. Medicare supplements (MediGap policies) are not accepted as form of payment either - but most will reimburse. An "HMO/PPO" is going to be via reimbursement as well.
If the patient has a Mexican (private) insurance company, it is always best to contact the agent who sold the policy.
If the patient is going to go via reimbursement, it is vital that they have the following information:
• Factura from the hospital (Official Mexican Receipt)
• Itemized bill from the hospital (called a "desglose")
• Report from physician(s)
• Copies of all diagnostic studies (lab work, X-rays, etc)
• Original payment receipts (credit card receipts)
This must all be translated in to English.
For Canadians, the government insurance is not accepted as form of payment.
Traveler's insurance is widely accepted and probably the easiest type of insurance company to work with.
The bottom line? Be prepared! Make sure you have, and understand, your coverage prior to an emergency situation. Never just assume! Make an appointment with us to sit down and go over your coverage, point by point. We are more than happy to assist.
Pamela Thompson has lived and worked in Puerto Vallarta for over 17 years, 10 of them in health care. Pamela now leads HealthCare Resources Puerto Vallarta, a local health care resource network. Her years of experience and expertise are available to you by emailing your questions to pamela(at)healthcareresourcespv.com or by visiting HealthCareResourcesPV.com.
Click HERE to learn more about the health and well-being services offered by HealthCare Resources Puerto Vallarta.