LEGAL
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Medical
Coverage and Hospitals When
it comes to health care, we all want the best possible coverage we can afford,
and needless to say the options can be staggering, whether it be from the
different benefits offered, or by the costs involved. When looking over
these policies, please read the fine print. Even though it maybe a full
service medical plan, some things may still not be covered. Also, make sure
you meet all the requirements set out by the insurance company, otherwise
you may be dropped when you need the actual coverage. We
help individuals obtain IMSS coverage, which is an excellent option for
medical coverage here in Mexico. However, some applicants have been informed
to lie on the application about pre-existing conditions. This is a serious
no-no. Doctors are not fools, and 9 times out of 10 they will discover the
problem if something happens to you where you will require IMSS. We have
clients who have explained their pre-existing conditions with the IMSS doctors
and have not been refused coverage. There were some limiting conditions,
but overall coverage was not affected. This will apply to any insurance
plan you decide to purchase. While
reading all the fine print in your applications, make sure you also pay
very close attention to the pay schedule your insurance plan has. When speaking
with a representative of the insurance company, they will tell you that
certain procedures are covered, but sometimes fail to mention how many dollars
they will pay for a certain procedure. Insurance companies take an average
of what these fees are from many different sources. This can be an issue
when you think you are fully covered, and you choose a high end hospital,
have the procedure completed only to find out that the insurance company
will only pay X amount of dollars for said procedure when in fact the hospital
charges 3 times that amount. This can leave you with a substantial bill. We
must also be careful from the hospital end. Make sure you get specific details
from the hospital including all extra costs involved with your stay. For
example, if your going in for an Angioplasty, find out what the procedure
costs, and what the cost of all the support costs. We had a client quoted
$50,000 pesos for an Angioplasty, which was acceptable, but the final bill
came to $130,000 pesos. All the additions included the room, nursing staff,
surgeon, and on and on. When
these types of fees are charged by a medical facility, they are going to
want a guarantee of payment if you can’t pay upon leaving. Please be careful
what you sign with these facilities, especially if you are a relative looking
after the patient. In some instances we’ve had clients asked to sign as
a witness (Testigo) on one of these bills, but they actually signed a statement
that read “El Aval”, which actually means you assume responsibility for
the cost if the patient defaults. If
you sign such a document, it doesn’t matter what false pretenses someone
might have had you sign it under, you ARE responsible. And this rule applies
to anything you sign whether it be a deed, lease, or contract of any type.
We must keep vigilant about these matters, it’s always better to be informed
and protected before hand, because it will always cost more and be more
of a problem afterwards. Adriana Perez Flores |