Let Go of My US Insurance or Not?

2014 Disclaimer:
This reflects the decisions we make in 2009. Anything written here may have changed since then.
This is a log of our story and you will want to do your own research as rules/plans change.

We’ve been living here most of the time
For three years now, and all of the time
For the last year and a half.
Earlier this year, we decided it was ridiculous
To maintain medical insurance that would only cover us
If we went up to the United States to be treated,
Especially for a very serious illness that required
Hospitalization, months of chemotherapy, or such.
We would have to move back to the US for the duration,
Then return for all the follow up visits.

It would require a move, an apartment, a car,
Plus all the other things you spend money on there
Like food, auto insurance, general living expenses.
And of course, we’d still be maintaining everything here.
Plus, there are airfares and traveling.
We have friends that are doing this right now,
So we know for sure this scenario can happen.
Thus, the search for a plan which would cover us here.

This year, John turned 65,
He now has Medicare, which only covers you in the US.
I’m not even going to to into Medicare here,
That’s another whole story and a maze of options
That make you realize the medical craziness
Is never going to end – even when you retire,
Maybe when you die.

Back to Mexico and medical care here.
Of course number one,
Is beginning with yourself.
Take good care.  Lose that weight,
Get good exercise and move around a lot.
Eat Well.  All the things we’ve always been told.
So many problems are solved by these things alone.
But because we don’t do those things,
Or we just plain old develop a medical problem,
It’s good to know where to get care.

As for us, we have always gotten our best care
From local natural healers.  They care about your health,
They aren’t just giving you your 15 minutes
They get to know you, your little quirks,
They think about whatever problems you are having
Working to unwind them rather than throw drugs at them.
That’s been our experience, and so far so good.

However, our little bout with Salmonella Typhi
Showed us that natural medicine
Plus a good philosophy about caring for your health
Aren’t quite enough for a serious medical problem.
So I went on the hunt for services here in Mexico.
Here’s what I came up with, beginning with
The local, least expensive for general care,
Non-life threatening care to critical care.
There are some suprising options,
There is also the need to get comfortable
With how things work here.
Which means if you use the public systems,
You may have to wait a little.
That is, unless you know someone.

So, locally here, we have:
Your doctor (or doctors.)
If you don’t have one you can trust,
Find one and establish yourself as a patient
That way they know you if they get the call,
That you are on your way to the hospital, and need help.
If you don’t speak Spanish well, this is a must.
This will also put your mind at ease
To know you have someone to call in an emergency.
Most doctors give you their cell phone.
Everyone advised me
If it is really serious or life threatening,
Don’t think about the horror stories
Or try to decide on the spot where to go,
Just get to the closest hospital to get stablized.

When you get there, and you are stable,
They will most likely require you give them a credit card
For a deposit against your stay.
They deduct your services from that.
If you have medical coverage for emergencies,
You will get reimbursed by your company afterward.
Save every single receipt, including your prescriptions,
Get a letter from the doctor describing what occurred.
The policy I decided to take works like this:
Any hospitalization up to 24 hours,
They reimburse me for the expenses.
Any hospitalization from 25 hours forward,
The hospital works directly with the insurance Company.
Be prepared ahead, for any deposits you will need to place,
Keep a credit card on hand to give them.

The General Hospital:
If you have an emergency,
And it is not life threatening,
You can choose to go to the general hospital
Who cannot turn anyone away,
And whose prices are VERY VERY low.
They have an excellent new ER,
Over 60 doctor specialists, many of whom are bilingual.
Your local private doctor may not treat you there,
Unless they are on the staff – consider this
In your search for a local doctor.
You might want to find one who is also in residency here.

The general hospital is subsidized by the government.
Services are extremely reasonable here.
Something on the order of 65 pesos
For a visit to the ER to be examined.
I read on one site of a man who broke his arm,
Went to the ER at the general hospital
Had 4 hours in the ER getting set and paid $50.
Now, this is second hand, but really… how reasonable.
I am working now on getting a list of costs for services
To add to this post later.

The general hospital system has three tiers.
Stage I hospitals, clinic type facilities.
Stage II hospitals, which have excellent emergency care
Stage III hospitals, handle critical medical problems,
Advance surgeries and care for patients with
Heart problems, cancer, Kidney problems and so on.
San Miguel’s general hospital is a stage II hospital.
They have a state of the art ER room,
An excellent facility for emergencies.
They handle all but the really serious illnesses,
In which case they would refer you to a stage III facility
Most of the doctors speak English, but some don’t.
Be prepared to bring a spanish speaking person with you
Or  call your English speaking Doctor to meet you there.
Your doctor can also call for an ambulance if you need it.

The general hospital has:
Three operating rooms
60 beds – all in wards except the isolation room
10 beds in the ER
MRI machine
Digital x-ray room
Lab
Pharmacy,
Waiting room,
Outpatient room
Ob/GYN area & pediatrics.
If you come to this hospital with a heart attack or serious emergency
You will be stabilized and sent to a major hospital
Of your choice, if you have one,
Or to a stage III general hospital in Leon or Celaya.
Keep in mind that if you have no health insurance at all,
The general hospital system, will be much more affordable
Than any private hospital. No one will be turned away.

Programs related to the general hospital:
Seguro popular.
It is a medical insurance plan,
Subsidized by the government,
Costs about 400 pesos per year,
It is in place to reduce the already very low cost  you pay at the general hospital
It is available to all Mexicans to help the very poor,
Who cannot afford even the lowest of rates in any medical system.
It is also available to expats with fm2 or fm3.
When I went  to their office, which is at the presidencia building,
They acted very confused and said I could not apply as an American.
I talked with my insurance agent, who called the director,
Who said the information they gave me was wrong,
You can apply with an fm2-3 and appropriate documentation.
Once approved, your rate to pay is based on your income.
Apparently they have some times that they cannot accept applications.
If this happens, you just have to wait until it opens up again.

Hospital de la Fe:
Is a private hospital.
They accept credit cards for payment deposits.
They do not accept insurance from any company.
You have to collect all your receipts to be reimbursed by your company.
They provide emergency and other medical services.
There are general family doctors and specialists in house.
Expect the rates to be high,
Especially in comparison to the general hospital.

They have specialists whose offices reside in the hospital in:
Internal medicine,
General surgery,
Gynecology,
Psychiatry
Pneumology
Neurosurgery
Dentistry and orthodontics
Infectious diseases,
Dialysis,
X-rays, Laparoscopy
Opthalmology
Plastic Surgery,
Cardiology
Ear, nose, throat,
Urology
Orthopedics
Trauma
Hiberbaric chamber

IMSS  (Instituto Mexicano de Seguridad Social)
Mexican Social Security Insurance.
IMSS has it’s own set of clinics and hospitals throughout Mexico
It is completely separate system from the general hospital.
There is a clinic in San Miguel but no hospital.
Referrals for medical emergencies
Are given to the hospital in Leon or another IMSS hospital.

To apply you must give them:
3 copies of our application
(You can get the application at the IMSS office in San Miguel)
1 complete copy of our FM3
1 complete copy of our US passports
1 copy each of our birth certificates
1 copy of our current electric bill
1 copy of our telmex bill
1 copy of our marriage certificate
2 ‘infantil’ passport size photos each.
Pay the applicable fees
For John and I it is about $500 per year combined.
Pre-existing conditions are not be covered
However others we know say
This has not been the case for them
See comments by others below.
They will assign you a doctor to certify your health.
After that, as long as you pay your yearly premium,
Which is a pre-set fee by age, you are covered for life
For everything that is not considered pre-existing

You apply in the city of Guanajuato
In the casa de moneda directly next to the Teatro Juarez.
There are people  who can provide the service of processing your applications.
Silvia Cadena (Friday San Miguel) and her office do this.
Cost $1800 pesos plus $200 for power of attorny as of August 2009.
I hear there are others as well.

Update: Aug 21st – we applied for IMSS
The story, process of doing it ourselves
Is on this link

When I asked my insurance agent about IMSS,
He first hesitated, then said that the IMSS system
Is actually a very good system with good hospitals.
The only problem, is that you might have to wait for some services
Unless, that is, you know someone in the system,
Who can work on your behalf.
Sometimes, in the case of small things,
If the wait is long, perhaps a local doctor,
Or the general hospital can get you quicker care
At not too high a price.

CHECK BACK for my research into health insurance companies that cover you at the best hospitals here.
This is a little more complicated and will take me a little time to finish the post.