#FullCoverageatLast, #1st-ratehealthinsurance, #Chileanhospitalsrule, #Nodeductibles
So yesterday I went to a gynecologist in Santiago. In order to schedule the appointment at a first-rate hospital, I emailed International Patient Services (IPS), who have an office in the hospital Clinica Alemana, where most of the specialist offices are located. I scheduled three different doctor’s appointments, and IPS took care of the guarantee of payment (insurance payment) on my behalf. All of the physicians I will see speak fluent English. When I arrived at my first appointment yesterday, I checked in using my RUT (national identity card number) at a machine. I was called to a desk in deli like fashion; she confirmed full guarantee of payment. In three minutes, my name was called, and I walked into office eight, where the doctor was sitting there waiting for me at his desk. I did not need to talk to a nurse or wait naked waist down for a physician. We talked for five minutes, and then I had the exam. He was able to use the ultrasound machine because it was in the room. We conferred afterwards, and he wrote me an “orden” there. I left the hospital, thirty minutes after arriving, having paid in full (absolutely nothing) because my Cigna health insurance will cover it all. I have never had a doctor’s visit in the United States in which I was seen so quickly and with the test that I needed on the sport. Can you imagine knowing the cost of your procedure will always be covered in full (if it is a doctor’s orden) and having it paid before you leave?
This past month we have had a CT scan, colonoscopy, ER visit, and kids’ yearly check-ups, all with the same result- a zero balance. The one time that I went for a CT scan, they initially could not find the “orden”, and because it was after 5:00 pm, they could not call International Patient services. I was told that to have the exam, I would need to pay in full but would then be reimbursed in full. I was notified of the entire cost of the procedure. I declined the procedure. However, in the end, another administrator was able to track down my guarantee of payment, so I had the service and paid nothing. The procedure would have cost me a few hundred dollars. Many expats do pay for the procedures out of pocket intentionally using a credit card with points and then get reimbursed by Cigna. The reimbursement is so quick (a few days), and they want the credit card points.
Rich claims that we have exceptional health care here, which most Chileans do not. That may be true, but the cost of healthcare is also reasonable and transparent. There was a sign in the ER of what payment would be (around $100 American). You cannot see a doctor without a conversation about the cost and confirmation of a payment plan. There are no surprises.
In contrast, this morning Rich was on the phone paying for the third bill for a small lump on the back of his head that he removed last June in Beverly, MA. We had already paid two bills for this procedure. Furthermore, our insurance had initially rejected the entire claim because of a coding misunderstanding. The insurance did not want to pay for a procedure that they felt should have been done in a hospital rather than in the medical office. Coding is a big thing in the United States. For example, Rich’s colonoscopy was not covered because it was preventative rather than diagnostic. They did not remove any polyps on this visit; therefore, we were on the hook for a few thousand dollars. If they had found an issue (as they had previously), then we would not have to pay, even though colon cancer runs in his family and this was a doctor recommended procedure given the polyps previously. There is no way that a doctor’s office in the US could ever assure me of the cost of any appointment or procedure because they really have no idea what our insurance (Tufts- the worst!) will cover and refuse to pay. The bills we used to receive made my head spin, intentionally I am sure, because of the complicated family and individual deductibles to factor in; our school covered the first $1500, but our yearly deductible was $2500 so then we covered the next $1000. Not all services go towards your deductible, and you can only find out your remaining deductible by calling your insurer. Furthermore, a different company would send us checks for random amounts that could be paired with dates of service to cover the difference between our portion of the deductible and the schools’. Sometimes, we received multiple bills for the same service, months later, but it could include separate billing for lab-work, anesthesia, and doctor services. Sometimes, we would receive an outrageous bill and our doctors’ offices might call on our behalf to find out the “right code” to resubmit the claim.
As a result, I rarely went to the doctor in the States beyond the recommended preventive appointments. I tried to use the minute clinic as much as possible with the kids. I thought about the deductible. If we were already over the deductible, then I would take them to our pediatrician. During consultations with my own physician, I refused her advice to get an MRI and a CT scan because it would have been too personally costly. I did not go to the ER on one occasion that I thought I might have an appendicitis because it probably was not the cause of my lower abdominal pain. That is insane. Our healthcare was incredibly costly in the States, and we both had excellent jobs. One of my major concerns in returning to the United States will be how to pay for and the quality of my family’s healthcare. I guess until then I am going to be emailing International Patient Services quite a bit. That reminds me, I should get my skin checked, the kids’ vaccines updated, orthodontic work for both kids, and perhaps all of our eyes checked, too.
Living in Chile 