After living in Ecuador for some time, many expats share the same frustration: “Why doesn’t my health insurance work the way I expected?”
The reality is not that insurance doesn’t work, it’s that the system works differently than in the US or Canada. A key concept to understand is the difference between ambulatory and hospital care.
In ambulatory cases (minor procedures where you leave the same day), even with pre-authorization, this is not a guaranteed payment. It works as a cost reference, meaning you usually pay upfront and then request reimbursement.
Additionally, all procedures follow pricing references set by the Ecuadorian health authority. If a doctor charges significantly above that reference, the insurance will reimburse based on the approved amount unless the difference is medically justified.
In hospital cases, everything changes. These can be properly pre-authorized, the clinic works directly with the insurance, and you typically only pay your deductible and copays. This is where insurance delivers its full value.
Another important point is pre-existing conditions. These include prior diagnoses, ongoing treatments, surgeries, or symptoms before the policy starts. However, a common misconception is that age makes everything pre-existing. This is not correct. Even at 70+, new diagnoses are covered if they are not related to prior conditions and are properly documented.
Switching insurance companies usually won’t solve these issues, the system works similarly across providers.
What makes the difference is understanding your policy, confirming costs in advance, and working closely with your advisor.
When the process is done correctly, insurance does work.
Carlos, cramirez@blueboxinsurance.com
City: Cuenca
