Having lived here for almost 15 years, I have learned many lessons. I still find the system infuriating, but understanding how it works helps a little.
First, medical insurance works differently in the US. There the Doctors and hospitals deal directly with the insurance company. The client is only aware of their deductible and copay.
Ecuador:
The Doctors and hospitals and the insurance company do their own version of coding. For example, say that you are “Pre-approved” (I use quotes because preapproved is not what you think it is) and use a hospital in the “Web”.
The insurance company will have a very detailed list of charges they approve for every procedure. . They plan to pay 80% of these specific charges. But the hospital has a different way of listing these charges. Only charges that happen to match perfectly will be covered. Even though the charges may be logically the same, it may be that only 20% match perfectly. The insurance will only pay 80% of those 20%.
Being “reimbursed” basically means that you pay up front and no matter what you do there will always be a reason that they will never “reimburse” you. But hey, you could get lucky!
If you choose to have medical insurance and use a good broker, you may save up to half the costs. Without good broker you will never get any coverage. Be prepared to spend a lot of time scouting down receipts, reports, and hundreds of other details you never imagined you would have to do. If you are not prepared for a lot of work, don’t expect the insurance to pay at all.
By the way, I still have insurance, I try to be realistic with my expectations though.
Ellen
City: Cuenca
