imss thanks V, however I am not interested at all in getting the IMSS insurance. I have a good private policy here in Mexico that I have had for three years that covers me up to $50,000 in the states for emergencies. I am in the states almost as much as here. I cant see giving IMSS 3000 pesos if I am not interested in the getting it. I have my insurance agent looking into this. Just trying to figure out the benifits of me paying into something I have no plan on using. I will let everyone know what happens. I have done so much research on this, I am going blind as there are so many conflicting information including what is covered and what isnt the first year and that some pre-exsisting is not covered the first two years.
Coverage I believe the two things you were told at IMSS are correct- because they told me the same things. They also told me there is no coverage for pre-existing conditions, and was given a long check-list of significant pre-existing conditions to mark, as part of the application process. (One of the things that complicates this otherwise simple picture- only primary care the first year, and no pre-existing illness coverage, ever- is that there are a couple of conditions which, even if not pre-existing, are not covered until the third year: one is orthopedic services resulting from degenerative changes.) [grandma, if you ran across something in your research that made you think pre-existing conditions would be covered, please let us know what it was, and I'll have a look at it, as well!] You could try having your husband specifically request coverage for himself, alone, if you decide to go ahead with it. Since he'd be applying down in Playa (is that right?), they might allow him to have coverage just for himself. But, I tried that here, in Cancun, and they refused to do it, insisting my wife must be included, and covered. (She has excellent, international insurance, but that made no difference to them, here: the explanation that they offered was that IMSS is family coverage, and a husband may not elect to exclude his wife from coverage, even with her consent.) Anyway, whatever you decide to do, good luck with it. ____________________ Speaking generally, and not about grandma's situation in particular, I consider one of the biggest incentives for enrollment at the first opportunity is the possibility of developing significant health problems in the future, adding yet another "pre-existing condition" to the list of things that will be excluded, should you decide to enroll later. It really makes sense, if you're going to enroll at all, to enroll while still in relatively good health, and obtain, thereby, the maximum possible benefit available through the system. _____________________
Application process Yesterday, my wife and I enrolled in IMSS, "Seguro Familiar". This is the self-sponsored, family medical coverage that has been discussed at some length on this thread. The process took, start to finish, two hours and ten minutes, including ten minute waits at each of three stages in the process and a trip to the bank to pay the premiums. We went in the early afternoon, as I've suggested, to avoid the lines. There were just three people ahead of us. Here is the area in which you enroll- The application process requires the following to guarantee it will go smoothly: a letter from the applicant, written in Spanish, requesting coverage (sample letter appears on this thread); then, originals and copies of each of the following: photo page of passports; apostilled birth certificates; certified translations of birth certificates; apostilled marriage certificate; certified translation of marriage certificate; a utility bill showing your current resident address and, a letter from the person whose bill it is, if it's not in your name, stating that you live at that address and, attached to the letter, a copy of that person's personal identification; CURP numbers for each person to be included in the coverage; and, finally, black and white photos of each person to be included in the coverage. Each family member is assessed a premium, based on age: being 60 or older, I was assessed the maximum annual premium, 3,325.70 pesos. You will be asked whether you suffer from any of a long list of medical conditions: the forms literally say that, if you suffer from any of these conditions, you will not be offered coverage; further, that should you be found to suffer from any of these during the first year you are covered, your insurance will be cancelled, without refund of premiums paid, though the remaining family members will continue to be covered. No physical is required with the application, but you must submit to a physical during the first six months of coverage. Coverage during the first year was said to be limited to primary care, but- it was explained orally- should you suffer a life-threatening emergency during that first year, IMSS would "absorb" the cost of treatment. (Since some of the coverage and exclusion information I was given, yesterday, is at variance with what I'd understood, before, and far more restrictive, I'm going to try to get all of this in writing before saying more on these details.) _____________________
How convenient... We've talked before about the possibility of getting high quality health care at remarkably low prices (by U.S. standards) in the private clinics and hospitals of Cancun. I had a particularly fine experience, recently, which illustrates what I'm talking about. I decided to have a screening for head and neck cancer, as a friend had had a recent experience with it. This is done by a procedure using a fiber optic instrument, a nasopharyngolaryngoscope (try saying that!). So, I went to Galenia Hospital and approached the information desk. They directed me to one of the EENT docs that offices there (doctors rent offices in the hospital and conduct their private practices, on site), and was offered an appointment for the next day. The doctor was young, very professional, English speaking, and spent an hour with me, carefully examining everything he could using this instrument. At the end of the process, he presented me a video showing what he saw- and I had seen on a TV monitor- while he was examining me. The total cost? One thousand pesos, and this at what is probably the most expensive place you can choose to go for medical care in Cancun. The ease of accessing medical care, coupled with the relatively low cost, can make going to see a doctor almost a pleasure....
Enrollment and coverage From the information I've been able to dig up it appears IMSS will not take you at all if you have any of the pre-existing conditions they ask you about at the time of enrollment, and they will boot you if you develop any of them in the first year of enrollment. However, the whole system is meant to be accommodating, and they may very well make an independent assessment and allow some to enroll, and continue, with some pre-existing conditions, based on the severity. The enrollment forms speak literally of conditions and diseases you know you have at the time of enrollment, and do not inquire about things you may have had at other points earlier in your life. Relying on that, and making allowances for the ambiguity that usually appears in descriptions of insurance coverage, it looks to me like emergencies would be covered in the first year. [An example of ambiguity would be the answer to the question whether, if you had a heart attack during the first year, and it was then shown that you had advanced coronary artery disease, would they then drop you, after treating you, initially?] ___________________ Our experiences with the services so far We're now in the system, having gone through the Preventive Medicine Clinic they send you to, where they inoculate you and do a few tests and take some measurements; and, we've gone for our first consultation with the docs, where they do a few physical exams, discuss your medical history, and order more tests, if they think they're needed. (As an older man, they ordered lipid panels and a psa for me, for example. In my wife's case, if she hadn't recently had a pap smear and mammogram, they would have ordered those: as it was, she was required to produce the results of her exams, recently performed at Hospiten, in lieu of repeating them.) The Preventive Medicine process was completed with no more than 5 minutes waiting time (no appointment required), in both our cases (we did it on different days); and, making the appointment for the subsequent doctor's visit was quick and easy, though it seems you have to do it in person Even though this appointment was for an extremely routine matter, our appointments were just three days from the day we went in to request them. On the day of our appointment, our assigned doc was running behind, so we were diverted to another, and not made to wait specifically for him. ____________________ It seems to me that, if there are those who'd like to consider enrolling, and need more information, those of us who follow this forum and have experience with the application process could get together to exchange information and help those who are interested get prepared with the documents, at almost any time.
Above- intensive care unit and hemodialysis unit at IMSS Regional Hospital No 17 in Cancun I've mentioned before that although some pretty exotic treatments are available here in Cancun through IMSS- such as hemodialysis- some things are not and its necessary to travel to Merida to IMSS Regional General Hospital Number 1 to receive those services Among those services available to IMSS members for which travel to Merida is necessary are cardiac imaging and cancer treatments- including chemo and radiation therapy IMSS provides free bus transportation to Merida for its patients who must go there for treatment: considering all the services IMSS offers its members are free- after the annual premiums are paid (3200 pesos for those 60 YOA and older)- it's still the best bargain in comprehensive health care in Mexico that I know of _________________ My wife and I are contracted for IMSS services on a "self-pay" basis (not through an employer) and I think "Mellow in Puerto Morelos" has said he and his wife are- but I'd be curious to know if there are any others out there among our posters: care to pipe up if you are?
Getting appointments at IMSS Turns out this is not particularly difficult but you do have to ask in person: there is a receptionist who makes the appointments for each doctor- you just approach their work station and ask for an appointment Follow up I mentioned that as part of the induction into the system they order some tests and I went today to meet with the doctor concerning the results of the tests and to express concern about something that had recently appeared just under the skin on my upper back I arrived about seven minutes prior to my appointed time and was seen about three minutes later: here is the waiting area in Family Medicine Unit No 15 (Av Coba)- physically attached to IMSS General Hospital Zone 3- and just five minutes walk from our home After greeting me the doctor reviewed the test results and pronounced me fit: as for the "bump" he said he felt it was a fatty tumor and would need to be surgically excised or it would just continue to get bigger He ordered a panel of pre-op tests and said he would schedule me for outpatient surgery to have it removed (gulp!) Here's the operating room- Just in the first and second round of tests they've performed- not to mention the outpatient surgery- my annual enrollment fee of 3300 pesos has paid for itself I'm sure IMSS would not be to everyone's taste- the demands made on the system are extreme and I expect there will be gaps in the services at times: I'm using it at this stage as much to learn how it works and just how good the service can be once one understands how to access the system efficiently It's tempting to continue to use the private hospitals and doctors but I would learn nothing about what to expect at IMSS if I did _______________________
V, I hope everything goes well for you. I also hope that the picture shown is not an Operating Room. I would think that the room would be an outpatient procedure room for very minor procedures.
LOL, and thanks for the well wishes, SCMcons! On a surgery like this- which involves making a small incision and freeing up a mass located just under the skin- the main risks, as I understand them, are excessive bleeding and post op infection The bulk of tests ordered were related to the first risk- with blood typing and measuring coagulation rates To get the preoperative tests done it was necessary to 1) present the doctor's orders to the lab tech who then gave me an appointment the next AM to 2) have the blood drawn- then to return to 3) pick up the results that afternoon None of this took any time at all at the hospital- there was little if any waiting at any step but it's a good thing we live nearby: assignments to Family Medicine Units are done according to where you live and there are many of them in Cancun- making it reasonably convenient to go I will make an appointment to see the primary physician with the results and expect him to then make a referral to a surgeon- probably at IMSS General Hospital Zone 3 across from Chedraui on Av Coba ______________________ IslaZina has again called our attention to the issue of extending Medicare coverage to include medical care and treatments received abroad- which is exactly the place this thread began: to do so would save Medicare money but seems to me unlikely to occur The way Medicare was structured- through its scheme of paying private physicians and hospitals in the US for treating those patients whose medical expenses were going to be paid for with taxpayer money- rather than creating a separate system of national health service hospitals and doctors- directly and enormously benefited those providers of medical services who now would be loathe to lose even part of that pie by allowing some of it to go abroad _____________________
