Health insurance, medical care

Sarah Kershaw · Dec 27, 2013

Hi everyone, nice to "meet" you!

My fiance and I are moving to the cabarete/sousa area in March, likely for a year, possibly longer (and will be getting married there!!) My top priority right now is finding the best possible health insurance. Part of the reason we are moving there is I am recovering from a bad case of late stage Lyme disease, which has left me with little money, but enough to live on down there, with my fiance's salary. (Luckily as far as I know the DR is not popular with ticks, though I read infections can be spread from sand fleas, so, after what I've been through I can't emphasize enough how important bug repellant with Deet is!)

I will continue with my Lyme doctor long distance (she can probably coordinate with a doctor there), but as I have a lot of prescriptions, and will need to see a few specialists, I'd like to get a good health insurance plan. The overall description of heath insurance on DR1 is great. I checked into U.S. -based companies, and the rates are high (and unfortunately they are not subject to the new rules on pre-existing conditions, although Lyme may not be listed; it wasn't with Geo Blue, but they would charge me $425 a month.

Another member of another forum mentioned he and his wife pay for a local plan, at about $50 a month, which sounds great to me! I don't plan to leave the DR during the year we plan to stay, so I think local coverage would be great - assuming they don't reject me for pre-existing condition.

Questions: This site listed two major insurance companies - has anyone had good/bad experiences with those or any other companies. Could you recommend a plan that would cover most things, especially prescriptions?

Also I was told that the Centro Medico DR Boringual in Puerto Plata is a good place to go for specialists - seems to have all I need. Anyone had experience with medical care there, or do you have any recommendations for finding good doctors?

Thanks in advance for any help/tips,

Sarah

Sarah Kershaw · Dec 27, 2013

Sarah again, P.S.: If you do have an experience but would like to share it privately, message me here or e-mail me at

And the two insurance companies listed on the forum are: Two of the largest insurance brokers are Ros & Associates, located on Winston Churchill at the corner of Jos? Brea Pe?a, Tel. 567-1021 or 562-4556 and Franco-Acra & Associates, Winston Churchill 32, Tel. 535-1655. Other providers include La Colonial, La Monumental, Seguros Banreservas, Caribalico, Seguros World Wide, Proseguros and Seguros Popular.

Thanks!

dv8 · Dec 27, 2013

not sure where your info came from. there are plenty of ticks in DR, my dogs were constantly getting infected and at some points we had hundreds of ticks crawling on the walls and the floor of dog house.

secondly, two biggest health insurance companies in DR are ARS humano and ARS universal. however, it will take 3 months for the insurance to kick in so you will have no coverage at the beginning.

third, even a good plan has limited ambulatory coverage, the minimum is 3,000 pesos per year upwards, with a good private plan it's 8,000 pesos per year. this is not a lot of money. the good news is doxycline, used to treat lyme disease can be purchased here OTC. bad news is that it is not cheap. in fact the complete lyme treatment will costs thousands of pesos in medicine.

anyways, the basic health insurance is something like 20 dollars a month. better plans are more expensive. pre-existing conditions are not covered but then when i took the insurance i had no checkup of any kind.

i live in POP and i do not use clinica bournigal. if o need a specialist i go to santiago. i have no confidence in doctors in POP.

dv8 · Dec 27, 2013

some more info:
ARS Humano
and:
Universal

the companies you listed are brokers or whatever that thing is called.

my mom had lyme as well and it flares up once or twice a year so expect the same, i guess. all antibiotics and most of other meds can be purchased here OTC and by one pill even which will make it easy for you to manage your issues. meds are not particularly cheap here in DR but they are easy available, at least. i find health care to be very decent here and private hospitals are really good.

Harleysrock · Dec 27, 2013

I strongly agree with everything Dv8 said!
We use Universal and like it.

Santiago or SD are the places to go for Hospitals, no luck with the NC Hospitals at all. I would go there for something small maybe but something more serious NO WAY IN HELL!! They (CMC, The hospital in Sosua/Cabarete) have misdiagnosed too many people I know and my wife twice and we have only been there a year!

MANY TICKS in the NC, not sure about the rest of DR?? Almost every day I pluck one from either my wife, animals or myself. Seriously every few days alone my one chihuahua has them in his ears!

Tarheel · Dec 27, 2013

I received very good care at Bournigal for a blood clot in my leg. I thought it was a good and super clean hospital. I would recommend it.

Mauricio · Dec 27, 2013

8000 pesos per year? Those are not good plans, those are plans where you are limited to what doctor or hospital to go to.

Seacreature · Dec 27, 2013

dv8 said:
secondly, two biggest health insurance companies in DR are ARS humano and ARS universal. however, it will take 3 months for the insurance to kick in so you will have no coverage at the beginning.

Not entirely true there. I have ARS Humano and the coverage was effective immediately for basic stuff like doctor visits, ER, that sort of thing. The three month thing is for surgeries, meaning if you needed surgery that wasn't something caused by an emergency situation, like appendix, then you're waiting 3 months for that portion of the coverage to kick in. I LOVE Humano insurance. I pay less than half what I paid with employer covered health care in the states to cover my family, and we have a 100% plan, which wasn't even available to us through any employer I worked for.

dv8 · Dec 27, 2013

Seacreature said:
Not entirely true there. I have ARS Humano and the coverage was effective immediately for basic stuff like doctor visits, ER, that sort of thing.

you are right in terms of covering the basics but in my experience (from working in the pharmacy) insurance companies will do anything not to pay up

Mauricio said:
8000 pesos per year? Those are not good plans, those are plans where you are limited to what doctor or hospital to go to.

it's 8,000 a year in medicine in a pharmacy, no in general costs.

mountainannie · Dec 27, 2013

you really can not judge the cost of insurance policies by what someone else is paying since it will depend on your age, health, what plan you pick etc.. Also remember that the DR policieis are all limited.. they are only 3million or 5m pesos per LIFETIME.. so if you have a chronic disease.. or if you are a big time consumer, you may use that up. I am not saying that you will. But you could.. This is not like the million dollars of coverage that you get in the US. So yes, the doctors are good.. and yes the insurance is reasonable.. and the younger you are, the lower your cost.. but you will still have a life time cap of a few million pesos.

To keep it honest.. A million pesos is $23,000 US.

If you are traveling with an illness and no insurance, you might consider some sort of travelers insurance.. which would at least cover you for emergencies./

bob saunders · Dec 27, 2013

dv8 said:
you are right in terms of covering the basics but in my experience (from working in the pharmacy) insurance companies will do anything not to pay up

it's 8,000 a year in medicine in a pharmacy, no in general costs.

I pay 985 pesos per month for PALIC . doesn't cover medication at all but covers specialists, hospitals, tests...etc. Fortunately I've only had to get blood tests prior to seeing my cardiologist (who doesn't take insurance). My brother-in-law who has the same plan spend three days in HOMS in Santiago and insurance covered it.

mountainannie · Dec 27, 2013

It scares me when I hear that someone pays less for a health insurance plan than for a good pizza.

dv8 · Dec 27, 2013

bob saunders said:
I pay 985 pesos per month for PALIC . doesn't cover medication at all but covers specialists, hospitals, tests...etc. Fortunately I've only had to get blood tests prior to seeing my cardiologist (who doesn't take insurance). My brother-in-law who has the same plan spend three days in HOMS in Santiago and insurance covered it.

there are different plans to pick from. in private plans you can choose pharmacy coverage, maternity, dental and other optios, creating something that suits your needs best. 985 pesos a month is not bad. my basic humano was 700 pesos a month (TSS). i have universal now but i don't really know how much it costs: it is partially subsidized by miesposo's employer.

i have not been a fan of palic ever since they started with their new policy regarding pharmacy coverage for head traumas and related issues. we had many prescriptions that needed to be authorized in their office, very strange.

mountainannie · Dec 27, 2013

I guess I am just too used to the US scam policies.. cannot imagine getting health insurance for under $25 US.. Mine is a lot more but I am a lot older and I smoke.

dv8 · Dec 27, 2013

mountainannie said:
I guess I am just too used to the US scam policies.. cannot imagine getting health insurance for under $25 US.. Mine is a lot more but I am a lot older and I smoke.

if you mean 700 pesos for TSS from humano then this was a very basic plan for all legally employed. the coverage is very limited but this is much better than no insurance at all, especially for those on minimum salaries. it works pretty well.

Seacreature · Dec 27, 2013

mountainannie said:
you really can not judge the cost of insurance policies by what someone else is paying since it will depend on your age, health, what plan you pick etc.. Also remember that the DR policieis are all limited.. they are only 3million or 5m pesos per LIFETIME.. so if you have a chronic disease.. or if you are a big time consumer, you may use that up. I am not saying that you will. But you could.. This is not like the million dollars of coverage that you get in the US. So yes, the doctors are good.. and yes the insurance is reasonable.. and the younger you are, the lower your cost.. but you will still have a life time cap of a few million pesos.

To keep it honest.. A million pesos is $23,000 US.

./

I'll agree all plans depend on variables, but you can get a pretty good sense of what you'll pay by asking folks who have the insurance. I don't know what policy you're talking about with the tiny lifetime limits, but that's not the case with our plan. We got a very specific breakdown of what's covered and for how much when we signed up, and that's in dollar amounts, not pesos. As I said before, the policy I have now FAR exceeds what I had in the States, and for less money. Plus dental is included, whereas in the states that was tacked on extra. Do some shopping around, you can get an awesome deal on health insurance here.

Seacreature · Dec 27, 2013

Just to give you an idea, for my policy which covers me, my wife, and my 3 year old. We're non-smokers. We pay 320 USD a month. Consider that with employer backed insurance in the states I paid 680 USD for an 80/20 plan without dental, whereas for my 320 USD I get a 100% plan with dental included, that's a steal IMO. That's the Platinum plan from ARS Humano. My wife has already test driven it and said it's seamless, no issues at all. That's also something we've never experienced in the states. Using BCBS, Allied health, etc was ALWAYS some kind of hassle.

dv8 · Dec 27, 2013

Seacreature said:
I don't know what policy you're talking about with the tiny lifetime limits, but that's not the case with our plan.

plan exclusivo from universal has 5 million pesos life limit, MA is correct. i had no idea such limits existed. i knew about yearly limits but not a lifetime...

mart1n · Dec 27, 2013

I cancelled by insurance and became my own doctor. I am healthier now than when I had insurance. Medical is a business and they need sick people to get money so the idea of insurance is to give you the idea that you can get away cheap. Except for catastrophic illness the medical system has nothing for you except managing your symptoms. They can’t cure diabetes, high blood pressure, arthritis, cancer, and even heart burn. Being your own doctor and going outside the box you will find you can deal with a lot of these problems

Mauricio · Dec 27, 2013

Mine doesn't have a lifetime limit either. I pay about 14,000 pesos per month for 2 adults and 3 children's. Medicines not included. I have checked other plans but they are either a lot more expensive to have a non-less coverage or cost less and I can't go to the doctors or hospital I choose.

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