Surgery - Medical Insurance Benefits

Robert

Stay Frosty!
Jan 2, 1999
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As some of you are aware, I just had an umbilical hernia repaired, so I thought I would share the costs so you can compare.

I had the surgery performed at Hopsiten. They have locations in Santo Domingo and Punta Cana. Nice modern facility, great staff. I would have no problem recommending them.
An Overall good and easy experience.

Hospiten - Dominican Republic (DR1)

I'm going to show what you would pay without insurance or if you go private and then my actual out of pocket costs ( ).

Costs to date:
3 x Consulates with the surgeon - RD$3,300 (RD$720)
1 x Consulte with the cardiologist - RD$1,100 (RD$240)

Various blood tests, x-rays, EKG - RD$4,200 (RD$1,400)

Surgery, plus all the associated costs (anesthetist, fluids, drugs, drapes, recovery etc) - RD$33,246 (RD$5,807)

Total cost: RD$41,836 (RD$8,177) in US$1,140 (US$225)

My insurance (ARS Humano - Plan Max) costs me a little over RD$16,000 (US$440) annually.
 

bob saunders

Platinum
Jan 1, 2002
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Pretty darn cheap I'd say. I have to have an umbilica hernia repair done soon also. It pretty small right now so the sooner the better. How's your recovery so far?
 

SKY

Gold
Apr 11, 2004
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could you have had this done at the new hospital between Sosua and Cabarete?

When you have Insurance you need to check in advance with the Clinic or Hospital you are interested in. Not all place's take all Insurance.

As for the one you mentioned I don't believe they are taking all Dominican Insurance yet, or any for that matter. But a phone call will tell you what you want to know.
 

Robert

Stay Frosty!
Jan 2, 1999
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Pretty darn cheap I'd say. I have to have an umbilica hernia repair done soon also. It pretty small right now so the sooner the better. How's your recovery so far?

Mine got large quickly :)
Maybe I'll post the before and after photos once it starts to heal.

Recovery is fine. A little pain, but to be expected as I have been cut open and have a some internal stitches.

One thing I love about the DR, you don't have to wait for medical work.
I have no doubt I could have gotten the blood work, consults and surgery all done in a week if I pushed myself.
 

juanita

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Apr 22, 2004
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In Canada you probably would had to wait 6 months just for the first appointment. Same reason I love DR, without appointment you can; see specialist, get x-rays, blood test, etc all in the same day, and some insurances like Palic pays 80% of your prescriptions.
 

jrhartley

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Sep 10, 2008
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I would be interested to know how ars constitucion fares .......Ive only had few tests with them but not had to pay very much...they seem to be fairly good so far
 

AZB

Platinum
Jan 2, 2002
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Mine got large quickly :)
Maybe I'll post the before and after photos once it starts to heal.

Don't worry about that, I will be clicking my camera everyday. The bandages will be changed today so lets see if don roberto would let me take a few pictures.
AZB
 
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Acira

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Sep 20, 2009
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Don't worry about that, I will be clicking my camera everyday. The bandages will be changed today so lets see if don roberto would let me take a few pictures.
AZB


Could you make the title very clear then please, I have no need to see pictures of somebody getting new bandages after surgery or a before and after :laugh:
 

DannyS

Member
Jun 19, 2007
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CMC and Insurance

When you have Insurance you need to check in advance with the Clinic or Hospital you are interested in. Not all place's take all Insurance.

As for the one you mentioned I don't believe they are taking all Dominican Insurance yet, or any for that matter. But a phone call will tell you what you want to know.

Went in shortly after they opened. Told them I have an artifical hip joint and I am still active surfing so if I bounce off the reef and it pops out can you deal with me. Oh yes we have an orthopedic surgeon on staff. Not that they would be replacing, that's only for Hospital for Special Surgery,NYC but they gave me the tour, and I would let them work on me. They gave me this card and wrote the insurances that they were taking on the back. This was a while ago so check but yes they were taking several insurance company's policies.

cmc1.jpg


cmc2.jpg
 
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dv8

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Sep 27, 2006
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the coverage greatly depends on insurance company and the plan itself. it pays off to read what benefits you are entilted to before signing the contract. some companies will cover more and some less, depending on the procedure.
i have an insurance from humano (plan basico from my work) and colonial (plan complementario). not sure how much i pay for them as humano is discounted from my salary along with taxes and colonial is paid partially by miesposo and partially by his employer. in any case, i went to union medico and i had cytologia - colonial does not cover than and humano covered 70%.

let me also explain the secrets of insurance covering the purchase of medicine. factors that come to play are: insurance company, individual insurance plan, the amount of money at a yearly disposal and the medicine itself. some meds are not covered at all, some plans have no benefits of pharmacy at all. insurance companies will cover anything from 100% to 70%, but i have also seen them cover only 40% of the costs. after you use all money disponible por beneficios de farmacia you have no more coverage for the medicine until your policy is renewed again.
in order to buy medicine with the insurance you need your insurance card and a receta medica with a stamp from a doctor. prescription has to be less than 10 days old.

i would also add one more thing, no offence meant but only an
idiot would live in DR with no insurance at all. medical bills can run high...
 

Robert

Stay Frosty!
Jan 2, 1999
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i would also add one more thing, no offence meant but only an
idiot would live in DR with no insurance at all. medical bills can run high...

Especially when good coverage is so cheap compared to many other countries.

I pay I think an additional RD$700 annually on my ARS Humano - Plan Max to get Salud Brucal - Dental coverage. I have saved a fortune in the past 2 years on some complicated procedures I needed done.

Once again, by excellent dentists in excellent facilities.
 

Chirimoya

Well-known member
Dec 9, 2002
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Except when they approve the procedure and then refuse to pay.
We have the approval code and the name of the person who approved it.
They're still saying no - on the grounds that it was "the wrong type of surgeon" (general as opposed to specialist). So what if it was - they approved it and have to honour it. But no, not in el pa?s de las maravillas. I'm trying to fight it but it's not even clear if there is some sort of appeal mechanism.

We're now uncovered while in the process of changing companies from the offending Universal to Humano. We've already had one incident - Chirimoyito had to have stitches and we had to pay in full. Luckily only a minor injury but it is infuriating to have to pay when you paid half a year's worth of contributions for nothing.

I always say I've never come across the personal rip off artists that some foreigners complain about all the time, but when it comes to institutions it's quite common to pay them money, get nothing in return and have no recourse whatsoever.
 

suzannel

New member
Jun 7, 2006
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Must you be a resident of the DR to purchase the insurance. We spend 5 or 6 months every winter in the DR and I wonder if we can obtain coverage.

Thanks for your response.

Suzanne


Especially when good coverage is so cheap compared to many other countries.

I pay I think an additional RD$700 annually on my ARS Humano - Plan Max to get Salud Brucal - Dental coverage. I have saved a fortune in the past 2 years on some complicated procedures I needed done.

Once again, by excellent dentists in excellent facilities.
 

whirleybird

Silver
Feb 27, 2006
3,264
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Must you be a resident of the DR to purchase the insurance. We spend 5 or 6 months every winter in the DR and I wonder if we can obtain coverage.

Thanks for your response.

Suzanne

I see no reason why you would need to be a resident (i.e. have residency status) to register for a plan of health insurance but would anticipate that you would need to keep the insurance running for 12 months although you would only need to utilise its benefits during the 5/ 6 months when you are actually physically in the DR.
 

waytogo

Moderator - North Coast Forum
Apr 3, 2009
6,407
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Santiago DR
We're now uncovered while in the process of changing companies from the offending Universal to Humano. We've already had one incident - Chirimoyito had to have stitches and we had to pay in full. Luckily only a minor injury but it is infuriating to have to pay when you paid half a year's worth of contributions for nothing.

O'Boy, I am currently pondering between Universal and Humano and was leaning towards Universal because they won't cancel if I ever reach 75 years of age.
Now I am at a total lose. I have been reading all of the medical insurance threads and pretty much decided on the Universal Exclusivo Plan. It is there best plan and will cost me about RD 5000 per month which includes 80% prescription coverage.
Back to the drawing board.....anyone with a suggestion.
 

whirleybird

Silver
Feb 27, 2006
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Medical Insurance / Hospitals / Specialists

Unfortunately, we had more than our 'fair share' of experience with medical insurance, hospitals and specialists in our just over 4 years in the DR.

It appears that each of the insurance companies excel or give a better deal in certain aspects - some are more prepared than others to pay higher specialist fees whilst others will more happily pay for pharmacy medicines (when, as dv8 stated, that particular drug on the prescription is covered).

We have used the insurance of Monumental and have their 'Estallar' plan + dentist which is one down from their top plan and found that, on average, they meet approximately 80% of the inpatient bills. However, if you happen to have a specialist who charges exoribitant rates such as Dr. Jose Ceara at Union Medica, Santiago (who was unable to diagnose correctly anyway) then Monumental will only cover a reduced percentage of his fees.

For an outlay of just RD$ 1200 per month each, this has to be worthwhile and I will give a simple example - I spent 3 days in CMC, Sosua in June with cellulitis. Whilst there I received excellent attention and medication in the form of antibiotics, pain killers and a blood transfusion, so nothing really exotic. The total bill for my stay was RD$ 27,000 and Monumental paid around RD$ 24,000 and we paid the balance of RD$ 3,000 so I got more than my 80% on that occasion.

One word of warning though - if you ever need an ambulance to take you from one hospital to another and they, as in the ambulance company, do not have a reciprocal agreement with the particular insurance company, do not let a friend pay and have their name on the receipt or you will never be able to claim it back from the insurance company and I say that from experience back in August of 2008 and I am sure that BB with remember the incident too!!