Pre existing medical problem and Insurance Companies

Deyvi

*** I love DR1 ***
Dec 23, 2009
579
2
0
My wife was in an auto wreck and maxed out her insurance quickly with head and neck injuries. Since then her company will not cover anything related to that problem. One doctor suggested she change ins. companys. Is this possible in the DR? Here in the states they would know right away about pre existing cases with another company. Is this good advise to change or just carry on with the same carrier?? Thanks much.
 

windeguy

Platinum
Jul 10, 2004
42,211
5,966
113
Pre-existing conditions are generally not covered by insurance companies here in the DR. Depending upon her age they will require a physical exam before insurance is issued. If you don't declare an existing condition, well, that is up to you. You take your chances if you go that way.
 

waytogo

Moderator - North Coast Forum
Apr 3, 2009
6,407
580
113
Santiago DR
I just purchased very good medical coverage here in Santiago. I just turned 64 and I wasn't asked anything about pre-existing problems or current medical conditions.
My rate is 800 pesos per month and I paid 6 months in advance. It is also renewable for many years to come.

B in Santiago
 

windeguy

Platinum
Jul 10, 2004
42,211
5,966
113
I just purchased very good medical coverage here in Santiago. I just turned 64 and I wasn't asked anything about pre-existing problems or current medical conditions. My rate is 800 pesos per month and I paid 6 months in advance. And it is renewable for many years to come.:bunny:

B in Santiago

What company was that?
 

belmont

Bronze
Oct 9, 2009
1,536
10
0
My wife was in an auto wreck and maxed out her insurance quickly with head and neck injuries. Since then her company will not cover anything related to that problem. One doctor suggested she change ins. companys. Is this possible in the DR? Here in the states they would know right away about pre existing cases with another company. Is this good advise to change or just carry on with the same carrier?? Thanks much.
Better check if your insurance company in the US is following new requirements under Health Insurance Reform Act. (unless you are a Tea Bagger and don't want these benefits).

The new law will help Americans with pre-existing conditions starting this year in the following ways:

•Individuals with pre-existing conditions who have been uninsured for at least six months can buy coverage under new “Pre-Existing Condition Insurance Plans.” These plans are available for the same price that healthy people would pay, and they don’t have any exclusions or waiting periods for pre-existing condition coverage.
•Insurers will be prohibited from refusing to cover children with pre-existing conditions. They will also be forbidden from imposing pre-existing condition exclusions for kids.
Insurers will be prohibited from putting a dollar cap on how much they’re willing to pay for an enrollee’s medical care over the course of their lifetime. This will protect people with health conditions from “running out” of coverage.
•Insurers will be prohibited from rescinding (retroactively canceling) insurance policies due to a person forgetting to mention a past medical treatment or condition. This abusive practice has left people uninsured when they needed coverage the most, even though they followed the rules and paid their premiums on time.

And starting in 2014…

•Insurers will be prohibited from refusing to sell coverage to individuals at any age because of their pre-existing conditions, stopping insurers from cherry-picking the healthiest among us and leaving those with pre-existing conditions out in the cold. Now, only five states require insurers to sell all plans to all people.
•Insurers will be prohibited from excluding coverage for people’s most important health problems, regardless of their age. Now, in 38 states, insurers can sell policies that permanently exclude coverage for people’s pre-existing conditions.
•Insurers will be prohibited from charging higher prices to people with pre-existing conditions than to healthier people.
Insurers will be prohibited from setting annual dollar caps on how much they will pay in claims for each enrollee over the course of a year. (Before 2014, insurers will only be able to apply restricted annual limits— for example, in 2013, they cannot be any less than $2 million.)

If you are considering a Dominican company for coverage in the DR, all the policies I've see have an exclusion of coverage for pre-exisiting conditions (usualloy 12 months). They might not ask on application but will deny when claim is presented.
 

windeguy

Platinum
Jul 10, 2004
42,211
5,966
113
ARS MetaSalud....They have offices everywhere.....also includes some dentristy

B in Santiago

I have never seen an office for them from Puerto Plata to Cabarete. There isn't one listed on their web site:

Recursos Humanos


Belmont, I think the OP was asking about insurance in the DR, not the US so your rant about the US medical system and who does and doesn't want coverage does not apply.
 

waytogo

Moderator - North Coast Forum
Apr 3, 2009
6,407
580
113
Santiago DR
I apologize, offices for medical services are all over the island.
in POP they have 3 listings...
1. Centro De Ginecologia y especialidades Dr Difo
2. Centro Medico Dr. Bournigal
3. Clinica Dr. Jose Gregorio Hernandez

Apparently the policy can only be purchased in Santo Domingo, Santiago and San Pedro De Macoris

Main office in Santo Domingo...#809-688-2020/2424
Santiago...# 809-583-1164/809-583-1203
San Pedro De Macoris...#809-529-8206

Hope this info helps you....

B in Santiago
 

Chip

Platinum
Jul 25, 2007
16,772
429
0
Santiago
I think the pre existing condition exemption may vary from company to company because one of my good friends here got insurance specifically for his wife to have surgery and they were told she would have to wait three or four months before they could use the policy. As far as I know everything went as planned.
 

Criss Colon

Platinum
Jan 2, 2002
21,843
191
0
38
yahoomail.com
The pre-issue medical exams here are not much.
All they did for me was take my blood presure and weigh me.And I am "Obese"!
Have had the policy for about 10 years,been hospitalized,and "SHOCKED" six or more times for Atrial Fib.,no problems with coverage,or renewal every year.
I would keep your present policy.Try to get a policy somewhere else,and see what happens. If she gets coverage somewhere else,and then treatment and payment for her ailments,after the waiting period,you can drop the first policy.
As this is a new year,she MAY have benefits again from the company you have now.
After working in a hospital in Santo Domingo for over 10 years,I can tell you,that when the bill is over 20,000 or 30,000 pesos,the insurance companies may try to dump you,and find a "reason" not to pay the bill!
Remember,"What the BIG PRINT gives,the small print takes away!!!!!"
CC
 

Deyvi

*** I love DR1 ***
Dec 23, 2009
579
2
0
I just purchased very good medical coverage here in Santiago. I just turned 64 and I wasn't asked anything about pre-existing problems or current medical conditions.
My rate is 800 pesos per month and I paid 6 months in advance. It is also renewable for many years to come.

B in Santiago

What company are you insured with? I'll be 62 in Oct. and have seen many posts about that being a cutoff-- and no garantees for renewals. Not ready yet to get seguro there. I "winged it" for 12 years. Now I just get the travel ins. with my plane ticket. In a couple of yrs. I'd like to have ins. there--since I'll be spending more time in the DR. Thanks for any advises.
 

CaptnGlenn

Silver
Mar 29, 2010
2,321
26
48
In the U.S. insurance companies are NOTORIOUS for using various delay practices trying to avoid payment. (If you want an ear-ful about it, just ask any doc., dentist, or other provider.) As a matter of fact, I just got scr3wed last year by my vision coverage who initially declined my new glasses, (which should have been covered), and when I didn't challenge the initial rejection in time, they refuse to pay. Does the same hold true in the D.R.?
 

cobraboy

Pro-Bono Demolition Hobbyist
Jul 24, 2004
40,964
936
113
In the U.S. insurance companies are NOTORIOUS for using various delay practices trying to avoid payment. (If you want an ear-ful about it, just ask any doc., dentist, or other provider.) As a matter of fact, I just got scr3wed last year by my vision coverage who initially declined my new glasses, (which should have been covered), and when I didn't challenge the initial rejection in time, they refuse to pay. Does the same hold true in the D.R.?
As a former healthcare service provider, I can tell you Medicare is 100x worse that private carriers, especially with the gatekeepers the private carriers now employ.
 

keepcoming

Moderator - Living & General Stuff
May 25, 2011
4,734
2,491
113
One of the bigger problems with insurance companies is although you may be eligible/have the benefits the insurance company can also deny a service by deeming it not medically necessary. You would see this happen much more in the US than here. But it can happen and that is something to be aware of.
 

Criss Colon

Platinum
Jan 2, 2002
21,843
191
0
38
yahoomail.com
As I was being wheeled into the OR here,to be defibulated,I was informed that the insurance company had denied coverage.
I had two choices,sign a paper for a 30,000 pesos "Bond",or leave.
That alone nearly "defibulated" me!
"SHOCKING"!
CCCCCCCC
 

jrjrth

Bronze
Mar 24, 2011
782
1
0
Better check if your insurance company in the US is following new requirements under Health Insurance Reform Act. (unless you are a Tea Bagger and don't want these benefits).



If you are considering a Dominican company for coverage in the DR, all the policies I've see have an exclusion of coverage for pre-exisiting conditions (usualloy 12 months). They might not ask on application but will deny when claim is presented.

~Belmont

With all due respect...you are the walking encyclopedia of knowledge~~~~The knower of all, and naysayer of nunka""" may we ask what you do for a living...or rather your background of expertise????? :)...Oh..ok...my guess...U r the "World Book of Knowledge"
 

jrjrth

Bronze
Mar 24, 2011
782
1
0
As I was being wheeled into the OR here,to be defibulated,I was informed that the insurance company had denied coverage.
I had two choices,sign a paper for a 30,000 pesos "Bond",or leave.
That alone nearly "defibulated" me!
"SHOCKING"!
CCCCCCCC

~CC...............that explains all....................you dont have a Heart:(

Wacccccccccccccccccccccccccccccckooooooooooooooooooooooooooooooou$$
 

jrjrth

Bronze
Mar 24, 2011
782
1
0
In the U.S. insurance companies are NOTORIOUS for using various delay practices trying to avoid payment. (If you want an ear-ful about it, just ask any doc., dentist, or other provider.) As a matter of fact, I just got scr3wed last year by my vision coverage who initially declined my new glasses, (which should have been covered), and when I didn't challenge the initial rejection in time, they refuse to pay. Does the same hold true in the D.R.?

Captnglnn...You are 100 % correct....u r getting "farked"...and not even the slightest bit of a kiss!!!!!!!!!!!!!!!!!!!!

and if you ask for an itemized bill, as is your right...you will possible find that they are charging you for services that could have killed you as I did....if they had given me a type of anethesia, they would have killed me...my due diligence proved them incorrect....and the charges where overturned and brought to my favor.....

We all need to be our own advocates when it comes to health care and every thing else for that matter.