My experiences with local medical insurance

beeza

Silver
Nov 2, 2006
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I thought I would share with you all my experiences with medical insurance and their brokers. A bit worrying if one of us was to get really ill and need hospitalization.

When my wife and I got together, one of the things I did was make sure she had good medical coverage. I bought her a comprehensive policy with Humano and paid the premium for the whole year in full. Unbeknown to me, the agent that I bought the premium from in Sosua didn't pay the insurance company in full and a couple of years down the line when my wife fell pregnant with twins, we found out that she wasn't covered!

Admittedly, the broker was able to resolve the issue, but it didn't instill much confidence during a rather stressful time.

Once the twins were born, we decided to change insurance companies and brokers. We took out a family policy for all four of us with Universal. The plan was called Supremo and we were told that it covered pretty much everything, including vaccines for the children. Again I paid a considerable amount up front and paid the whole year in full.

In February this year I got a letter from Universal saying that they were changing their coverage and it was actually an increase in coverage. The letter also confirmed that all vaccines were covered 100%.

When the time came to inoculate the babies we went to the recommended center in Santiago that accepts Universal insurance. When it came to the crunch, the secretary called Universal and we found out that we were not covered.

In a nutshell over the last few months I have shelled out over 16,000 pesos for vaccines for the babies that my contract from Universal says I am covered for. My broker has had no luck in resolving this, stating that they didn't know anything of the change and that Universal made a mistake by saying we were covered! Even though it clearly states in the advertising blurb, my contract and a letter. Some mistake!

So basically you sign the contract, pay the premium then they change their mind and not cover you! Not a very ethical business if you ask me. Especially when this company is supposed to be covering your health. And why on earth would an insurance company have a problem in inoculating babies against serious diseases? Surely it's an insurance policy for themselves if you want to look at it at a business angle. It would cost them a lot more if they were to contract meningitis, pneumonia, septicemia or rotavirus.

As I said before, I hope none of us need a hospital as I have no faith at all in this company. I will be going back to Humano at renewal time.
 

santa110xyz

Active member
Oct 25, 2005
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you must go yourself to a main Universal Office with all your papers and talk to a supervisor. i am sure you will get it solved. actually Universal is the most reliable health insurance here and insurance brokers very often only like to get their commission and don't like to fight for you.
 

AlterEgo

Administrator
Staff member
Jan 9, 2009
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South Coast
Insurance in DR is mysterious at best. No one seems to know what is really covered. My suegra spent a week in a hospital/clinica in SD in March, with supposedly excellent Humano Insurance coverage [through my sister-in-law's work], and we still ended up owing 120,000 pesos. No point contesting it, from what I was told.
 

Hillbilly

Moderator
Jan 1, 2002
18,948
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I do not know if it will do any good but I forwarded your post to some people in BPD about this terrible customer service.

IMPO, I would never pay more than 3 mos service up front. Also seek legal help if you have the documents. A lot of people (lawyer people) would like to take on Universal for breach of contract if the evidence is airtight..

HB
 

beeza

Silver
Nov 2, 2006
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But why should you have to fight for something to which you are entitled to in the first place?

I was in the agent's office when they made the call to their call center. Again they refused to cover these vaccines. What else can the broker or I do? The broker knows I will not be renewing if this isn't sorted, so they stand to lose more in the future.

They have changed their coverage since I took out the plan and that is it. They are sticking to it. Maybe with a lawyer, I could resolve it, but that's just throwing good money after bad.
 

Robert

Stay Frosty!
Jan 2, 1999
20,574
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dr1.com
I have only ever used ARS Humano here and never had a problem. I have claimed for dental work, surgery and not once been questioned or refused.
 

Chirimoya

Well-known member
Dec 9, 2002
17,850
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First of all, always remember that behind the touchy-feely caring images and slogans it is a callously hard-nosed business. Their profit comes a long way before your family's health.

I wrote about a problem we had with Universal a couple of years ago. The clinic phoned them to approve a minor surgical procedure, which they did, so we went ahead with the procedure. However, they then refused to pay on spurious grounds (we should have used a specialist instead of a general surgeon). The fact that they had approved it and we had the name of the person and reference number was no help whatsoever.

We are now with Humano which has been OK but almost everything that is not completely routine has to be pre-approved by the broker.
 

beeza

Silver
Nov 2, 2006
3,480
732
113
I know this story is based on hearsay, but I heard about a German who got a complication from Leptospirosis during the recent floods here in Sosua. He had an open wound in his leg that got infected in the flood.

He was taken ill and was admitted into HOMS in Santiago. He ended up in intensive care and once the limit of his insurance policy was reached he was discharged from HOMS and admitted into the public hospital in Santiago.

He died a few days later.

It seems that it's not only the insurance companies who are in the business on making themselves rich by preying on our medical fears, but the medical practitioners too! What happened to the hypocratic oath?
 

dv8

Gold
Sep 27, 2006
31,266
363
0
sent you PM with contact details for one of gerentes medicos in ARS universal.
hope you can either solve it or clear things up for the future.
 

Criss Colon

Platinum
Jan 2, 2002
21,843
191
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38
yahoomail.com
Ihave 4 kids,and a wife on my SDS policy.I pay by phone,15,000 pesos every three months.I am WAY ahead of them having been ic cardiac unit at CEDIMAT six times,kids "interna" many times,mostly for Dengue Fever. the bills add up to hundreds of thousands of pesos over ten years.All paid by the insurance company.
Vaccines are given free by "Salud Publica"if not covered by your insurance go there.Public Health visited my girls school in Arroyo Hondo last year to vacinate thm for,"something".
NEVER,use a broker,or pay in advance in the DR!!!!
For ANYTHING!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
If they got your money,you ARE screwed.
iT WILL COST YOU MORE IN LAWYER FEES,AND YOUR TIME THN YOU HAVE ALREADY LOST!
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
 

bob saunders

Platinum
Jan 1, 2002
32,504
5,932
113
dr1.com
Ihave 4 kids,and a wife on my SDS policy.I pay by phone,15,000 pesos every three months.I am WAY ahead of them having been ic cardiac unit at CEDIMAT six times,kids "interna" many times,mostly for Dengue Fever. the bills add up to hundreds of thousands of pesos over ten years.All paid by the insurance company.
Vaccines are given free by "Salud Publica"if not covered by your insurance go there.Public Health visited my girls school in Arroyo Hondo last year to vacinate thm for,"something".
NEVER,use a broker,or pay in advance in the DR!!!!
For ANYTHING!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
If they got your money,you ARE screwed.
iT WILL COST YOU MORE IN LAWYER FEES,AND YOUR TIME THN YOU HAVE ALREADY LOST!
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC

What is SDS?