Another health insurance question

Neargale

Active member
Jul 4, 2013
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Is there any advantage in going to a broker or directly to the insurance company?

Is the role of the broker to help in issues with the insurance company or just to sell insurance?

Are there any recommended brokers in POP?

It seems that the health professionals that I want to use (the better ones?) do not deal with insurance. I was told that I pay up front then submit a claim for reimbursement. That reimbursement seems elusive... the insurance company comes up with new requirements, new questions etc.

Has anyone used the group insurance for expats? What was your experience in terms of coverage and reimbursement.
 

windeguy

Platinum
Jul 10, 2004
42,211
5,967
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There are many health care providers who do not accept insurance. Heart surgeons, neurosurgeons and other prima donnas of the doctoral world. I do not know of a plan locally that will reimburse you no matter what paperwork you fill out if you choose to go to those doctors. You would simply be out of pocket on those expenses. Perhaps someone knows of a local plan that would do this? (International expensive plans could do this.)

As for using a broker, yes, the reason you would do that is to have them help you with any problems you might face in dealing with the doctors or the insurance company. If you go direct, you fight those battles yourself.
 

MikeFisher

The Fisherman/Weather Mod
Feb 28, 2006
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the brooker lady i use since around 15 years been very helpful on any isues to date, with many people under the same insurance registered. a whatsapp message or short call been always enough to get things resolved satisfying.
as windeguy stated above,
i would also not know of local insurances running a system of "pay upfront-get reimbursed later".
i know such practice only from some(mostly northamerican) travel insurances, which are for most part for emergency use, they do not all cover regularly sheduled Doctor Visits.
what actions are included and which doctors/hospitals accept which Card and specific things, depends a lot on what kind of health insurance plan you choose.
it is a wide variety of things available, not easy to overview, yeah.
i would recommend you to ask people about a known/reputable brooker in your specific area and meet up with him/her, to get detailed information on specific questions of specific inclusions suitable for Yourself.

Mike
 

mountainannie

Platinum
Dec 11, 2003
16,350
1,358
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elizabetheames.blogspot.com
So far, my plan (Universal Exclusivo) has reimbursed me for the bulk of any cost for a doctor who is not covered.

My broker actually SEND a messenger to my apartment to pick up the receipt, then sends him eback with the check. They also send him to pick up the premiums every three months.

I appreciate them because when I first went to buy the policy - they called each company to see which one actually continue coverage after age 70 without requiring a physical (at the time Universal was the only one)
 

MikeFisher

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Feb 28, 2006
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So far, my plan (Universal Exclusivo) has reimbursed me for the bulk of any cost for a doctor who is not covered.

My broker actually SEND a messenger to my apartment to pick up the receipt, then sends him eback with the check. They also send him to pick up the premiums every three months.

I appreciate them because when I first went to buy the policy - they called each company to see which one actually continue coverage after age 70 without requiring a physical (at the time Universal was the only one)

great info, Annie.
so, aside of the doctors/hospitas etc included in their coverage,
did i understand correctly that you also used medical services not named as covered by the Insurer, paid directly to the doctor, got a receipt, sent receipt to Insurer and they reimbursed you?
I ask, because my wife is using one specific doctor twice a year, who does not accept insurance cards. no biggy, a doctor where the wife feels comfy, is fine for me, too, even that i pay the stuff out of pocket.
if that's the case, then i let her know to get a receipt for the stuff on the next visit, and send it to the insurer.
anyways worth a try, i guess, never thought of that.

Mike
 

Neargale

Active member
Jul 4, 2013
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I have Humano Platinum. So far they have reimbursed some of the expenses that I have paid up front. But now that the expenses are adding up they are starting to ask more and more questions, which is fine, if they give me the list of questions or documents they need up front. It is the running around that is getting to me i.e. they ask for a bit more info, I give them, then they want more, I give them then they think of more ... The broker does not seem to be proactive and is just acting as a mailbox with the accompanying delays. So now I have requested a meeting with the broker and Humano together to sort out outstanding questions and paper work.

So again, does anyone have a good proactive broker in POP?

Has anyone experienced changing broker and or insurance company? any adverse effect?
 

MikeFisher

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Feb 28, 2006
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I have Humano Platinum. So far they have reimbursed some of the expenses that I have paid up front. But now that the expenses are adding up they are starting to ask more and more questions, which is fine, if they give me the list of questions or documents they need up front. It is the running around that is getting to me i.e. they ask for a bit more info, I give them, then they want more, I give them then they think of more ... The broker does not seem to be proactive and is just acting as a mailbox with the accompanying delays. So now I have requested a meeting with the broker and Humano together to sort out outstanding questions and paper work.

So again, does anyone have a good proactive broker in POP?

Has anyone experienced changing broker and or insurance company? any adverse effect?

i am surprised about that.
I have myself in the family several ARS Humano Platinum plans running, including for myself.
never ever was anybody required to pay anything Upfront to get reimbursed later on.
we visit a doctor or shedule a surgery etc etc, show the card, it gets typed in their system, all is fine.
what ever has to be paid in addition to the ARS coverage, been always billed with the whole bill AFTER surgeries/Doctor visits.
i get the full bill in hand and it states what is covered and what has to be paid out of pocket.

Mike
 

Neargale

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Jul 4, 2013
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Mike, I am talking about when the doctor does not deal with the insurance company. So I pay for the visit to the doctor, I get the paid receipt which I then submit to Humano.
If the doctor takes my insurance company then things work the way you describe.
 

MikeFisher

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Mike, I am talking about when the doctor does not deal with the insurance company. So I pay for the visit to the doctor, I get the paid receipt which I then submit to Humano.
If the doctor takes my insurance company then things work the way you describe.

o.k.,
sorry for my misunderstanding.
thats exactly what i have to do with the Mrs on her next visit to that specific doctor, which we always pay out of pocket.
i have to send tatbill to humano to see what's coming out of it.in such case,
do you just hand it over to them, send it as a scan, personally, do you add any specific note?

thanks

Mike
 

Neargale

Active member
Jul 4, 2013
347
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o.k.,
sorry for my misunderstanding.
thats exactly what i have to do with the Mrs on her next visit to that specific doctor, which we always pay out of pocket.
i have to send tatbill to humano to see what's coming out of it.in such case,
do you just hand it over to them, send it as a scan, personally, do you add any specific note?

thanks

Mike

I present the paid receipt to my broker who makes me sign a reimbursement request form of sorts, then I wait, wait and wait. I would advise to take photocopies of everything or photo scans in case things get lost which they seem to do at an alarming rate. I also advise to B/F in 3-4 weeks. Good luck. I have received all requested reimbursements until recently when they are starting to deny...eg why did the doctor send you to get a MRI, need to see the results of the MRI, what was the diagnostic he wanted to confirm by using the MRI and show the MRI request form signed by the doctor. That was an MRI ordered by a local doctor, the MRI machine was down in POP for the week for maintenance, I happened to go to Santiago so dropped in at Union Medica and their machine was down as well for 1 week for maintenance so I went to CIMEN which is not linked to Humano for MRI. By the way CIMEN's MRI report is much more detailed than I have ever seen.
 

MikeFisher

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thanks a bunch,
thatsvery helpful info.
i already informed the Mrs,
then next doctor bill without handing me over the complete papelero,
will be deducted from her Salon Account.
that always works.

Mike