Health Insurance….again

Nellybelle

New member
Mar 19, 2021
3
0
1
USA
I was just informed by an insurance broker that she is unable to insure us due to age, 76 and 70. I am looking at SeNaSa ….will it allow visits to private nospitals? Is SeNaSa the only possibility? How much should we expect to pay? Are there any other expats that have solved this issue? Any advice/knowledge would be appreciated.
 

Kipling333

Bronze
Jan 12, 2010
1,792
159
63
I was in the same position some years back and could not obtain any health cover in the DR because of my age . Although I am not American, I settled for paying insurance for a helicopter to take me to Florida in case of something urgent that could not be handled here. There are several companies that have plans and I am sure your insurance agent can find them. The problem is that I think these only leave from a few places in the DR.
 

JD Jones

Moderator - Covid 19 in DR & North Coast
Jan 7, 2016
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I was just informed by an insurance broker that she is unable to insure us due to age, 76 and 70. I am looking at SeNaSa ….will it allow visits to private nospitals? Is SeNaSa the only possibility? How much should we expect to pay? Are there any other expats that have solved this issue? Any advice/knowledge would be appreciated.
This has been discussed before in the last week or so.

My admin. Asst. spoke with the Senasa rep and she was told they accept anyone of any age but you have to have a cedula.

I am having problems now with Universal, which has been my insurance company for decades.

I was having some scans done and lab work. When the labs call for authorization, they are told I only have basic coverage, when in fact I have the highest level of completivo coverage.

In the last week this has happened 6 times, and I had to pay out of pocket.

I called my broker who called the guy at Universal while I was at the lab each time. The guy from the insurance checked my policy number each time and said I am completely covered, but the folks who give the authorizations are saying that is not true.

I suspect it's due to my age. (69)

I have quite a few employees with Universal, so I am going to play the "if this happens again I'm dropping you" trick and see what happens.

I'm also going to investigate Senasa a little deeper.
 

chico bill

Silver
May 6, 2016
8,193
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I was in the same position some years back and could not obtain any health cover in the DR because of my age . Although I am not American, I settled for paying insurance for a helicopter to take me to Florida in case of something urgent that could not be handled here. There are several companies that have plans and I am sure your insurance agent can find them. The problem is that I think these only leave from a few places in the DR.
A helicopter from DR to Florida?
That would take a while. Better hope it is not an emergency.
Got any idea where they will refuel? (Bahamas maybe) Don't think there is a commercial whirlybird with that range.
I would be curious to know what insurance company promises a private helicopter for a 1250 KM trip.
 

Drperson

Well-known member
Sep 19, 2008
725
89
48
It is important for expats for example to get health insurance before 70 years old. After 70 years if you have insurance the premiums increase however you stillhave insurance. After 70 years lets say it is more difficult.
We have not heard of insured people at say 69 years being denied services / coverage because of their age
 

JD Jones

Moderator - Covid 19 in DR & North Coast
Jan 7, 2016
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I'm pretty sure if I showed up at an emergency room my costs would be covered 100% as it always has, but it's a PITA to try to get procedures/resonance/whatever studies done when the insurance approval folks says you don't have coverage when the Insurance contact person says I do.
 

Drperson

Well-known member
Sep 19, 2008
725
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48
I'm pretty sure if I showed up at an emergency room my costs would be covered 100% as it always has, but it's a PITA to try to get procedures/resonance/whatever studies done when the insurance approval folks says you don't have coverage when the Insurance contact person says I do.
Normally you submit documents to the insurrer for tests or to the agent for pre=approval
 

JD Jones

Moderator - Covid 19 in DR & North Coast
Jan 7, 2016
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Normally you submit documents to the insurrer for tests or to the agent for pre=approval
That's what everyone does when a doctor wants a scan or a test.

When a doctor sends me to get a test, I go to the lab and the lab calls the insurance company to approve the test.

That is what I am doing.

But when the lab calls they say I only have basic coverage. When I call my broker, he insists I have the top level of "complementario" insurance. Both sources are utilizing the same policy number I have had for years.

How do I handle that?
 

Cdn_Gringo

Gold
Apr 29, 2014
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How do I handle that?
This is a question for your broker. Ask them for the best way to avoid a problem when going for tests or treatment. I have heard that in some instances the receptionist getting authorization will ask you to pay so they can pocket the money or share it around the office while billing your insurance for the full authorized amount. If you are sure you should not be paying anything and your go to lab insists that you pay, go somewhere else and maybe get a different result. Your broker should be able to offer you some practical advice or get the issue resolved with the insurer for you. Is your actual plan not printed on your insurance card?
 

JD Jones

Moderator - Covid 19 in DR & North Coast
Jan 7, 2016
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This is a question for your broker. Ask them for the best way to avoid a problem when going for tests or treatment. I have heard that in some instances the receptionist getting authorization will ask you to pay so they can pocket the money or share it around the office while billing your insurance for the full authorized amount. If you are sure you should not be paying anything and your go to lab insists that you pay, go somewhere else and maybe get a different result. Your broker should be able to offer you some practical advice or get the issue resolved with the insurer for you. Is your actual plan not printed on your insurance card?

Not to keep kicking a dead horse, but in the last two weeks I've gotten a bunch of stuff done. Some of the tests were normal blood and urine stuff.
Some of the items they refused to cover, as well as magnetic resonance scans. I always deal with lab Referencias so I doubt there's anything
shady there.
In each of the refusal cases, I spoke to my broker, who in turn got his contact at the Insurance company on the line who told me in each case that my policy is correct and in good standing and everything should be covered.
I'd tell the person calling for the approval and they said the insurance person was denying the charges due to lack of coverage.
Since the costs were not that high, I lost my patience and told the secretaries that I'd go ahead and pay it and file a claim. I could have handled it with a little more patience I suspect.
I asked the broker to get me a new card. Mine has to be at least 10 yrs old but that shouldn't make a difference. All they need the card for is my policy number. Perhaps a new card will have the plan printed on it.
Anyway, I'm still trying to get it all straightened out.
To be honest I have never had problems with Universal and I've been with them since the 80's.
 

NanSanPedro

Nickel with tin plating
Apr 12, 2019
3,130
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Not to keep kicking a dead horse, but in the last two weeks I've gotten a bunch of stuff done. Some of the tests were normal blood and urine stuff.
Some of the items they refused to cover, as well as magnetic resonance scans. I always deal with lab Referencias so I doubt there's anything
shady there.
In each of the refusal cases, I spoke to my broker, who in turn got his contact at the Insurance company on the line who told me in each case that my policy is correct and in good standing and everything should be covered.
I'd tell the person calling for the approval and they said the insurance person was denying the charges due to lack of coverage.
Since the costs were not that high, I lost my patience and told the secretaries that I'd go ahead and pay it and file a claim. I could have handled it with a little more patience I suspect.
I asked the broker to get me a new card. Mine has to be at least 10 yrs old but that shouldn't make a difference. All they need the card for is my policy number. Perhaps a new card will have the plan printed on it.
Anyway, I'm still trying to get it all straightened out.
To be honest I have never had problems with Universal and I've been with them since the 80's.

JD, specific to Referencia, do you need an appointment or can you just walk in? Also, I'm assuming you don't need a doctor's script, is that accurate?

Thanks

Rob
 

JD Jones

Moderator - Covid 19 in DR & North Coast
Jan 7, 2016
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JD, specific to Referencia, do you need an appointment or can you just walk in? Also, I'm assuming you don't need a doctor's script, is that accurate?

Thanks

Rob
Either/or. You can walk in and ask for a test and pay out of pocket. You need the doctor's script if you're hoping the insurance will cover.

In either case, they give you a printed receipt with a list of what was done and how much was covered and how much you have to
pay which you also use to pick up the results.

You can also have them create an account online where they post all of your results with them so you don't have to return to pick up the results.
 
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JD Jones

Moderator - Covid 19 in DR & North Coast
Jan 7, 2016
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I was 69 when I bought my first plan from Humano..... I have a great broker who has connections within Humano
TBH, I had the opportunity to switch to Humano about 6 years ago. I wish I would have done it.
 

windeguy

Platinum
Jul 10, 2004
36,526
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TBH, I had the opportunity to switch to Humano about 6 years ago. I wish I would have done it.
I have Humano, but they pulled their agent out of Bournigal, probably due to CV19, and now you have to go to the main office on Beller for authorizations.
And doctors complain about Humano as well.
 
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