Case study with insurance having a baby
My wife's sister was in santiago on monday to have a scheduled cesarean section.
She had a beautiful baby girl 7 lbs without incident at about 9 in the morning.My wife Ramona stayed with her throughout.
The next morning when she went to checkout from the hospital , she was waiting for the hospital to send the bill to the insurrer. They waited till 12 . Ramona called the insurer and they said they had not received the bill from the hospital. She told that to the hospital and they then informed her that her sister had in fact 4 surgeries including removal of an alleged cyst and the bill instead of being fee was now 101,000 pesos which was not covered by insurance. .
Apparently the doctor had forgot to tell them about the additional surgeries.
Ramona kept calling the doctor who did the surgery, about 20 times and had submitted the bill. The doctor would not take the calls and kept passing to her secretary, but we are sure was listening in to the conversations. .
The insurrer told my wife that these additional surgeries were not covered by insurance as there were not any prior tests or consultations.
The doctor demanded 101,000 cash not credit card and that there was an alleged assistant as well who did not have insurance authorization. My wife said she should have got one who was covered by insurance.
The doctor demanded the money. and said we needed to leave a 25,000 deposit.
Ramona said that what she did was illegal because there was no prior authorizations for the alleged surgeries.
She also said that if she left a deposit the bill would still be open and they could demand all the money later.
My wife Ramona sells insurance and she said to the doctor that although she is not an expert in medicine she is an expert on insurance as she sells it and has won many awards. . She said that if there is a problem with the doctor we would contact the fiscal in the morning. , and send as well Ramona's family member who is the chief of auditing for the insurer to audit all the doctors accounts.
The doctor finally sent the proper invoice 5 minutes before she thought the office was closed thinking that we would have to stay one more day. It was open 24 hours so they did receive the invoice.
We finally were able to leave the hospital at 6 that night. and paid the normal 6000 pesos as the insurrer paid the rest. I guess the doctor got scared and withdrew the bill.
So what did we learn from this?
1. The doctor or clinic can do lots of monkey business and demand large payments in cash when you are vulnerable .
2. You need to be aware to your rights. as a patient.
3. I am guessing that they only want payment in cash for their monkey business as if it is by credit card you can reverse it later.
4 You need to have someone who speaks spanish on your side like a good agent who will go to bat if there is ever an issue.
In fairness we have had a lot of positive experiences with doctors and clinics etc. but there still are a few bad apples.
My wife's sister was in santiago on monday to have a scheduled cesarean section.
She had a beautiful baby girl 7 lbs without incident at about 9 in the morning.My wife Ramona stayed with her throughout.
The next morning when she went to checkout from the hospital , she was waiting for the hospital to send the bill to the insurrer. They waited till 12 . Ramona called the insurer and they said they had not received the bill from the hospital. She told that to the hospital and they then informed her that her sister had in fact 4 surgeries including removal of an alleged cyst and the bill instead of being fee was now 101,000 pesos which was not covered by insurance. .
Apparently the doctor had forgot to tell them about the additional surgeries.
Ramona kept calling the doctor who did the surgery, about 20 times and had submitted the bill. The doctor would not take the calls and kept passing to her secretary, but we are sure was listening in to the conversations. .
The insurrer told my wife that these additional surgeries were not covered by insurance as there were not any prior tests or consultations.
The doctor demanded 101,000 cash not credit card and that there was an alleged assistant as well who did not have insurance authorization. My wife said she should have got one who was covered by insurance.
The doctor demanded the money. and said we needed to leave a 25,000 deposit.
Ramona said that what she did was illegal because there was no prior authorizations for the alleged surgeries.
She also said that if she left a deposit the bill would still be open and they could demand all the money later.
My wife Ramona sells insurance and she said to the doctor that although she is not an expert in medicine she is an expert on insurance as she sells it and has won many awards. . She said that if there is a problem with the doctor we would contact the fiscal in the morning. , and send as well Ramona's family member who is the chief of auditing for the insurer to audit all the doctors accounts.
The doctor finally sent the proper invoice 5 minutes before she thought the office was closed thinking that we would have to stay one more day. It was open 24 hours so they did receive the invoice.
We finally were able to leave the hospital at 6 that night. and paid the normal 6000 pesos as the insurrer paid the rest. I guess the doctor got scared and withdrew the bill.
So what did we learn from this?
1. The doctor or clinic can do lots of monkey business and demand large payments in cash when you are vulnerable .
2. You need to be aware to your rights. as a patient.
3. I am guessing that they only want payment in cash for their monkey business as if it is by credit card you can reverse it later.
4 You need to have someone who speaks spanish on your side like a good agent who will go to bat if there is ever an issue.
In fairness we have had a lot of positive experiences with doctors and clinics etc. but there still are a few bad apples.
