Medical clinics and Insurance

planner

.............. ?
Sep 23, 2002
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I have been sick for about 2 weeks now and ended up in the clinic for a few days. It was quite the experience!

The clinic is a good one here in Puerto Plata but it seems all of them, including this one, run a similar scam.

First of all they NEVER have the room level that your insurance pays for. SO they upsell you to the next level and you pay extra. Then they will try and convince you to have extra tests and proceedures.

When I checked out I faced an interesting bill, including doctors fees which should have been included!!!!

So, here is the advice sent to me by my insurance agent - I will know better the next time something happens:

1. Never accept a not covered room, they just tell you that your level is not available to steal from you.
2. Go directly to the insurance representative in the clinic and check your coverage before you start with any medical attendance.
3. Check before every treatment if it is covered by health insurance.
4. Don't accept any doctor who is not covered by your health insurance. Don't assume because he works from the clinic that he is covered (that was my error)
5. At last and most important: Don't pay a ridiculous bill! Until you refuse to pay we can't negotiate.

Hope this helps someone else.
 

Rocky

Honorificabilitudinitatibus
Apr 4, 2002
13,998
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www.rockysbar.com
I have been sick for about 2 weeks now and ended up in the clinic for a few days. It was quite the experience!

The clinic is a good one here in Puerto Plata but it seems all of them, including this one, run a similar scam.

First of all they NEVER have the room level that your insurance pays for. SO they upsell you to the next level and you pay extra. Then they will try and convince you to have extra tests and proceedures.

When I checked out I faced an interesting bill, including doctors fees which should have been included!!!!

So, here is the advice sent to me by my insurance agent - I will know better the next time something happens:

1. Never accept a not covered room, they just tell you that your level is not available to steal from you.
2. Go directly to the insurance representative in the clinic and check your coverage before you start with any medical attendance.
3. Check before every treatment if it is covered by health insurance.
4. Don't accept any doctor who is not covered by your health insurance. Don't assume because he works from the clinic that he is covered (that was my error)
5. At last and most important: Don't pay a ridiculous bill! Until you refuse to pay we can't negotiate.

Hope this helps someone else.
Good advice, Planner, and sorry to hear that you're so sick.
Is there any chance of sharing the name of the clinic where you were treated, with us?
 

planner

.............. ?
Sep 23, 2002
4,412
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Thanks Rocky, the clinic is Centro Medico Bournigal. I do want to stress that I received good care while I was there (although it was interesting...) And I want to stress that these scams are common in the clinics and not just to foreigners, they do it to those with good insurance who look like they could afford to pay a bit more.....
 

alicious

Bronze
Oct 2, 2007
631
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This should be a sticky!!

Thanks for the information Planner!!

I have also rec'd some redicously high medical bills from Bournigal when I was there...good care yes, but very expensive!
 

Hillbilly

Moderator
Jan 1, 2002
18,945
501
113
I am glad that they even took your insurance. The current struggle between the insurance providers and the clinics and doctors is getting heated.
Currently the ENT, the urologists and a couple of other specialists will not even accept a patient with insurance. What happened was that previously the insurance companies paid, say, RD$400, for a consult. When the government plan said that they were going to pay just RD$100 for a consultation, the insurance companies said that they were going to lower their payments to RD$100.
Obviously, the doctors balked.
According to my boy, the shyte will hit the fan when the surgeons come out and say that they will not participate in the plan. Then what? Have that appendectomy done by a GP? Or an Intern?

Glad you were made better Blondie...

HB
 

caro

New member
Sep 24, 2003
241
4
0
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I have the same problem of planner in september 2006 at the same clinic. the first bill was around 82000 pesos and we battle the fee and finally pay 49 000 pesos ( my insurance)

one thing I remember is they bill me for doctor I never see during my 3 day stay but if you want more information of what was the other thing I can always look in my paper because I keep everything.

but except the fee the care was really good .

hope your are better planner . take care of you
 

La Profe_1

Bronze
Oct 15, 2003
1,710
86
48
Well, I was "treated" there in 2005 and they billed my US insurance the equivalent of 300,000 pesos, for care that did not solve my problem. I ended up spending 5 months in the US having surgery, recuperating and having physical therapy for the issue they put me under general anesthesia TWICE to try to correct - to no avail.
 

planner

.............. ?
Sep 23, 2002
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I've learned a valuable lesson and not too expensive either! Thanks HB for the info, that is usefull to understanding what is going on currently.

I am a bit better but now am told there is a bad influenza making the rounds and the hospitals are stacked with people.
 

M.A.R.

Silver
Feb 18, 2006
3,207
146
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According to my boy, the shyte will hit the fan when the surgeons come out and say that they will not participate in the plan. Then what? Have that appendectomy done by a GP? Or an Intern?

Glad you were made better Blondie...

HB
Wow difficult situations, but more difficult is if you have no insurance at all, one of my relatives just took his wife home after having their first baby.

Now he is borrowing from everyone to pay the medical bills, he is someone who lives in the campo doing day laboring, which means he gets paid minimum wage for whatever work he does.

AFter he took his wife back to the campo a few days later she started getting sick again with pains, she had a C section and now the pains wouldn't go away, after taking her to the Santiago and the doctors finding nothing wrong with her he took her back and forth a few times in the Noel storm, until her appendix popped!!!!!!! So now she has a C section a baby and recovering also from appedicitis, wow, poor people. They have a lot to be thankful for, she is still in a relatives house in Santiago recovering, and they had a baby girl 8lbs :cheeky:
 

dv8

Gold
Sep 27, 2006
31,271
358
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just been to the doctor who ordered papanicolaou. there is a brand new version of this test not yet covered by insurance - more than 800 pesos for a stupid thing.
hell, if i could get an old version and live with it just last year why is it no good now?
i got seriously p****d off.
 

oldschool

Active member
Oct 9, 2004
521
17
38
Brugal

Centro Medico or Bournagal or whatever it's called now has been notorious for overcharging for years.

The best option is always Santiago if you can get there if you can't go to Clinica Brugal downtown see Dr. Mejia best doctor in Puerto Plata.
 

M.A.R.

Silver
Feb 18, 2006
3,207
146
0
So is RD50,000 a lot for an appendectomy?
Plus he has to pay for the C section and everything else that comes along with that.
 

karlheinz

New member
Oct 2, 2006
451
4
0
RD50,000 / US$ 1500 - if that's the TOTAL costs then that is indeed a bargin in comparison to US health care costs. an appendectomy, paid for without insurance in the US could easily costs $15,000 +.
 

planner

.............. ?
Sep 23, 2002
4,412
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It is not about comparing the cost to the US. For those of us who choose to live here we deal with the situations here.

Further discussions with the clinic got me nowhere - no big surprise. I will simply know better next time.

I too have heard good things about Dr. Mejia - apparently he takes a special interest in diabetes and its complications.
 

caro

New member
Sep 24, 2003
241
4
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41
if the Dr. Mejia is Dr Manuel Mejia Baez is the one who immigration canada trust for the medical examen for immigration in puerto plata.
 

M.A.R.

Silver
Feb 18, 2006
3,207
146
0
RD50,000 / US$ 1500 - if that's the TOTAL costs then that is indeed a bargin in comparison to US health care costs. an appendectomy, paid for without insurance in the US could easily costs $15,000 +.

Yeah I wasn't trying to compare, its impossible to do that, all the poorest of the poorest have no insurance in the DR, they must go to the public hospital/butcher shops to take care of themselves and they refuse them if they can't pay and if the hospital gets a wiff that the patient might even know someone who lives in the US and might help him, forgetaboutit, right there and then they would want to charge more.

btw: this relative of mine is very poor and has no job and can work in Santiago doing odd jobs around the house and painting houses too, if anyone would like to help. thanks.