Medicare Accepted in Santiago/SD??

[Tamborista]

Even if they don't accept Medicaid/Medicare you can still get treatment in the DR and get reimbursed. I paid the clinic I was in like 100,000 pesos and got most of it back from my insurance in the US (Aetna).

Which Aetna plan do you have?

 

[PICHARDO]

Here a translation for the article in English by me:




The HOMS arrived at an agreement with Medicare so that Dominican patients with foreign health insurance can be provided for in that care center.

Doctor Rafael Sanchez Espanol said that they're trying to expand the coverage of services which they offer.

The HOMS is deemed like the ideal place to study the tropical illnesses. Because of that it will receive a delegation from Florida International University, to coordinate joint actions.

They have prepared a research unit within the international required connections.

It aims to become a complete educational and services hospital within the next five years, where doctors in all the specialties will be educated.

The hospital has an educational agreement with the Pontificia Universidad Catolica Madre y Maestra (PUCMM).

Services:
Among the services HOMS offers are:

Emergency treatment and Trauma, Diagnostic Imaging Department, Clinical Laboratory and blood Bank, Department of Pathology, Endoscopy unit, Dialysis, Cardiology, Hemodynamics and Cardiovascular Surgery.

Also general surgery, cosmetic surgery, bariatric surgery, laparoscopic surgery, obstetrician/gynecologist, oncohematology clinic, multi-organs transplants, service of advanced dentistry, hospitalization, intensive care, pediatric intensive and neonatal care, pharmacy and executive medical evaluation plans.

Administrative council Rafael Sanchez Spanol, president; Jose Clase, vice president; Felix Garcia, secretary; Manuel Estrella, treasurer; Agripino Nunez Collado, Angel Rosario Vinas, Carlos Sully Fondeur, Jose Hazim, Jose de Jesus Alvarez Torres, Fernando Capellan, Luis Manuel Bonetti, ex officio, Bautista Rojas Gomez, ex officio, Jose Ramon Brea.

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The agreement allows Dominican "residents" that hold an active "MEDICARE" NOT "MEDICAID" insurance coverage, to continue to have their regular checkups, non-major surgical interventions, people already on mid and long term health treatments and the like, to be able to receive these services IN the DR w/o having to travel back to the US to get the services rendered. HOMS presented the US program with a competitive value for the money. They offer services at rather large savings to the otherwise very expensive ones back in the States.

As the clinics and relevant specialties departments are opened in HOMS, the list of services under the general agreement with MEDICARE will continue to expand.

This agreement is ONLY on a trial basis for NOW, as in a PILOT plan. They want to be able to conduct the trials within the DOMINICAN/AMERICAN population first. As it stands, Dominicans who hold MEDICARE insurance are deemed first as DOMINICAN patients and liable to the DR only. Once the PILOT meets the expectations, they DO plan to extend the coverage to all insured under MEDICARE, DOMINICAN or NOT.

 

[Celt202]

Here a translation for the article in English by me:
........

This agreement is ONLY on a trial basis for NOW, as in a PILOT plan. They want to be able to conduct the trials within the DOMINICAN/AMERICAN population first. As it stands, Dominicans who hold MEDICARE insurance are deemed first as DOMINICAN patients and liable to the DR only. Once the PILOT meets the expectations, they DO plan to extend the coverage to all insured under MEDICARE, DOMINICAN or NOT.

Does HOMS have a facility in Santo Domingo?

 

[sweetdbt]

Thanks for the translation PICHARDO. It looks promising for a future expat resident like myself. Hopefully in 8 years, when I am eligible, there will be other facilities, and a wide range of services. This is a win/win for Medicare, as it enables them to allow their recipients to get services where they live, and at substantially less cost than in an American facility.

 

[bienamor]

not true

Thanks for the translation PICHARDO. It looks promising for a future expat resident like myself. Hopefully in 8 years, when I am eligible, there will be other facilities, and a wide range of services. This is a win/win for Medicare, as it enables them to allow their recipients to get services where they live, and at substantially less cost than in an American facility.

You would be surprised at what Medicare really pays. Not what was billed but what was actually paid. According to most of my friends and family in the medical field this is somewhere around 20%,or less, this is one reason that you are starting to find so many doctors that will not take either Medicare or Medicaid, not enough reimbursement, and too much bureaucracy, not worth the hassle. Why do you think you have to have GAP insurance for Medicare.

 

[bienamor]

not true

Thanks for the translation PICHARDO. It looks promising for a future expat resident like myself. Hopefully in 8 years, when I am eligible, there will be other facilities, and a wide range of services. This is a win/win for Medicare, as it enables them to allow their recipients to get services where they live, and at substantially less cost than in an American facility.

You would be surprised at what Medicare really pays. Not what was billed but what was actually paid. According to most of my friends and family in the medical field this is somewhere around 20%,or less, this is one reason that you are starting to find so many doctors that will not take either Medicare or Medicaid, not enough reimbursement, and too much bureaucracy, not worth the hassle. Why do you think you have to have GAP insurance for Medicare.

 

[AlterEgo]

You would be surprised at what Medicare really pays. Not what was billed but what was actually paid. According to most of my friends and family in the medical field this is somewhere around 20%,or less, this is one reason that you are starting to find so many doctors that will not take either Medicare or Medicaid, not enough reimbursement, and too much bureaucracy, not worth the hassle. Why do you think you have to have GAP insurance for Medicare.

Not so bienamor, I was my mother's caregiver for 6 years and handled all her medical bills, until she recently passed away. Medicare pays a flat fee schedule for all medical items/procedures/tests, minus 20%. Meaning they pay 80% of the allowed amount - the patient is liable for the other 20%, which is what the supplemental insurance pays. There is also an annual deductible for Medicare, which the supplemental insurance also pays. Once you pay your monthly supplemental insurance, ALL medical is paid in full. We never ever had anyone reject Medicare, and believe me she saw a lot of doctors.

Medicaid is a whole different story, very few doctors accept it. That's why the Emergency Rooms are always full of people with colds and fevers - they can't find a doctor so they use the ER for everything.

 

[bienamor]

In a way your right

Not so bienamor, I was my mother's caregiver for 6 years and handled all her medical bills, until she recently passed away. Medicare pays a flat fee schedule for all medical items/procedures/tests, minus 20%. Meaning they pay 80% of the allowed amount - the patient is liable for the other 20%, which is what the supplemental insurance pays. There is also an annual deductible for Medicare, which the supplemental insurance also pays. Once you pay your monthly supplemental insurance, ALL medical is paid in full. We never ever had anyone reject Medicare, and believe me she saw a lot of doctors.

Medicaid is a whole different story, very few doctors accept it. That's why the Emergency Rooms are always full of people with colds and fevers - they can't find a doctor so they use the ER for everything.

yes Medicare has a flat fee for each procedure, and they pay 80% of that fee the Gap insurance picks up the other 20%, but the dr. and hospitals are billing true charges and getting paid the schedule amount, thats when they get paid, and don't have to write it off because it's either been denied due to miscoded, or over the time limit which was caused by the first coding. If you had the same procedure done on your regular ins(nothing to do with Medicare/aid) then you would see the true cost of the billing. Annual fee for part B think around $90 a month this year. Part A is free, also a charge for Part D.
Your mother was great where was she at, as there are entire counties in fl. THAT WILL TAKE NEITHER.
I am wondering why AARO, AARP, have or seem to have no knowledge of this, the only thing that mentions overseas medical care is tricare which is military.
AARO - Association of Americans Resident Overseas - Medicare
Ask Ms. Medicare: I?m an American citizen living overseas ... what should I do about Medicare?
TRICARE for Life - Military Benefits - Military.com

 

[mountainannie]

Great information!

yes Medicare has a flat fee for each procedure, and they pay 80% of that fee the Gap insurance picks up the other 20%, but the dr. and hospitals are billing true charges and getting paid the schedule amount, thats when they get paid, and don't have to write it off because it's either been denied due to miscoded, or over the time limit which was caused by the first coding. If you had the same procedure done on your regular ins(nothing to do with Medicare/aid) then you would see the true cost of the billing. Annual fee for part B think around $90 a month this year. Part A is free, also a charge for Part D.
Your mother was great where was she at, as there are entire counties in fl. THAT WILL TAKE NEITHER.
I am wondering why AARO, AARP, have or seem to have no knowledge of this, the only thing that mentions overseas medical care is tricare which is military.
AARO - Association of Americans Resident Overseas - Medicare
Ask Ms. Medicare: I?m an American citizen living overseas ... what should I do about Medicare?
TRICARE for Life - Military Benefits - Military.com

Thanks for this information, bienamor/ I think the links make it perfectly clear that the American residents in Mexico (a very large number, I think) have been working on this issue for years. So all this talk from the Dominican hospitals about getting Medicare coverage is.... just that.

 

[mountainannie]

What they could be talking about is offering the services at 20% of what the costs of the standard Medicare billing costs are. Would that be even possible. That is the only thing that I could think of.

 

[bienamor]

dont know

What they could be talking about is offering the services at 20% of what the costs of the standard Medicare billing costs are. Would that be even possible. That is the only thing that I could think of.

Doubt it, from talking to my family in the field, they are telling me that the cost of the procedure to the hospital is sometimes more than Medicare pays. or you have an anesthesiologist, making 6 bucks an hour. its costing some of them more to keep up with the paperwork than they can bill for. which is why they are starting to not take it,

 

[mountainannie]

misunderstanding

Doubt it, from talking to my family in the field, they are telling me that the cost of the procedure to the hospital is sometimes more than Medicare pays. or you have an anesthesiologist, making 6 bucks an hour. its costing some of them more to keep up with the paperwork than they can bill for. which is why they are starting to not take it,

No, you misunderstood me, I was talking about Dominican hospitals actually just billing at 20% of what Medicare bills and calling it "Medicare" to make the Dominicans who were on Medicare feel ok about it... those who perhaps did not have the Medigap insurance.....

I think this is all just hype. There is no way there is going to be any sort of Medicare coverage down here. This is a foreign country... Just buy an international policy with the money that you save on your real estate taxes.

 

[mountainannie]

BTW all the local policies end at age 72 so there really is no medical insurance for the elderly here at all.

 

[sweetdbt]

I have always thought it strange that US citizens who paid Medicare taxes all their lives, but then chose to retire overseas, should be excluded from coverage. The justification seems to have been that Medicare did not want to pay for substandard services. It appears this is being addressed by this certification process.

I don't see what is so hard to understand about the fact that medical care is less expensive in places like the DR than it is in the US; therefore Medicare will save money if American retirees living overseas are able to receive services where they are rather than returning to the US.

 

[mountainannie]

only 6 million

I have always thought it strange that US citizens who paid Medicare taxes all their lives, but then chose to retire overseas, should be excluded from coverage. The justification seems to have been that Medicare did not want to pay for substandard services. It appears this is being addressed by this certification process.

I don't see what is so hard to understand about the fact that medical care is less expensive in places like the DR than it is in the US; therefore Medicare will save money if American retirees living overseas are able to receive services where they are rather than returning to the US.

according the links that were posted there are only 6 million americans living overseas so that the paperwork involved along with the potential for fraud and the inability to oversee will probably not make this a big priority

i would not count on it.

 

[jaguarbob]

BTW all the local policies end at age 72 so there really is no medical insurance for the elderly here at all.

where did you get that idea...if you have medical insurance here before you are 72,then it is good until you die...you cannot purchase insurance after 72,unless you pay very high premiums..bob

 

[mountainannie]

Really?

where did you get that idea...if you have medical insurance here before you are 72,then it is good until you die...you cannot purchase insurance after 72,unless you pay very high premiums..bob

the insurance agent told me that all the local policies actually STOPPED at 72

and he said that he had checked with ALL the local insurance companies.

I have posted that on this board... so you are saying that they cover you til death?

do you know what the rate increases are?

anyone with any experience?

which policies?
which companies?

thanks

 

[mountainannie]

OK-- I STAND CORRECTED.. As does the insurance agent) this was posted last month in answer to my posting on another forum


Ars Universal is excellent...the maximum age to issue a new policy is 65 years old and they don't drop you at an older age as long as you pay...they give you a 10% discount if you pay annually, but you need "to ask for discount"...
The payment depends on the plan that you choose...I have Plan Supremo Plus...I don't know if the plan is accepted in the new hospital (Homs) but it is accepted at excellent clinics, medical center all around the country....
809-724-2211 Ave. Metropolitana corner of 13 Street...Los Jardines Metropolitanos...
Seguros Universal


So while it is in fact, true that MANY insurance companies will not insure the ELDERLY
SEGUROS UNIVERSAL will!

 

[Chellow]

They maybe a work around the problem. A coworker some time ago retired to Costa Rica, He intentionally gave up his Medicare in order to receive additional money from the government, with this money he bought a local insurances policy with money to spare, I don't know if I'll do that but that's what he done.

 

[Ken]

So while it is in fact, true that MANY insurance companies will not insure the ELDERLY
SEGUROS UNIVERSAL will!

As long as you are not over 65, that is.