Health Insurance-Locals

[TundraGreen]

Originally Posted by stilltraveling

Private insurance treats preexisting conditions just like they do in the States. The public insurance plans do not have any restrictions on preexisting conditions.

IMSS excludes coverage of some things for awhile after you first sign up:

6 months -
Breast cancer

10 months -
Child birth

1 year -
Kidney stones
Surgery for gynecology problems, except cancers
Surgery for vein insufficiencies
Surgery for sinus problems
Surgery for varicose veins
Hemorrhoids
Tonsil and adenoid removal
Surgery for hernia
Bunion surgery
Surgery for strabismus (eye alignment)

2 years -
Orthopedic surgery

[Mellowmarsh3]

I'm also married to a Mexican although we have been living in The U.S. for 5yrs. We are planning to move to Cuernavaca next year. Can you expand on your comment that you are eligible for IMSS because of her.

My wife is not currently enrolled in IMSS but thinks that she can enroll when we get to Mexico and I will be covered because of her Mexican citizenship. She doesn't think I need to take a physical, etc. - I should be automatically eligible.

My main concern - I have high blood pressure - I'm reading in some of these post that this may be considered a pre-existing condition that may disqualify me. Do you have any knowledge or insight as to whether, if at all, her citizenship may figure into this??

Tanks a lot,
Marshall

[August55]

Originally Posted by tundragreen

imss excludes coverage of some things for awhile after you first sign up:

6 months -
breast cancer

10 months -
child birth

1 year -
kidney stones
surgery for gynecology problems, except cancers
surgery for vein insufficiencies
surgery for sinus problems
surgery for varicose veins
hemorrhoids
tonsil and adenoid removal
surgery for hernia
bunion surgery
surgery for strabismus (eye alignment)

2 years -
orthopedic surgery

how do you find out about other pre exisiting condition exclusions?? Is there a web site or an office to contact to determine what conditions are not covered at all?? Thank you so much for this information.

[Mellowmarsh3]

Originally Posted by August55

how do you find out about other pre exisiting condition exclusions?? Is there a web site or an office to contact to determine what conditions are not covered at all?? Thank you so much for this information.

Here's two websites to follow that will at least give you some idea of what's covered, waiting periods, etc. I'm not allowed to post the complete URLs yet because I don't have 4 posts but if you Google Mex Connect and Med to go- you should be able to explore those sites until you find the correct articles.

However, as someone noted earlier - IMSS may be administered differently depending on where you apply.

[TundraGreen]

Originally Posted by August55

how do you find out about other pre exisiting condition exclusions?? Is there a web site or an office to contact to determine what conditions are not covered at all?? Thank you so much for this information.

IMSS does have a web site.

However, the list I quoted is a translation of a list I was given by IMSS in printed form when I enrolled. I suspect any IMS office might have a copy of it. I didn't look for it on the web, but it might be there. The list is one page copied from a legal document it looks like. Article 82 covers pre-existing conditions that can preclude getting coverage at all. Article 83 is the list I posted here. In another thread, I posted the same information plus the permanently excluded conditions listed in Art. 84

For completeness, all three Articles, 82, 83, and 84 are translated here:

Art. 82 Preexisting conditions precluding coverage:
1. complications of late stage diabetes mellitus, Gauchers illness, chronic kidney disease, chronic kidney insufficiency, cardiac valve pathology, cardiac insufficiency, consequences of cardiac isquemia (arrhythmia, pain, myocardia), COPD (chronic obstructive pulmonary disease), respiratory among others.
2. systematic chronic infirmities of the connective tissue, alcoholism and other toxicomanias (I like that word better than other drug addictions), mental treatment for psychosis and dementia, congenital infirmities, AIDS and HIV.

Art. 83 Exclusions for time periods
- 6 months
breast cancer

- 10 months
pregnancy

- 1 year
kidney stones
gynecology surgery except tumors
sinus surgery
varicose vein surgery
nasal surgery
variococele surgery (scrotal condition)
hemorrhoids
aenoids
hernias, except herniated disks
hallux valgus surgery (foot and ankle)
strabismus (squinting?)

- 2 years
orthopedic surgery

Art. 84 Permanently not covered
cosmetic surgery
eyeglasses
eye surgery for vision issues
self inflicted conditions, attempted suicide
wounds from professional participation in risky activities
behavioral and learning disorders
dental problems, except cleaning, extractions, and fillings
prostheses
chronic conditions requirement long term therapy
fertility treatment
treatment of consequences of muscle, skeletal, or neurological conditions of traumatic origin acquired earlier and continuing
treatment of degenerative ailments of the central and peripheral nervous systems and of circulation problems acquired earlier and continuing

I apologize for my translations. I can read Spanish pretty well, but am no expert on disease so the vocabulary may not be right. I am a Doctor but with a PhD not an MD and not in any biology/medical field.

PS I also apologize for posting parts of the same information on different threads. We seem to have three IMSS/medical threads going at once and I have gotten confused about what is where.

[August55]

Originally Posted by Mellowmarsh3

Here's two websites to follow that will at least give you some idea of what's covered, waiting periods, etc. I'm not allowed to post the complete URLs yet because I don't have 4 posts but if you Google Mex Connect and Med to go- you should be able to explore those sites until you find the correct articles.

However, as someone noted earlier - IMSS may be administered differently depending on where you apply.

WOW THANKS SO VERY MUCH for the prompt response!

[johnmex]

My first personal experience with the IMSS 20 years ago prompted me to buy private health insurance. I had my first kidney stone at the ripe old age of 25(thanks Dad!). After arriving to Centro Medico(the IMMS headquarters in GDL) and being given an IV and a really hard chair to wait in for 4 hours, I noticed the guy next to me on the floor vomiting blood and no one paying attention to him. I thought...if he isn't getting attention...when will I?

Getting private coverage was, for me, a great decision. Why? About 5 years ago I started getting "something". The something turns out to be APS, a nasty, silent condition that makes your blood form clots and eventually will cause a stroke or heart attack. The system at the IMSS would not have been beneficial in detecting this condition in a timely manner. In fact, we used the IMSS as another option in this diagnosis. I ended up at "Nutrición" , the IMSS flagship hospital in Mexico City. There, after a week of every test (almost!)known to modern medicine, I was diagnosed as having a STD. This diagnosis made my wife (an ENT) very suspicious as she tested negative!

It turns out that APS antibodies will give a false positive on tests for STDs. As this hospital was the pinnacle of the IMSS system, what other choices did I have? Well, my private insurance. We looked for more and better doctors, finally finding a rheumatologist who was very good. He sent me to get a test, ironically at the same IMSS hospital in Mexico City, that the IMSS system "neglected" to order for me (too expensive?). This test confirmed my lack of an STD (duh!).

Now, my APS is controlled with medication, studies are on-going to see if this condition is secondary to something else (say it softly, Lupus) and I really no longer care how much my premiums are because just my yearly medications cost more than the premiums!

[August55]

Originally Posted by johnmex

my first personal experience with the imss 20 years ago prompted me to buy private health insurance. I had my first kidney stone at the ripe old age of 25(thanks dad!). After arriving to centro medico(the imms headquarters in gdl) and being given an iv and a really hard chair to wait in for 4 hours, i noticed the guy next to me on the floor vomiting blood and no one paying attention to him. I thought...if he isn't getting attention...when will i?

Getting private coverage was, for me, a great decision. Why? About 5 years ago i started getting "something". The something turns out to be aps, a nasty, silent condition that makes your blood form clots and eventually will cause a stroke or heart attack. The system at the imss would not have been beneficial in detecting this condition in a timely manner. In fact, we used the imss as another option in this diagnosis. I ended up at "nutrición" , the imss flagship hospital in mexico city. There, after a week of every test (almost!)known to modern medicine, i was diagnosed as having a std. This diagnosis made my wife (an ent) very suspicious as she tested negative!

It turns out that aps antibodies will give a false positive on tests for stds. As this hospital was the pinnacle of the imss system, what other choices did i have? Well, my private insurance. We looked for more and better doctors, finally finding a rheumatologist who was very good. He sent me to get a test, ironically at the same imss hospital in mexico city, that the imss system "neglected" to order for me (too expensive?). This test confirmed my lack of an std (duh!).

Now, my aps is controlled with medication, studies are on-going to see if this condition is secondary to something else (say it softly, lupus) and i really no longer care how much my premiums are because just my yearly medications cost more than the premiums!

thank you for sharing your experience. Good to hear you identified the aps and there is a treatment. It sounds like the message is everywhere a person goes hoping someone/nation is doing it right for everyone and all concievible conditions is just chasing the pot of gold at the end of the rainbow. I hope things continue to go well with the treatments.

Bob

[DHHawkeye]

Originally Posted by johnmex

My first personal experience with the IMSS 20 years ago prompted me to buy private health insurance. I had my first kidney stone at the ripe old age of 25(thanks Dad!). After arriving to Centro Medico(the IMMS headquarters in GDL) and being given an IV and a really hard chair to wait in for 4 hours, I noticed the guy next to me on the floor vomiting blood and no one paying attention to him. I thought...if he isn't getting attention...when will I?

Getting private coverage was, for me, a great decision. Why? About 5 years ago I started getting "something". The something turns out to be APS, a nasty, silent condition that makes your blood form clots and eventually will cause a stroke or heart attack. The system at the IMSS would not have been beneficial in detecting this condition in a timely manner. In fact, we used the IMSS as another option in this diagnosis. I ended up at "Nutrición" , the IMSS flagship hospital in Mexico City. There, after a week of every test (almost!)known to modern medicine, I was diagnosed as having a STD. This diagnosis made my wife (an ENT) very suspicious as she tested negative!

It turns out that APS antibodies will give a false positive on tests for STDs. As this hospital was the pinnacle of the IMSS system, what other choices did I have? Well, my private insurance. We looked for more and better doctors, finally finding a rheumatologist who was very good. He sent me to get a test, ironically at the same IMSS hospital in Mexico City, that the IMSS system "neglected" to order for me (too expensive?). This test confirmed my lack of an STD (duh!).

Now, my APS is controlled with medication, studies are on-going to see if this condition is secondary to something else (say it softly, Lupus) and I really no longer care how much my premiums are because just my yearly medications cost more than the premiums!

I am not sure is we can relay this information on this blog, but how do we find out more about private insurance alternatives or do you have suggestions?

[mickisue1]

Originally Posted by August55

thank you for sharing your experience. Good to hear you identified the aps and there is a treatment. It sounds like the message is everywhere a person goes hoping someone/nation is doing it right for everyone and all concievible conditions is just chasing the pot of gold at the end of the rainbow. I hope things continue to go well with the treatments.

Bob

THAT is true.

My sister had great private insurance, and access to some of the best care in the world--literally--the Mayo Clinic is only 70 miles from where she lived. But the rarity of her condition, an autoimmune disorder called Takayashu's arteritis, meant that no one, and I mean no one, could figure out what was going on with her for THREE YEARS.

Three years in which she underwent surgery (at the Mayo) that left her with a nasty infection, and a summer spent with drains and a heparin lock for her at home IV antibiotics. A kidney infection that lasted for 6 months, despite the same at home IV antibiotic routine.

The condition was identified, in the usual manner for rare diseases: you rule out everything that it could be, but isn't, and all that's left is the thing that it has no business being. And, even then, it only meant that it had a name, because it's chronic, progressive, and has no cure, and very little in the way of treatment.

When the person who's sick is YOU, or someone you love, you want the best of the best of the best. But the reality is that even then, there won't always be good outcomes, and even with the mediocre, the outcomes are so much better than nothing at all.

For many people in the US, both with and without insurance, nothing at all is the default, because the cost of being cared for, with copays and non-covered diseases, as well as non-covered treatments, is so high as to be prohibitive of obtaining the care, even when available.

To know that one has access to care, even if not "the best", is so much better than many in this country have available.

And that's a sin against humanity, in one of the wealthiest countries in the world. For those of you already in MX, and eligible or not for the IMSS, please remember to be grateful that the country where you live has made access to healthcare a priority over profit.