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MarkoBoquete

You can't make this up, watch where you step, better medical care for Boquete

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It all started a few days ago when Keith took me to task on this forum for commenting about what was said in a Tuesday Talk without providing full reporting about what had gone on for those who couldn't attend. I agreed with Keith's comments, so I decided to video the talk this Tuesday by Dr. Digna Diaz of the Alpha Clinic here in Boquete. Being a person who seldom needs medical help, I barely knew that the clinic existed, right across from Mailboxes Etc. 

So I did video the presentation, which was excellent and informative, and Wednesday morning uploaded it to YouTube for all to see, thank you Keith. After that I ambled downtown to do some errands and stopped off at Mailboxes. As I prepared to cross the street to return to my car. I stepped up not quite all the way onto the pavement, my heel rocked back, I heard a loud POP and found I was hustling across the street with one leg working and the other about as useful as a stick. Instantly I realized that the Alpha Clinic was only ten meters away, so I hobbled in their door and collapsed in a chair. 

As I knew from just having watched their presentation, the Clinic operates on appointments and is not an emergency room. None of the principal doctors had yet arrived for their 4PM appointments. However, the receptionist was very accommodating and within five minutes an on-call internist appeared and diagnosed my injury. Fortunately it was not as serious as I feared, the nurse gave me a painkiller shot and in less than 20 minutes we were done. All for the princely sum of $25. Later examination by a senior orthopedic surgeon friend who happened to be in Boquete for a dinner party confirmed both the diagnosis and the quality of the doctor who attended to me. 

Leaving the clinic, Dr. Sue and Dr. Diaz had arrived along with a gaggle of mothers and children. I couldn't help noticing the friendly and personal doctor-patient relationships that were expressed. Two of the people in the waiting room had been to the Tuesday Talk and were there to sign up. 

Which brings us to the topic of improved primary clinical care in Boquete. Had my injury been only a little more severe, I would have been schlepping down to David for a visit to an emergency room for an ultrasound, at huge cost in time, frustration and money. Why don't we have this basic equipment in Boquete? 

Medical providers frequently use pre-paid medical plans as a way to raise money to improve facilities and services. In the last two weeks, we have had two plans presented to us - one from the Panamanian-serving hospital Cooperativo in David and this Tuesday, the Alpha Clinic in Boquete. It is not my purpose to do a complete comparison, but having seen both presentations, one huge item jumps out. 

The Cooperativo plan provides discounts on some covered procedures. However, the math doesn't add up. If you purchase the plan direct from the hospital for $120 and receive a 30% discount, it means that you have to spend $400 at the hospital - on covered procedures - before you begin receiving ANY discount - you have to "pay off" your initial payment. For jubilados, the scenario is much worse. Dr. Wong is undoubtably a wonderful and sincere doctor, but this is a structural problem with their plan. 

With the Alpha Clinic plan in Boquete, you pay $200, but that includes three free email consults with each of the principal doctors at the clinic along with other discounts. In short, the doctors are investing their own time and effort to match your financial investment.  If you have chronic medical problems, or had a serious procedure at the hospital and need local followup, this could be worth the price of admission alone. They also provide discounts to Rodny Direct members even if you are not in a plan. 

As the expat population in Boquete grows and ages, there is great need for a fully-equipped primary care clinic in town. If you watch the Alpha Clinic presentation, you will see that they have such a plan for growth and are evolving it to better meet the needs of the expat community. I was very impressed with both their forward-thinking professionalism and the friendly atmosphere of the clinic. 

In Coronado, Rodny's sister helpline, the Panama Helpline, partnered with the local Rotary Club to deploy defibrillators. Maybe it's time for some of our forward thinking expat community leaders to begin working on how we might "invest" in equipping a first-rate clinic that would benefit everyone in town and in the end save us all a great deal more money than simplistic discounts and more ambulances. 

Thanks Keith, without your prodding and an unplanned slip in front of Mailboxes, I wouldn't be writing any of this today - from my bed with my leg up...

Best wishes to all for a great Christmas.

Mark

Edited by MarkoBoquete

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Mark,

I know you pretty well as a friend, and find this kind of personal sharing in a public forum not to be your typical style. Thus I know that you are really pondering and processing all of these related events deeply, and expressing yourself very clearly.

Like all other expats, the both of us are getting older one day at a time. We are heavily insured for health issues in US facilities. We have researched and continue to research and analyze both health care resources and health care insurance options in Chiriquí.

We found it interesting that two security related entities came up with group health care discount programs at roughly the same time. Our analysis of the AAC program concluded that it probably is a good program, but that the numbers don't work for us. And since we already are RD subscribers, that program will come to us with no further outlay.

We know from first-hand experiences that one simply cannot predict future needs. Just short of two years ago we were in Cancun (Mexico) and I came down with a serious MRSA infection in my left foot. Great health care resources in Cancun, and nine days of hospitalization resulted in avoiding an amputation of my left foot and part of my leg. However, that was at the cost of $4,000/day, and involved three rounds of surgery to remove necrotic tissue. Fortunately we had travel insurance that covered almost everything. And then on another trip I broke a toe. Great health care, and again we have travel insurance that protects us financially. However, travel insurance doesn't cover us when we are home in Boquete, and so local programs are important and worthy of serious consideration.

Bottom line here is that our experience makes us strong proponents for doing as much advance planning and risk avoidance as feasible. Credible, detailed information is the best tool that one can use to help make a decision for themselves.

Thanks for your posting. This is serious business.

And so, for the bottom line as to why I am posting this, how can we (in our role as owners/administrators of CL) help you and others get the word out, and assist our community?

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This is serious business indeed. I know from experience. Many of you know the story, but for those who don't here's a brief synopsis. My husband (now deceased) about six years ago shattered his foot in an accident. He contracted a hospital-acquired infection. In total he spent 50 days in the hospital and had four surgeries, not to mention many other procedures (hyperbaric chamber, regular wound cleansing, etc.). This happened at a "gap" time in his insurance coverage, so he had none. The total cost exceeded $70,000. People think it can't happen to them, but it can. And if you're not insured and don't have a high-maximum-limit credit card, you're sent to Hospital Regional at the expense of the Panamanian people and where the hospital care is substandard. I now have complete coverage, less the $5000 deductible for out-of-hospital costs, up to $1,000,000. It's expensive, particularly at my age, but it beats the risk of taking another hit like my husband's misfortune.

Based on the above experience and my own financial calculations relating to these discount plans, I continue to believe that what senior citizen expats need (in the absence of a financial cushion making it possible to comfortably self-insure) is catastrophic health insurance. Most of us can come up with the $12-$20 for a doctor visit, $50-$75 for a specialist, a similarly inexpensive emergency room visit, lab tests, and the like. But a serious illness, a heart attack, or a major accident--anything requiring surgery and/or a lengthy hospital stay--can cost big, big bucks. Even 20-30% deductibles could leave you with a financially ruinous bill or necessitate your being shipped off to the public hospital. My husband's hospital stay preceding his death last summer, for example, cost $36,000 (no surgery), and insurance paid every penny of it, no questions asked. I never even saw the bill. If he had had one of discounted-services plans of 20% to 30% off, I still would have been left with a bill of $28,800 or $25,200.

If you absolutely cannot afford comprehensive coverage, I encourage everyone to join a plan that at least will cover some of your hospital expenses if hospitalization is ever required.

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4 hours ago, Bonnie said:

This is serious business indeed. I know from experience. Many of you know the story, but for those who don't here's a brief synopsis. My husband (now deceased) about six years ago shattered his foot in an accident. He contracted a hospital-acquired infection. In total he spent 50 days in the hospital and had four surgeries, not to mention many other procedures (hyperbaric chamber, regular wound cleansing, etc.). This happened at a "gap" time in his insurance coverage, so he had none. The total cost exceeded $70,000. People think it can't happen to them, but it can. And if you're not insured and don't have a high-maximum-limit credit card, you're sent to Hospital Regional at the expense of the Panamanian people and where the hospital care is substandard. I now have complete coverage, less the $5000 deductible for out-of-hospital costs, up to $1,000,000. It's expensive, particularly at my age, but it beats the risk of taking another hit like my husband's misfortune.

Based on the above experience and my own financial calculations relating to these discount plans, I continue to believe that what senior citizen expats need (in the absence of a financial cushion making it possible to comfortably self-insure) is catastrophic health insurance. Most of us can come up with the $12-$20 for a doctor visit, $50-$75 for a specialist, a similarly inexpensive emergency room visit, lab tests, and the like. But a serious illness, a heart attack, or a major accident--anything requiring surgery and/or a lengthy hospital stay--can cost big, big bucks. Even 20-30% deductibles could leave you with a financially ruinous bill or necessitate your being shipped off to the public hospital. My husband's hospital stay preceding his death last summer, for example, cost $36,000 (no surgery), and insurance paid every penny of it, no questions asked. I never even saw the bill. If he had had one of discounted-services plans of 20% to 30% off, I still would have been left with a bill of $28,800 or $25,200.

If you absolutely cannot afford comprehensive coverage, I encourage everyone to join a plan that at least will cover some of your hospital expenses if hospitalization is ever required.

Sage advice, I think, Bonnie.  Just wish I could follow it.  I began looking before I moved here last June, but at age 70 (now 71) found that the comprehensive plans (Worldwide, PALIC, etc.) cost from $500 to $1,500 per month with quite large deductibles ($10,000 to $25,000 as I recall).  And the Chiriqui Plan seemed only good for small emergencies (though I still may opt for this plan) for the first 12-36 months, and then maybe something more comprehensive after 24-36 months.  Since I maintained my Medicare coverage in the US, and since the HMO plan that administers Medicare for me will pay up to $20,000 when traveling outside the US, I've so far decided to take the risks and self-insure to a certain extent.  But I'm not comfortable with that.  So do you have any further recommendations that I might investigate? 

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Hmmm. I have Worldwide Medical Assurance, I am 72 years old, and I pay $4,165 annually. Perhaps the difference is that I signed up prior to my 70th birthday? Or maybe my insurance agent was able to get a better deal?

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I “invested” 26 years of my life in military service. In return, I was promised a pension for life and free medical care for life. The pension is working out okay and will continue to do so unless and until the US government runs out of money. The “free medical care” turned out not to be the case. It might come close if I lived near a military medical facility where I could be seen, generally with secondary priority after active duty personnel, to which I would not object. Failing that option, which has not existed in Panama since 1999, I need an approach that works where I live. The option didn't practically exist where I lived in the US because the nearest military medical facility was about 75 miles away. I have coverage that has a $3,000 annual deductible (scheduled to increase to $3,500 in 2020) and, beginning in 2018 a $300 annual registration fee (set to increase based on inflation). In effect, what I now have is “semi-catastrophic” coverage. So my “free” medical care only costs me $300 per year if I stay well. (And it keeps me from paying a fine for not having Obamacare!)

 

It's also true that processing claims via a government contractor is not much fun, particularly in an area that does not have a numeric code to cover all sorts of symptoms and diagnoses. My wife had one moderately expensive major surgery, and the claim for it was paid. The only real reason for processing claims for lower cost services and procedures is to establish credit on the deductible. I usually just don't bother with it.

Two or three years ago, without realizing it, I became dehydrated by walking around the feria in David for hours. That night I had severe leg cramps to the extent that I could not walk and also diarrhea. The combination is pretty disastrous. We used the private ambulance service because they send a med tech, who in this case administered an IV immediately and maintained it all the way to the hospital.  I was seen in the emergency room, given more IV's for hydration and placed in a hospital room. I was at the hospital for about 12 hours overall. The hospital bill was a few hundred dollars. I forget the exact amount. With the Hospital Cooperativo plan I would probably have paid around $150 or less. The top cost for a hospital room there with the plan discount is $49. The emergency room fee under the plan is $7.50.

Though we have insurance that covers us here and worldwide, we will be using the AAC-Hospital Cooperativo plan for our routine and low to moderate cost services. The $150 (or $125 for family members) cost is low and properly is compared to net costs at other facilities AND to the deductible of any insurance you may have. There is no point in paying higher than necessary prices just to satisfy the deductible sooner.

As I have written before, for people who can easily afford to pay high premiums, it is a perfectly reasonable thing to do.  But every year those $2,000 to $5,000 premiums are gone forever, whether or not you have had any payable claims. For some people it makes a lot more sense to put the premium amount in a separate savings account, add more to it every year and use the low cost Hospital Cooperativo discount plan for routine, lower-cost services. If something quite expensive comes up, you will have cash in the bank to pay with or, if an emergency is not involved, money with which to return to the US for Medicare service.

Sometimes the “pearl of great price” principle may apply. It can be worth a lot to have a good, long-term relationship with a hospital and with a doctor or group of doctors you trust and who know you and your medical history. It's worth even more if the cost for their services is low and then discounted. For several years in the US I used a doctor who did not accept assignment of my insurance. But he and his office staff were so good and efficient that it was worth it to me to just pay and go on with my life.  Even if you have good insurance, if the deductible is high, the Hospital Cooperativo plan can make good sense.  If you don't have good insurance, it makes even more sense.

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Yes, "[e]ven if you have good insurance, if the deductible is high, the Hospital Cooperativo plan can make good sense." But for those who have jubilado status, don't forget that you cannot use both your jubilado discount AND the plan's discount. (As I understand, the same is true for the Rodny Direct and Alpha Clinic plans.) Both the law and the HC plan offer 20% discount on doctor visits, for example, so you gain nothing. You get an additional 15% off on hospital visits, however, and an additional 10% on drugs purchased at the HC pharmacy in David. With emergency room visits discounted 50%, putting them at $7.50, you save 35% off the regular HC cost. The question you must resolve is whether these savings are likely to offset the cost of the plan. This holds true for the Alpha Clinic plan as well (although it has the advantage of being local and the disadvantage of providing no hospitalization coverage).  One of the advantages of the Rodny Direct plan is that there is no recovery cost. The initial cost of $80 is, and has been for some time, the cost of Rodny's services. The RD/Mae Lewis plan is a bonus provided RD members.

Everyone should run their own calculations, taking into consideration their legal status, personal health, financial situation, and risk tolerance before choosing any health insurance plan. If you anticipate that your medical needs may be many but not significant, and/or you want to establish a medical relationship locally, the local Alpha Clinic plan may fit you best. The Alpha Clinic plan also may be preferable for those who take a lot of medications and don't want to go to David to have them refilled (although, I feel compelled to observe, every time I've gone to the Danka Pharmacy it has not had the medication I sought). If your doctor practices only at Hospital Chiriqui, neither the HC nor the RD plan may be right for you. And jubilados in particular should carefully examine the value of the discounts offered compared to the cost of the plan and to the discounts already provided them by law.

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When our grandson dislocated his shoulder one evening during his recent visit, we immediately took him to the Alpha Clinic.  It was locked and dark.  There was a lighted sign with phone numbers.  We called those numbers, only to discover they were not in service. 

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There is another aspect of this health care discussion that I feel should be included. When facing a critical health challenge then you typically are not in a position to negotiate or ask for more details. 

It has been our experience that hospitals/medical facilities outside of the USA require money (cash or credit card) at time of treatment or admission. In some cases they may start treatment but then require progress payments, and in most cases full payment before discharge. This even when insurance coverage is verified and approved.

It is good if you have insurance, but again based on our experiences, unless (a) you, (b) the care provider, and (c) your insurance carrier coordinate and get firm commitments, then the paperwork burden is yours. Another gotcha is that sometimes the documentation provided by the care provider may come up short by the insurance carrier's standards. That means you end up underwriting the expenses yourself. Make sure you get documentation that your carrier will accept.

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21 hours ago, Bonnie said:

Hmmm. I have Worldwide Medical Assurance, I am 72 years old, and I pay $4,165 annually. Perhaps the difference is that I signed up prior to my 70th birthday? Or maybe my insurance agent was able to get a better deal?

Yes, it must be because you signed up before you were 70.  I contacted Worldwide Medical and was quoted (at age 72) $5,400/year with a $5,000 deductible.

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7 hours ago, Brandy said:

When our grandson dislocated his shoulder one evening during his recent visit, we immediately took him to the Alpha Clinic.  It was locked and dark.  There was a lighted sign with phone numbers.  We called those numbers, only to discover they were not in service. 

I'm confused.  What is the Alpha Clinic?  I can't find that mentioned in Rodny's plan or AAC.  I thought Rodny's was for Mae Lewis and AAC's was for the Cooperativa.

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51 minutes ago, JudyS said:

Yes, it must be because you signed up before you were 70.  I contacted Worldwide Medical and was quoted (at age 72) $5,400/year with a $5,000 deductible.

I double-checked and found I was wrong. I accidentally pulled out an old statement. My last premium, which I paid in October of this year, was $5,131.20. Still less than you were quoted, though.

Edited by Bonnie

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1 hour ago, Marcelyn said:

There is another aspect of this health care discussion that I feel should be included. When facing a critical health challenge then you typically are not in a position to negotiate or ask for more details. 

It has been our experience that hospitals/medical facilities outside of the USA require money (cash or credit card) at time of treatment or admission. In some cases they may start treatment but then require progress payments, and in most cases full payment before discharge. This even when insurance coverage is verified and approved.

It is good if you have insurance, but again based on our experiences, unless (a) you, (b) the care provider, and (c) your insurance carrier coordinate and get firm commitments, then the paperwork burden is yours. Another gotcha is that sometimes the documentation provided by the care provider may come up short by the insurance carrier's standards. That means you end up underwriting the expenses yourself. Make sure you get documentation that your carrier will accept.

This is an excellent point, Marcelyn. Unless your insurance company/plan has an established relationship with the hospital which provides that they pay the hospital directly, you are responsible for payment and then seeking reimbursement from the company. I assume this would apply regardless of any discounts you may have received. So you may still need substantial cash or a high maximum credit card if the hospital bill is high.

When I moved to Boquete ten years ago, I had international insurance issued by a company and broker in the U.S. Even had my husband had the same insurance at the time of his accident (he didn't qualify), I still would have been out a lot of money for a long period of time--not to mention the many hassles associated with insurance reimbursement, particularly when the records are from a different country and in a different language. The medical codes also probably are different. I have no doubt that any money I received would have been a long time coming. If the insurance company doesn't have a relationship with the hospital for direct payment, you face the same reimbursement problem. Reimbursement always has issues, I have found. Even with my husband's comprehensive coverage, I directly paid for a private ambulance when he was hospitalized last summer. I submitted the invoice for reimbursement back in July and still haven't seen the money. (We're disputing whether it is part and parcel of the hospitalization or subject to the deductible.)

Another thing I realized from my husband's experience is the importance of having an in-country medical advocate. There not only is the language barrier; there is all the medical terminology in a language that is not our native tongue (in most instances). Given these two recognized issues, I changed my insurance to a company with a presence in Panama and a relationship with the hospitals in David, and I found an insurance agent who ably runs interference when needed. I note that all three of the plans discussed in these threads (HC, RD, and the Alpha Clinic) all offer some form of help in this regard.

Edited by Bonnie

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44 minutes ago, JudyS said:

I'm confused.  What is the Alpha Clinic?  I can't find that mentioned in Rodny's plan or AAC.  I thought Rodny's was for Mae Lewis and AAC's was for the Cooperativa.

Judy, read Mark's above post again. And watch the video he provided of the Alpha Clinic's presentation at the Tuesday Morning Meeting. It is a third plan, offered by the local Alpha Clinic. Besides their own plan, Mark reports (above) that they also offer discounts to RD members.

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Guys, I might be wrong but I think the name of the clinic is "Alfa" and not "Alpha".

That might be part of the confusion.

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Of course. "Alfa" would be the Spanish spelling of "alpha." Mark and I both should have known better.

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15 hours ago, Bonnie said:

I double-checked and found I was wrong. I accidentally pulled out an old statement. My last premium, which I paid in October of this year, was $5,131.20. Still less than you were quoted, though.

Judy, further on this point. The $5000 deductible does NOT apply if one is hospitalized. You would be responsible for out-of-hospital expenses up to $5000, but any hospitalization bill is paid in full by Worldwide Medical Assurance. That's why I call it catastrophic insurance. You pay for occasional $15 doctor visits, $20 lab costs, etc., up to $5000 (which you likely will never reach), but if your condition requires hospitalization, the insurance completely takes over. If my husband had had this insurance throughout his two medical crises, he would have paid $20,000 for insurance while his hospitalization expenses were roughly $106,000. The insurance will be less expensive, of course, for those younger than you and I.

Edited by Bonnie

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Thanks for that information Bonnie.  I am 73 now, so I suppose the premium will have increased even more.  There is also the option to self-insure for emergencies (use your own funds), then go to the U.S. and use Medicare for follow-up and non-emergency treatment.

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Several postings in this topic were split off into a new topic because of a change in subject matter. No problem here, and not complaining.

Here is a link to the new topic:

 

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