Expats from the United States often arrive in Costa Rica expecting that the U.S.-issued health-care insurance they carry with them will provide no-hassle protection here. In many cases, despite assurances before moving here, expats receive a nasty surprise when they encounter a serious medical problem.
Although a policy might cover a needed procedure or treatment, local hospitals, clinics or doctors may not accept it, and before rendering treatment – even in an emergency – may require the patient to pay either a hefty co-pay or the full amount up-front. This can leave patients and their families scrambling for funds, sometimes necessitating the foregoing of a treatment until payment is found.
One of the groups hardest hit by this policy are retired U.S. military and disabled veterans. Back “home,” this group is well provided for with military and Veterans Affairs (V.A.) hospitals strategically located around the U.S. For those who aren’t in close proximity to these installations, or for various reasons choose not to use them, the federal government has established a program called Tri-Care.
Tri-Care is essentially a health insurance program limited to qualified military veterans and dependents. Most U.S. hospitals and doctors honor the program and put up with the sometimes complicated and frustrating claim-filing processes, often waiting months for payment for the services they have already delivered. In some instances they even have to settle for a smaller payment than the billed amount, eventually collecting the difference from the veteran.
In cases where the doctor, clinic or hospital doesn’t honor or file for Tri-Care payments, the patient must pay and then file a reimbursement claim.
Tri-Care eligible patients can follow that same procedure in Costa Rica, but possibly due to large amounts of fraud in some various overseas locations, or because the person filling out the forms isn’t an expert on filing claims, recovering money a patient has already spent is a slower process, and sometimes reimbursement is even denied.
It wasn’t always that way. In the past, major medical centers in Costa Rica accepted Tri-Care patients and filed their claims for them. Some of the reasons for this include: millions of dollars in unpaid claims, slow payment by the Tri-Care claim processing sites, disallowed claims due to a minor technicality in the filing, and payments significantly less than the amount claimed. Whatever the reason, today many medical facilities in Costa Rica have stopped taking patients who have Tri-Care, except on a cash basis.
For patients without large cash resources, this can be a real burden, including dealing with international banking rules that complicate getting the money transferred. It entails many hours spent filling out forms and making international phone calls, as well as delays and charges for money transfers.
At the time of this writing, Clínica Bíblica Hospital and Cima do not take patients under many U.S. insurance plans, including Tri-Care, unless the particular provider guarantees payment. There are some insurance policy issuers who do this, so it’s best to know what your policy will or will not do in Costa Rica before needing care.
There are other options that expats can take advantage of that can mitigate their health-care payment concerns. First, and most obvious, is to apply for residency and join Costa Rica’s Social Security System (Caja).
Joining the Caja, as it’s popularly called, is a requirement for residency. Costs are minimal and based on income and the number of family members. Being enrolled provides access to complete care under any circumstance at Costa Rican national hospitals and clinics. Additionally, expats can always purchase private health insurance.
For travelers, many companies sell trip insurance. Travelers planning on staying longer than a short vacation can buy private insurance policies locally or back home.
Previously, travelers already in Costa Rica had only one source for private insurance, the National Insurance Institute (INS). With the advent of the Central American Free-Trade Agreement with the United States, or CAFTA, several new companies are now exploring and entering the market.
For expats who want more than just a policy to cover them in a time of need, a primary care clinic has recently arrived that acts as a gateway to private doctors and hospitals, similar to how an HMO or PPO operates in the U.S. This facility, however, can go further than many U.S. primary care providers.
Operating under the name Sinai Clínicas Médicas (not associated with Sinai Hospitals in the U.S.), it has top-quality physicians on staff, and the medical director is U.S. board certified. The clinic has resources to do blood tests for a metabolic panel, glucose, lipids and annual exams on-site. They are also equipped to do mammograms, EKGs, ultrasound, pap smears, minor surgical procedures, stress tests, electrocardiograms and echocardiograms in their offices.
More serious health-care needs and specialized treatment can be managed through an arrangement with specialists (who mostly operate at Hospital Cima and Clínica Bíblica). In addition, a network of specialists, pharmacies, laboratories and other medical services offer discounts to Sinai members.
Sinai Clínicas Médicas is a member-based organization that charges monthly, based on the size of the family being enrolled. It is owned and operated by U.S. investors, and its clean, modern offices are operated at U.S. standards. Most of the staff is fluent in English, something extremely welcome to many expats living here.
For patients with insurance, Sinai will file Tri-Care or other insurance company claims for their members. Sinai cannot, however, provide members with assistance to hospitals that do not accept U.S. healthcare insurance. For more information, call 2248-1280.
Another option is La Católica Hospital, which will accept many U.S. insurance plans. It’s important to check with them for the current list of providers before making appointments. Their International Health Insurance Department can be reached at 2246-3147.
For veterans, La Católica Hospital will accept Tri-Care patients through an organization named Veterans Care International. VCI has an office in the hotel adjacent to the hospital and will process Tri-Care claims. Additionally, they can assist all U.S. veterans with other services, including applying for new or renewed military ID cards, obtaining private insurance, or finding other health services available to veterans.
VCI has been in business for ten years, their staff speaks English, and they have extensive experience in all aspects of military health care. They can be reached at 2246-3509.
For help with filing insurance claims, including Tri-Care, some businesses will help customers fill out the appropriate forms for a fee. One of those businesses is Collecting and Claims Management. CCM is an international company with offices in Costa Rica and Panama. They’ve been in business for 12 years and have extensive experience with filing claims with most major international health care insurance companies. Most of their staff speak English and will gladly assist North Americans.
If you know in advance that you’ll need medical treatment, making a quick call to CCM might a good idea. They have a list of doctors, clinics and hospitals that will accept foreign insurance policies with billing through CCM, and they’ll be happy to help patients avoid paying up-front for health care.
They can also help with reimbursement claims during a medical emergency. For more information, call 2242-4797.
Regardless of what brand of personal health insurance you carry, if you plan on visiting Costa Rica or already live here, it’s always good to check with appropriate local health-care providers to ensure they’ll honor your policy. Relying on what you may have been told back home could result in serious financial consequences and lack of treatment here.
Allen Dickinson, a native of Oregon and Florida, in the U.S., served 23 years in the U.S. Navy before moving to Costa Rica in 2006. He can be reached at: humphree@bellsouth.net.
