Recently, a member of my church put himself in the able hands of the medics because a cancerous lump had been detected in his insides and needed removing. I will protect his privacy by calling him Mr. Blitzen.
Mr. Blitzen checked himself into one of our more popular private hospitals, correctly alerted the insurance company – INS, or the National Insurance Institute, in this case – that he was going to undergo a surgical procedure, and everything was hunky-dory. So the surgeons did what they had to do, which unfortunately was more than expected, and poor Blitzen was confined to the intensive care unit in an induced coma.
A few days ago, I got an alarmed call from my pastor, who was worried because, as we all know, ICUs are not cheap and he was not sure how much insurance Blitzen had. Was it going to be enough?
Although Blitzen is not one of my clients (I am going to speak to him most seriously about this in a few weeks), I was able to find out that he has a most suitable type of policy, “INS Medical Regional,” which provides $200,000 in coverage per person per year. In Costa Rica, despite our escalating medical costs, $200,000 is still quite a lot of coverage, so I was able to reassure my pastor by telling him I thought Blitzen’s policy would be adequate.
Now we come to the bitter bit. Yesterday I got calls from my pastor and also from a friend of Blitzen’s who is watching over him, saying that, according to the hospital, Blitzen’s insurance policy needs to be paid in the next couple of days or they will stop all further care.
Now this is pure hogwash. Following Article 15 of the General Conditions of the INS Medical policy, the insurance starts paying for treatment any time within the policy year, and must continue paying for that ailment until the patient is cured or until the coverage (moneywise) is exhausted. In other words, for example, somebody can have a serious accident on day 360 of his policy year, and payment of treatments will commence at that time and will continue until the patient is cured or until his $200,000 runs out, whether or not the policy renewal is paid for by day 365. Of course, it behooves him to renew his policy, but that is something else. Repeat: Article 15 states that payments of ongoing treatments will not stop even if a premium for policy renewal goes unpaid.
Things are slightly different if the premium of a medical policy is paid semiannually or quarterly. If an “interim” payment is skipped while a patient is undergoing treatment or has a claim in process, the amount of the premium for which payment was omitted is deducted from the final payment of the claim. Once again, coverage will not cease, so care must not be discontinued.
So what happened in Blitzen’s case? Two theories: The lower-level personnel of the hospital didn’t know what they were talking about, as I can hardly believe the administrators of a serious hospital would risk “pulling the plug” on a patient, with all the legal consequences this might entail; or Blitzen’s insurance agent is thirsty for commissions, and has misinformed the caregivers as he wants to scare Blitzen into paying the premium ASAP. I don’t expect to be able to get to the bottom of this – all exchanges so far have been verbal and, typically, everybody will deny everything.
The opinions expressed are those of the writer. Our purpose is to give the reader a better understanding of insurance in Costa Rica. For information, contact David Garrett at 2233-9520 or [email protected]