www.CostaRicaTicas.com

As many of you know, I have lived here for 4 years now and have always labored under the impression that Cima accepts Blue Cross/Blue Shield for in hospital stays and proceedures.

*************** WRONG! *******************

About 7 months ago, I was diaognosed with skin cancer on my nose. The Doc, who works out of Cima advised me that the operation would cost $1000.00 US plus 400 the anatieoligst and 450.00 for him. Well, since I had Blue Cross, I visited the office in the hospital where they told me that, sure Blue Cross would cover it but I had to pay up front. They gave me a bunch of forms to fill out and told me that Blue Cross would pay me about two months after I submitted the forms along with copies of the bills from the Doc and Hospital.

I had the proceedure, paid the bills and submitted the forms to an address in Richmond, Va which handles all overseas claims.

After more than two months, I checked with them at the 800 number provided and they told me that all my claims were denied! Seems that they only cover EMERGENCY proceedures for members who are overseas at the time of the proceedures. They told me that I should have flown back to the US for the proceedure and they would have covered me.

Another myth! Don't beleive them when they tell you CIMA accepts Blue Cross.

LVSteve

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Just an old horney, fat gambler.

In general, U.S. health insurance only covers emergency procedures outside the U.S. You can get travel insurance, which may cover certain other items, but read the policy.

This can be an issue not just when outside U.S. borders, but even when traveling within the U.S. A few years back on a trip to Hawaii, I had a foot problem that was killing me, making it very painful to even walk. After calling my doctor in the U.S. for pre-approval, I went to have it looked at while on Kauai. They gave me some anti-inflamatories, I paid the charges, then filed a claim for reimbursement. Sure enough, the bastards denied it because of the "emergency" provisions, even though I insisted my doctor had given me prior authorization.

Moral of the story - when away from home, stay healthy...

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Check out http://weluvlatinas.com/ for the web's best info on the latin american monger lifestyle...

You should always check with your health insurance prior to having any service rendered, domestically or internationally. Verification by the provider does not normally include exact services being rendered but only that you are eligible at that moment to receive benefits. Later during the processing/adjudication of the claim do you discover that it was denied due to medical necessity, pre-existing, non-covered services, or a host of other reasons.

You pay the premium, so be sure your insurance will pay by calling them to check your coverage.

Personally, I'd be a lot more pissed at Blue Cross than CIMA. How much would that have cost them in the USA? A Hell of a lot more, be sure of that. I worked in the health insurance 'industry' (and believe me, it's all business) and they have massive resources applied to DENYING claims. Even before the invention of the laser printer, they specialized in fine print.

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"The only normal people are those you don't know very well." Joe Ancis

Bilko;
How true! This proceedure would have cost in the neighborhood of $5000.00 in the US. Blue Cross would have covered 80%, so my final cost would be $1000.00 which would be an 800.00 savings to me which would have been wiped out by the cost of the trip north.
LVSteve

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Just an old horney, fat gambler.

In doing some stuff for my Dad, nearly anything that goes through the emergency room at Cima is covered at 100% for Medicare. You must always make sure you enter the hospital through the emergency room.

You must be referring to some sort of supplemental medical insurance your father has.

Medicare absolutely covers nothing outside of the United States except with the very small exception of emergency care in Canada and Mexico when the medical facility in that country is closer than one in the United States.

This has been well documented on such forums as Costa Rica Living, Democrats Abroad, Republicans Abroad, etc. Members of those groups have written to their Congressional representatives pointing out how absurd that policy is seeing as expatriates have contributed to the system all their working lives and as previously mentioned cheaper medical costs abroad wold save the government money.

Members of Congress always reply that presently Medicare is not available outside of the US. Both CIMA and Clinica Biblica tried to get an exception from that policy about two years ago and were rejected.

A lot of info on the Medicare web site. This link covers care outside the United States.

http://www.medicare.gov/publications/pubs/pdf/11037.pdf

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Pura Vida
Only Irish coffee provides in a single glass all four
essential food groups:
alcohol, caffeine, sugar and fat.
Alex Levine

ANY word , positive or negative on Veteran's Health care coverage provisions at Clinica Biblica or CIMA ???


Or last months' ad in AM Costarica for veterans being covered at

www.hospitalcsantamaria.com

Cyg --- old nam vet

Yes, It is some type of Humana add on

Is clinical Biblica a better hospital than Cima?

As far as insurance coverage goes, the problem does not lie with either CIMA or Clinica Biblica, the problem lies with what the insurance companies will pay for.

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"The only normal people are those you don't know very well." Joe Ancis

Is Absolut a better vodka then Stolichnaya?

Same type question. Any answer is going to be subjective and more anecdotal than empirical.

Just to muddy the waters a little more many expatriates claim that Clinica Catolica is superior to either Biblica or Cima. It is relatively unknown because the staff is predominately Spanish speaking only and they do not advertise or solict gringo business as Biblica and Cima due aggressively.

_________________
Pura Vida
Only Irish coffee provides in a single glass all four
essential food groups:
alcohol, caffeine, sugar and fat.
Alex Levine

LVSTEVE

Here is the direct answer from CIMA...I emailed them and asked them because I have a friend that is looking to buy in Escazu. First is my question and below is their answer...Straight from CIMA's Accounting department. Check out the English, I love it...Reminds me of talking to my girlfriend who speaks good english. Gotta give them credit for responding to my email too.

My question was:

CIMA's response was:

Seems simple to me after reading this thread.

Cima accepts BCBS

BCBS pays for emergency care and Cima accepts that as payment.

BCBS pays for non-emergency care based on your policy conditions of contract so Cima wants payment upfront as they have no way of determining what your policy covers.

Why is this so difficult?

_________________
Pura Vida
Only Irish coffee provides in a single glass all four
essential food groups:
alcohol, caffeine, sugar and fat.
Alex Levine