More on IMSS &amp; pre-existing conditions

More on IMSS & pre-existing conditions

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Hello,
Are there anyone who has a pre-existing condition that is listed on the question form for applying for IMSS - and got either turned down or accepted?
I have a pacemaker, which I have had since quite young and it gives me no problem and is not caused by a chronic degenerative disease. But, I will have to have a new one every 8 - 9 years.
Any information?
Also, any idea how much a private insurance run?
Thanks

Feb 21, 2011, 10:06 AM

Post #2 of 23 (6605 views)

Re: [leeza] More on IMSS & pre-existing conditions

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I know someone who was turned down for IMSS for declaring arthritis as a pre-existing. This was in Jalisco, and ten years ago, but I am sure it is even stricter, and the system more stressed, than it is now. I know someone who was recently declined a quality private insurance because they declared under control high blood pressure as a pre-condition. I know one good company which will insure with no preconditions, for $150 (dollars) per month, $1,000 deductable, but there cutoff date for enrollment is age 60 or lower.

I appears to me, and I may be wrong, that a lot of people hire IMSS facilitators, or insurance agents, to guide them through, and then hope for the best. It would be pretty difficult to 'fudge' a pacemaker though, especially as it would effect so many other procedures (MRI for example).

(This post was edited by Sculptari on Feb 21, 2011, 10:16 AM)

Memo

Feb 21, 2011, 10:13 AM

Post #3 of 23 (6601 views)

Re: [Sculptari] More on IMSS & pre-existing conditions

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Could you name this insurance company please?

Feb 21, 2011, 10:27 AM

Post #4 of 23 (6595 views)

Re: [Memo] More on IMSS & pre-existing conditions

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Allianz. They have good hospitals onside. Think of it as catastrophic insurance that you hope you will ever need. The hospital will require a $1,000 deposit, then insurance takes over from there. I would check the fine print, but I believe an Emergency Room visit with a same day discharge is not covered. Prescriptions and regular doctor visits are not covered, at least at this lowest rate.

Another good way is an interest bearing deposit to cover unexpected medical expenses, every year have a 'life celebration' party, spending the interest for that year. Carrot and stick - I like it!

MazDee

Feb 21, 2011, 10:44 AM

Post #5 of 23 (6586 views)

Re: [leeza] More on IMSS & pre-existing conditions

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Here in Mazatlán, I understand that persons with pre-existing conditions are accepted, but the pre-existing conditions are not covered for the 1st 2 years of enrollment. In your case, I think it would be helpful to use a facilitator who is familiar with IMSS in your area. The "rules" seem to be different every where, and possibly are applied differently in the same location!

Feb 21, 2011, 12:43 PM

Post #6 of 23 (6561 views)

Re: [MazDee] More on IMSS & pre-existing conditions

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I know many people in Mexico who receive IMSS as an employee benefit will take into account the reputation of IMSS service in that area before deciding to take a job. I know of a government employee who moved from Jalisco to Nayarit because one of his sons required a lot of care (autistic, I think).

Also, upon reading of IMSS experiences over the years, it becomes apparent that you may have to retain a 'specialist' who of course speaks very good Spanish, but also has the personality and status to push things for you. This is even after two years. Mexico still remains a "not what you know, but who you know" society. Of course cash is king in nearly any society, but health care, education and worker's rights touch upon some political sensitivities unknown to most us from Canada or the U.S.A.

tonynico

Feb 21, 2011, 1:09 PM

Post #7 of 23 (6547 views)

Re: [Sculptari] More on IMSS & pre-existing conditions

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This is what i read also that pre existing conditions would be covered after a period of time. But on another thread someone stated that pre existing conditions are a no go no way no how
I hope their wrong

Tony

Feb 21, 2011, 1:48 PM

Post #8 of 23 (6528 views)

Re: [tonynico] More on IMSS & pre-existing conditions

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If you are going to go the IMSS route - get on it as soon as possible, any way possible, and hope you are never going to need it for at least a couple of years. That's where your 'hope' should lie. It would usually be quite difficult, expensive and time consuming for IMSS to make a case for non-declared pre-existing conditions.

I am giving this warning because there are those in the corridors of power who believe, quite strongly, that 'rich foreigners' should not be given access to a health care system heavily subsidized by Mexican employers (private & government), to benefit workers and their families. These are the same lines of political thought that have struck down capital gains exemptions for FM3 visas (FM3 is/was clearly identified as a long term, temporary resident visa). If the PRI recovers power in 2012 - this will be a move to the 'left'.

Vichil

Feb 21, 2011, 1:54 PM

Post #9 of 23 (6522 views)

Re: [Sculptari] More on IMSS & pre-existing conditions

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FM3 is a long term tourist visa not resident. FM2 is resident.
Why would anyone "hurry" to join a system that is going bankrupt and runs out of medecine now that it is even more in trouble is beyond me.

Feb 21, 2011, 4:18 PM

Post #10 of 23 (6488 views)

Re: [Vichil] More on IMSS & pre-existing conditions

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I think Vichil, and her fine furry friend(s), found good success with this strategy. Find a good, full service insurance agent and then get your auto, home, and health insurance from him (or her) making it worthwhile for them to pay close intention to your needs. A good insurance agent is like gold in Mexico for expats.

Memo

Feb 22, 2011, 6:58 AM

Post #11 of 23 (6403 views)

Re: [Sculptari] More on IMSS & pre-existing conditions

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People will hurry to sign up for IMSS because it is significantly cheaper than private insurance. While there are some problems as you mention, youre most important consideration is a good doctor. As you know, they are the same doctors who work in IMSS and private hospitals. So, you can get a top notch doctor for cheap.

Personally, I wouldnt put any more faith in the private insurance companies than IMSS considering their motive is purely profit and they are likely to take advantage of any trick in the book to deny you care.

If youve got the money of course get your private insurance and then IMSS on top of that just in case the evil corporate empire tries to bury you for a few bucks profit.

morgaine7

Feb 22, 2011, 7:14 AM

Post #12 of 23 (6393 views)

Re: [leeza] More on IMSS & pre-existing conditions

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A Mexican-American couple I know got turned down. IMSS said they weren't required to provide an explanation and didn't. The husband thought it might have been his blood pressure medication, though the condition is under control. His wife had no medical issues at the time. Both were 59-60, and this was in Baja California Sur.

Kate

Feb 22, 2011, 8:04 AM

Post #13 of 23 (6377 views)

Re: [morgaine7] More on IMSS & pre-existing conditions

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The incentive to work for IMSS is the pension plan. An employee or medical professional is eligible to receive a pension at 53 years old, of about $1,500 (dollars) per month. The average Mexican worker, if they are even covered has to wait until 65 years, and receives about $200 per month. When Vincente Fox became Presidente, he tried to reform IMSS and hell broke loose.

Feb 22, 2011, 8:18 AM

Post #14 of 23 (6372 views)

Re: [morgaine7] More on IMSS & pre-existing conditions

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When an IMSS thread gets going on one of these forums, it's usually filled with reports of someone else's experiences, rather than first person accounts. This is not really very helpful to the rest of us.

Why? because usually, there are parts of the story untold. For instance, what if a couple who were turned down were obviously morbidly obese? What if the blood pressure being "under control" was due to daily doses of drugs, and might have been through the roof without them? What if the cholesterol levels required daily doses of drugs?.....etc.etc. I'm not saying this is the case here, but we're not hearing from the horse's mouth, either.

When spouse and I signed up over three years ago, there was a long questionnaire about our health, including what drugs we were taking. (In our case, none). Our doctor had told us to sign up for it as a backup to paying out of pocket for care, but he and the facilitator said that there was hardly anything covered for the first year, and not much else until after the third year.

I'd like to hear directly from people who had NO pre-existing conditions requiring drugs and their experiences with IMSS, both in obtaining the services and using them. We haven't yet used it for anything, so we can't provide any info.

Feb 22, 2011, 9:37 AM

Post #15 of 23 (6341 views)

Re: [Gringal] More on IMSS & pre-existing conditions

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Gringal, with respect. You have what sounds like a very hospitable doctor, probably well liked, a facilitator, and perfect health. It is extremely unusual for both of you to get into your 50's without some medical baggage. It would be like joining the Catholic church and declaring you have never, ever, committed a sin!

The person turned down for IMSS was my mother, who declared the arthritis in her fingers. You have lived in Mexico long enough to know that rules are a very liquid thing. It goes to the very core of Hispanic thinking. If an IMSS admin clerk feels that 'rich foreigners' should not be able to receive IMSS benefits, well, that's that. Move on to work around it. IMSS is a 'privilege' after all - heavily subsidized health care. Private insurance is a business - if you put $10,000 in, I don't think they would mind putting $5,000 out.

This is a very important issue, especially for Canadians. I would venture that the number 1 reason they reluctantly leave Mexico to return to Canada is because of spiraling medical costs, especially as you get into your later, senior years.

Feb 22, 2011, 12:59 PM

Post #16 of 23 (6296 views)

Re: [Sculptari] More on IMSS & pre-existing conditions

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With respect also, Sculptari, the picture is not quite to rosy, but perhaps it is because we take a different approach to our health care than many others do. Neither of us smokes at all or indulges in alcohol to excess. This helps. However, back in the states, one doctor told my husband to take lipitor for cholesterol numbers: he took nopal and made dietary changes. The numbers plummeted. Another told me to take a drug for thinning bones: I increased my walking regime and now it appears that very drug has a detrimental effect instead. Still another wanted to perform foot surgery: I went to a sports medicine specialist and changed my footwear. Cured, after several months. Another wanted to prescribe blood pressure medication: I changed some diet and exercise habits. I could go on; but no, we do not have perfect health and get our fair share of colds, amoebas, other digestive bugs and so on. Doctors mean well when they over-prescribe for conditions that lifestyle changes could repair; what one of them said was simply "people won't do it." So, it's more work than taking a pill: IMO, it's worth it.

If you PM me, I'll pass on the name of the OTC enzyme that works for many people with arthritis. It might help your mom.

Yes, we have a very nice GP in town who treats people like people. We hope we never have to use the IMSS system (MASH, without incoming artillery, it is said) but it is there in case we are in a serious disaster.

(This post was edited by Gringal on Feb 22, 2011, 1:01 PM)

Feb 22, 2011, 4:09 PM

Post #17 of 23 (6256 views)

Re: [Gringal] More on IMSS & pre-existing conditions

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Good for you Gringal - over the years I have grown to admire your spirit and intelligence, I can see now that this hunch was not misplaced.

It is a cruel joke in our society that it seems like you have lots of money, then no time - or - no money, and lots of time. It seems like when the choice is health, or wealth, that people often choose wealth - and then begin to regret their choice. I know I do, and in the end I am not even wealthy! For me, I can't wait to get back into fitness and nutrition. What I hate up here, in the 'most liveable city in the world' is driving to the gym in a cold, wet car.

I think for my mother mental outlook is very important. She enjoys the assisted living place they are in because of my father (he is 83) but complains that all the people talk about there is their latest ailments and treatments. I don't hear her complain about arthritis, I think she just thought she was supposed to mention it to IMSS.

My wife and I are looking forward to our move to Puerto Vallarta. We arrive just in time to live in the center of the 'carnivale' celebrations and I just realized today that within a couple months we will have a pirate ship parked in our front yard. Now how cool is that!??!

Feb 22, 2011, 4:30 PM

Post #18 of 23 (6247 views)

Re: [Sculptari] More on IMSS & pre-existing conditions

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ROFL. We have plenty of "pirates" around here, but it's waaaaay cool to have a pirate ship! Enjoy.

Marlene

Feb 25, 2011, 11:16 PM

Post #19 of 23 (6062 views)

Re: [Vichil] More on IMSS & pre-existing conditions

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I agree with you, Vichil. The system is over taxed and in crisis. If anyone cares to see what their future might hold in an emergency situation at an IMSS hospital, I encourage you to pay a visit before signing up. Note the rules as to visitors and times if you stick around that long. Aside from that, to get in and see an IMSS doctor on a routine visit, is a circus. If you have lots of time on your hands, and are fearless, it might be fine for you. Myself, I would rather see the low paid working class of this country get the benefits they are entitled to, and not have to sit in the hallways for days on end waiting for emergency care.

(This post was edited by Marlene on Feb 25, 2011, 11:23 PM)

Feb 26, 2011, 6:10 AM

Post #20 of 23 (6023 views)

Re: [Marlene] More on IMSS & pre-existing conditions

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It's would just be so much nicer all around if everyone had boundless options.
But.....that isn't the case, is it? I think it's safe to assume that most people do the best they can with what they have to work with.

The sorry truth is that no expat in his/her right mind would rather use IMSS health care than have a full coverage insurance policy that would allow for treatment from the best doctors and hospitals, but there are barriers to this happening for some expats. First, there is an age barrier. Most insurance companies won't insure anyone over a certain age at all. Then, there is the financial barrier. For some expats, the cost of good health insurance is greater than the amount they're paying for rent, and then some.

The other sorry truth is that this issue didn't occur to some people before they decided to move to Mexico and leave Medicare behind. Health care is one of the most important considerations for those contemplating such a move.

Pity the poor souls who have a very limited income AND pre-existing conditions. Maybe they would be wise to hitch up the wagon and head back NOB.........if they can find an affordable place to live up there.
the phrase "Mexico isn't for everyone" is true on many levels.

Memo

Feb 27, 2011, 10:55 AM

Post #21 of 23 (5883 views)

Re: [Gringal] More on IMSS & pre-existing conditions

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The doctors in IMSS and the private hospitals are the same very doctors.

IMSS sucks for small stuff, but is good for serious ailments.

It is no frills.

People complain about stupid shit like they have to bring their own pillow. Give me a break.

It costs a couple hundred bucks a year for cancer treatment, transplants, open heart, etc etc etc.

prorader

Mar 5, 2011, 2:30 PM

Post #22 of 23 (5566 views)

Re: [Memo] More on IMSS & pre-existing conditions

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There are other ways for Mexican medical care. I had a very bad truck accident about 8 months ago, had to go through the state free clinic and referred to the state general hospital. One thing is true the doctors all free lance the private hospitals and clinics, I guess that is some how there pay back. But was seen by a lady internal medicine doctor who was wonderful. I was then referred by her to the public hospital in Guadalajara and there Nuro surgeons. I ended up spend 23 days total in this hospital in a 6 person ward but the entire medical staff was as good as any that I have ever seen. The food sucked but for what I paid small price. The doctor said I had 4 fractured vertabraes but he was also a contract specialist and they where hosting a nuro seminar and the surgery was offered for free, the plate and screws where also free. I was the big show operation, I didn't mind I was sleeping. Now 23 days in the hospital, a 6 hour nuro surgery including parts and 4 follow up visits end up costing me about $800.00 US total. Now it wasn't easy you have to fight the system which is the social workers that decide how much you pay. Then I was able to walk away. The key is the Social workers they decide how much you pay and how much they pay. Be aware the term general or free hospital is not true. U need xrays U pay they do the xrays, U need an MRI or Catscan U pay they do inside the hospital is aways cheaper if U can get it done same with lab work, and of course my partner lady slept on the floor next to my bed, and fed me, and showered me and the other stuff. But over all the nurses, and trainees, and staff doctors where as good as any place that I have ever been in. I also use the state clinic for general medical care, flue shots, colds and other stuff, cost less than $50 pesos, the doctor is good and speaks some english what a deal

(This post was edited by prorader on Mar 5, 2011, 2:37 PM)

Mar 6, 2011, 8:39 AM

Post #23 of 23 (5456 views)