Know the Law in Mexico
A Series by Adriana Perez Flores © 2005, All Rights Reserved
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Medical Coverage and Hospitals

In an effort to educate as many people as this column can reach, we touched on many legal issues surrounding our lives in Mexico. Our office deals with many issues that we are faced with each and everyday. Some of these issues can be quite serious, and we can get stung either because of our trusting natures, or because our Spanish skills are weak. Whatever the reason, some people have inadvertently been caught up in some problems they wish not to have.

When it comes to health care, we all want the best possible coverage we can afford, and needless to say the options can be staggering, whether it be from the different benefits offered, or by the costs involved. When looking over these policies, please read the fine print. Even though it may be a full service medical plan, some things may still not be covered. Also, make sure you meet all the requirements set out by the insurance company, otherwise you may be dropped when you need the actual coverage.

Many individuals obtain IMSS coverage, which is a great affordable option for medical coverage here in Mexico. However, some applicants have been informed to lie on the application about pre-existing conditions. This is a serious no-no. Doctors are not fools. They could discover the problem if something happens to you where you will require IMSS. We have had clients who have explained their pre-existing conditions with the IMSS doctors and have not been refused coverage. There were some limiting conditions, but overall coverage was not affected. This will apply to any insurance plan you decide to purchase.

While reading all the fine print in your applications for medical coverage, make sure you also pay very close attention to the pay schedule your insurance plan has. When speaking with a representative of the insurance company, they will tell you that certain procedures are covered, but sometimes fail to mention how many dollars they will pay for a certain procedure. Insurance companies take an average of what these fees are from many different sources. This can be an issue when you think you are fully covered, and you choose a high end hospital, have the procedure completed only to find out that the insurance company will only pay X amount of dollars for said procedure when in fact the hospital charges 3 times that amount. This can leave you with a substantial bill.

We must also be careful from the hospital end. Make sure you get specific details from the hospital including all extra costs involved with your stay. For example, if your going in for an angioplasty, find out what ALL the costs are, not just the procedure costs, but the support costs as well. We had a client quoted $50,000 pesos for an angioplasty, which was acceptable, but the final bill came to $130,000 pesos. All the additions included the room, nursing staff, surgeon, and on and on.

When these types of fees are charged by a medical facility, they are going to want a guarantee of payment if you can't pay upon leaving. Please be careful what you sign with these facilities, especially if you are a relative looking after the patient. In some instances we've had clients asked to sign as a witness (Testigo) on one of these bills, but they actually signed a statement that read "El Aval", which actually means you assume responsibility for the cost, if the patient defaults.

If you sign such a document, it doesn't matter what false pretenses someone might have had you sign it under, you ARE responsible. And this rule applies to anything you sign whether it be a deed, lease, or contract of any type. We must keep vigilant about these matters. It is always better to be informed and protected before hand, because it will always cost more and be more of a problem afterwards.

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Adriana Perez Flores is an Attorney at Law based in Ajijic, Jalisco for legal and immigration services throughout Mexico.
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