Insurance

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Interview with Myriam Casas Ortiz

International Insurance Manager and Chief Coordinator. In health. Medical codifier

Company: Consultora de Cirujanos

Myriam what insurance is accepted in Consultora de Cirujanos within the AmeriMed Hospital?
We accept all national and international insurance, to mention some: Bluecross operating in the U.S., Canada and Europe.

What is the process performed when a foreign patient arrives for an emergency to the Hospital?

Admit the patient to the hospital and give him the attention that he requires at that moment. The first step is to safeguard the life of the patient, if the patient is accompanied we ask information to his family, if it is not the case, when the patient is in condition for giving information we approach him to solicit the necessary information to contact his insurance company and open the case.

How should the patient be prepared in case of an emergency?

Have with him an insurance card, ID or passport, a guarantee of payment (credit card) this helps us streamline the paperwork with the insurance company regarding the conditions of the insurance policy.

Tell me about the Brokers and your relationship with them.

We work with several companies, the broker companies which are intermediaries to primary insurers, are responsible of verifying the conditions of the Policies for sending the benefits and ensuring the originated accounts for medical services rendered to the patient. for example an insurance company in Europe, due to time differences, needs to use an intermediary company , which can be located in this part of North America and due to their closeness, it is easy to coordinate the necessary arrangements. We link through internet, Skype or phone calls.

How long does the process for the payment of medical service take?

In the agreements and payment guarantees, it is stipulated that they have 60 days to verify the case, once they receive medical records, invoices, the total cost of medical and hospital fees, they are ready to send payment.

What is the process?

In patients from the U.S., before being discharged by their physician, we explain that the procedure with their insurance company is in process and that it is necessary to make a guarantee payment, in the case of applying a deductible or coinsurance charge, a check-in is performed to their card, not a charge but they can use that amount while it is processing. When there is a charge, the patient is notified before realizing it and he is sent proof of it.

In the case of Canadian patients, once the full payment of the invoice is sent to the insurance company, the voucher closes in zeros, since most insurance companies from Canada don't handle a deductible. In the guarantee payments come the conditions of the policy and the amounts that patients must pay for the deductible or coinsurance.

How can a person know what kind of disease is going to be covered by the insurance?

They must verify the conditions in which they acquired their policy. Most insurance companies do not cover pre-existing conditions. It is not up to our administration to authorize medical cases, but it depends on what the insurer gives us permission to do.

In which cases does the insurance not apply and in what kind of illness?

Cancer, Parkinson's Disease, Alzheimer's, bariatric, plastic or elective surgeries and dental services.

How do foreign insurances operate?

Foreign insurance companies have doctors and nurses that certify the information that is sent in the medical reports of the patient's condition and treatment to follow. In coordination our doctors make sure that each case is handled properly. Whenever the submitted information is verified, they authorize the treatment and ensure payment for the services rendered.

When surgery is needed, the insurance company is notified and we wait for prior authorization before carrying out the procedure. If it is about life and death, the procedure is obviously performed and then we make arrangements with the insurer, the priority is to safeguard the patient's life.

Some companies prefer to transfer the patient to their home and are responsible in coordination with our management and medical staff to do everything necessary to ensure that the transfer is carried out without any problem for the patient or family member. In many cases it depends on the patient, if he wants to be treated here in our hospital facilities.

What about people who travel on boats?

We have agreements with some of the shipping companies and often there are patients who come to checkup and before docking the boat, we already know who comes to checkup and who comes to emergency surgery.

Can foreigners buy a policy in Mexico and what insurance is handled here?

If they can buy policies of major medical expenses and have international coverage. Most have a direct agreement with our administration and medical specialists.

What would you recommend to foreigners about insurance?

Mainly to inform themselves before purchasing any type of policy, and in what refers to emergencies, they need to use the insurance to cover hospital expenses and not pay for them directly to the person in charge of advising about international insurance.

What is the support for Medical Tourism?

Consultora de Cirujanos, supports medical tourism offering advice to use and accept foreign insurance policies. Here we have packages for any specialty surgery. With this we help people who do not have an insurance policy, who have a high deductible or simply can not wait for treatment in the place they are.

In Consultora de Cirujanos, we are up to date in order to address and bill other companies, which have no infrastructure to manage and handle cases with foreign insurers.
Can you give me an email where they can access and communicate directly with you?
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