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opinion
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The Other Side of ParadiseA health insurance primerby Susan Hahn My husband and I find ourselves like so many other expats, in that no man’s land of being retired and not having health insurance as we look toward our 60’s and beyond. As I look at the postings on various Internet groups, I see that this lack of health care is perhaps the greatest concern for people deciding to relocate to Panama. It’s a real problem, so I thought I’d relate our experience and that of friends who have attempted to tackle this dilemma. Good health care is definitely available in Panama City and David, the largest cities in Panama. I understand there are adequate clinics and a reasonably good hospital in Changuinola in the Bocas Del Toro Region, and probably in other areas as well. Our home is on Isla Colon in the town of Bocas. Here, the hospital is woefully inadequate and certainly unclean, as I know from an experience I related in a previous article. This is also probably the case in many smaller communities. For most ongoing health care, insurance really isn’t necessary. The cost of lab work, medication and emergency room services, is very reasonable and most expats can get their needs met with a minimal outlay of cash. I know people who live here in Bocas and do just that. They go to David to have monthly blood work done, treat infections if they arise, and care for chronic medical conditions with a minimum of travel and expense. These people seem highly satisfied with the kind manner and level of care they receive from Panamanian health care providers. From what I hear, dental care is also quite good, especially with a few Panama City dentists who treat many expats. I know Dr. Charlie Garcia is used by many expats throughout Panama, and I intend to contact him myself for regular preventative dental work. I have had problems with eyeglass prescriptions being accurate, but the provider has been gracious in fixing the problem at no extra cost to me. What concerned us most was the possibility of some catastrophic illness or accident that could cause us to lose our home and what resources we have for our future. Like many other expats, we sold our home in the states, our greatest resource, to come here to Panama. If we lost our new home here, we might have to return to the states and the specter of becoming a burden on our children or society in general just is not in our plans. So for us, health insurance was a necessity. When we reached that conclusion, we discovered that we had two main options: international health insurance or domestic health insurance. Since Medicare would kick in about five years from now, we thought if need be, after five years, we could go to the states for treatment of anything major. If we could just stay healthy for five or six years, it might be enough to get by with a local health insurance policy for now. We attempted to contact a well-known and widely advertised insurance broker. However, our emails were not returned for quite some time. I kept trying, because this person seemed to be well thought of. Finally I spoke with him. He told me he had a person working for him who handled domestic health insurance and that she would call me. In the meantime he attempted to sell me one of two very expensive international policies, even though I was adamant that I wanted the local only. I did study the international policies he linked me to on the Internet and related to him that they were too expensive (many thousands of dollars annually), and that we wanted a local policy only. We never heard from him or his employee again. So I asked a Panamanian friend who referred us to his Mundial Insurance agent in Panama City. This gentleman was gracious, efficient and knowledgeable. He showed us various choices such as a large deductible catastrophic coverage and a slightly more expensive prevention-focused plan. Both of these policies were relatively inexpensive (about $600 a year) for the coverage and could be used in hospitals and with preferred providers throughout Panama. We filled out the application and proceeded with thorough physical exams arranged through Hospital Nacional in Panama City. In less than 2 hours we both had urine analyses, EKG’s, blood workups and an interview with a doctor at the hospital. My husband had an extra blood test for prostate, something given to all men over 50. For all this we paid close to $200. After about 3 weeks without hearing anything we called the agent who told us that other tests were needed for both of us at a hospital in David. We would have to see a specialist, again at our own expense, because of the result of one of the tests we both took. Let me say here that both my husband and I are very healthy. Before we came to Panama, we had clean physicals while still insured in the states. We take no on-going medication and have no on-going medical conditions. We questioned the need for further testing and my husband, becoming uncomfortable with the outlay of money, decided not to continue with the process. I agreed. I had heard good things about the individual hospital plans offered by Mae Lewis and Chiriqui Hospitals in David, so I set about to have interviews at both places. Chiriqui Hospital had a prevention-based plan that was very inexpensive, but with minimal coverage and a $15,000 cap. I had visions of open heart surgery wiping us out, so I passed on that. Hopefully they will improve their coverage in the future. I was impressed with the facility, although for serious surgery, we would have to go to Panama City. I skipped Mae Lewis only because I thought their policy might be similar to Chiriqui Hospital’s and decided to check in with an insurance agent first. With the help of a translator, I was sold on a very good and reasonably inexpensive domestic policy. As we got deeper into the nuts and bolts of the policy, she seemed to switch tracks and was selling me an international policy…at about 5 times the cost. When I questioned this, she told me there was no local policy available to me because I was over 60 years old. Also, the international policy was very good, comprehensive and required no medical examination. Now, I know bait and switch when I see it, and even though I was carrying the printed results of our physical examinations taken less than a month before, the idea of no more physicals and my husband’s distrust of the system which required more and more cash outlay for the physicals, made this option seem most attractive. The international policy was with American Life (or Pan American Life in the States). It had evacuation coverage and a low deductible of $1,000 in Panama and $2,000 if used in the United States. There was no choice as to the amount of the deductible. The policy covered catastrophic illness and regular physical exams with a very low co-pay. The cost for both of us was around $3000 a year. I wrote a check for half the annual cost, signed the application and took another application home for my husband’s signature. All this occurred in late May. I have yet to receive any membership cards, preferred provider lists or the written policy itself. Upon inquiry, it seems that the agent never sent the second check to the insurance company. When we discovered that, we made sure it was indeed sent to the company in Panama City. Still, we heard nothing. We were then told that the company had never received my husband’s part of the application, so we sent another application to Panama City. Last week we got a phone call that the company needed complete copies of our passports, so for about $30 we faxed that to them. We are hoping that soon we will actually have health insurance and that it will not be predated back to May, since it was unavailable to us then, and still is unavailable to us now. In the meantime, last month I had a bout of probable dengue fever and had to visit Mae Lewis Hospital to take care of the migraine headache that was part of that misery. I’m fine now. The care at Mae Lewis was wonderful. Not being insured, I paid cash for it. It’s too bad that there is a two-year waiting period for mental health coverage. But be on notice…. I’m saving up and I intend to get my money’s worth in 2008!
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