Catalina had to go to the doctor today, and I found myself breathing a prayer of thanks for her timing. It’s always scary to see your kid throw up repeatedly for no known reason. It would have been even scarier a month ago when we didn’t have health insurance.
That’s right. We spent just over a month in Colombia without a health insurance plan. Coming from the US - where a bout with kidney stones practically causes bankruptcy - it’s amazing that we’ve been able to sleep at night without having coverage.
I am exaggerating, but unfortunately not too much. We’re still in negotiations with a public hospital in Miami over a 2-hour emergency room visit that cost my mother-in-law $10,000 in 2007. Just one year later, I was hospitalized for three days in Bogotá, and a private room with food and medications set us back $650. We paid in cash since our US insurance didn’t cover it. What difference a health care system makes.
That’s not to say that health care in Colombia is ideal. While there’s universal coverage for everyone, treatment received depends on how much people are able to pay. Everyone who makes any money at all in Colombia is required to contribute to the Plan Obligatorio de Salud (POS), which costs 12% of a monthly income. The system is overloaded, however, so people covered by the POS and nothing else often wait hours to be seen in emergency rooms, and they may have to wait weeks for a doctor’s appointment. Those who have the means often pay extra for complementary and pre-paid plans that offer additional services like being able to choose their doctors and clinics, seeing a specialist without a referral and receiving preferential treatment in hospitals and emergency rooms.
Since Juan Carlos and I always have worked for employers that offered health plans, we have never had to choose our own company before. The prospect of doing so was both exciting and intimidating, especially with a completely different system that offers dozens of options. I did as much research as I could, trying to find out which plans are financially stable, which plans cover what and how much coverage is adequate for our family. The POS costs around $100 per month, but complementary and prepaid plans range from $220 to $500 per month in addition to that cost. On top of that are a variety of copays for doctors visits and prescriptions. Fortunately most of them are cheaper than what we would pay in the US. The primary factor for the reduced cost is a lower cost of labor, though I would imagine that part of it also has to do with fewer malpractice suits.
I have learned some important differences between medical coverage in Colombia and the US. Complimentary and prepaid plans are graduated. In the first couple months, subscribers can see general practitioners and receive emergency care. A couple months after that they qualify for additional services and elective surgeries. Maternity care isn’t available for seven months to a year after enrollment, and treatment for cancer and other terminal conditions isn’t covered for two years or more. If someone gets pregnant or sick too quickly or has a preexisting condition before enrolling in the plan, they have to pay out of pocket or seek services through the POS system. That’s not always a pretty picture. Finally, the deductible and max benefit payments in Colombia work opposite of the way they work back home. In the US, deductibles and maximum payments are the most that the customer pays. Here they are the max that the company pays.
Our company pays up to a max of 120,000 pesos ($66) per night for a hospital stay. We have to pay any amount over that. If we stay in a hospital that costs 100,000 pesos per night that’s fine, but if we stay in a facility that charges 400,000 per night, we’re going to pay a lot out of pocket. Certain medical centers, depending on the name and the area of town where they’re located, charge vastly different rates for the same services and even the same doctors. We will need to do some investigative reporting ahead of time to know where to send the ambulance!
The enrollment process was interesting. We signed up on August 22 and paid the POS through the entire month of August. Paying that ahead of time qualified us to sign up for prepaid medicine starting September 1. Before we could be accepted for the prepaid medicine plan, I had to get a pregnancy test and a pap smear, which cost 10,000 pesos ($5.50 USD). Our representative sent the results via email two weeks later - so much for patient privacy - and sent plan information and ID cards in the mail. We still haven’t gotten our ID cards. We found out this morning that the POS plan had our mailing address incorrect, so hopefully we don’t have ID cards and plan information circulating in post office limbo.
Having prepagada private insurance helped this afternoon; Catalina saw an appointment within an hour, and the doctor called our house twice this evening to follow up. If we had relied on the POS for service, we probably still would be sitting in a clinic waiting room. Hopefully we won’t have to use most of the coverage we’re paying for, but we still feel better knowing we have it.
I also learned throughout this process the way we’ll be covered if we have one of the most probable emergencies we’ll face living in this city - automobile accidents. Damage from car accidents, and any resulting medical care and disability pay, is covered by the Seguridad Obligatorio de Accidentes de Tránsito, obligatory insurance for transportation accidents. That will cover us if we get hit by a private motorcycle or a public bus. Ironically, on the way out of the insurance building, I got hit by an SUV, a lady backing down out of the parking garage. I screamed and she stopped, but when she tried to pull back up, her standard transmission car popped out of gear and she ended up backing into another car. I was fine, but I was happy to know that the SOAT is in existence. I also recommitted to the fact that we need to buy an automatic transmission car. More about that in another post. For now I’m going to check on Catalina and kiss her poor little tummy.
