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Monday, August 11, 2014

HEALTH CARE IN ECUADOR - IESS HEALTH INSURANCE - Our first IESS Doctor Appointment!!



When we first moved to Cuenca, Bo and I decided to be "self insured" for our medical needs.  We figured if we kept the money we would have to pay for monthly health premiums in our own account, we would come out ahead - due to the low cost of medical care here.  Most insurances we had inquired about wanted at least $100 a month per person (way less expensive than the high premiums in the USA) and the coverage wasn't that great - plus the paper work and hassle to get reimbursed was not a smooth process.  We decided that $2,400 in the bank per year would cover more than enough of our yearly medical bills.  But, what if we had an emergency?  A BIG emergency???

Sometimes we sail through our life by faith.  We have been back to the USA three times without any medical coverage.  Yes, it's risky - but, we've been okay so far.  As for medical coverage in Cuenca, that's different.  To spend a day or several days in the hospital is low enough for us to pay out-of-pocket if we had to.  Yes, it would be a big chunk of money, but we could do it.  Then I heard about the IESS Government insurance.  For a few months it was blocked from ex-pats being able to apply for it, and we missed that window of opportunity.  Around March of this year it became available again for ex-pats, and I jumped on it and got Bo signed up with me as his dependent.  However, the rules were changed.  Now, there was a three month wait for coverage from the time we were entered into the computer.  Bo's monthly payment would be $70.04 and mine would be $11.59, for a total monthly medical premium of $81.63.

For the first three months, the payments were for Bo's coverage only.  My payments then began in August.  We are now both covered 100% for all of our medical needs:  Doctor appointments, lab work, x-rays, ultrasounds, prescriptions, eye, and dental (the DENTAL covers us when we turn 65).   So how does it work?

1 - Once your 3-month waiting period is met - you call the IESS phone # (07-413-4555) and ask for your first GP doctor appointment.  I told them I wanted a doctor in El Centro, so they scheduled Bo at the IESS Consultorio building near Parque Calderon (we love walking to everything - even our doctor appointments!!!).  On Friday, we met with Dr. Marco at 7:15 am.  He was kind, attentive, and thorough.  Of course, going to a doctor appointment here is so painless.  No waiting, no paperwork to fill out.  The doc does all of that in front of you on his computer - and it's minimal and to the point, "How can I serve you, and why are you here today?"  No privacy act rules, no secretary or nurses or other patients waiting in adjacent rooms!  He does it ALL and you're it for the entire appointment.  He asked Bo why he was there, we told him all Bo's concerns, he ordered labs, an ultrasound, and scheduled Bo for his specialist appointments and physical therapy.  He checked Bo out for a couple of GP issues, gave us our future appointment instructions, shook our hand, and we were out the door.  No papers to sign, no money to pay - just a friendly "Gracias."

2 - We were given a slip of paper with three different numbers.  We went to the pharmacy line, gave them the paper, and they gave us Bo's prescription.  Free!  We then went to the lab area, gave them the paper with the other two numbers, and they entered two appointments into the computer for Bo's lab work and Ultrasound.

3 - Today we walked back over to the lab (same building as our doctor).  We stood in line for about 5 minutes, Bo's turn came and they sat him down and drew his blood - free.  His results will be back on Thursday, and he has a follow-up appointment on Monday with Dr. Marco to review his labs.  He is also scheduled next week at the IESS Hospital for physical therapy and in September he will go see a specialist at the IESS hospital.

4 - The next appointments we will make will be for eye care and to have Bo's hearing checked.  The procedure is the same.  The General Practitioner doctor will schedule these appointments during Bo's Monday visit.

5 - The appointments are important to keep.  If one has a medical emergency during the waiting period, you can go to any hospital and supposedly IESS will cover your medical care there.  I have heard conflicting stories about this - so I need to verify this information.  Sometimes the pharmacy does not have the prescription required, so one has to go to another pharmacy (plenty of those in Cuenca) and pay for the prescription.  Because medication is so inexpensive here, no problem!!

6 - Are the doctors as good as the ones practicing outside of the IESS Government Insurance?  Absolutely.  Our family doctor in Cuenca, Dra. Rosita, told us that she would be an IESS doctor but because she doesn't have handicap ramp access to her office (you have to climb stairs - yes!) - she was not approved.  I think some doctors like that monthly fixed income paid to them by the Government.  We will still see Dra. Rosita if we need her medical expertise.  She is brilliant, kind, and charges $10 per visit with free follow-ups.  We love her!  For now, we are establishing our medical care with IESS so we are in their computer system.  Then if and when an emergency occurs, we will have that 100 percent coverage.

Yes, for less than $1,000 a year medical insurance premiums and 100% medical coverage, it's worth it for us to go through the system.  Nothing fancy here when it comes to hospital care.  You don't get a private room, you provide your own personal care items for your hospital stay,  and you're not pampered and charged for every little thing like back in the USA.  The important thing is the quality of care - and we have heard only wonderful things about the care and treatment others we know have received from the IESS doctors.  Is it like the USA?  Of course not!  Don't come expecting a USA doctor-hospital experience.  But, do expect to receive quality medical care from excellent physicians.

If you are a legal resident of Ecuador and have a Cedula, you are qualified to apply for IESS Insurance.  Application for voluntary enrollment can be made at the Social Security office in Cuenca on Gran Columbia  (Instituto Ecuatoriano de Seguridad, or IESS).  You can also sign up on line at www.iess.gob.ec.  

We embrace the medical benefits and care we continue to receive here and we are thankful for a country that offers us, as ex-pats, the opportunity to be a part of their Government health care benefits.  Another reason we love living in Cuenca!!


12 comments:

  1. Praying for Bo's health, that all goes well. Thank you for your post. Paulette

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  2. Apparently it doesn't like Google+. I was asking for your permission to repost your article on WelcomeToEcuador.ca.

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    1. Hi Gary,
      Yes, if you link back to my BLOG, you are welcome to post this article. Let me know.
      Linda

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    2. This is important information to know after what happened to me at Mt. Sinai hospital. The "happy " rule is not to have high expectations and don't have an emergency. The illness that took me down is something we all are carrying and most don't even about it. I didn't I hit the hospital floor with no blood pressure and although the care was good trying to leave though fully insured and paying the 20 percent was not good enough. So they confined to my room and had security sit on me. This was a nightmare that is apparently common in Cuenca. So the IESS is a must have and you must have everything at your fingertipslike phone numbers, friends to call. Getting blood is challenging, you must pay $65.oo to give your blood and then take it to the hospital. I will make recommendations that may solve this North American need after I get on my feet as well as explain the bug we all carry. Have to do more research because I don't know if what I was told is accurate although it has been confirmed by many. I hope all is well with Bo and am at your disposal if need be. Mike W.

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    3. Hi Mike,
      I was troubled to read about your illness and hospital confinement - and I pray you are home and healing. I assume from your comment that you are not covered by IESS? I am very interested to know more about this "bug we all carry" and also what health insurance you are covered by that the hospital would not recognize - or did they just want the full 100% and then have you deal with the reimbursement? Lots of questions. Bo is well, just some routine concerns that we want to address before they escalate. Thank you for your honest comment. I would like to know how you are recovering. It is important for all of us to know the best route to take when it comes to our health insurance and care here in Cuenca. Your information and recommendations would be helpful. Feel free to comment with more on your personal experience so it can help others who read this post make informed decisions for their own insurance and health care needs. May God bless you with His divine healing,
      Linda

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  3. Thanks for sharing, Bo & Linda. And glad to hear that it's nothing too serious, Bo. Take good care, amigos : ) We're just finishing our 3-month waiting period. We managed to do the signup part on our own--just a little back and forth/confusion when it came time to pay our premium as I was unclear on a minor detail--but all went really well. We'll try our first appointments this coming month. Did you opt for auto-debit from your bank account or are you paying in person each month? We tried to set up auto-debit starting this month but it didn't work (yet). Not sure why--perhaps just be a timing issue, perhaps we just missed the cutoff date when we set it up. Will have to look into it. In any case, thanks for encouragement and support to all. Appreciate everyone's insights!

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    1. Hi,
      Not sure who this is - but thanks for your comment and glad you have your IESS covering you now. We do not do auto-pay here for any of our bills. We would rather pay monthly ourselves. We go to the Western Union caddy corner to the IESS building on Gran Columbia and pay our IESS monthly (due by the 15th - we pay by the 10th). Yes, do your appointments so you are in the system and have a go-to doctor. If you request a doctor near your area, they will accommodate you - they did us. Best to you, whoever you are!!!! Do we know you???
      Sincerely,
      Linda

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  4. Hi Linda and Bo:
    I live in Quito and always try to read GT in Cuenca for the 3 years I have lived here in EC. Lots of useful and helpful info here. I appreciate your clarity and your story about signing up, waiting periods, getting services, etc.in the IESS system. I have had lots of problems with the computer system and need to sign up asap. Iam single and have sort of given up trying. Can you PM me at sueb4bs@yahoo.com and tell me the ropes? In late August I will be back home in QUito and have to get signed up then. Can you help me?
    Many thanks...

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  5. Hi Sue,
    Let me know what you questions are, and I will be happy to answer them only from what I know and have experienced signing up for and using our IESS insurance.
    Sincerely,
    Linda

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  6. My saga continues as Mt. Sinai holds my documents in lieu of something. My insurance carriier said they made arrangements with the hospital but they reneged on the deal. It will be officially a miscommunication. I learned that the local government reads these blogs and was quite upset over two in particular. This is not a place you can say what you want. For example I could not tell you to avoid a hospital even if I backed it up, in fact I cannot even tell you events.
    You explanation on the IESS was great. I know three others who are in a similar situation as me, actually worse because of residency issues underlying their inability to get IESS. Right now I am walking a razor's edge because I have no financial reserves. So I would advise 3 things to anyone in EC or thinking of EC. 1. Don't get sick. If you are healthy you will be able to see the beauty of the trees. 2. You must have a credit card to help you in any hospital emergency so if you are healthy and wealthy read no more you can look at the tree. I have a dear friend who only sees the tree while I see the guy standing behind it. 3. As soon as you get here, get insurance and the residency. This reminds me of the 60's in the US when ERs refused patients wo funds. I understand the argument, the methodolgy is the issue.
    Other suggestions are the 'buddy system' and close friends. I think the expats need to devise a plan to protect our health. So many come here unprepared and receive information that does not assist them or maybe no information given will assist them. We are strangers in a strange land ( Heinlein, sorry) and we must do the adjusting.
    Once I get my strength back I hope to suggest some protections for all who live here.I have a blog site I will dedicate to this information.

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    1. Thank you Mike,
      For your story - and for finding this post helpful regarding IESS Insurance. Unfortunately, we cannot plan not to get sick . What we can plan for our family is to have the insurance that will see us through those unexpected illnesses. I'm thankful we live in a country and area where we can become healthier because of the wonderful foods available to us, and also because of the exercise and healthier lifestyle. However, this is all a personal choice. We can all become correctly informed if we do our research and ask the right questions to the right people. There is no reason not to have the medical resources available to us here if we plan wisely.
      Get well soon and may your testimony of the reality of your sudden illness and emergency hospitalization become positive and helpful information for others forging their way here. Bo and I have found the residents here to be helpful and encouraging - and when we take responsibility to do our homework we usually get our answers. My advice to others reading this - Plan ahead and be ready for any medical emergency that comes along.
      Sincerely,
      Linda

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