Posts Tagged ‘insurance’

Rounding third base during a pre-season baseball scrimmage game where we shut out the competition by an obscene margin, I ruptured my achilles tendon. I didn’t know what it was at the time, but it felt like someone had kicked me in the back of the leg, and then all of a sudden my foot didn’t work anymore. At first I thought I had been beaned again, since I made it to first that way (and now have a nice bruise on my inner thigh to show for it), and I thought to myself, “By God, if they frigging beaned me again I am going to tear someone’s spine out and shit down the hole.” And then the pain hit, things started getting fuzzy, tunnel vision, and I hobbled into the dugout to spend the rest of the game icing my ankle. We still won, despite being short-handed to begin with.

Then began my expedition through the Chilean health care system.

After waiting 48 hours to see if it was just a bad sprain, it was clear that it was not. Stuff was flapping around as if it was disconnected, and that’s bad. LaserBob showed up to visit me for a vacation in Chile just in time, “Hey, we can’t go anywhere since I am a cripple, and I can’t drive either. Fun!” But bless her heart, she has helped drag my immobile corpse around town to throw me to the doctors. So I went to find a leg injury specialist to see what was wrong.

My health insurance works sort of like a PPO, where you have a “home clinic” and are mostly covered for stuff that will happen to you there. It provides partial coverage for “out-of-network” stuff and international. So I went to my home clinic and they had no specialist consults available there, but set me up with one the same day at another branch across town.

He took one look and said, “Yeah, that’s bad,” and told me to go get an ultrasound and find out where exactly the tear was. So we then checked the ultrasound availability, but there were none until the 21st (this is the 9th, more or less). He told me to go to the ER, in that case, since this is not an injury you want to wait more than 10 days or so to get fixed. He wrote “Urgente” at the top of his order for the ultrasound.

Total cost for the specialist consultation: US$19.00

And so to the ER I went, where I had to wait for about 4 hours but got my ultrasound. They verified that my achilles was wrecked, and I would need surgery to fix it. They then recommended a doctor to go see about this specific injury, gave me his phone number, and told me to call in the morning. They also issued me a Frankenstein Boot to wear.

Total cost for the ER visit, before insurance coverage: US$336.37
Total after insurance coverage: US$170.16. That includes the boot for which I will have to be reimbursed, so if you take that out, then the cost was $96.84

I called the doctor in the morning, and set up an appointment to see him the next day. He had already been informed of my case. And so I went and saw him, and he told me about what would need to be done to fix my tendon. Then we made an appointment for surgery, and I was issued a set of diagnostic stuff I would need for the anesthesiologist: blood tests and ECG.

I also got an estimate for the whole procedure, from the hospital, and for the whole thing, including surgery, recovery, etc, the cost I would have to pay out of pocket if I had no insurance, was just US$2831.24. After consulting with LaserBob and MomBob, who are both medical people, they both figured that the cost for the same thing in the USA would be at least $30,000.00. Probably more. Saved by a factor of 10.

But wait, there’s more. I also went to the insurance booth to find out just what they would cover for this operation, and they said they would cover 100% of it. Score!

There is a little diagnostic place right next door to where I live, so I went there to do them.

Total cost, diagnostic blood work and ECG: US$27.70

Arriving early in the morning on Saturday, at the hospital admissions desk, DeskTrollBreaucratLady did not want to let me check in because I was missing some stamped paper from something.

“Am I in the system there?” I asked.

“Yes.”

“And the entry is scheduled, with this procedure, with my name?”

“Yes.”

“And you have my ID which proves that I am who I am, and I am here, to undergo this procedure, which the hospital has scheduled in their system.”

“Yes. But I cannot admit you without the blahblahblah paper.”

“Well I am not going back home to get it. As you can see I do not get around easily, hence my presence here.”

Now in Uruguay, the story would have ended here, with me not getting my surgery, and the hospital wasting thousands of dollars while doctors and staff sit around a prepped ER waiting for a patient who won’t show because the desk jockey simply refused to admit him, and to hell with the urgent surgery to prevent him from being a cripple for life, you are breaking the rules and must not be permitted to enter, you filthy yanqui capitalist!!!

However, she found a way, and summoned her precious paper from the aether. But she came back with a new form for me to fill out because she found “making money” an unacceptable entry under employment, on the one I had already filled out. I could not conceive how marital status or type of employment had any bearing on getting hospital treatment, but she wanted it all her way and the forms must be completed or the planets will fall out of alignment, fire and brimstone falling from the sky, dogs and cats living together, mass hysteria.

“Are you sure I can’t put Super Hero on here?”

She didn’t laugh or even smile at that. “This is a legal document.”

Which makes me wonder which tribunal I would be called to testify in, where I would be chastised and told I cannot have this operation because I am not, in fact, a super hero.

Once we had passed beyond Checkpoint Charlie, the surgery went quickly and efficiently; it was done within an hour. I did not fit well on the operating table, and so they modified it by adding arm holder thingies to better support my upper body; I was hanging precariously off of both ends. It was a source of giggles among the staff; they are not accustomed to working on ogres. They sedated me after the spinal block, not before, which I thought should have been done the other way around. I could hear my heart beeping rapidly, which did not help calm me either, while they stuck the needle into my spine. Regardless I felt no pain and the procedure was well-done; I was mostly conscious through the whole thing and could see that they took good care of me.

Rolling me over and transferring me to a gurney afterwards was also a source of giggles, since I could not move my lower body and they all had to have a conference to plan how they were going to go about it. They finally agreed to put a sheet under me and take their places; 6 people gathered around, counted down, and slung me onto the gurney.

The supervision ward afterwards was a bit stressful, since there was a child in there who was scared and wailing nonstop. They should have wheeled him into somewhere away from the other folks. Seriously, it went on for the entire 3 hours I was in there. The supervision ward lady kept asking me if I had the urge to pee, and I kept telling her that no, I did not feel the urge, and I could not feel anything below my waist. She seemed surprised I didn’t have to pee, and kept hooking me up to new IVs. Once I could prove I had control over my legs again, they wheeled me out to my own private room, where it was another 3 hours or so before I gained full control over my extremities, and my bladder 🙂 I swear, peeing out all those IVs was the longest pee I ever had in my entire life, longer than the press conference pee scene in Naked Gun. LaserBob, who was there to drag me home, and the nurses present, were all giggling as I counted off “cinco litros… seis litros…” I have to admit I found amusement in it, not just for its standard excrement humor, but because I could not believe my own neverending bladder capacity.

The doctor came in to check on me before I was discharged, and made an appointment in a week’s time to have a look at how it is healing, and start my physical therapy. Then we waited for another hour while crutches were signed out of the bureaucracy and the wheelchair guy came to take me to the taxi stop outside.

So, total outlay to fix my ruptured achilles tendon: US$216.86. And that’s before I am reimbursed for the FrankenBoot. This medical insurance costs me about US$200 per month to maintain.

“Go home, go straight home, and go straight to bed. Stay in bed for at least 2 days. No moving furniture, no going outside to the hardware store, no painting the apartment. You are young and otherwise healthy and you Polakos are built like tanks, but look at yourself. You have a temperature of nearly (102F/38.8C), you can hardly breathe, and sweat is pouring off of you in sheets. And you tell me that you haven’t eaten or slept in 2 days because you cough all night and have lost your appetite? Frankly I am amazed that you made it all the way out here under your own power and are still able to stand.”

DoctorBob had valid points, all around. OK, I’ll go home and do nothing for 2 days, but I don’t have to enjoy it.

“According to these chest x-rays, you don’t have pneumonia. Yet. So get some rest. You’re in bad shape.”

He gave me a laundry list of stuff for the pharmacy and made sure I understood what does what, to get better fast. DoctorBob works in a clinic across town, and I needed to take a combination of metro, buses, and taxis to get there. I found him through the IntegraSalud website and recommendations for a good lung-and-throat doctor who specializes in respiratory funk in Santiago. These clinic websites tell you which specialist is going to be at which clinic when, so you can make an appointment with them online and just show up. Efficient, and it works. I waited max 30 minutes initially, had a very good consultation, was sent down for chest x-rays, which had maybe 5 minutes wait, and then back up for the final words which you see above. This was my first experience with the health care system in Chile, and it was a positive one.

The only weird and extremely South American part came when I went to check in at the front desk, and the lady there told me I had to use the little number-issuing kiosk to take a number. I looked around, there was nobody in line with me, maybe a dozen people sitting in chairs waiting who had already checked in. So I went to the kiosk, punched in my info, got the little printed ticket, and then instantly my number came up on the screen behind the desk, and assigned me to the same lady who had told me to use the kiosk. Riiiiight…

I was not able to use our Fonasa coverage, which technically kicks in once we are earning a salary here, because I never went in to activate it. Could have gotten me some discounts. As it was, I had to pay out of pocket, which cost me about CLP$38000 each for the consult and the x-rays (about USD$160 total). Not cheap but VERY cheap compared to what it would cost in the US, and much better care. In February, our Isapre Aleman plan kicks in, by which we will pay about USD$450 additionally per month to cover both myself and WifeBob, for excellent coverage. To put it into perspective, WifeBob’s old plan in the US was costing us $350 per month just to cover her, and only for severe accidents (no clinic checkups, no preventive stuff, only covers you if you lose an arm or something). To top it off, her plan was made illegal by Our Dear Leader so it’s got to be cancelled anyways.

Last night was a show of crazy fever dreams. Almost as good as mushrooms. I was being whisked around in a Lazy River of sorts, my body held up by an invisible inner tube under the arms, lounging through s-curves of slowly moving water that I could not see or touch, but it held me up in the sky. I passed through groves of melted black plastic geometric shapes which morphed, as if there was a fibrous structure inside which changed fractal shapes, nested inside a sticky melted tar-like goo. Fascinating.

Then I was in someone’s front yard at night, which was haunted. As we walked up their driveway, a mirror silhouette of a man sliced itself into existence with a metallic scraping sound at the top of the driveway and started advancing towards me. There was another guy there, a sort of generic bearded war correspondent cameraman movie extra, who tried to run past it, and as it slid past him it sucked the life out of his body in a Tesla-like display of electric sparks which glowed at the edges of the mirror silhouette and then faded, the lifeless corpse falling to the ground behind the advancing mirror. Then the sound started, reverberating noise like my head was in a rumbling exhaust pipe, the mirror getting closer and closer… This must have been inspired by my reading of Tesla’s diary of experiments with light and electrical fields being effected by the weak bioelectric/biomagnetic field that human beings give off, which I had read about before bed. Fascinating.

Then the next dream I am in my grandparents’ house constructing the set for the previous monster movie, when the folks there decide to have a costume party, so we go to the local convenience store where they have bags of candy with wigs inside, so I buy the bag with the afro wig, and decide that my costume will be Wilt Chamberlain. “But you’re white,” they tell me. Naysayers! Once everyone has their stuff I try to herd everyone back into the car and nobody wants to leave.

About 3 weeks ago I received a call from a representative from our home insurance company in Uruguay, with information about the upcoming expiration of our homeowners policy and how to deal with the bill payment. As I had wanted to find a new, different agency, but had run out of time, I simply let it slide and decided to renew it. So I explained that I am leaving within 48 hours and have no time to deal with running around doing bank deposits, so can I do it online,? The lady said yes, gave me the account number, and her email, etc. so here I thought I would be slick and technology-oriented and do the transfer online and have it done without needing to drive to the bank, like the way it is done in the rest of the world.

WRONG!

The bank deposit went without a hitch, I made a PDF of the transfer receipt, sent it via email to her, received no bounce message, so I assumed it was done. However, you must do everyone else’s job for them in Uruguay, even if you are not in Uruguay, so I called her today, 3 weeks later, to verify that the funds were properly received and credited. No sign of anything from her end. No checking of email, nothing. So of course she says she must search her records and call me back, so she takes my number and I know I will not hear from her until… never.

I am beginning to think that Uruguay cannot cope with technology and only understands grunts, simple hand signals, and pieces of paper with stamps and foil seals.

Meanwhile… is my house insured? Nobody seems to know. If a tree falls our your house in Uruguay and nobody is there to insure it, does it still make a sound?

The other day a lady shot out from the left side of an intersection, right in front of us. By the time we saw her coming it was already too late and we ran right into her. Fortunately nobody was injured. Her car was trashed but our truck, while the steering and front frame is bent, suffered little more than cosmetic damage. We drove home.

We did the standard insurance thing, two inspectors come out to survey the damage, information is exchanged, and then you wait to hear from your insurance company. Meanwhile you research the local laws and educate yourself on right-of-way and other sundry items.

…such as the following, which states clearly that when in an unmarked intersection, the right-of-way preference goes to the vehicle on the right, and/or the street with through-way preference.

I was both on the through-way street, *and* the vehicle on the right. So, clearly, I thought, I had the right-of-way and the other lady’s insurance will pay for the damage. Having learned the laws I felt confident when I went in to get the results from my insurance agent.

WRONG!

My insurance company is leaving me to hang. “This all depends on where you are from,” my insurance agent explains to me. Translation: because you are a gringo, you are instantly guilty. Nice. Forget the law, forget that it is much more expensive for them to pay to replace the entire front end of the car WHICH CAUSED THE ACCIDENT than it is to say, “this is the law, your client is clearly guilty, and you should pay for the damage to my client.” Forget that they will lose a customer. Forget that I am a legal resident, forget that I have a local drivers license and a locally registered vehicle and I know what I am doing and know the laws. Nah, that’s all unimportant.

The corporate office’s official excuse: Because the street I was on changes names on the other side of the intersection, I am therefore culpable. Not a note about the fact that it is the secondary throughway through town on which all the bus routes run to avoid traffic on the main road. Nor that there are no street signs to signify the change-of-name. Because the locals are too lazy to post them and also because if they did, someone would steal them (as in here and here). So I shall hang because of mismanaged data on a map.

Fortunately the agent is on my side despite the ruling from the corporate office, so he has arranged tomorrow afternoon to help me get this straightened out. He has written in to appeal the decision in corporate, and he is going with me to Crash Lady’s insurance office to see what we can wrangle out of them. We shall see what happens. I am not hopeful. If they fail to please me I shall put their name up here with a notice to boycott.

Added Aug 25, 2012:
The company in question is RSA. They are reputed to be a quality insurance company (we have multiple policies for vehicle and home coverage). However at this point, I will not renew my policy with them, and instead I shall transfer it to a different company upon its expiration.

Welcome home! I can’t wait to get the F back out of here and get back to Chile where laws are at least more respected than the Kangaroo Subjective Interpretation you get here in Uruguay backwardsland.