# Experience with Health Insurance?



## Bajamas (Jul 14, 2010)

Does anyone have experience with IMG Global or HCC Citizen Secure healthcare plans? Specifically, have you had experience with making claims in Mexico and/or the US? I would also be interested in other options that folks have experience with.
Thank you.

Mark


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## circle110 (Jul 20, 2009)

I have IMG Global but have yet to make a claim in either country (knock on wood). I'd love to hear from someone who has made a claim to know if I'm wasting my money or not.

I'm hoping this thread brings in someone who can give us some first hand experience.


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## Bajaceresa (Aug 17, 2012)

I have had policies with both carriers. [excised] paid claims for services received in Mexico after requisite paperwork was filed and also paid claims in the US. I carried [excised] insurance for 6 years. Only problem with [excised] was that when I turned 55, they raised my premium from about $3500/yr. to over $7000/yr. I was unable to pay that premium so I purchased the [excised] policy that cost only about $1500/yr. I never made a claim with [excised], yet they also attempted to more than double my premium the second year. I dropped them and on the advice of my insurance broker, purchased a policy from [excised] which, according to the broker, carried identical coverage to that of [excised] and in fact, was run by former employees of the company selling the [excised] policy. Eleven months after I purchased [excised] policy, I was diagnosed with a brain tumor, [excised] confirmed coverage with my providers and I proceeded with the surgery. I was devastated and worried that [excised] would not renew my coverage. I spoke with my broker, explained the situation and he assured me that as long as I hadn't seen any doctors about this condition previously - I hadn't - that I would be covered. With that assurance, I paid my annual premium for the next year and started my search for treatment. Low and behold, even though [excised] was well aware of my condition, gladly accepted my renewal payment, and confirmed coverage with my chosen providers, they declined to pay even 1 penny of my $200K expenses, citing a pre-existing condition exclusion. I am now saddled with this debt. I learned that [excised] is one of apparently many insurance companies selling international insurance that are not regulated in the US and have redefined the term pre-existing condition. Learn from my sad experience. Look carefully at the definition of pre-existing condition in your policy. A legitimate company defines pre-existing condition as a known condition. The scamsters like [excised] have redefined pre-existing condition to be any condition that existed before the policy is written, whether you are aware of that condition or not. Run from these policies. I do not have the resources to retain an attorney to fight these scumbags, but want to alert others to be very careful before shelling out any money to international insurance providers that sell policies not written in the US and that are exempt from US regulation.


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## TundraGreen (Jul 15, 2010)

Bajaceresa:

I removed the company names from your post. There is a rule prohibiting "naming and shaming". The rule is there to protect the forum from libel accusations.

In addition, while I have no doubt that your post accurately reflects your experience, this forum does not provide a mechanism for the companies to provide their explanation of the events. Thus it is really not a good place for a discussion of problems like yours.

I suggest any other members who are curious about the companies involved should send a Private Message to you.

You have my sympathy for the unpleasant experience and expenses that you have been subjected to.


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## Bajamas (Jul 14, 2010)

Bajaceresa, I'm really sorry to hear about your experiences. Thank you for sharing, as it is very helpful for those of us wondering if we should purchase insurance from these International Insurance Companies (IIC). I was concerned about those things you mentioned. I had read of other experiences whereby the IIC refused to pay claims citing Pre-existing Conditions. I suppose they could use High Blood Pressure or High Cholesterol, even if controlled within limits by medication, as a Pre-existing Condition related to many, many things.

Mark


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## Bajamas (Jul 14, 2010)

TundraGreen said:


> Bajaceresa:
> 
> I removed the company names from your post. There is a rule prohibiting "naming and shaming". The rule is there to protect the forum from libel accusations.
> 
> ...



TundraGreen,

Yeah, it's really to bad that the company names from Bajaceresas post needed to be removed. The experience that was incurred is exactly the type of information I was requesting and without the names of the insurance companies, it really is not helpful to other individuals that are wondering about experiences with specific international insurance companies. Luckily, I saw the post before it was edited!

Mark


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## Isla Verde (Oct 19, 2011)

Bajamas said:


> TundraGreen,
> 
> Yeah, it's really to bad that the company names from Bajaceresas post needed to be removed. The experience that was incurred is exactly the type of information I was requesting and without the names of the insurance companies, it really is not helpful to other individuals that are wondering about experiences with specific international insurance companies. Luckily, I saw the post before it was edited!
> 
> Mark


If you hadn't read the message before it was edited, you could have sent Bajaceresa a PM to get the names of the companies.


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## Bajaceresa (Aug 17, 2012)

I understand completely, Will and will gladly communicate privately with anyone who would like more info on this most unfortunate situation.



TundraGreen said:


> Bajaceresa:
> 
> I removed the company names from your post. There is a rule prohibiting "naming and shaming". The rule is there to protect the forum from libel accusations.
> 
> ...


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## Isla Verde (Oct 19, 2011)

I've had health insurance from a Mexican company for a few years. Knock on wood, I haven't used it for anything other than check-ups, but I've been pleased with the doctors I've seen through them. I did join before I hit 65, which is the usual cutting-off point for initially signing up with an insurance carrier here.


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## mickisue1 (Mar 10, 2012)

Bajaceresa: If you can sue this insurance company in the US, you might be able to find an attorney who will take your case on contingency. That is, you pay nothing unless you win, and then they take a percentage of the winnings. It's usually up to 50%.

But bad faith in insurance companies is highly frowned on by US and US state laws. When an individual sues an insurance company, or any other large corporation for such actions, it's not just your actual losses that are at play. It's your pain and suffering, the mental anguish of having such large bills and no coverage--and punitive damages based on the net worth of the company, not on the size of your claim.

I do hope that you are feeling better physically, and that you will find the way that works best for you to deal with this situation.


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## DNP (May 3, 2011)

mickisue1 said:


> Bajaceresa: If you can sue this insurance company in the US, you might be able to find an attorney who will take your case on contingency. That is, you pay nothing unless you win, and then they take a percentage of the winnings. It's usually up to 50%.
> 
> But bad faith in insurance companies is highly frowned on by US and US state laws. When an individual sues an insurance company, or any other large corporation for such actions, it's not just your actual losses that are at play. It's your pain and suffering, the mental anguish of having such large bills and no coverage--and punitive damages based on the net worth of the company, not on the size of your claim.
> 
> I do hope that you are feeling better physically, and that you will find the way that works best for you to deal with this situation.


WashDC/SMA


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## Longford (May 25, 2012)

Bajaceresa said:


> I have had policies with both carriers. [excised] paid claims for services received in Mexico after requisite paperwork was filed and also paid claims in the US. I carried [excised] insurance for 6 years. Only problem with [excised] was that when I turned 55, they raised my premium from about $3500/yr. to over $7000/yr. I was unable to pay that premium so I purchased the [excised] policy that cost only about $1500/yr. I never made a claim with [excised], yet they also attempted to more than double my premium the second year. I dropped them and on the advice of my insurance broker, purchased a policy from [excised] which, according to the broker, carried identical coverage to that of [excised] and in fact, was run by former employees of the company selling the [excised] policy. Eleven months after I purchased [excised] policy, I was diagnosed with a brain tumor, [excised] confirmed coverage with my providers and I proceeded with the surgery. I was devastated and worried that [excised] would not renew my coverage. I spoke with my broker, explained the situation and he assured me that as long as I hadn't seen any doctors about this condition previously - I hadn't - that I would be covered. With that assurance, I paid my annual premium for the next year and started my search for treatment. Low and behold, even though [excised] was well aware of my condition, gladly accepted my renewal payment, and confirmed coverage with my chosen providers, they declined to pay even 1 penny of my $200K expenses, citing a pre-existing condition exclusion. I am now saddled with this debt. I learned that [excised] is one of apparently many insurance companies selling international insurance that are not regulated in the US and have redefined the term pre-existing condition. Learn from my sad experience. Look carefully at the definition of pre-existing condition in your policy. A legitimate company defines pre-existing condition as a known condition. The scamsters like [excised] have redefined pre-existing condition to be any condition that existed before the policy is written, whether you are aware of that condition or not. Run from these policies. I do not have the resources to retain an attorney to fight these scumbags, but want to alert others to be very careful before shelling out any money to international insurance providers that sell policies not written in the US and that are exempt from US regulation.


Yes, the devil is always in the details. And it's almost at the point we need to consult an attorney before we sign on the dotted line. Best wishes for a healthy future.


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## Bajaceresa (Aug 17, 2012)

Thank you all for your support and suggestions. Your concern is truly heartening and much appreciated. My health at this point is excellent although I still do not know the status of the part of the tumor that was not removed. To date, I have not had the recommended followup MRI because I had neither the insurance coverage to pay for it or a doctor to review the results. I have however recently purchased insurance through IMSS in Los Cabos. It took about one month of going to and from the administrative office and two local IMSS hospitals in order to complete the paperwork, schedule and take a blood test and have the doctor's interview that were required before my application was accepted. Once my IMSS insurance became effective, I was advised to have a consultation with another doctor who prescribed medication for high cholesterol and referred me to a specialist to follow-up on the tumor. Although the specialist has not approved an MRI, a CAT scan will be scheduled. Interestingly enough, a friend had a CAT scan at a private facility here in Los Cabos this weekend, a few hours after being seen by a private physician. The CAT scan took about 10 minutes and cost $3500p including interpretation of results. This compares to between $650 - $3,000 USD charged in the States which I suspect does not include the radiologist's fee to interpret the results. There are no CAT scanners at any IMSS facility in Los Cabos, therefore I will have to travel to La Paz, a 2 hour drive from my home, and wait 6-8 weeks for the test to be scheduled. I doubt seriously that IMSS could have treated my rare condition successfully as there are only a handful of doctors in the US that specialize in the surgery that was required. Bottom line is I am grateful for having been accepted by IMSS and am satisfied with services received to date, but realize that their capabilities are limited and hope that I will never be in need of treatment for any serious conditions in the future.


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## edgeee (Jun 21, 2012)

Hi Bajaceresa.

Sorry to hear of your crappy treatment by Big Insurance, but the scenario is familiar.
The world of health care is swamped with stories like yours.
If they could get away with it, they would declare dying an invalid claim on life insurance because everyone has to die sometime, thereby being a pre-existing condition.

FYI, try to break up your posts into smaller pieces, with a little white space.
It's much easier on the readers, and it will spare you unwanted criticism from Lucy van Pelt.

Good luck.


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## Bajaceresa (Aug 17, 2012)

Thanks for the support and writing tip, Edgee. I'm usually the one who is anal about layout, grammar and spelling - just call me Lucy


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## edgeee (Jun 21, 2012)

Bajaceresa said:


> Thanks for the support and writing tip, Edgee. I'm usually the one who is anal about layout, grammar and spelling - just call me Lucy


It's acceptable to be anal, we all do, but try to avoid being banal; we all do that too, but for some reason it's more objectionable.


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## RVGRINGO (May 16, 2007)

My US insurance, which came with my retirement, is a total hassle. Mostly, the copay and minimums are more than the costs in Mexico .IMSS is impossible for us and we haven't seen anything to encourage us to use Seguro Popular.
So, we pay out of pocket and it has been less expensive than paying for private insurance, which is now out of sight, as we age.
It a couple of days, I'll have another retinal surgery and expect it will cost about $15,000 pesos, the equivalent of about $1200 USD. That is expensive, on our limited budget, but manageable and free of paperwork and aggravation. 
The USA experience makes people scared to death to need medical care, even if insured. It can still lead to bankruptcy. In Mexico, there are more options, expenses are much, much lower and are generally manageable. In our case, lacking other insurance avenues, we are fairly comfortable being 'self insured'; we really don't have any other choice.


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## kito1 (Aug 4, 2012)

Bajaceresa - I am so sorry for what you are going thru, I hope it all works out for you.

Health Insurance is something I am sure many expats (and non-expats) worry about and many just do without. For many this is probably the best financial move, unless of course something seriously wrong happens to you.  

I self-insure due to a pre-existing condition making health insurance extremely costly. I was quoted anywhere from $1100 and up per month, and most wouldn't take me on at all. I don't smoke, am in good health, take only one medication which costs about $25 per month but one major, but successful, spinal surgery 8 years ago and no one wants anything to do with me at a reasonable cost so I can't justify health insurance. I hope one day that I don't regret it...


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## Isla Verde (Oct 19, 2011)

kito1 said:


> I self-insure due to a pre-existing condition making health insurance extremely costly. I was quoted anywhere from $1100 and up per month, and most wouldn't take me on at all. I don't smoke, am in good health, take only one medication which costs about $25 per month but one major, but successful, spinal surgery 8 years ago and no one wants anything to do with me at a reasonable cost so I can't justify health insurance. I hope one day that I don't regret it...


Have you looked into private Mexican health insurance?


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## Isla Verde (Oct 19, 2011)

RVGRINGO said:


> .IMSS is impossible for us ...


I don't mean to pry, but would you mind telling us why IMSS is impossible for you?


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## kito1 (Aug 4, 2012)

Isla Verde said:


> Have you looked into private Mexican health insurance?


That is something I plan on doing, looking into it at least. Is there a company or agent you recommend? 

Honestly, I still have not decided on how long I plan to stay in Mexico. If I find that I really love it, I will probably start planning for the long term at that point which will hopefully include getting health insurance here.


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## Isla Verde (Oct 19, 2011)

kito1 said:


> That is something I plan on doing, looking into it at least. Is there a company or agent you recommend?
> 
> Honestly, I still have not decided on how long I plan to stay in Mexico. If I find that I really love it, I will probably start planning for the long term at that point which will hopefully include getting health insurance here.


I have a Mexican insurance agent here in Mexico City. When I renew my policy every year, he looks for the most economical plan for me, which has gotten a bit difficult since I turned 65 a couple of years ago. Right now I have a policy with a company called Plan Seguro. In addition to covering me for expenses I would incur if hit by a speeding car or microbus or a major illness, it also gives me a big discount when I visit their affiliated doctors for checkups and the like.


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## RVGRINGO (May 16, 2007)

We had IMSS, years ago, but one 'facilitator' lost control of her staff and we ended up with forged papers; as did many other couples. So, we had to start all over again, with a new waiting period. Later, a second 'facilitator' made errors and we lost our 'no restrictions' again. By then, pre-existing conditions prevented signing up and going through another waiting period. The Chapala IMSS office is particularly tough, even illegtally so.
At age 75, private Mexican insurance is not an option. Even if we had purchased it before 65, it would now be much too expensive; they plan their rate structure that way.


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## Isla Verde (Oct 19, 2011)

RVGRINGO said:


> We had IMSS, years ago, but one 'facilitator' lost control of her staff and we ended up with forged papers; as did many other couples. So, we had to start all over again, with a new waiting period. Later, a second 'facilitator' made errors and we lost our 'no restrictions' again. By then, pre-existing conditions prevented signing up and going through another waiting period. The Chapala IMSS office is particularly tough, even illegtally so.
> At age 75, private Mexican insurance is not an option. Even if we had purchased it before 65, it would now be much too expensive; they plan their rate structure that way.


RV, I'm sorry to hear about your unfortunate experiences with "facilitators". If I decide to sign up with IMSS, I'll do it on my own. In any event, I would have no idea where to find such a person in the D.F. I know that private Mexican health insurance gets more and more expensive as you get older and older and expect that eventually I won't be able to afford a decent policy, even with the help of my excellent broker.


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## TundraGreen (Jul 15, 2010)

Isla Verde said:


> RV, I'm sorry to hear about your unfortunate experiences with "facilitators". If I decide to sign up with IMSS, I'll do it on my own. In any event, I would have no idea where to find such a person in the D.F. I know that private Mexican health insurance gets more and more expensive as you get older and older and expect that eventually I won't be able to afford a decent policy, even with the help of my excellent broker.


I signed up for IMSS with no help. My Spanish is getting better and maybe is almost functional now but it certainly wasn't when I started with IMSS. 

I made a few mistakes but none of them were related to lack of Spanish, at least none of them were related to signing up. I did miss one appointment recently because I didn't realize I had an appointment.

I find you can get a long ways with pretty poor spanish if you are willing to ask the same questions of different people and pay attention to body language and other clues. You certainly learn a lot that way. This has worked for me with IMSS, Hacienda, and numerous other offices. But it is easier, more fun and less traumatic now that I understand more of what people tell me.


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