A dear reader named Sharon recently left a question on the Facebook profile of The Costa Rica Star about the questionable practice of private health facilities charging money upfront for ambulance transportation or even medical procedures. She also wanted to know about the insurance policies accepted by private hospitals like CIMA, Clinica Biblica and Hospital La Catolica. Sharon thinks that the INS policy does not provide sufficient coverage for older retirees, something that could hurt medical tourism.

Hello Sharon, thanks for writing. Medical tourism and medical insurance are worlds apart from each other, although they are beginning to get a bit closer to each other. The highly lucrative medical insurance industry is indifferent to medical tourism, particularly because so many procedures chosen by medical tourists are elective, something that health insurers tend to frown upon.

Insurers thrive on the advice of actuaries who pour over detailed statistics and complex formulas that determine the likelihood of an individual to need medical assistance. The pricing of policy premiums is determined by actuary research into mortality and disease rates. We all have to go to the doctor at some point in our lives, but the insurers would rather we don’t. Medical insurance providers want us to be super-healthy not just because they care about us, but also because the less we use the policy we purchased from them, the more money they make.

Many of our medical tourists arrive seeking elective procedures that aren’t covered by either public health systems or insurance policies. In most parts of the world, procedures that involve cosmetic plastic surgery or LASIK eye procedures are considered elective and thus are not typically covered by insurance policies. According to medical tourism facilitators SurgeryCR (an enterprise that advertises in The Costa Rica Star), bariatric and gastric surgery are procedures not covered by many insurance policies, even though morbid obesity is becoming a serious public health matter in North America.

Some group and employer-supported health insurers in North America are beginning to consider medical tourism as an item to include in their coverage, but for the most part medical tourism remains a cash-only affair that is very affordable for European and North American visitors.

Private Medical Insurance in Costa Rica

According to a recent news article in Costa Rica Hoy, a greater number of Ticos are interested in private medicine and health insurance coverage. The beloved institution in charge of our public medical care system, La Caja, is currently struggling to stay afloat with greater expenses and reduced budgets. An aging population and the constraints of modern life are taxing public medical care resources; something that Ticos are taking in stride by seeking private alternatives.

The National Insurance Institute (INS in Spanish) is Costa Rica’s insurance Goliath. INS offers two medical policies: one for medical expenses incurred by the insured due to accidents and illnesses, payable in colones. Premium pricing of this policy depends on age, gender and medical condition. The other policy is the popular INS Medical, which is accepted internationally. INS Medical is comprehensive in its coverage; as it includes maternity, physical exams, sports injuries, air ambulance, advanced cancer care, repatriation of the deceased, and more. There are three deductibles to choose from: $5K, $10K and $15K. According to Seguros Metropolitanos (PDF), INS medical has a co-pay of $30 per medical visit, the annual premiums are less than $1,500 for men and women 34 years of age and younger, all the way up to $6,000 for men aged 80 and up.

Just like many other health insurers, INS Medical does not cover the elective procedures that are so popular among the medical tourism crowd. Ticos must pay out-of-pocket for these procedures as well, with the exception that they do not travel outside of Costa Rica to get them done.

The big three private hospitals, CIMA, Clinica Biblica and Hospital La Catolica accept insurance policies from INS, Alico, Panamerican and others. Those interested in visiting any private medical care facility in Costa Rica should check with their insurance agent or provider to see if their policies will be accepted at a particular facility.

Upfront Medical Payments

Private medical providers and facilities have the right to establish pricing for their services or to negotiate payment terms with patients, including the cost of medical transport. Many hospitals and clinics ask for a cash deposit from the uninsured before initiating non-emergency treatment, and they are free to do so as long as the patient is not in need of emergency care.

In case of a medical emergency, no private hospital can deny care or ask for money. The ambulances of private medical facilities are not usually dispatched to patients in situations when a 911 call has been initiated. In such cases, the Red Cross will arrive and take the patient to the nearest public medical care facility. If private medical providers become involved at some point of an emergency, they will be bound by the Hippocratic oath to render life-saving service without asking for money upfront or even at the end.