Whether you’re thinking about getting international health insurance or you already have it, it’s crucial you understand how health insurance reimbursement in Mexico works.
That’s because international insurance requires a few additional steps that you may NOT be used to.
And, if you are unprepared, you may be on the hook for large medical bills.
Read on to learn more about health insurance reimbursement in Mexico.
Understanding the Reimbursement Model
Health insurance in Mexico for foreigners is a learning curve.
This is because all international health insurance companies use the reimbursement model, which means you are responsible for paying out-of-pocket for most medical procedures.
Then, you file claims to go toward the deductible and then for reimbursement once the deductible is reached.
This can be confusing for some new policy holders from the US because in America, the doctor’s office works directly with the insurance company.
In the US, medical visits are processed between the insurance company and the doctor’s office and go toward the deductible.
And you receive a bill after the fact.
It’s the opposite for health insurance reimbursement in Mexico.
With international health insurance, the insurance company will only know if you saw a doctor or had tests done if you file your claims (or you are pre-certified for a procedure).
So, if you want your medical appointments to go toward the deductible and get reimbursed, you must file a claim for it to be processed.
If you do not start the health insurance reimbursement process yourself, you will not get your money back.
TIP – This is why staying organized with your medical consultations, documents, and receipts is critical.
Health insurance in Mexico for foreigners helps alleviate the cost of some medical events, but you will still be on the hook for paying the bill until you have filed a claim.
For instance, you will be expected to pay when you leave the hospital, even with insurance.
You are not reimbursed until the claim has been processed.
There are some exceptions.
For example, direct billing arrangements can be made for certain medical events, such as surgery or long-term cancer treatments.
How Long Does It Take to Get Reimbursed for Medical Expenses in Mexico?
As mentioned, you should not expect to see your reimbursement right away.
There are steps and processes for filing health insurance claims in Mexico and receiving reimbursements.
Patience is key!
The turnaround time for reimbursement is typically 2 weeks to 30 business days, depending on the insurer and if everything has been submitted correctly.
The turnaround time can be as little as 24 hours for claims going toward your deductible.
Here are some of the factors that tend to affect reimbursement processing times:
Missing documentation: Missing documentation is the #1 reason claims take longer to be processed. If documents are missing from the claims, they will not be processed. You can submit incomplete claims if you’re still waiting on paperwork, but it can get confusing if it’s a bigger claim. Try to submit everything at once when you file your claims.
The claim team might also require additional information and can request it, such as lab reports, images, additional medical details, etc. The longer it takes to provide this information, the longer it will take for your claim to be processed.
Claim complexity: We hope this never happens, but significant problems can arise during medical procedures that require additional surgeries or a longer hospital stay, which would require more documentation.
Another possible outcome could be that an underlying condition is found during a medical event that requires additional testing and treatment, which the insurer may need to complete the original claim. It can get tricky.
Third-party organizations: Insurance companies tend to use a third-party organization, which can mean more time to process your reimbursement based on their unique processes. If there are delays from the third-party company, it can be out of the insurer’s hands to expedite the payment.
Insurance company’s schedule: Some insurers have a specific day of the week to issue reimbursements. Check with the insurance company or broker if you are waiting for reimbursement.
What Do I Do If My Claim Status Takes Longer Than Expected?
Follow up!
Stay in touch with your broker.
You can also contact the insurer directly for updates.
While rare, claims sometimes get “lost in the ether” with an insurer, so following up is never a bad idea.
Step-by-Step Process to Getting Reimbursed
Follow the steps below for filing health insurance claims in Mexico.
#1 Gather necessary documents.
- Factura (Electronic invoice for Mexico, which all international insurance companies require)
- Proof of payment
- Doctor’s complete medical notes (Must be on the doctor’s letterhead with clearly written dates for the onset of symptoms, the evolution of the diagnosis, and recommendations for treatment, testing, etc.)
- Written prescriptions for medication and/or test
- Printed receipts from the pharmacy
NOTE – Depending on the type of medical visit you are seeking health insurance reimbursement in Mexico for (e.g., hospital stay, physical therapy, or surgery), it may require submitting additional documents.
#2 File a claim. By email or via a client portal provided by the insurer.
#3 Provide your preferred direct deposit information. Health insurance reimbursements in Mexico are done by wire transfers or direct deposits to your bank account from their US bank accounts. The insurance companies can make deposits to your preferred bank in the US, Canada, or Mexico.
If they are sending the reimbursement to a Mexican bank account, check with them to see if you need to take any steps to receive a payment from a US bank account.
Check with your bank to see if there are any fees for wire transfers or direct deposits.
NOTE – Physical checks can be issued if requested.
#4 Track your claim status. Keep track of when your claims were submitted. Talk to your broker for updates and to see if your insurer needs additional information.
#5 Understand the typical reimbursement timeline. Depending on whether all information has been submitted, health insurance reimbursement in Mexico typically takes 2 weeks to 30 business days, depending on the insurer.
#6 Know what to do if your claim is denied. Unfortunately, filing health insurance claims in Mexico does not mean they will automatically be approved. Your claim may be denied.
If your claim is denied, you can appeal the decision.
[Related Read: How to Appeal a Denied Health Insurance Claim]
What Documents Do I Need to File a Claim?
When filing health insurance claims in Mexico, you must gather the following documents.
-
- Claim form: Insurance companies have a claim form that clients are required to fill out and submit to the insurance company by email or the insurer’s portal.
- Doctor’s complete medical notes: The doctor’s complete medical notes, including the date of the onset of symptoms, the evolution of the diagnosis, and treatment recommendations, should be provided on the doctor’s official letterhead.
- Factura: This is the official electronic invoice for Mexico that all international insurance companies require. Make sure you request the factura when you’ve paid.
- Itemized medical bills: A clear breakdown of each medical test/treatment/visit/fees and the cost.
- Proof of payment: A receipt that shows payment was received. If you pay in cash, make sure the receipt has a pagado stamp on it.
- Written medical reports and test results: Written reports or results for each medical procedure, test, lab results, and prescriptions for medication.
- Printed receipts from the pharmacy.
- Claim form: Insurance companies have a claim form that clients are required to fill out and submit to the insurance company by email or the insurer’s portal.
Are There Any Out-of-Pocket Expenses with Health Insurance in Mexico?
Yes, there are some out-of-pocket expenses with health insurance in Mexico for foreigners.
You should anticipate paying your deductible.
Speak with your insurance broker about other options.
Additionally, you should anticipate paying copayments and coinsurance depending on your policy.
Coinsurance is typically 10 – 20%, depending on the policy. This is the percentage you are responsible for paying AFTER the deductible has been reached. This amount is an out-of-pocket expense that will not be reimbursed.
Your insurance policy will not cover over-the-counter (OTC) medications available in Mexico, which will be another out-of-pocket expense.
NOTE – It’s important to review your policy to make sure you know what will and will not be covered by your international health insurance policy. Insurance companies have some general policy exclusions, such as not covering any medical treatment considered cosmetic.
Tips for Budgeting for Out-of-Pocket Expenses
Find out the names of any medications you are taking regularly and see which pharmacy has the best price.
Pharmacies also offer specials and discounts, especially on OTC medications. Check in occasionally to see if your medication is on special, and stock up!
Shop around for different doctors and specialists for cost options.
Find out if they offer payment plans for larger medical events and issues.
How Do I Choose the Best Expat Health Insurance in Mexico?
It’s important to do your own research on health insurance in Mexico for foreigners.
Multiple factors must be considered, such as the type of coverage offered, the network, and the costs of premium plans, as well as your unique medical insurance needs.
Additionally, you want to consider their overall reputation.
Are they respected in the expat community? Do they have good reviews?
Pay attention to how you are treated when you interact with insurance brokers.
Is it quality customer service, or do you feel like “just another number”?
A clever way to assess their customer service is to ask them to explain how health insurance reimbursement in Mexico works.
Do they take the time to walk you through the process?
Do they answer questions?
Or do you feel rushed?
Finally, ask around your expat community or in Facebook groups.
