If you are living in Mexico as an expat, there may come a time when you need medical care.
If your medical care includes a procedure performed in hospitals in Mexico, it is important to understand how insurance works so that you won’t wind up paying significantly more than necessary.
Understanding How International Insurance Works
You may be surprised by how insurance works when it comes to hospitals in Mexico.
Unlike in US hospitals, where you can present an insurance card and be seen, Mexican hospitals require payment upfront – or expect you to pay out-of-pocket and then be reimbursed by your insurance company.
This is because international insurance works following a model of reimbursement.
With international health insurance, you will be expected to pay out-of-pocket and then collect the necessary documents and submit the claim to the insurer.
At this point, the claim will be reviewed, and the cost of the medical care you received will go toward your deductible.
Unfortunately, you cannot simply hand them your ID and insurance policy card and have everything automatically applied to your deductible.
It is up to you to pay out-of-pocket and then file claims.
Here’s what you need to know…
How Hospital Pre-Certification in Mexico Works
Should you need medical care in Mexico that includes a hospital stay (such as surgery), you will need to confirm your policy covers hospitalization in Mexico.
If your policy covers a hospital in Mexico, you will need to get pre-certified.
This ensures that hospital care in Mexico will be covered and protects you from being overcharged.
Also, it allows you to set up a direct pay arrangement between the insurer and the hospital.
Not all facilities or doctors accept insurance or work with foreign insurance. Check your policy.
Tips for Hospital Pre-Certification in Mexico
- Make sure your surgery/hospitalization is covered and pre-certified before the scheduled procedure. You will need to work with your broker on this to get pre-certified and set up direct pay with the hospital. You don’t want to show up for an inpatient procedure to discover you aren’t covered or need to pay out-of-pocket.
- During the pre-certification process, the insurer will contact the hospital you select to arrange direct payment. If there’s an issue with a specific hospital, the insurer will try to find a coordinator, or you will have to pay out-of-pocket and file claims for reimbursement. Some hospitals don’t work with foreign insurance (international insurance).
- Be sure to bring your insurance information, including the GOP (guarantee of payment) letter issued by the insurer, and enough money to cover your deductible.
[Related Read: Pre-Certification for Medical Procedures in Mexico: Don’t Get Blindsided]
Picking Hospitals in Mexico
When it comes to choosing hospitals in Mexico, begin by checking with your insurance company.
Although international health insurance is a “free network,” there are hospitals in Mexico that have contracts in place with insurers, making it easier and faster to pre-certify your procedure.
You can choose to go to a facility that is not on the insurer’s list and see if they will be able to either accept a GOP (guarantee of payment) letter, work with a third-party coordinator, or pay out-of-pocket for reimbursement later.
Are hospitals in Mexico good for foreigners?
Most are, but some are not.
This is why it is necessary to verify hospital accreditation and standards when picking a hospital in Mexico.
For instance, there are some hospitals that have been blacklisted by an embassy and are deemed predatory.
Ask for recommendations in your community or online groups for expats living in Mexico.
When looking for hospitals in Mexico, find out if the staff is bilingual.
If not, you will need to bring someone (a buddy) who is fully bilingual.
If you bring a buddy, notify your buddy system where you will be and for approximately how long.
Personal Documents You Need to Have with You
It is wise to have all your personal documents together to simplify the process.
Here is a list of personal documents to have with you:
- Health insurance details
- Passport/ID
- Visa or temporary or permanent residency card
- Medical records
- Insurance card
- Copy of GOP (guarantee of payment)
- Pre-admission instructions
- Any requested test results
- Emergency contact information
If you do not have family in Mexico, it is especially important to have a contact person the hospital can reach out to in case of an emergency.
Along with your emergency contact list, it is also smart to bring any advanced care planning instructions (such as wishes on feeding tubes and DNR orders).
It’s better to be overprepared than underprepared.
Post-Hospital Care in Mexico
When it comes to follow-up care after being discharged from a hospital in Mexico, you will also need to notify the insurer for insurance purposes.
If you need home healthcare or physical therapy following your hospital stay, let your insurance company know as soon as possible.
This is considered light pre-certification, which means you’ll need to pay for it out-of-pocket and then file the claims for reimbursement even though your deductibles have already been met.
To get this type of post-hospital care in Mexico covered by international insurance, you will need a prescription from your doctor for aftercare, as well as the following medical notes.
- Nurse care – Outline approximately how long nurse care will be needed, what the nurse’s medical duties will be, and why it’s necessary.
- Physical Therapy – Outline approximately how many sessions will be needed. If they know the cost, the doctor must include the estimated cost of the sessions.
It’s wise to speak with the insurance company and let them know what is going to happen and that you’ll be filing the claims later.
Prescription Medications in Mexico
Medication coverage in Mexico is also a little different.
Anything that’s considered over the counter is not covered by insurance, even if it’s written up as a prescription.
Most medications in Mexico are OTC, which means you do not need a prescription to get them.
However, this also means many medications will not be covered by insurance.
If your doctor prescribes a medication that is being used for a purpose other than its FDA approval, it will NOT be covered, regardless of how often it is used for that issue in the medical world.
Unfortunately, there is not a list of medications that will and will not be covered by insurance.
Your best option is to go ahead and file a claim for your medications. There is no penalty if the claim is denied.
Medications in Mexico can be either really easy to get or hard to find in stock. Talk to your doctor about the availability of what they prescribe.
Managing Payments and Insurance
Mexican hospitals do not bill.
You are responsible for ensuring payment before you leave the hospital.
For pre-certified surgeries/inpatient stays, you will be responsible for the deductible balance and copay if you have one.
This will be outlined in the GOP letter sent to and accepted by the hospital – don’t get tricked into paying more than was already agreed upon.
If you pay fully out-of-pocket for reimbursement, as in not pre-certified, request all required documents before leaving and submit them to your insurer as soon as possible.
Chances are the insurer will ask for more information, and it is easier to get it a few days after the surgery than waiting a few months.
NOTE – We do not recommend an uncertified hospital stay in Mexico where you pay out-of-pocket and expect reimbursement.
NOTE – In the event of an emergency, such as a car accident, most Mexican hospitals require a deposit of approximately 20,000 to 30,000 pesos before they will even begin to treat you. It is critical to have access to emergency funds.
Tips for Keeping Records for Mexican Hospitals and Insurance Claims
If you must pay out-of-pocket to get reimbursed for visiting a hospital in Mexico, then you need to make sure you get ALL documents required by the insurer to successfully submit a claim.
Even if your surgery has been approved (pre-certified) and you have to pay out-of-pocket to get reimbursed, you STILL need to get all the documents.
- Do not throw anything away, ever.
- Keep digital records of all hard copies. Use phone apps, scan documents, etc.
- Find an organizational method, such as using Evernote or Google Drive, to store all these digitized records.
NOTE – If everything has been pre-certified, you do not need to worry about managing all the documents because the hospital and the insurer are now in charge and will communicate directly.
