Obra Social - Preexisting Conditions

[cafeamericano]

Hello everyone. I am interested in any insight people have into how much the obras sociales charge for preexisting conditions. I have a family friend that has leukemia that is considering coming from Venezuela and trying to figure out if it’s viable to sign up for an obra social. From my understanding you can sign up with a preexisting condition, but you have to pay a “differential value” (a large up front amount so that the obra social will include the preexisting condition in the coverage). Does anyone have any experience with this and what amounts they charge for this (leukemia or other conditions)? My initial thought was it would be exorbitant but have also read it’s regulated by the government so thinking that could keep it from being prohibitive.

 

[Stafford]

Entirely depends on the severity of your preexisting condition and whether it’s necessary to mention it right away. e.g. If you have cancer and you need to continue your chemotherapy, you need to mention that. If you’re prone to occasional migraines or anxiety attacks, my unofficial advice is to let that come up once you’ve signed up.

 

[Quilombo]

Hello everyone. I am interested in any insight people have into how much the obras sociales charge for preexisting conditions. I have a family friend that has leukemia that is considering coming from Venezuela and trying to figure out if it’s viable to sign up for an obra social. From my understanding you can sign up with a preexisting condition, but you have to pay a “differential value” (a large up front amount so that the obra social will include the preexisting condition in the coverage). Does anyone have any experience with this and what amounts they charge for this (leukemia or other conditions)? My initial thought was it would be exorbitant but have also read it’s regulated by the government so thinking that could keep it from being prohibitive.

This friend will have to do a couple things, si o si:

- Find a pre-paga with the coverage/hospitals/clinics they like
- Declare their leukemia on their intake forms, along with providing documentary evidence of their clinical history and treatment
- The pre-paga will at first lie and say they aren't taking on new members, they don't cover foreigners, they don't cover cancer treatment, etc. or straight up ghost the family friend/fail to respond to emails or WhatsApp messages
- When they do, let the family friend explain they know their rights, and they will be using this as proof for a denouncement of the pre-pago to the Superintendent of Health Services for failure for adhesion to the requested plan for having a pre-existing condition
- The pre-paga needs to also be notified in writing, ideally via registered mail, and given 10 business days to respond following the denuncia if I remember correctly
- They will again try to discourage adhesion via a false differential value and/or claim it must be paid at once
- Differential values MUST be approved by the Superintendent of Health Services; companies can't make them up on a whim
- I believe the extra quota can be paid over the period (3 years iirc) at which point the member must have their disease considered as part of their medical history, and are exempt from a differential value going forward

It's important to know ahead of time that ALL pre-pagas will try to ratfuck your family friend, and don't be afraid of the denouncement, along with considering an Amparo claim if the Superintendency of Health Services is taking too long to respond.

That being said, they will have to declare their leukemia as you can't lie about something so obvious, and the quota approved can be in the hundreds of thousands or even millions of pesos, but I believe (don't quote me) that you can appeal it too even if the Superintendency of Health Services approved one is unreasonable.

In the meantime it may make sense to begin/continue treatment at a public hospital, in which case they may need to make an Amparo claim as public hospitals have been very understaffed lately, and slow at providing turnos for cancer treatments (I speak from personal experience with my family in Provincia, and I'm told capital is similar).

Good luck, and I wish your family friend a successful treatment.

P.S. I believe @nikad is an RN here and she may be more familiar with the above mentioned processes, and is generally kind in helping those with seeking guidance.

 

[nikad]

This friend will have to do a couple things, si o si:

- Find a pre-paga with the coverage/hospitals/clinics they like
- Declare their leukemia on their intake forms, along with providing documentary evidence of their clinical history and treatment
- The pre-paga will at first lie and say they aren't taking on new members, they don't cover foreigners, they don't cover cancer treatment, etc. or straight up ghost the family friend/fail to respond to emails or WhatsApp messages
- When they do, let the family friend explain they know their rights, and they will be using this as proof for a denouncement of the pre-pago to the Superintendent of Health Services for failure for adhesion to the requested plan for having a pre-existing condition
- The pre-paga needs to also be notified in writing, ideally via registered mail, and given 10 business days to respond following the denuncia if I remember correctly
- They will again try to discourage adhesion via a false differential value and/or claim it must be paid at once
- Differential values MUST be approved by the Superintendent of Health Services; companies can't make them up on a whim
- I believe the extra quota can be paid over the period (3 years iirc) at which point the member must have their disease considered as part of their medical history, and are exempt from a differential value going forward

It's important to know ahead of time that ALL pre-pagas will try to ratfuck your family friend, and don't be afraid of the denouncement, along with considering an Amparo claim if the Superintendency of Health Services is taking too long to respond.

That being said, they will have to declare their leukemia as you can't lie about something so obvious, and the quota approved can be in the hundreds of thousands or even millions of pesos, but I believe (don't quote me) that you can appeal it too even if the Superintendency of Health Services approved one is unreasonable.

In the meantime it may make sense to begin/continue treatment at a public hospital, in which case they may need to make an Amparo claim as public hospitals have been very understaffed lately, and slow at providing turnos for cancer treatments (I speak from personal experience with my family in Provincia, and I'm told capital is similar).

Good luck, and I wish your family friend a successful treatment.

P.S. I believe @nikad is an RN here and she may be more familiar with the above mentioned processes, and is generally kind in helping those with seeking guidance.

I agree with all of this, I will only add that once you start a claim with Superintendencia, you cannot go with an Amparo claim. It will all take several months though. Basically your friend will need a lawyer as soon as he/she lands here. Of course tratment is always available at public hospitals no matter what ( public hospitals that specialize in cancer treatments are Roffo and Marie Curie )

 

[Silvie]

That is assessed personally by the Company with the applicant, it can vary from one person to another, depending on age, medical conditions and many other factors. The difference in monthly premiums to be accepted can be a lot more for a sick person.
This isn't something that we could really tell you on a forum.

 

[nikad]

There are no standard numbers at all, however they must be approved by Superintendencia de Salud, it is not that they can just give out any figure ( but they will ) . They cannot deny enrollment ( but they will ). They cannot deny enrollment based on migratory status ( but they will ). These are the things he or she will have to legally fight for.

 

[cafeamericano]

This friend will have to do a couple things, si o si:

- Find a pre-paga with the coverage/hospitals/clinics they like
- Declare their leukemia on their intake forms, along with providing documentary evidence of their clinical history and treatment
- The pre-paga will at first lie and say they aren't taking on new members, they don't cover foreigners, they don't cover cancer treatment, etc. or straight up ghost the family friend/fail to respond to emails or WhatsApp messages
- When they do, let the family friend explain they know their rights, and they will be using this as proof for a denouncement of the pre-pago to the Superintendent of Health Services for failure for adhesion to the requested plan for having a pre-existing condition
- The pre-paga needs to also be notified in writing, ideally via registered mail, and given 10 business days to respond following the denuncia if I remember correctly
- They will again try to discourage adhesion via a false differential value and/or claim it must be paid at once
- Differential values MUST be approved by the Superintendent of Health Services; companies can't make them up on a whim
- I believe the extra quota can be paid over the period (3 years iirc) at which point the member must have their disease considered as part of their medical history, and are exempt from a differential value going forward

It's important to know ahead of time that ALL pre-pagas will try to ratfuck your family friend, and don't be afraid of the denouncement, along with considering an Amparo claim if the Superintendency of Health Services is taking too long to respond.

That being said, they will have to declare their leukemia as you can't lie about something so obvious, and the quota approved can be in the hundreds of thousands or even millions of pesos, but I believe (don't quote me) that you can appeal it too even if the Superintendency of Health Services approved one is unreasonable.

In the meantime it may make sense to begin/continue treatment at a public hospital, in which case they may need to make an Amparo claim as public hospitals have been very understaffed lately, and slow at providing turnos for cancer treatments (I speak from personal experience with my family in Provincia, and I'm told capital is similar).

Good luck, and I wish your family friend a successful treatment.

P.S. I believe @nikad is an RN here and she may be more familiar with the above mentioned processes, and is generally kind in helping those with seeking guidance.

This is great info. Thank you! And thank you to Nikad as well!

It sounds like we should prepare for her to be in the public healthcare system for some time as we work through things.

What is the amparo you mention that will speed up attention in the public hospital? Is it something she would need a lawyer for?

She’s obviously a native Spanish speaker so no language barrier. But as recent arrivals they might have some initial challenges with managing bureaucratic processes. I can help, but I don’t have any experience whatsoever with the public healthcare system.

 

[Quilombo]

This is great info. Thank you! And thank you to Nikad as well!

It sounds like we should prepare for her to be in the public healthcare system for some time as we work through things.

What is the amparo you mention that will speed up attention in the public hospital? Is it something she would need a lawyer for?

She’s obviously a native Spanish speaker so no language barrier. But as recent arrivals they might have some initial challenges with managing bureaucratic processes. I can help, but I don’t have any experience whatsoever with the public healthcare system.

As Nikad said, you can only do one, not both for the pre-paga which is separate from getting care at a public hospital while waiting for affiliation.

Some people have had to use Amparo claims for cancer treatment because hospitals claim they don't have the meds or the money for them. The public hospitals via the hospital director can request cancer meds from the El Banco de Drogas Especiales but apparently some don't want to because it makes them look bad, you're basically saying you lack the ability to attend to the patient otherwise.

Try getting treatment first at a public hospital while waiting for the pre-paga, and if the public hospital doesn't have the meds she can have the director do the requisition, and then if they don't get the meds still she can do an Amparo, for which she'll need a lawyer, but the BA Bar Association has lawyers that can help with this.

My knowledge is all second hand mostly, Nikad may know more details, but don't assume getting pre-paga coverage will be easy, it will require a fight.

 

[cafeamericano]

As Nikad said, you can only do one, not both for the pre-paga which is separate from getting care at a public hospital while waiting for affiliation.

Some people have had to use Amparo claims for cancer treatment because hospitals claim they don't have the meds or the money for them. The public hospitals via the hospital director can request cancer meds from the El Banco de Drogas Especiales but apparently some don't want to because it makes them look bad, you're basically saying you lack the ability to attend to the patient otherwise.

Try getting treatment first at a public hospital while waiting for the pre-paga, and if the public hospital doesn't have the meds she can have the director do the requisition, and then if they don't get the meds still she can do an Amparo, for which she'll need a lawyer, but the BA Bar Association has lawyers that can help with this.

My knowledge is all second hand mostly, Nikad may know more details, but don't assume getting pre-paga coverage will be easy, it will require a fight.

Thank you! Yea I think she is likely to go with the public hospitals. I wanted to see what costs could potentially look like if she couldn’t get treatment in the public hospitals (because I’d likely have to assist with the cost for private treatment), but it sounds like the public hospitals are a more reasonable/solid option at least in the short/medium term. I’ve paid my taxes here for 5 years now, so at least I can get some benefit from all that.

I really appreciate all of the advice here. If anyone has any other additional tips for navigating the public hospitals, they are very welcome!