Surgery/Health Insurance Question

[philly2386]

Hello forum!

I am in a bit of a quandary and was wondering if I could get some perspectives on the situation from people a little bit more familiar with the healthcare sector here.

Im a masters student here (from the USA) with DNI and visa temporaria. I dont have health insurance here, but have a chronic health problem which is now flaring up. I have what is called ulnar nerve compression/cubital tunnel syndrome, which is basically like carpal tunnel syndrome but in the elbow region. It was diagnosed in the US, and I was given a splint to use to stabilize the elbow while I slept. This worked to stabilize the situation for a couple of months, but unfortunately it is now worse and I believe surgery may be in order.

What are my options in the event that I do not want to interrupt my program and return to the USA to fix this?

While I dont have loads of money, I have enough to get one of the Hospital Italiano or Hospital Britanico health plans here, especially since I am only 24 years old. So my questions are

1) What it be possible to get on one of these plans and then go in to the neurosurgery department at one of these hospitals a month later? Would this raise some pre-existing condition red flags? Are these plans likely to cover such an operation? (I know that obviously I would have to speak with them and ask specifically about coverage, but Im wondering if any people have any personal experiences with this). I have read in other posts that pre-existing conditions tend to not be a problem with coverage here, but Im wondering if there could be some sort of problems once the coverage is accepted.

2) I see that Hospital Italiano, Britanico, and Aleman have good reputations here, but would it be recommendable to undergo an operation of this nature here instead of going back to the States? This is not exactly brain surgery, but certainly a botched operation could lead to further problems. Of these hospitals, does anyone have any recommendations as to which one would be best?

3) And, finally, does anyone suffer from this/carpal tunnel or any other similar syndromes who would recommend a specific doctor?

Thanks so much for any help.

 

[Mano Negra]

I don't know much about health insurance (I currently self insure) but I suspect an undeclared pre-existing condition would be fraudulent.

However I did wake up a few months ago unable to move half my hand and thinking I must have had a stroke in the night (though I didn't feel too bad). I went down to the Sanatorio Mater Dei in San Martin de Tours in Palermo. They sent me to Dr Juan Hernan Morchio who specialises in hand and upper limb surgery. He was excellent, told me I had carpal tunnel (just taken up the guitar over enthusiastically after many years without practice and bought a lap top that required different movements), and prescribed some stuff that may have helped but certainly put me at ease. I would thoroughly recommend making an appointment with him 4809 5533, I think he spoke some English, and he was totally professional. If I remember rightly the whole thing only took an hour despite him taking me to 3 other people for tests (in case he was mistaken and there was a risk I might spin off my mortal coil) and cost about 200 pesos. I am confident he would give you good advise. However, as these things can take time to heal you might consider going to a good acupuncturist as well. Can't help with that though, sorry.

 

[jimdepalermo]

I don't think there would be a problem with pre-existing conditions here, but you'll never know until you ask. The insurance companies here are nothing like you're accustomed to dealing with in the US, and they tend to have few or no restrictions on coverage.

My suggestion is that you go to the Aleman or the Italiano (I'm not a fan of the Britanico) and speak with an asesor for their health plans. Explain that you're here for x months studying and you're thinking of joining a plan. Discuss coverage in general, and listen well. Ask about limitations for pre-existing conditions. During the conversation, tell them that a doctor in the US told you surgery might eventually be necessary for the cubital tunnel. And see what they say.

If you find the hospital plans don't give you the answer you want, you could try again with asesores for the independent prepagos, especially OSDE. They're a little more expensive than the single-hospital plans, but they tend to be a good deal more flexible as well.

And report back here what you learn, for future foristas!

I can recommend two traumatólogos for consultations. Both are in the OSDE cartilla, and I don't know which others. I would ask them who specializes in this sort of surgery. You can also discuss insurance coverage with them - they're likely to know of any problems you might encounter with the various plans you're considering.

Dr. Carlos Edgardo Bertolini
Av. Olazábal 5392, 4° B (Villa Urquiza)
4522-3682

Dr. Jorge Cavallo
Medico Cirujano especialista en Ortopedia y Traumatología de la Asociación Argentina de Ortopedia y Traumatolgía.
Medico especialista en Cirugía Artroscópica de la Asociación Argentina de Artroscopía.
Médico Cirujano Artoscopista instructor de la Asociación Argentina de Artroscopía.
(011)154-411-8080 - Capital Federal, Argentina
Consultorio: Olazábal 1520 - - BELGRANO - Capital Federal

 

[ElQueso]

Hospital Aleman certainly does care about pre-existing conditions. If they know about it, they exclude it specifically in your plan.

My wife fell off a horse when she was about ten years old and it ruined her left elbow - dislocated and tore up the joint pretty bad. This was in Paraguay. She saw a "witch" doctor who set her her arm straight, splinted it and she couldn't move it afterward. Later, she went to a clinic where they re-dislocated it performed some surgery on it; they didn't do it correctly, but at least they set it with the elbow bent instead of straight. Since she was 10 she hasn't been to move her elbow more than about 15 degrees.

When we signed up for Hospital Aleman, they asked us about pre-existing conditions and she told them about her arm (one doesn't really notice it when she is dressed in normal clothes most of the time). She told them about it. They sent her to get x-rays and had a doctor opine about whether it fit into their plan. The doctor disallowed it and her condition has been specifically precluded from our plan.

With something like carpal tunnel, you might be able to get away with it, particularly if you haven't had any kind of surgery to show scars. Almost certainly you will not have a problem when you sign up since it doesn't show with no scar on the outside.

Technically, it is fraud I suppose. I don't want to advise you to break the law and my advice doesn't come with condition of refund if something happens , but to answer your question you can probably get away with it.

However, I do remember they told us something about the amount of time between joining the plan and having something taken care of, that it may be seen as a pre-existing condition. Unfortunately, I don't remember the details of that. Again, for something like carpal tunnel, I think you'll be alright. It probably only relates to big, expensive things.

I went to the hospital about three months after joining the plan because I had some terrible pain in my rotator joint in my right shoulder. Turned out to be bursitis and they gave me a shot that day to help the swelling, and a physical therapy plan at a private clinic that participates in HA to help with the bursitis.

I mention that because they never said anything about the possibility of my bursitis being a pre-existing condition.

 

[Ceviche]

Hospital Aleman certainly does care about pre-existing conditions .

El queso, any reason why you chose Hospital Aleman insurance as opposed to OSDE? Personally, I like Hospital Aleman very much but I hear OSDE is way better.

And a query to people from USA, amongst you guys who have taken insurance in Argentina also have some plan to cover you in USA?

Although I am very satisfied with Argentine medical system/hospitals/insurance..I want to have a plan to cover me for cancer treatment in US . All said and done, feel US has the best cancer treatment but also feel that Argentina is pretty upto the mark in all other ailments etc.

 

[vtw]

Things always change but last year OSDE required you be in the plan 6 months before you could have surgery under their plans.

 

[Crema Americana]

How long are you planning to stay? If it's going to be for a few months, I'd suggest you get health insurance anyway. Most companies offer different plans. If you opt for one of the premium plans you may be covered without much issue. It will be expensive, but less so than paying for surgery out of pocket.

Every insurer is different and has different requirements. But you should see a Dr. in any event. Perhaps there's something they can do for you until you're eligible for surgery.

When I signed up with OSDE the only "preexisting condition" they were really concerned about was if I was pregnant. Though I did have to fill out a form.

 

[ElQueso]

El queso, any reason why you chose Hospital Aleman insurance as opposed to OSDE? Personally, I like Hospital Aleman very much but I hear OSDE is way better.

Cost/benefit ratio. I enrolled in Hospital Aleman almost 5 years ago. At the time, HA was about in the middle of the pack of decent private hospitals cost-wise. I'd been to their main hospital a number of times previously and I really liked the professionalism, and they had good coverage in other clinics outside of Cap Fed and throughout Argentina.

I also knew a couple of guys who had HA, and a couple who had Swiss Medical. Swiss Medical was about twice the cost of HA for what seemed like the same level of care, plus I really liked that HA had a central hospital, which Swiss didn't.

OSDE, I didn't know anyone who had it at the time and was going by recommendations of people I knew. It was also, at least at the time, more expensive than HA though I don't remember it being that much more.

However, my premiums have almost tripled since then - I really don't know if others are more expensive now or not. I'm sure everyone else has gone up in the same fashion though.

 

[DontMindMe]

I had a similar dilemma when I was exactly your age last year in BA, debating getting surgery that was recommended to me by my Argentine cardiologist, and later my Argentine cardiac surgeon. I had OSDE 210 but my heart condition was diagnosed a few months after I signed up, after a couple delightful months of running all over town going to different labs for diagnosis after an overnight stay hooked up to machines in the guardia. Health insurance companies aren't evil in Argentina the way they are in the U.S., but do your research. When I signed up for the 210 plan, for example, I remember reading that you have to have the plan for nine months before getting pregnant or else your pregnancy won't be covered. So there are some things like that. I would suggest going to the office of the plan you're interested in personally and asking. I know, it goes against every instinct you have as an American in the way you approach health insurance. But you won't be punished for it like in the U.S.

My surgery would have been an exploratory heart surgery done with catheters. The Argentine surgeon, who I was told was the best in the city, was waiting on some new technology for the procedure, which is part of why I ended up not getting it in Argentina. (That and having no family there, etc. in case something went wrong, and some other stuff I will detail later.) I was going to have to wait God knows how long for whatever new equipment they needed, then basically be a guinea pig for a bunch of people who had just learned a new surgery technique. These were excellent doctors, but ehhh, no thanks. I was also told that the surgery was "very safe" when I asked about the risk. In the U.S., where they've of course had the modern equipment for quite some time, I was told that 1 in 100 patients die of a stroke on the table. In the words of that surgeon, "It's certainly not a lot, but it's not nothing."

My doctors back in the U.S. were actually confused as to why the surgery was recommended to me in BA, since my case was not that extreme and I was doing okay on medication. I decided not to get the surgery and manage my issue with a beta blocker, which I will have to take for the rest of my life, that or get the surgery eventually. Many heart medications can affect a developing fetus, and at 24 I guess I was approaching the age where women want babies, so the doctors in Argentina recommended that I get the surgery then if I wanted to get pregnant one day. The reaction of the cardiac surgeon in the U.S. upon hearing this: "Are you married?" Me: "No." Him: "Are you trying to have a baby, or do you want to have one in the next few years?" Me: "No. I'm applying to graduate schools in Europe." Him (cocks head): "Then I am genuinely perplexed as to why they were pushing this surgery." Me: "Uh...Cultural differences? I really don't know, but they seemed awfully concerned about fetal development." Him: "Huh." (Later, my stateside gynecologist, who is actually from Buenos Aires, would be equally perplexed.) He also switched me to a milder medication than the one I was on in Buenos Aires, which has worked great so far. Perhaps due to import restrictions my current medication wasn't available in Argentina, and the medication I was on would wreak havoc on a future fetus. That and abortions are illegal in Argentina, maybe? I must stress that that's 100% pure speculation; I really cannot be sure.

Obviously your situation is different, and I guess my point is that I would suggest 1) getting a diagnosis and 2) researching the hell out of whatever this surgery might be, if in the end a surgery is recommended. Maybe research the surgery before picking a plan, if you know what it is. If it requires an imported part, you may have to pay out of pocked depending on the plan--or they may not have the part. Import restrictions are affecting the medical community of Buenos Aires in a major way. It's unfortunate since the medical schools and medical care tend to be good. I am not discouraging you from exploring your options in Argentina, but I do want to warn you that what would take a day or two in terms of labs, diagnosis, etc. in the U.S. could take much, much longer in Buenos Aires. (Lucky that you're a student so your schedule is flexible!) Getting surgery while abroad is a big decision. Who will be there for you if something goes wrong? Do you have health insurance in the U.S.? How's your Spanish? Doctors tend to speak English, but not all of the hospital staff, nurses, etc. will. How long are you planning to stay in Buenos Aires? I don't know what kind of surgery you would need, but you did mention the neurosurgery department. Let's face it, that's not like getting a broken leg set.

Pro tip: The best specialists work in big clínicas or hospitals. Skip private practices; you are not looking for a dentist here. I liked my OSDE plan because I could go to great clínicas like the two Bazterrica locations on Billinghurst and on J.D. Perón, and I wasn't stuck at one particular hospital. Odds are you will be diagnosed by a specialist, who will then recommend a surgeon to you. Good luck with your decision!

 

[Ceviche]

Basis "dontmindme" comment- So does it mean for someone living full time in Argentina, its prudent to have a insurance both in Argentina and USA?