#1132 – Navigating Health Insurance and Cultural Insights in Latin America

Automatically transcribed from the original recording; names and wording may contain errors.

[00:00] South of the border, down Mexico way That's where I fell in love when the stars above came out to play and now I wonder Hello there all you expat wannabes I'm Johnny Mueller and you're listening to the expat files living in Latin America the show that tells you just what it's like to live Work play and or retire down here in Latin America It's a mix of the good the bad the ugly and the great and it's all right here. So let's get started All right now you're gonna learn something I hope today a brand new boots on the ground story that happened to me as I was helping an older gringo Seventy-something guy friend of mine who suffers from one of the chronic problems longtime gringo seemed to have that is he knows very little Spanish

[00:47] It doesn't seem to want to learn it Claims he's too old and you can't teach an old dog new tricks and all that So he often needs someone a bilingual someone to hold his hand But that's just one small point we're gonna hit on in this story It's just more proof in another indication yet You could live down here a long long time and there'll be lots of things You still don't understand even if your Spanish gets there and it's pretty good There will be many surprises and sometimes a bit of confusion and you'll need to lean on people to get things done so anyway, this 70-something guy came down to Latin America to live permanently when it was about 67 years old and unfortunately being a typical American gringo. He had lots of little medical problems You do if you're the average overweight sedentary gringo of that age So what he went looking for Latin American insurance policies to get some coverage

[01:33] He found out that almost all of them wouldn't accept him anymore Because most of them have a cut-off date of 64 years old In other words, if you're 65, you can't get on the plane and with some plans the cutoff date is 59 years old So anyway, we came down five or six years ago. He was already past the age of 64 So he kind of gave up on getting private health care insurance Though I have to mention since then just a couple of years ago Some private insurance companies have been offering plans to people over 64 years old senior citizen plans Even a couple of those very good bank insurance plans like the Banco industrial insurance plan in Guatemala They introduced a senior citizen plan to you long-time listeners have heard me talk about bank insurance plans That's a very common thing here in Latin America

[02:18] You open up a bank account even put a hundred bucks in and all of a sudden You're eligible in fact you and your whole family are eligible for a bank affiliated private health care insurance And some of them are very good plans I know it's hard to believe but once you open a bank account Most banks will offer a health care insurance plan that has various levels good better best and for gringos the next best I always recommend get the best plan. It's only something like a hundred bucks a month. Come on It's even harder to believe they offer family plans starting at 35 or 45 bucks a month. Whoa Remember they have a good better and best plan That means the best family plan might cost a hundred or a hundred twenty five bucks a month, but it's very complete For example, let's take Guatemala the best bank affiliated health care insurance plan is when offered by Banco industrial

[03:08] Just get a bank account and you can get on it It used to be the very best standout plan, but now other banks are offering very competitive plans, too now I mentioned the cutoff age to get on those plans is either 59 or 64 but Even Banco industrial who have one of the best plans is offering a senior citizen plan now It's a little more expensive with a little less coverage than some of their better plans But it is a good way to get a private insurance plan whether you're 65 70 or even 75 years old I mentioned that their top plans around a hundred bucks a month for a single guy 50 years old Well the senior plan if you sign up and you're 64 and older is around 125 a month though with some reduced benefits, but it's still good

[03:53] Wow 125 bucks a month. What a tragedy So anyway, here's what happened with my 70 something year old gringo buddy when he came down There were no private insurance plans available because of his aid that was five or six years ago He didn't care all that much because he knew how ridiculously inexpensive The health care costs are here in Latin America. Even so at the time he really had no choice, but to do without go out of pocket So anyway a couple weeks ago. He went to a GI specialists without insurance cost him 35 bucks or the office visit in the workup He was having some stomach issues and his doctor ordered some blood tests and pelvic cat scan or tomograph with contrast Remember, he doesn't have insurance and it's all out-of-pocket costs Now this guy goes back to the states once a year around Christmas time and thinking about what something like that might cost up in

[04:42] the states he checked it out on the internet and he found that the average scan of a pelvis a CT scan using contrast material was around 1400 bucks. That was the national average up in the states So anyway, this gringo guy called me and asked my opinion about what clinic or hospital He should go to to have that cat scan done locally knowing of course that he was paying out of pocket I said let's check out two or three different places. He said why don't they all cost the same? Don't they all use the same equipment and the same payment schedules? I said, yeah, they all use the same equipment But the cost will vary dramatically and it's not about whether you have insurance or pay cash It's the fact that here in Latin America They grade the hospitals in clinics and depending on your hospital clinic or laboratory rating

[05:29] You pay a different price for different treatments. Oftentimes down here You'll see clinics and hospitals and laboratories rated with an A through C system a B and C With clinic and hospital a being the most expensive B average and C sort of a budget hospital clinic Now again, we're talking about private hospitals and clinics. The only kind gringles and expats should ever frequent We're not talking about the public national health care hospitals and clinics because most of them are just pure medieval In fact, there's such crap I always tell gringles and expats unless you get in a car accident right in front of a public hospital Under any other circumstances and as soon as the ambulance comes you say hospital brevado por favor That means take me to the nearest private hospital, please See it loud and clear hospital brevado por favor and chances are if you've been living in Latin America for a while

[06:20] You'll actually know the name of the private hospital you like the best or not It doesn't matter because the ambulance driver will usually ask you if you're conscious what hospital you want to go to But back to this hospital and clinic a B and C business now Of course, you're thinking you want to go to an a hospital or clinic cuz it's gonna be the best, right? No way you want to go to a hospital or a clinic that's got a C rating That's what all going goes and expats think when they first find out hospitals and clinics are graded like that But here's what you didn't know that grading system has nothing to do with the quality or the treatment Should get at those hospitals. It has everything to do with location and an a hospital or clinic will always be more expensive than a B Or a C one, even though they all are affiliated hospitals and clinics and the same docs and nurses are rotating through on a scheduled basis

[07:09] They've got the same high-tech equipment and technology But still a class C hospital or clinic is a lot less expensive than a class a so you have to ask Why is that? How could that be? And How do hospitals and clinics get rated a B or C? Well, it's like this an a rated hospital or clinic is in a very upscale neighborhood or business district in Small medium or large Latin American metropolitan area another way to find a class a hospitals and clinics wherever you find upscale hotels and malls and expensive houses and Man, those hospitals and clinics will look first world all the way nice modern architecture beautiful designs spic and span inside great lighting new furniture a Lot of glass and open spaces expensive marble granite and teak details great gardening and artwork

[07:58] Let's face it You want to be in a nice environment when you're sick if you're recuperating in a hospital room You don't want to be looking out at a motorcycle traffic jam a brick factory or a cell tower in a hospital or clinic You'll have none of that. So then what about the B hospitals and clinics? Well, you'll find those in middle-class residential areas Maybe a half-hour ride or so outside the central business and upscale hotel districts They're generally buildings that aren't so new anymore Showing a little bit of wear and tear and they do get a lot more patient flow and wear and tear Than an a hospital or clinic kind of look like hospitals and clinics look back in the 80s and 90s is where we come from So when you walk in they've got that kind of 80s and 90s institutional look Though again the equipment and all the technology is modern and up-to-date and the doctors and nurses

[08:46] Rotate through various hospitals and clinics So you will get the same level of care that you get in a class a hospital But man those B and C hospitals clinics and laboratories are crowded and there are long waits and lines in the end for the patient Anyway, it's all about the cost For example, let's say you need some kind of treatment or surgery Let's say gallbladder or elective surgery like plastic surgery, whatever your Latino doctor will give you some options he'll say we can do it at an a hospital for 3,000 bucks at a B Hospital for 2800 or a C Hospital or clinic for 2200 your choice note you'll still have your own doctor his team his anesthesiologist nurses, whatever But the treatment price will vary depending on the location

[09:31] Now I've been to all three kinds of hospitals and clinics the A B and C believe me I know the drill and I have to say the ones that are rated C Can be in some pretty scruffy neighborhoods and here's the other thing if you go to a B or a C hospital or clinic They're almost always super crowded as they're cheaper than the a hospital clinics and labs They are the number one choice of the common man. That is the common man who's got insurance Though down here in Latin America if you got insurance, you're not quite the common man You've heard me say before that less than 10% of Latin Americans have private health insurance And really the only reason why even 10% of Latinos have private health care insurance is that their companies are starting to give it to Them especially the transnationals like Starbucks McDonald's Sears Ace Hardware Walmart Costco and Taco Bell

[10:18] Kentucky Fried and my personal favorite Chucky cheese. Yep, Chucky in Spanish is Chucky. So it's Chucky cheese But I digress as usual anyway down here in Latin America You and your doctor can negotiate where you're gonna have that gallbladder or nose job done but still the way it works down here most insurance companies will pay 80% of the cost of an a clinic hospital or lab and 90 to 100 percent of a B clinic hospital or lab and they'll pay a hundred percent of a Class C clinic hospital or lab though There's some variation between insurance companies. It's pretty obvious why the B and C clinics are always pretty crowded by the way That's why when you walk into an a clinic hospital or laboratory They're almost never crowded and you never have to wait much at all to get ushered into the lab or get your treatment started

[11:07] in fact before the covidia thing I'd always take my seminar groups to an a class hospital and They'd always be amazed to see that the place was so empty and uncrowded with just a handful of patients in the emergency room Reception area, but man you go to one of those B or C hospitals everywhere you go You got to take a number and stand in line So my advice to gringles and expats who have Latin American health care insurance There's really no point to go to a B or a C hospital or clinic unless you've got way more time than money Because you will be standing around waiting in line now If you don't mind doing that and I hate it myself then okay By the way when you buy and get accepted in a Latin American insurance plan and they give you the documentation You know when you pay your first premium Well, if you look through the contract and the contracts usually six or eight pages long

[11:56] They spell out their coverage and co-payments listing those a B and C hospitals clinics and labs and their locations, too By the way with some Latin American insurance plans They'll only have type a and B clinics and hospitals not a B and C Don't ask me why these things vary a lot from city to city and country to country and insurance plan to insurance plan There's no cut-and-dried formula, but it'll all be spelled out in the documentation once you get on an insurance plan Oh and some plans won't call out hospitals clinics and labs as a B or C or a and B They'll just have for example a blanket 80 or 90 percent coverage for whatever hospital clinic or lab you pick And then your co-payment will be 10 or 20 percent and just like in the state some health care plans down here

[12:42] Will have a list of doctors clinics and hospitals where they'll pay a hundred percent coverage like in a first world HMO plan those are the hospitals doctors and clinics that are affiliated on the list in their plan and Generally, there could be hundreds of doctors in your plan But if you go to any other hospital or clinic or doctor outside their list, then they'll pay 80 or 90 percent again It depends on your insurance company, but be aware that down here. It's a bit different than what you're used to up in the states That's why by the way, if you don't speak Spanish, it's very difficult finding the right insurance plan You'll need someone to do you're translating for you because nearly all the plans here are in Spanish That means that six or eight page contract document you get when you sign on will be in Spanish, too In fact for my seminar people I took one of those contracts and translated it into English

[13:30] Just so they'd be able to see how it differs from insurance contracts up in the states and to be able to suss it out for Right now said about that now to the case of my 70 something gringo buddy who needed to have some lab work done Specifically a pelvic CAT scan with contrast a test that would cost him on average 1,400 bucks in the states So naturally since it was out of his pocket He was price shopping and me being curious about the breakdown myself. I offered to take him around and translate for him first stop a type a imaging laboratory we walked in and mosey'd over to the radiographic imaging department and Being a class a hospital clinic There were no long lines and no wait at all and the lady at the appointment desk gave an estimate of around

[14:17] $280 for the scan which turned out to be actually three different scans That's how they do a pelvic contrast scan one normal scan Then one scan after you drink some terrible crap and one scan after you check contrast die into your veins So the non-insurance estimate there 280 bucks Then off we went to a type B Imaging clinic it was about 30 minutes away in a normal middle class middle class by Latin standards Which is kind of lower middle class up in the states We found a parking place about a block away walked in to the waiting room Every chair was filled with about 10 people standing so we walked up to the little machine pulled out a number number 56 They were serving number 22. So I thought no gringo advantage here Though after about 10 minutes of standing around and they were still on number 22. I decided to take a chance

[15:07] I walked up to the cashier and I said approximately how much would it be for a pelvic contrast scan? Well, she didn't seem bothered that I skipped the line. No one seemed to care In fact, she seemed glad to do it. Maybe it was because we were the only gringos in the whole place Anyway, she looked at her computer punched in a few keys and came up with a figure 190 bucks now that was a Monday and she said you'll have to come on Wednesday morning early at 7 o'clock It's first come first serve no fixed appointments And I knew what that meant that meant hurry up and wait standing in an untold number of lines By the way, I forgot to mention at the a clinic We first went to where it was around 300 bucks You paid right there and they gave you an appointment for the following day or the next day, whatever Sure, it was more dough, but fewer unknowns like how many lines you'd have to stand it

[15:57] And finally after we left that B rated clinic We went to a C rated clinic in a pretty scruffy neighborhood lots of noise chicken buses and rec cars driving by Definitely not an upscale neighborhood and when we got within a block of the imaging clinic Although we'd never been there before we could see exactly where it was by the line stretching out to the front sidewalk This time there was a rent a cop outside handing out numbers Luckily that gringo advantage was holding out and I asked the guy if I could just pop in and see how much it cost to get That scan I told him I just had a question an inquiry as to how much it would cost We weren't there to get any kind of scanner lab work And you know if I wouldn't have opened my mouth We would have ended up in a line for a half hour or more just to ask that question Well that gringo advantage kicked in

[16:45] He said come with me and he ushered us in and when we posed that question to the cashier Slash front desk lady. She said a pelvic scan with contrast costs a grand total of 130 bucks But again, there were no appointments you show up first come first serve doors open at 7 a.m She said but if you want to get served fast get here on the day you want your exam by 6 a.m You heard right 6 a.m. So there you have it folks I just went through a gringo boots on the ground health care story Describing what the health care system is really like and I don't suppose anyone anywhere on any program or blog on the internet as By the to explain this thing about a B and C hospital clinics and labs not with this kind of detail anyway now to bring this Information full circle, you know how lately I've been talking about stem cell clinics and how stem cell injections

[17:34] They're often used to treat bad shoulder knee and hip joints The thing is before you get those injections your stem cell doctor is gonna make you get some CAT scans of those joints Tomographs so that he's got a three-dimensional picture of exactly where he's got to inject those stem cells Now if you've been listening to the last couple months of these shows You know, I took my brother to the stem cell clinic in the DR and he had three CAT scans done They were required before he got his injections He had a scan of each knee and a scan of his bad shoulder and because he was paying out of pocket Save him some money. I took him to a type B imaging clinic where each scan cost him slightly under 200 bucks Remember, these are not scans with contrast and dyes injected and such They're much simpler The thing is though I could have taken him to a type C clinic and each of those scans would have cost him around a hundred

[18:24] Dollars apiece, but he figured it wasn't worth waiting in the Sun in one of those uncomfortable lines So anyway by now I think you're getting the idea on how things work here in Latin America bottom line Even if you go to the more expensive type a hospital clinics and labs You'll find there's something like a fifth to a sixth the price of what you'd pay out of pocket up in the states if you didn't Have insurance and if you really want to pinch pennies and you've got a lot more time than money You could take a number and stand in lots of lines and get the same results By going to a B or C rated hospital clinic or lab your choice. It's up to you Oh and one last thing if you don't speak any Spanish at all You're much better off going to an a type clinic hospital or lab Why well since they're in nicer upper-scale neighborhoods and districts and mostly serve upper-middle-class people with more dough

[19:12] That means you'll have no trouble finding people who speak English there That as opposed to a type B or C hospital or clinic where English speakers are far and a few in between Sure, most doctors will speak English, but that's about it. Just saying Alright now here's an email that surely tops them all at least for 2022 now If you don't find something to like or hate about this one Then I guess when you were born, the doctor should have slept your mom instead of you This comes from a Chicago Irishman named Darby O'Shaughnessy Like that. Hmm. I wonder if that's real. He says Johnny top of the morning to you You know Johnny we're coming up on the greatest feast of all time March 17 st. Patty's Day he says well everyone's wearing green kissing shamrocks and drinking green beer and

[19:59] Celebrating st. Patty's Day to excess while all that's fine and good. There's something very serious. I have to mention today It's been bothering me for ages and especially when March 17th comes around Often he says when I'm tipping a few single malt whiskies I think about who secretly runs the media in the world again Some think it's gates sorrow is the Jews the Chinese or Russian bots. Nope. I'll let you in on a little secret It's the Irishman The Irish are secretly running the world and while they're at it getting even for all the wrongdoing That's been handed to him over the ages mostly by the bloody British It's about time the Irish finally get to run the world Yes, it's our turn to pull the wool over the eyes of the world We want them to think we are just a bunch of drunks cops and barstool philosophers singing Danny boy

[20:51] Meanwhile, our secret plan is rolling out nicely Of course, you'd be asking why why the Irish now first off There is the six million souls lost in the potato famine all due to those Brits No, you'll hear no mention of that on the lame Street News I'll ask Johnny the world is full of potato famine deniers us Irish will never forget those six million souls Now is our time to get even and who was directly responsible for that catastrophe? Nope, you'll never hear the lame Street media. Tell the unvarnished truth Not a single mention of that catastrophic 19th century climate change disaster caused by the Brits that took out the entire potato crop today's science, however tells us it was a plan a

[21:36] Direct result of the million-plus farting British horses in London it'll go down in history as the great British horse flatulence conspiracy and One might ask what became of those thousands of tons of horse droppings You don't know. Well, let me fill you in their poo ended up on the feet of every working-class Irishman day after day Contaminating the threshold of home sweet home and all our pubs. Yes those devil Brits planned it all and there must be reparations One acre and 40 sacks of potatoes for every McHenry O'Leary and O'Brien Yes, the Brits will have to pony up or face Irish fatwa Yes for the Brits the fates have turned sour and when it rains it pours now

[22:22] They have the tragedy of brexit and a pound floating free no longer tied to the euro They can run the printing presses till hell freezes over and further destroy their once mighty Empire Meanwhile the cost of potatoes worldwide is skyrocketing another cunning underhanded British trick Thank God the tables have turned and it's the dark web Irish secret societies running everything now Not the Brits or the Welsh or the bloody transgender Scots with their fairy pipers and girly skirts Anyhow Johnny just thought I'd warn you about the Irish fatwa It's coming or as we call it no kill Arnie a mick fatwa If you don't believe me, you can look it up on the black Irish web and Johnny one more thing a question What do local Latinos and gringos think of all the light-skinned Irish illegals flooding in from Europe into Latin America?

[23:11] I'm wondering how they blend in when they get down there if they blend in at all though I'm thinking Latin America must surely need beat cops bartenders politicians poets and paddy wagon drivers Guinness drinkers and whiskey makers Anyway, Johnny, happy st. Patty's Day to you signed Darby O'Shaughnessy Late from Boston presently kicking off my plan B in Panama Well, thanks for that Darby. What can I say? If that really is your name, but I could tell you this mr. D You don't see many pure Irish people in Latin America And when you do run into one of those geyser gals man, do they burn the tropical Sun is not forgiving to that Irish skin Most of them I've run into our beet red though. I have to say mr. D There's lots and lots of Irish whiskey drunk throughout Latin America mainly Johnny Walker

[24:01] I believe I mentioned probably hundreds of shows ago now for some reason Johnny Walker brand got the jump on all Whiskies throughout Latin America and now anyone who's anybody I'm talking about Latino males now as a bottle of Johnny Walker black stashed around the house Now this in no way applies to Latin American females They just don't drink whiskey But Latino men when they go into a bar and one would press someone they order Johnny Walker black Same thing when company comes over they'll dig out that hidden bottle of Johnny Walker black But that's only when they're around people when they're at home drinking alone It'll be Johnny Walker red or something much cheaper Oh, and I've been to a lot of Latino weddings too in the standard setup is to have a bottle of Johnny Walker black on every table now there is a rumor going around as to how Johnny Walker black became the Latin American go-to brand as

[24:52] It turns out early on maybe 30 or 40 years ago When Johnny Walker and other whiskies first appeared in a big way in Latin America No one was really drinking any particular brand of whiskey yet mostly beer and rum Well, it turns out a lot of whiskey brands came in tried to penetrate the market and failed But Johnny Walker took off because of a clever marketing scheme The Johnny Walker distributors would hire a couple of beautiful Latina models Dress them up in a tux and tails like you see on the Johnny Walker logo send them out to events like beauty pageants car races beach parties and such and Their job was to mingle with the crowd and give out free samples free samples and shots of Johnny Walker that is well Nothing grabs a guy's attention better than a beautiful girl giving out free samples, right? And that was how Johnny Walker became king of the whiskies in Latin America and about their competition

[25:39] There's not another brand that runs even a close second But back to old Darby and that st. Patty's Day email You know, mr. D some down here in Latin America Say Peru is where the pot of gold is for the Irish desperate sure Peru has lots of rainbows But they also have over 50 kinds of potatoes. Oh and one last thing, you know, mr. D. I'm from Chicago and you know, we always turn the Chicago River green on st. Patty's Day I'm sure that's always been a non-toxic and 100% environmentally friendly thing to do, huh? Oh And don't forget all that green beer and green dye number 17. Oh And one last thing mr. D. You know every medium and large Latin American city seems to have an Irish pub and believe me There's no local Latino that could set one of these things up. It's gotta be a true blue

[26:27] Irlandes, that's what Irish people are called down here in Latin America Irlandes or Irlandesas So if you're visiting down here in Latin America We've got your plan be going down here and you're longing for the atmosphere of a real Irish pub. Don't worry You'll find one. Oh and to deform you go into one of those pubs You'll find quite a few Irish people hanging out and since the Irish are quick with a quip and a phrase I've noticed myself that oftentimes a fight or a skirmish will break out In fact a few years ago in my band was playing the bar circuit throughout most of Central America We played in a number of Irish pubs because the patrons of those places like English speaking rock and roll music And the one thing that comes to mind for me is that it seemed almost every weekend Someone there would start a fight They'd come to blows and in the end end up shaking hands drinking together becoming best buddies at least for that night

[27:15] Now that's something you almost never see with Latinos when they get in a bar fight It's almost always a macho jealousy thing It's almost always over a woman and they never end up shaking hands having a few makeup drinks and becoming best buddies That's not gonna happen, but you knew that already, right? You've been listening to the expat files living in Latin America If you need some help with your own plan B We can schedule a one-on-one phone or Skype consult just send me an email the expat files at gmail.com and if you want to get on the waiting list for my next week long expat Insider seminar in Central America where you're guaranteed to get a two to five year head start on your plan B Send me an email the expat files at gmail.com No spamos