Gastro Medical Help For Friend in Chile With Fonasa

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vamoschile
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Gastro Medical Help For Friend in Chile With Fonasa

Post by vamoschile » Fri Aug 23, 2019 12:16 am

Hello Everyone,

I have recently moved to Chile and I have a friend who is on the Fonasa system. They are lower income and have not paid into private insuarance at all. From my understanding they can go to a private doctor and get "bonos?" I don't know what it means and for how long they can get a bono to go to a private doctor. Recently my friend has been having serious bowel and stomach issues and wants to go to a doctor for a colonoscopy. My question is how do we get them in front of a Doctor quickly to get a colonscopy? I would like to get them seen ASAP to help them out. Do you all have any recommendations? I live in the sixth region by Rancagua. I was also curious if the colonoscopy results are bad how would someone get treatment in the private system with Fonso for a long duration? Can they just keep buying bonos forever? Any advice on how to help them would be very appreciated. Also curious if anyone recommends a clinic or doctor to treat colon issues in Chile.

Thanks

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Re: Gastro Medical Help For Friend in Chile With Fonasa

Post by eeuunikkeiexpat » Fri Aug 23, 2019 12:39 am

They must be FONASA B, C, D to be able to get bonos for the private system. FONASA A cannot use the private system, only the public system with its waiting lists but it is totally "free". With FONASA B or above, they are paying monthly into the system at the minimum wage level or above whereas FONASA A is for those who cannot pay into the system. That said, any private entity which accepts FONASA has no issues issuing bonos indefinitely if one can pay for them. Plan AUGE subsidies also function in the private system again if you can pay. Generally, the bono is a discount of around 50% of the private system retail cost.
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Re: Gastro Medical Help For Friend in Chile With Fonasa

Post by admin » Fri Aug 23, 2019 7:15 am

well that is a little close to home.

my mother in law just had emergency surgery yesterday for a bleeding colon at the regional hospital in puerto montt. she was however transferred by ambulance in the middle of the night last week. first to the local hospital where they stabilized her for about 15 mins, then they transferred her to the regional hospital. she has a bunch of other medical issues, so it took them about a week to to stabilize her to the point where they could even conduct a colonoscopy. finally she started bleeding again and they rushed her to surgery.

not sure about her fonasa category, but she qualifies for Plan AUGE because she is diabetic. it did not really apply to this situation anyway, because all the regional gastro specialist work at the regional hospital (just built a couple of years ago). even the ones in private practice use the public hospital surgical sweets because they are the newest in the region.

by luck, 3 out of 4 of the regional gastro surgeons are friends / clients of ours; which helped cut out a lot of the bullshit families typically get fed in these situation. The 4th specialist did the surgery. the other 3 supervised. given her preexisting conditions, it is not like there is a whole lot of room for sugarcoating this situation anyway.

last year she had an infection from a dialysis and spent a month and a half in the regional hospital. all free. If all goes well, she will probably be there for a couple more months.

the thing with her situation, we have seen is that because she came in by ambulance, she jumped the line for treatment. I don't know what to tell you if it is a serious but none-emergency situation. we have not been that lucky this year with medical emergencies.
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Re: Gastro Medical Help For Friend in Chile With Fonasa

Post by admin » Fri Aug 23, 2019 7:34 am

Plan AUGE is a series of chronic conditions that the public health system must cover the costs, in the public or private system. diabetes, cancer, hiv, bunch of others. they keep adding conditions to the list.

my father in law had cancer and was covered for treatment at the private cancer clinic in Santiago. this was like 5 years ago or so.

after he died, we sort of never found out what AUGE did not cover. turned out the head of the accounting department at the hospital has been a good friend of my father in law. so when my wife went to settle the bill, he just looked at her and asked, "what bill"?
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Re: Gastro Medical Help For Friend in Chile With Fonasa

Post by admin » Fri Aug 23, 2019 9:03 am

I have been debating when, how, and if to tell this story. I suppose since we are on the subject of how insurance works in chile, this is as good a place as any.

I believe it is important for foreigners that are new (or not so new) to chile to have a sense that for the most part the medical and insurance system is really good. not perfect, but about as good as you are going to get anywhere in the world. especially better than that developing country north of the equator.

like I said, we have not been that lucky with medical emergencies this year.

my best friend, a american gringo, that lives in frutillar had a major medical emergency earlier this year. him and his wife had cruz blanca private insurance.

48 years old, really good health, had some sort of none-specific medical issue develope where his leg just quit working out of the blue. we drove him to the emergency room in puerto varas. it stopped, he was released later that day. the doctors could not find a cause.

about a week later, it happened again. he was rushed to the emergency room again. this time he started having heart palpitations and other complications the doctors could not diagnose. we have another doctor that is a mutual friend that is a cardiologist that works in the region. he came in, examined him, and told us take him to santiago.

so let me explain how private insurance works. In any countries' medical system about 90% of all medical costs are caused by about 10% of patients or less. chile did something really smart, and found a way to insure the insurers against those really expensive edge cases. so, with private medical insurance in chile you get a catastrophic insurance on top of your plan. It is a pool of money all the insurance companies pay in to. they they can focus on making money off all the bells and whistles they hang on the basic insurance package they are required by law to cover (e.g. private hospital rooms, etc).

so, one way or other he is going to be on a medical evacuation flight to santiago that day. the only question at this point is who is paying for it.

this is not our first rodeo. we handle medical emergencies for our clients all the time. his wife and him have money to pay for this if needed out of pocket, but we are going to at least document that we went through the proper procedures to activate the catastrophic insurance. we figure even if they deny coverage, we can sort it out in court later.

so, 2 p.m. in afternoon, we have to go talk to the insurance company. unfortunately, due to some mismanagement of the PV hospital (long story), they don't have private insurance reps at the hospital like most private hospitals in chile typicaly do. typicaly there is a desk with an insurance rep for each company near the admission desk of a private hospital.

lunch hour in PV. the office of the insurance are officially closed, but we go knock on the door. the one woman that is there lets us in after we explain the situation.

she files the paperwork in the system. says it will be about an hour to process. again, not being our first rodeo, we take that hour to contact the companies that do these medical flights. they quote us $8 million to $11 million pesos for the flight, two doctors, two nurses, twin turbo props, 2000 km round trip. I guess there is only like three companies that do this, so they told us the typicaly they get the call from the insurance companies in about 15 to 20 mins.

to put that in perspective, when we contract private planes to fly in to the Patagonia in non-emergency, but time sensitive. situations, we typically pay around 5 million pesos for a thousand km flight, in to a really dangerous area to fly (mountains meeting the ocean). so with two doctors and two nurses on board, not bad. I seen an article recently that in the u.s. it is typicaly over a $100,000 u.s., and almost no insurance company covers it.

so, at this point we got them on stand-by at least. at 3 p.m. we get the call from the insurance company. flight approved. they are prepping the plane, filing flight plans, etc. ETA is 3 to 4 hours they will be at the puerto montt airport. our friend is stable. there are faster flights available, using local planes, but it is not that type of situation.

so, this is where I want to explain the politics / economics here. Their medical insurance company is actively assisting us, to spend more money on his evacuation and treatment. a lot more money, and they are not even asking questions. why?

stay tuned, next post coming.
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Re: Gastro Medical Help For Friend in Chile With Fonasa

Post by admin » Fri Aug 23, 2019 9:46 am

so, at this point, my friend is in route to Santiago on private med plane, to one of the ICU of the best private clinics in the country, to see the best specialist in the country. the insurance rep is calling around to find the best hospital for his known symptoms, with available ICU beds. by law, they have to send him to the best hospital available; and if the best hospital for the condition is not available, transfer him as soon as possible to that hospital.

as we still have no diagnosis, a lot of specialist are going to be involved. we are north of $50,000 u.s. in medical bills at this point, and the plane has not left ground.

so, why is the insurance company so helpful?

as i understand, this castrophic reinsurance pool in chile has worked almost too well. there has been some political debate recently about even refunding some of the money because it has grown so large, relative to its use. it seems the debate has come down to who and how to do the rebate. do the clients get the money, the companies, or is there some sort of middle ground that lowers everyone's insurance costs, etc? terrible political problem, that few countries have. definitely few countries in latin America.

In the meantime, from the insurance companies perspective, it is in their own best interest to push anyone they can on to the catastrophic coverage pool, with no questions asked. all they need is a doctor to make the call that it is a medical necessity. insurance companies in chile do not get to second guess doctors and hospitals; but, even if they could, due to this castrophic pool of insurance, there is this strange economic motivation where if they are going to question doctors, it is in the insurance companies intrest to advocate for more treatment, not less.

a few hours later, we are home, and we hear the plane fly overhead with our friend and his wife. not that many types of flights at night in southern chile.

he was transferred by ambulance from PV to PM airport, then flight to Santiago airport, then ambulance to the hospital.

ICU for a little over a week. hundreds, possibly thousands of tests. he easily seen a hundred doctors, including the head of the neurological hospital and the neurological association of chile. most studied and /or worked in the u.s. or Europe. almost everybody involved spoke English. we also had some political poll
at that hospital. the husband of one of our buisness partners, is a doctor and founder of the hospital.

a little over a week later he is released. he spends about another week in a hotel in Santiago, seeing more specialist on an out patient basis. then he finally flies home, commercial, to frutillar.

unfortunately, this story does not have a happy ending.

next post
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Re: Gastro Medical Help For Friend in Chile With Fonasa

Post by admin » Fri Aug 23, 2019 10:15 am

about a week later, we get a call, 2 a.m. in the morning from his wife crying. he has had a heart attack, she is doing compressions on him, and needs us to call an ambulance.

we jump in the car. my wife has the dispatcher on four way call with his wife still on the line, and the ambulance driver, as I am hitting 130 km an hour in town. luckily, 2 a.m. in the morning in a small town in the south, not even the street dogs are out. we intercept the ambulance in route and lead them to the house.

EMTs go to work on him. his wife at this point, has already been doing compressions on him for about 15 mins (she has CPR training). we all look at each other without saying it, but we know what this means. the EMTs give it a go though for another 30 to 40 mins. then they have to call it.

the conclusion, next.
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Re: Gastro Medical Help For Friend in Chile With Fonasa

Post by admin » Fri Aug 23, 2019 10:41 am

one of my bestfriends i have had in my life is dead.

the EMTs are leaving, and as standard procedure they have to notify the police. the police arrive. they tell us that they have to wait for the prosecutor to arrive, which will probably be about 9 a.m. They tell us, that the room where he died has to be treated as essentially a crime scene until the prosecutor releases the scene.

I get why they have to do this. look at it from their perspective. they have an unknown cause of death.

my wife, goes in to attorney mode, to nip this bureaucratic stupidity in the bud. no way we are letting our friend go through that, after everything that has happened.

we call his cardiologist, and friend, who had just examined him the day before to issue a death certificate. same doctor 5hat told us to take him to Santiago. he goes to his office to get his medical stamp and a certificate, and comes out to the house. after he certifies a heart attack as the cause of death, the police finally leave.

so, I am not going to try and armchair diagnose the underlying cause that killed him. we never did determine that cause. however, i don't think it was for lack of trying, lack of resources, lack of experts. sometimes people just die.

next, the medical bills.
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Re: Gastro Medical Help For Friend in Chile With Fonasa

Post by admin » Fri Aug 23, 2019 11:39 am

so, total cost and insurance company.

we are still waiting on some various bills (hospitals are suprisingly slow with billing), but our estimates is this was well over 100 million pesos, all in. Had this been the united states, well north of a million dollars in medical services. probably closer to two million dollars, and he would probably have died in a waiting room without seeing a doctor while filling out paperwork anyways.

so, all in, total out of pocket cost, minus a good friend and husband, for our other friend the widow, was ZERO pesos.

further, we get a call from the insurance company, informing us that his widow, as he was the primary holder of the policy, has a year of free medical insurance and that her rates will be the same when the year us up. believe there is a provision somewhere in the regulations that stop insurance companies from canceling insurance or raising rates on the other family members after such a situation.

so, in conclusion, to this very long story, when gringos ask me if it is worth paying for private medical insurance in Chile, the answer is a very loud YES!!!!
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Re: Gastro Medical Help For Friend in Chile With Fonasa

Post by snobrd4life » Fri Aug 23, 2019 12:19 pm

Sorry for your loss, admin. Very good story and insight into the catastrophic insurance coverage and ISAPRE experience overall.

I know that you mentioned it before that there were a few times in all of this they your connections helped smooth out the process, but realistically, how much would this have been any different for any other ordinary extranjero with private insurance, assuming they knew how to activate coverage based on the timing and situation?
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Re: Gastro Medical Help For Friend in Chile With Fonasa

Post by admin » Fri Aug 23, 2019 12:21 pm

a couple other observations from this experience.

even though we did not find the approximate cause of his death and illnesses, I still want to, in a round about way, blame this on the u.s. medical system.

here is why.

my good friend and I, over the years in chile, had long conversations about our experiences growing up in the united states with the u.s. medical system (1980's /90's). we both recall our parents and other family being terrified of the cost of going to the doctor, and especially the hospital. I remember at about 10 years old, having developed some sort of bronchitis, and telling my father that I needed to go doctor, and him looking at me very seriously and asking, "ARE YOU SURE you need to go to the doctor"?

my friend had similar experiences in his family. That does not leave you, even when your insurance has insurance, in a completely different country.

my friend, left the hospital in Santiago, against the doctor's recommendation early. they wanted him to stay for another week or two.

would it have made the difference? I don't know. It was at least a contributing factor.

but, as a gringo, I understand why he made that decision.

My wife has subsequently informed me, due to my own chronic grigoness, I no longer am authorized to make any of my own medical decisions; especially if i am still conscious.
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Re: Gastro Medical Help For Friend in Chile With Fonasa

Post by admin » Fri Aug 23, 2019 12:26 pm

snobrd4life wrote:
Fri Aug 23, 2019 12:19 pm
Sorry for your loss, admin. Very good story and insight into the catastrophic insurance coverage and ISAPRE experience overall.

I know that you mentioned it before that there were a few times in all of this they your connections helped smooth out the process, but realistically, how much would this have been any different for any other ordinary extranjero with private insurance, assuming they knew how to activate coverage based on the timing and situation?
over the years, we have never had a problem among friends and clients that had private medical insurance in chile.

we have had clients also depend on the public fonasa system. obviously, not as good as the private system; but also not bad experiences reported overall.

we have also had a few friends and clients pay out of pocket. expensive, but not u.s. expensive. I also would not want to get caught out in a crisis of this level with no insurance. medical costs in chile have gone up over the years.
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