Registering for IESS health insurance & filing a claim for our limited insurance

In August, I started getting hives. This is not new for me, I’ve had hives before. I have lots of allergies. Usually, I wash them with mild soap, put some cream on them, and they go away. Not this time. For 2 weeks, they drove me nuts! I tried everything. Antihistimines, benadryl, soothing creams hubby got at the pharmacy, you name it. Nothing worked. I tried limiting my diet, washing my hands a lot; I thought maybe it was those flowers I touched, so I avoided flowers. Nothing.

Finally, on a Saturday, I woke up to the hives on my face, my cheek, my neck, my forehead. Yikes! The ones on my arms and legs, because I itched them when I shouldn’t, had become very red, and I figured might even scar. I did NOT want a scar on my face. No. 

We have insurance here. I called every number on the little card they gave us, none of them went through. Some said they were the wrong number, others just rang and rang. Bother. So I hauled myself into a taxi and directed him to the one hospital that I was familiar with, Santa Ines. Supposed to be the best. OK. I entered the emergency area, and the nice nurse brought me immediately into a cordoned off area with a bed, and said wait. A GORGEOUS young intern or doctor (I can’t even remember his name) asked me lots of questions. When did it start, where did it itch, what had I taken, etc. Did I have any other medical issues, etc. Then he asked if I wanted a specialist to come look? Of course!! The specialist came, asked the same questions, and prescribed a shot of benadryl, Allegra!! and a special cream. I was given a slip to take to the cashier, I paid $61.00 and came back to the ER for my RX script. I told them I had insurance and they said, come back Monday for your forms. OK.  I went home, hubby went to the Farmacia for my drugs and I took and used everything. By the way, I love that cream. It worked wonders. 

We came back on Tuesday, asked in about 3 different places for the appropriate forms, they gave us some forms, and then we took them to Banco Pichincha to file with the insurance department. The insurance lady said, this won’t work. You need a different form, and they must be signed and stamped. OK. We went back to the hospital, asked for the forms to be actually SIGNED by the doctor, they ran around, got the doc to sign, and we went back to the bank with the forms. I think I am simplifying the whole process because it seems to me that hubby made at least 3 trips to the hospital and to the bank, each, to get the right forms. Next I got an email from Confiamed that a check in the amount of $18 was ready for me. $18? Hmmm. 

When we went to pick up the check, they told us that to get the entire reimbursement, I need an ‘affidavit of emergency room service”. If I can obtain that, bring it back, they will pay an additional $20. Deductible and Coinsurance makes up the rest.

So we went back to Santa Ines. Asked for the form. The ER tech says, you are not in the system, you aren’t showing that you were ever here. What? I went to the cashier, since I KNOW I paid them. She looked me up, then took us across the hall to another ‘customer service’ desk. We told her the situation, and she looked me up, found me, and then telephoned the ER to say that someone input my last name incorrectly, that she had corrected it and told him where to find it.

We returned to the ER, and he said, the form has not been produced yet, we’re busy, come back later today or tomorrow morning. OK. The next morning, I returned to the same guy, and he still can’t find it! He telephoned the lady, apparently she told him where, and he hung up and started typing. I asked, still can’t find it? No, he found it, but, the form hadn’t yet been ‘done’. I stood at his desk and waited. He asked me a few questions and then he took off to get the printed form. Yay! I’ve got the form. Now, we’ll have to take it back to the bank to submit. Whew. It’s a crazy process even in the United States. I guess insurance companies are the same everywhere.

Maybe there’s another solution to this Ecuadorian health insurance process. If you are young enough, anyway.

This month, October, I turn 60. Earlier this week, I went to the IESS (Ecuadorian Social Security) to register for the Ecuadorian Health insurance, covered by the government. If you are not an employee, but under age 60, you may register and pay for this complete health insurance for life. If we just kept our Confiamed, once we turn 70, it will be either horrendously expensive or we will need to sign up for another, also expensive, insurance for ‘older’ people in Ecuador. 

Since I am still a young thing, I decided to try the IESS process. See what happens, maybe I’ll get accepted.  I was instructed to go to the online website of IESS and sign up for the ‘voluntary’ health insurance, using my Cedula number. I could never get past ‘processing’. So, hubby and I trudged down to the IESS office in El Centro, got a number, and waited. And waited. The number paper said the wait would be 16 minutes. Hmmm. We waited for an hour and a half until finally, the security guard called my number. Using one of their computers, he went to the very same site I had visited unsuccessfully to register myself. He tried about 15 times to get into the system with my cedula number, until he finally got into the record of my cedula. Apparently, it wasn’t my number, or my computer. It’s their system. He said that happens all the time. It’s a busy system.

The system printed out a record with 2 items: my ‘base’ salary ($330.00) and the cost for me to buy the insurance, if I am accepted, at $55.00 monthly. I protested to the guard, but I am not an employee! No matter, he said. Here’s what your cost will be. Next he printed out a letter for me, with my name and number, etc., and told me to take the letter to the IESS clinic and get a complete physical, blood and urine work (checking for HIV, Hep B, urea, creatine, glucose, etc), a chest x-ray, and a PAP smear (all of which is outlined in the letter). If all of those are good, then I’m in!

The guard told me to go to the IESS dispensary, just around the corner off Borerro. I went, but they told me, no, they do NOT do any exams for ‘voluntary’ enrollees at that location. I must go to the IESS hospital, near the Monay mall, on the southeast side of town. OK. Can I make an appointment? No, I was told, you just show up and take a number. They will see you as they can, and it must be done within the next 15 days. P.S. the clinic opens at 7:30 a.m. I’m going tomorrow very early, hopefully, the taxi driver will know where to go, and hopefully it won’t take all day!

Later Monday, while getting a pedicure, I was chatting with the salon owner. Not understanding it all, I asked if she knew about this. She said, oh yes, I need to do that. When I was an employee, I had that insurance, but now that I’m a business owner, I will need to sign up just like you. What did you do? how was the process? where do I go? Yikes! I’m here for 4 months and a native Cuencana is asking for my advice and directions? no wonder it seemed difficult to me to get through this process. 

I showed her the letter for her help me with what it said, maybe explain the details to me. Eureka! remember that ‘base salary’ that I mentioned? When I get the exam tests, I can only be charged no more than 20% of my ‘base salary’ for the tests. Which will be $66.00. Not bad for a complete physical! I figured that I haven’t had a complete physical for a few years, it’s not too bad a price to pay, and then I may even get this permanent full insurance for life (as long as I pay every month – I’ll have to figure out where/how it gets paid, next step) and there will be no claim forms to submit. 

On my next blog: registering our ’employee’: our once a week cleaning woman, and figuring out how to register and pay her social security taxes on the wages we pay her. It’s ALSO a complicated process.

 

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2 responses to “Registering for IESS health insurance & filing a claim for our limited insurance

  1. I read online in a January 2014 piece that the law has been changed and now those over 60 may also be covered at the same rate. Do you know if this is actually true? This would make a big difference for my husband and I as we will both be over 60 when we would move to Ecuador. Thanks!

    • Yes, it is true that there is no longer any age limit to join the IESS. Also, they do not do any health exams for ‘voluntary’ members. Your ‘premium’ is based on the minimum wage in Ecuador, which was raised on Jan 1, 2014. I am now paying $61.00 every month for full coverage. I haven’t had the chance to use it yet, but will chronicle the experience, if I have to use it. I have also learned, that if an IESS member goes to another hospital for a TRUE emergency for care, if you tell them that you are a member if IESS, they are required to treat you but not charge you as they will then charge IESS for your care. This is only in the case of a TRUE emergency, which may be ambiguous. We have maintained our Confiamed limited medical insurance plan, which I have used a few times with minimal problemse, most recently when I fell and went to the Hospital del Norte. Very nice, clean, new facility.

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