Sunday, June 19, 2011

My first big encounter with a Brazilian health insurance company

Most people who have the means opt into a private health insurance network. There is free, universal health service for all Brazilians, but the quality of care can, at times, be sub-standard, and there are usually long waits for any interaction.
Luiz and I pay for private insurance as members of a large purchasing pool and get pretty good rates.  As a 51 year old consumer, my monthly premium, for example, is just over R$300 a month.

The system works pretty much like it does for HMOs in the States.  There is a network of providers, labs, hospitals and an ambulance service.  You must stay within the network.  Contrary to the USA comparison, there are no co-pays, deductibles or gate-keeper physicians.  If I want to see a cardiologist I just call and make an appointment, no need for a referral from a GP.
In November of 2010 I decided to get a gastric bypass operation to help me manage my weight and improve things like my high blood pressure and aching knees and feet. So we went to the surgeon’s office and started the process.
Over the coming weeks I went for numerous tests (endoscopy, 24-hour blood pressure monitoring, overnight sleep apnea testing, multiple blood tests, x-rays, etc.).  I never paid a dime for any of it.
We also went to our insurance provider, UNIMED, to get the details as to what we needed to get approval for the procedure.  It seems being fat is considered a pre-existing condition. So I would not qualify for the procedure until I had logged two years with the insurer.  While I had been a client of UNIMED for over 3 years, it turns out that when I switched from UNIMED-Rio to UNIMED-Fluminense that moved me from one independent entity to another.  So I had to have two years with UNIMED-Fluminense.  Sigh.  So that pushed things back about 5 months.
Other than that delay, the insurance company pretty much played it straight down the middle.  If I could provide all of the necessary tests and recommendations, they would sign off. So eventually they got what they needed and approved the procedure.
From my point of view I got very good coverage.  But if you ask any provider along the food chain they will scream about how low the reimbursement is for their services.
Now – the story of the surgeon’s office and that adventure – ha! That’s another story! Stay tuned.

4 comments:

bee and jay said...

Looking forward to the next installment, and glad to see that you're home & healthy.

B&J

Danielle said...

Hi Jim!
I'm happy to hear things are going well so far (through the blog and fb).

I married into a Brazilian doctor family, and I don't take their whining seriously for a second. The average price a doctor receives through an Unimed consult is 35 reais, but the average consult lasts 8 minutes. They have to pay fees for the first few years that they serve as doctors under Unimed, and they whine about that, but they never have to market themselves to find patients. What is essentially marketing from Unimed (putting their name in the Unimed book) saves them tons of time and money in self-promotion. Also, they get free Unimed insurance, plus super discounted insurance for even extended family (I get a huge discount under my mother-in-law's name! Once Alexandre is registered as a doctor with them, I don't think I'll have to pay anything.)

So don't listen to their doctor sob stories!!

Ray and Gil said...

Jim,

It sounds like you had a good experience with the Brazilian Health Insurance companies.
One thing worth mentioning is that Brazilian Health Insurance companies DO NOT cover medication.
So, the US companies charge co-payments, but pay for all medication, Brazilian companies don't charge co-pays and don't pay for medications.
Danielle makes a good point, if Brazilian doctors are making good money, imagine the American doctors who usually get a U$160,00 for a 10 minutes visit?
There is a lot of people making a lot of money in the Health Care business, that is one conclusion we can all make and agree on!

Ray

Meredith said...

Good to hear you're doing well. I had Unimed when I was in Manaus and they were fabulous. I visited every single doctor in one year and had excellent service.