Navigating Costa Rican medicine
When we were planning to relocate to Costa Rica a year ago, I took on the responsibility of figuring out health insurance. When Tabatha retired in August of 2022, we lost our health insurance through her employer. We knew her income would be too high for the year to get a subsidized marketplace plan, and the insurance offered through my employer was too expensive.
We thought, “How about going without insurance for a few months?” We decided not to risk it since one major injury or illness could be financially devastating. We opted for a cheaper alternative to traditional health insurance: a health sharing plan through Zion Health.
With the coming of 2023, we were able to enroll in an affordable government-subsidized marketplace plan. Since we planned to leave in March, I had been researching international health insurance policies. They all seemed complicated and expensive. Tabatha was willing to risk more in order to pay less. I wasn’t so much. Needless to say, we had many “discussions” about health insurance plans. Our marketplace plan offered minimal coverage outside of the U.S., so we decided to keep it through the end of March. We also purchased travel insurance which included some coverage.
Once we arrived in Costa Rica, we found affordable tourist health insurance through INS (Instituto Nacional de Seguros) with the help of an insurance company called Desyfin. We got the best plan INS offered, “Disfruta,” and it cost $750 for both of us to be insured for six months. I struggled to understand how the insurance worked. All of the literature was in Spanish. Insurance is hard enough to understand, but insurance from another country written in another language?
¡Aye!
We found that many businesses use messaging apps, and it really helps with communication. Calling wasn’t a great option, especially when we first got here, because my Spanish sounded something like this: “Uhh … hola! Umm … yo necesito … uhh … una cita … umm por favor?” Thankfully, we can set-up most appointments through WhatsApp or Facebook Messenger, giving us time to translate messages back-and-forth.
Our first experience with Costa Rican medicine was to visit the dentist. We were both due for a cleaning and exam. We asked for dentist recommendations through an expat Facebook group, and a dental practice right up the street from our rental was recommended. We were pleasantly surprised. An exam and cleaning cost us $95 each. Later, I got two fillings replaced for $140. In the U.S. it costs about $90 just for the exam and more than $140 for just one filling.
Next was a visit to the chiropractor. I was experiencing numbness and tingling in my leg, so I contacted a chiropractor and scheduled an appointment. A few days later, I took a ten-minute Uber ride to the location. The chiropractor didn’t speak any English, so we used Google translate. I explained my issue, and she explained what she was going to do.
I thought I was going to get the typical ten-minute adjust-and-go. First, she adjusted me. Then, I received a 50-minute massage from a message therapist. The hour-long session cost $50. Afterwards, the doctor explained what was causing the numbness and what I can do to fix it. I expected her to recommend multiple visits, but that didn’t happen. I go every month anyway, and whenever I have an issue, they are able to fix it in one visit. In the U.S., I would pay the same amount of money for a ten-minute adjust-and-go and an additional $70 for message therapy.
We got our first experience with the tourist insurance when Tabatha suffered an injury during the first week of May. She fell, and a few days later, we noticed her knee swelling up. The insurance works like an HMO, so pre-authorizations and paperwork are required for everything. The primary care doctor sent Tabatha for an ultrasound. Surprisingly, the test was done by a doctor, who handed her the ultrasound film and his findings that her meniscus was torn.
The primary care doctor recommended surgery and referred Tabatha to an orthopedic doctor. Tabatha didn’t have surgery until July 3rd. Why did it take so long? Well, it took us that long to figure out the insurance.
We found out that the first orthopedic doctor was not affiliated with the insurance. He was an “authorized provider.” This meant that we would have to pay the entire cost of the surgery up-front and then hope to be reimbursed. As an authorized provider, he also wasn’t required to accept the $2300 the insurance was willing to pay. He wanted $700 more. On the day of Tabatha’s surgery, we would have to pay him $3000 and the surgery center $2000. Then we would need to “hope” the doctor would submit the proper paperwork within the required timeline so that we could get reimbursed.
The doctor joked about this. We didn’t think it was funny.
By the time we figured this all out, Tabatha’s surgery was scheduled and cancelled twice. We realized we didn’t like the idea of shelling out $5000 up front, and we didn’t trust this doctor. We decided to find another doctor – one who was affiliated with the insurance. It was a difficult decision. By this time, Tabatha had been stuck in the house and unable to walk for two months. She was going stir-crazy, and I was exhausted from being the only one who could walk the dog and run errands.
To our delight, we were able to find a female orthopedic doctor, so we scheduled an appointment with her. At that point, we decided to get our Costa Rican driver involved. Chris speaks English, and he’s much more than just a driver. He’s also a law student who helps foreigners navigate Costa Rican processes, like getting a driver’s license, opening a bank account, and figuring out health insurance. Lord, we wish we had involved him sooner.
He drove us to the appointment, talked to the doctor, and made sure that we would pay only our 20% for the surgery. Afterwards, he gave us his opinion about the new doctor. He thought she was a very good choice. We think he really liked the receptionist too.😉
The surgery went very well. In the end, we paid about $900, and we were very pleased with the level of care. Tabatha is on the mend. She’s going to pool therapy twice a week for $60 a month. What a bargain!
God took care of us throughout this process. We trusted our gut feelings about the first doctor, and we were led to another doctor who took good care of Tabatha’s knee and also respected our finances. The first doctor tried to take advantage of us. Many people here think that all white people are rich.
Good news! Our residency has been approved, so we should have our residency cards by the end of October. At that point, we are required to sign-up for Costa Rica’s public healthcare system, “the Caja Costarricense de Seguro Social (CCSS), commonly known as “La Caja.”
Next Post: Returning to the U.S.
Rev. Joan M. Kistler 