Universal vs Humano experience and some questions

A lot to address here. So in my opinion, they are both similar in nature. Both are big  and secure.   Both  have issues on an administrative level and both are making a lot of changes.

After age  65 it is almost impossible to get good coverage. There is something out there but its not good coverage and its expensive.

Most companies are moving towards an age based system.  The older you are the more you will pay.  I have a group with Humano, currently  a 5 year old pays the same premium as a  64 year old male or female.  That will soon change.  It will be scaled but is not definitive yet. I am told it will look something like  55 - 70 pays  120% of premium.  70 to 80  will pay 150% of premium. Over 80  will be  200%. AGAIN that is an example and not set in stone.  You can also expect many more  rated policies or policies with exclusions.

Switching - this is rarely a good idea.  When you switch its a brand new policy, brand new application and brand new waiting periods!  Anything that happened in the previous company can be used against you.  Insurance companies love to deny claims. 

Both Universal and Humano have a large  base of doctors to work from.   Be advised many doctors are opting out of accepting many many insurance companies.  They are unhappy with the amount they are being paid.  When this happens you want to make sure your coverage  includes out of network reimbursement! 

At your ages, I recommend  getting coverage sooner rather than later!   Policies are getting harder to qualify for, the companies are realizing that expats are a market they do not understand. Aging populations are still somewhat understood here.

Years ago when I was  analyzing what I wanted, I chose Humano. I find the administration slightly less frustrating than Universal!  That said, they all can drive you mad!

Dental etc -  depends on your policy. In my group coverage we have some decent but not great dental coverage.  That said, you will find dental care is not that expensive here!   

Requirements will change based on age.  Humano and Universal both require a visit to one of their doctors from age  60  or if there are pre existing conditions. The company pays for it all! Think of it as a paid for check up!

I hope this helps.

How have been the yearly increases been on a typical policy been?

There was a significant increase in premiums this year.  I expect because of COVID.  About 20% from Universal.

Ok thanks so much for the insight! I really appreciate it. Interesting that they may go to an age-based system grouping a wide range of ages

I know some people that have said the doctors  they have been to will accept the insurance , but the still want you to pay something , I guess it’s like a co-pay or the equivalent , they mention the same problem with not getting reimbursed enough

Say your a Domincan citizen with no health insurance. They can only go to certain places? Government reimburses in those cases to the facility/doctor?

A Dominican with no insurance pays or goes to a public hospital. They have very limited resources in public hospitals.

My friend I’m sitting w/here says the same they pay at a clinic and if they have no money they go to the public hospital and cross there fingers….:-)

I might add that you could also be waiting for hours at the public hospital or clinic.

So how would you rate from top to bottom of care? Different quality clinics and private and public hospitals?

my friend was In the doctors office and waited 4-5 hours to see the doctor and was given number 8 on line when he made his appointment 2 days earlier,  he stated that as you sit there other people come in that had an operation and the doctor will see them before the person with aches and pains….then on the follow-up everyone was sitting there for 2-3 hours before they found out the doctor was still home eating lunch…. They waited…lol

Rating care - 

The upper half ALL Private hospitals and clinics.  Some are much better than others so investigate what is close to you BEFORE  you need care.

In the bottom half ALL public hospitals.  Some are marginally better than others. ALL are underfunded, over run, stretched to the limit  etc but not all the time. 

The systems here are very different! An appointment usually is not an appointment as many of us understand them.  You arrive early early in the morning to "get your number" and then you sit and wait all damn day!   A very few doctors and clinics  actually use and honor appointments! 

I’m sure that’s true Planner, when you say some private hospitals and clinics are better than others. It’s the same here in South Florida. Anyone in the PC area have input on the ones there? I.e IMG, Hospiten, etc? If you had an emergency where would you prefer to go and why?

From what I know, Hospiten is excellent.  I use Hospiten in Santo Domingo and am very happy with them.

Good to know! Thank you 😊

Are the wait times in private clinics and hospitals long in general or depends on location?

Depends on location depends on the day of the week and the time! And can depend on the doctor!

planner with the rejection of ASR Universal by the Dominican Medical College, would that not mean the choice between Universal and Humano is now much simpler?

The massive disaffiliation of all doctors from the ARS Universal was announced on Tuesday as part of the struggle strategy of the Dominican Medical College (CMD) and its 56 specialized medical societies. Whoever disobeys this directive of the National Board of Directors “will be summarily submitted to our Disciplinary Court with the consequences that this entails in the benefits for their future work and union exercise,” the organization’s president Senén Caba warned. This decision is effective right away, and it is “specified Caba,” specifically, that “from now; the plan is to escalate.”

It is estimated that ARS Universal brings together 7% of national affiliates, affecting some 325,000 patients. In response to inquiries regarding the decision, the president of the medical profession claimed that “of the four largest ARS, although it is the one with the fewest affiliates, (Universal) is one of the most powerful and one of the ones that has been more belligerent in confronting, in confronting the doctors and the specialized societies.”

A campaign, he continued, “has been imposed in this process in a cunning and treacherous manner to position us in the population’s imagination as the bad guys in the movie, while they have served themselves with the big spoon, receiving more than 188%, once the capitation has increased.”

Caba recalled that the per capita income was 620 pesos 15 years ago and that it is now 1,400 pesos, totaling an accumulation of more than 152 billion pesos since the Family Health Insurance program started.

https://dominicantoday.com/dr/local/202 … ffiliated/

I have Humano, but I switched to Humano previously from Palic.

From what I am reading I am glad I didn't switch to Universal.

It seems doctors will face penalties for accepting Universal at this time.

DR citizens have very low coverage automatically with basic SENASA and the Dominican Medical College has a movement afoot to have everyone covered eventually by SENASA. What I think is called "single payer". Time will tell on that. Senasa has various paid levels as well as the very basic one for citizens only.

What is the experience with Mapfre - months ago had seen that carrier being pushed.

https://www.expat.com/forum/viewtopic.php?id=1005012

This seems to be a regular issue.

The Dominican Medical College (CMD) does the same every year with the top 3 ARS

In 2020 they did it with HUMANO, In 2021 with MAPFRE SALUD, well, this year they took Universal.

They are in negotiations. 

I wouldn't get too excited.  I received this response from my broker who I consider to be a reliable and knowledgeable source.

My broker says this is normal posturing and negotiating!   Dont make any rash moves!   Don't leave Universal  because of this!   Just give it a bit of time to settle out.

can someone give me a some dollar figures as to how much it would cost for a 75 YO male to sign with Humano or Universal... on a monthly basis

We sell humano health insurance . it is not available to people 65 or older.

@colmcb We are HUmano agents and the premiums do not increase until 70 years old. You cannot get humano 65 years or older  Norm

can someone give me a some dollar figures as to how much it would cost for a 75 YO male to sign with Humano or Universal... on a monthly basis
-@kschw9883

Are you a legal resident of the DR?

Any insurance you get to start with at your age (over 65) in the DR will be rather limited, if possible at all.

Others can chime in with advice on that. I had heard about some group plans or possibly paid SENASA versions.

@colmcb

Hi,

I apologize for the lengthy message but I saw your question and I felt that I needed to respond. I can honestly tell you that I would never ever ever refer anyone to Universal. I say this from experience as a policy holder for the past five years. It has been the most horrible experience I have ever had dealing with any type of insurance company, aside from be terrible auto companies here.

My husband broke his leg a little over a year ago and it was a compound fracture where the bone just nearly missed penetrating through his skin. We brought him to the hospital where they call the orthopedic to come down and set his leg. He had I'm very nasty cut on the ankle and I asked the doctor leave clean the area very well and leave it exposed so that it can heal properly but instead he insisted on casting the entire thing and sent us on our way. My husband then went to see the orthopedic who insisted on giving it 10 days and then discuss if he needed surgery or not. We then had to wait another 10 days to see how it set and then finally discuss surgery (oh, by the way, the doctor also wanted 45,000 pesos on the side plus what he would bill the insurance company).  All throughout this time, my husband was developing a nasty infection from the cut. We went to a different hospital to have the cast removed, have the infection treated, and then properly casted so that he could schedule surgery. The insurance company not only refused to pay for x-rays to check on his leg after the initial x-ray but they refused to pay for subsequent Orthopedic visit, they refused to pay for the recasting of his leg, and then although it was expressed the urgent need for surgery so that his leg would not be deformed, they dragged their feet for nearly six weeks because they were negotiating a price with the doctor because they didn't want to spend too much money. When finally approved, the doctor refused to do surgery because too much time went by.  We visited 4 other doctors and we could not find a surgeon who would perform the surgery.  My husband's ankle is now severely deformed, he limps, and he struggled with pain. In addition to that he has a permanent scar on his ankle because of what the doctor did. No matter how many times we went down to the insurance company, emailed, or called them they kept blowing us off. They are responsible for my husband's current medical condition.

That being said, I've also had my own personal experience. I was unable to get an MRI done in time at Cedimat because there was a very long wait list for anesthesia which I must get because I am extremely claustrophobic. Other facilities did not do anesthesia nor would they allow me to take any type of medication to help me to relax so I had to find another facility which had an Open MRI machine. I went to the insurance company and they told me that they would make an exception and pay for the MRI at this family due to the other circumstances I just mentioned and put a notation in my file. I went to the other facility paid 10,000 pesos for the MRI and submitted the receipt as I was told. Lo and behold I received a message that my claim was denied because  they do not pay for any out-of-network testing and that the person who made an exception should not have done so. I am now out of pocket for that amount of money for a test that I couldn't get done in network because their in-network provider was unable to do an MRI for 4 months and no others did anesthesia.  I had the injection in my knee done and still waited for the appointment 4 months later at Cedimat so that I can have the MRI done of my shoulder. I need double shoulder surgery but I'm only able to get one shoulder done at a time for obvious reasons.  The MRI was completed and the orthopedic surgeon prepared all the paperwork to send to the insurance company for approval.  He explained the issue where my muscle was torn, my rotator cuff was 80% damaged and that they needed to fix that as well as move the muscle. With all of that being done, it took approximately weeks for them to approve the materials and the surgery but instead of covering the percentage they’re supposed to cover they decided that it was too much money and I should pay 30% of all the fees. Mind you the total for the surgery was 180,000 pesos and the materials were just about as much coming in at about 214,000 pesos.  The hospital told me that the insurance  company is getting worse and worse and wanted me to pay a bill of nearly $1,300 out of pocket plus the assistant to the doctor which they claim is also not covered by the insurance. I had to go down to the insurance company numerous times to get approval and finally when it was done it was a huge relief. I had my surgery done on October 3rd. I have now spent the past two-and-a-half weeks trying to find a physical therapy place that accepts my insurance and I have been unable to do so. Many places have told me that they have stopped working with the insurance company even though they are on the approved list because the insurance company is giving them lots of problems.  They are constantly trying to negotiate every single thing and they just don't have the time to deal with them anymore so they have decided to cut ties.

In my experience there are many doctors who are no longer accepting Universal, including many facilities. I am now stuck in the position that I cannot find a physical therapist who accepts my insurance and who has an appointment anytime soon. I strongly recommend that you connect with whatever doctors, hospitals, and facilities that you may think that you will use the insurance for and find out which insurances they accept and which ones they feel they will continue to work with before choosing one. We are going to research another insurance company but as Planner said, existing conditions can be a huge problem which is my current situation plus the fact that I am 51 years old so I'm not sure if they will accept me or not. The plans have just gotten more and more expensive and they're covering less and less. Although they say that they cover 80% in fact they do not. If my appointment is 1200 pesos,  I'm still paying 900 out of pocket every time I go to the doctor. In some instances I feel like it's just better to pay for your medical costs on your own unless you have some major issue that might happen and you think you're going to need the insurance. Make sure you read all the fine print, check the maximum that they will pay out, Etc. Many plans do not include dental or vision and your prescription limits are usually extremely low, something like 10,000 pesos. Just make sure you read every little bit of fine print that you can find.  Also, do not take the lower plans.  Many providers will now only work with the top tier plan.

@lmclmf2009

sorry for any typos. I wrote it on my phone.

I just received this article in my inbox:

Medical Association calls for physicians not to accept Mapfre coverage

https://dr1.com/forums/threads/.404265/#post-5667080

Check your coverage if you are affiliated to Mapfre Salud ARS medical insurance plan. As of Monday, 14 November 2022, you may no longer be covered.

The Dominican Medical Association (CMD) is calling for physicians not to accept Mapfre (BHD Bank) insurance coverage as of Monday. Previously, the CMD had banned doctors from taking Universal (Banco Popular) medical insurance.

Dr. Senen Caba has said the suspension will be indefinite.

The CMD has complained against the insurance companies selecting which doctors can be in their plans. It also complains about the low pay physicians receive at a time when insurance companies' profits have been on the rise. The medical insurance companies enjoy high yields.

The CMD says physicians will continue to attend to patients but they need to be paid directly by the patients. Diario Libre reports that in many cases, the insurance company will reimburse the payments made by the affiliated parties.

Dr. Caba is calling for a protest march on 30 November 2022. He called for the eastern region and Santo Domingo to suspend services for 48 hours next week.

Dr. Caba said that as of 1 December, specialized medical societies in the country will charge the same and patients need to pay these new rates.

CMD affiliated physicians are instructed to no longer accept medical insurance from the companies Universal, Mapfre, Monumental, Renacer and Simag.

Dr. Caba is recommending people migrate to the government medical insurance plan, Senasa.

Read more in Spanish:

Noticias SIN

Diario Libre

Senasa

Will Humano be next? 

The medical association is attempting to funnel people to:

https://www.arssenasa.gob.do

I have no idea how that would work for people that are retired and/or over 65 here in the DR.

Another ploy for the Government to control people.  Never ending...

Another ploy for the Government to control people. Never ending...
-@DominicanadaMike

This issue is instituted by the Dominican Medical Association and not the Dominican government. They say the doctors are not payed enough or in timely fashion. by the ARS's.

The government may step in to resolve it. I do see a long term plan by the Dominican Medical Association to disband the ARS companies and force everyone to some level of SENASA. Is it posturing or do the doctors have that much power?

Who knows for sure?  What I do know is that some Doctors and institutions are just scamming their clients and the Insurance companies.  We all become victims in the end.  Something simple seems to always require several tests (scans, blood work etc.) repeated returns to the doctor (multiple fees) to confirm the cut on your hand is nothing to worry about.  So many people can't afford this run around and not to mention how much time it takes.  We are at the mercy of these Doctors and Yes, they need to be governed and properly regulated.  Not just in the DR but everywhere.  Senasa and the social security system here will maybe help some people but others are just left in the cold.  The medical system here is a mess just like everything else.

Health should not be played with like a privilege.  Healthcare should be a common right to all and therefore it must be governed.

just my personal experiences and observations but I am seldom wrong...

I don't agree that healthcare is a "right", and healthcare is anything but a right here.

If you want that situation then you will have to live elsewhere. Like Canada for example.

The DR Doctors want to get paid more and are putting pressure on ARS companies. That is what reality is here.

@windeguy:  Please read what I said again as I didn't say that it is a right, I said" Health should not be played with like a privilege.  Healthcare should be a common right to all and therefore it must be governed."

Trust me, it's not a right in Canada either or anywhere else I am aware of.

For further clarification, I am only referring to the "politics" of the Heathcare not the quality of care itself.  Take away the money issues and I am quite happy with the Healthcare I receive here.  My main point was governance and yes I know it's wishful thinking.

I guess I don't understand what you mean by this DominicanadaMike:

"Healthcare should be a common right to all and therefore it must be governed."

A right , or not a right?

I read it several times and it is still as clear as mud.  I don't agree with the statement that healthcare should be a common right to all. But that is just me.

Healthcare in the DR is not a common right to all and I don't expect it ever will be.

I hope the ARS's and the Doctor's Association can work things out since SENASA is not a great option.

I hope the ARS's and the Doctor's Association can work things out since SENASA is not a great option.
-@windeguy

Just curious, why do you say so ?

Should!  and only my opinion...