HealthCare Resources Blog

General HealthCare Information: Insurance Coverage — Outpatient Services

(General HealthCare Information, part 2)

The bottom line is this: Any and all outpatient services in the Banderas Bay area must be paid out of pocket and turned in for reimbursement. This includes lab work, X-rays, MRI’s, CAT scans, medications, physician consults, physical therapy treatments, ambulance services, mental health consults and anything else that is done on an outpatient basis. As well, this includes Emergency Room visits (with no admission).  It does not matter what kind of insurance that you have, even if it is a five star, top of the line, full coverage insurance.

In order to submit these claims to your insurance company for reimbursement you must have the following information-documents:

  • Receipt (preferably factura) for services rendered.
  • Copy of results.
  • If it is for prescriptions, you must have the a) original prescription from the physician b) receipt from the pharmacy for the medications.
  • For physician consults, it is preferable to have a brief report from the physician.

It is very important to obtain these receipts, reports and information at the time of service. If you attempt to go “back” and obtain these documents, you will be hard pressed to receive them.

As well, most insurance companies will require the documents to be translated in to English. Even if they do not, it definitely speeds up the reimbursement process if they are in English. Otherwise they will use a translation company which will take more time to receive your reimbursement.

Be sure and keep copies of everything that is submitted to the insurance company. This will save time in the end if for some reason the insurance company “misplaces” the claim, need further information or have questions regarding the claim.

Many folks who have insurance do not submit any of the above in to their insurance companies for reimbursement, saying “Well, I have a really high deductible”. We suggest turning them in anyway, to be applied to your deductible. You never know when you might need to be admitted for one reason or another and these smaller bills will make your portion to be paid (to meet your deductible) a little bit easier to reach.

It is highly recommended that you check with your insurance carrier as to their policies for reimbursement. Many insurance companies do not cover for “well checks”. That means they might or might not cover you for things such as a mammogram, general physical and the like.

Remember that if you go to see your physician and you whip out your insurance card to the receptionist, she will smile and look at you but then, ask for cash or credit card.

We are more than happy to assist you in any of the above. If you would like to sit down and go over your policy individually with us, just let us know. It is always better to be informed ahead of time rather than when you get sick and have a medical emergency.


5 Responses to 'General HealthCare Information: Insurance Coverage — Outpatient Services'

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  1. John Coake said,

    We live in Puerto Vallarta six months of the year. While we have “emergency” medical insurance we understand that it is advisable to have insurance for air ambulance service for return to the US if needed. Can you provide us with information on this service. We will be returning to PV in October.

    • Pamela said,

      John, If you have “emergency” medical insurance and it is a traveler’s insurance, then most likely that policy has an air evacuation provision in it. If not, there are numerous air evacuation policies available which I can send on to you to look over.
      Remember that to be air evacuated out of the area, the patient would need to be quite critical and-or services not available here in Vallarta. Stipulations vary from policy to policy. I will be doing a separate article soon on air evacuation services. In the meantime, please feel free to email me directly!

  2. John Wilson said,

    My wife and I have New York Life major medical health insurance. New York Life has branches in Mesico. If your insurer has branches in Mexico, and your insurance claim is processed in Mexico, you MUST have a factura for outpatient services, not just a receipt. Only facturas are honored in Mexico.

    Also, if you have outpatient services near the end of the year, and you submit your facturas in the next calendar year, your insurer can require you to go back to your provider and submit a factura for the current year, even if the services occurred in the previous year.

    I believe it is all in the name of delaying payment. They hope you will just give up!

  3. Pamela said,

    Good points all around! Always best to have a factura regardless of who your insurer is! And do not give up!

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