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Renewing Our Seguro Popular Policy

September arrived and it was time to renew our Seguro Popular policy. It comes up for reaffiliation every three years and since I have a doctor’s appointment scheduled in November plus all the lab work that goes with that, we needed to make sure our policy didn’t lapse.

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So first we headed to the Módulo de Afiliación y Orientación building. I was just the paper carrier. I let my husband do all the talking. First, he showed the guy at the desk our expiring policy. Then another guy came over to take a look at it. He said we needed a copy of identification and comprobante de domicilio (proof of residency). 

When my husband explained we had no utilities at our house, he said we should go to the presidencia (town hall) and request a letter. We’ve tried that route and since we live outside of town, they won’t do it. Then I handed my husband the letter we have from Super Prez verifying that we live in La Yacata. We haven’t had to use it since the last time we applied for Seguro Popular. The letter was dated 2016. So we’d need a new letter.

My husband showed his driver’s license, but it was expired. Then he showed his motorcycle driver’s license, but that too expired in May (as did mine). So we’ll need to renew those as soon as we have the chance but that was a quest for another day. His IFE was still valid and even though his photo makes him look like a psychopath, it would do. Whew!

We went home and I typed up the letter we’d need from Super Prez, the president of the asociación de colonos de La Yacata. I don’t have any ink in my printer, so we headed to a Ciber (computer cafe). Everything was fine except it printed on two different pages. Since I had saved it as a PDF, the girl couldn’t alter it there. And I couldn’t remember my Google password to access Google Docs, so we went back home. I took out a space and saved it again.

Back to the Ciber and it printed out just fine. Our next task was to locate Super Prez to sign it. We were in luck! While he wasn’t in his office, his brother who runs the ferretería (hardware store) next to the office said he was at home. So we rounded the corner and rang the bell. 

This worked out really well since he not only signed the letter, but we could bring him up to date on the goings-on in La Yacata. We were even able to brag a bit about our completed solar system

With this letter in hand, we headed back to the Reaffiliation Office. My husband was given a number (10) even though there was NO ONE else there. Whatever. We sat down to wait. Eventually, he was called up to the desk. As the clerk was entering the information, the system flagged my husband as having an IMSS policy. Thus, in the computer anyway, it looked like we were double-dipping in the healthcare system. In order to proceed, he would need to present a letter from IMSS that stated he didn’t have a policy. 

IMSS in Moroleon, GTO

We headed to IMSS which was on the other end of town. Let me tell you, it was liking into the gates of heaven when compared to el Regional where I go for my appointments. There were no lines. The floor wasn’t broken. There was AIR CONDITIONING! And the nurses, staff, and doctors were just strolling around, not harried and frantic. 

We were sent around the bend to an office where a nice young girl looked up my husband’s information. She said he DID have an IMSS policy in 2007. It turns out that the job he had then which lasted about 2 months, had turned in his paperwork for IMSS. If you remember, IMSS is healthcare for employed Mexicans. Of course, once the job was done, my husband was laid off, so we had no medical benefits since then, hence our application for Seguro Popular. 

So this nice young woman gave me a list of requirements we would need to request the letter stating my husband didn’t have IMSS including a sample letter. Apparently, this sort of thing happens enough that they printed up this information to hand out. 

We would need to bring back the original and copy of his birth certificate, CURP, IFE, comprobante de domicilio, and the signed letter entitled CONSTANCIA DE NO ASEGURADO. We headed home and I typed up the letter. It was too late in the day to continue our pursuit, so we would have to wait until morning. 

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Bright and early the next morning, we headed to the Ciber for the print-out and copies required. Then back to IMSS. My husband asked if we would need a ficha (number). Nope. The nice young woman took the documents and printed out the letter we needed for Seguro Popular. My husband asked if there was a charge associated with this. Nope. We thanked the nice young lady and left.

Back to the Reaffiliation Office then. My husband was given a ficha (number) even though there was NO ONE there and we sat and waited. With all the documents in order, the application could proceed. The clerk asked my husband a few questions about his work, our house, our income. I remained silent even when my husband didn’t get my education information correct. 

I primed my husband to ask about our son’s coverage since he will be turning 18 in May. He’s covered until then and as long as he is enrolled in school which can be proved by a constancia de estudios (a letter written by the school). 

I was a little worried about that since his school is online until I remembered that there is a UVEG branch in town where we could go and ask about it. If he is still studying, he can remain on our Seguro Popular policy until he is 26. If he isn’t he may need to apply for his own policy, which I’m not sure he’d get approved for since he isn’t the head of a household. I guess we’ll cross that bridge when we come to it.

The clerk printed out the new policy sheet and we are hunky-dory for three years. Of course, the new president AMLO has been making sweeping changes in the national healthcare sector and they’ve been going along as swimmingly as the changes in gas distribution went in January. Medication shortages in states where the reforms have begun have created an unbelievable healthcare crisis. That means it’s hard to say what the future of Seguro Popular will be and how that will affect us personally. 

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Read more about negotiating the healthcare system in Mexico!

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A Little about Healthcare in Mexico

Navigating the healthcare system in Mexico isn’t easy. The US embassy even has a page or two available for hospitalized citizens in Mexico and a list of Air Medical Evacuation Services if needed in the worse case scenario. Unfortunately, air ambulance service is not covered by most insurances and must be paid for upfront. In the event of emergency air evacuation, having an insurance policy that covers the cost, would be a good idea. 

For none life-threatening medical scenarios, however, with a few bits of information and a little practice, you’ll be sailing through these high changeable medical seas in no time.doctor1.jpg The good news is that Mexico has universal health care which is divided into three categories. Seguro Popular is for residents without formal employment. IMSS (Instituto Mexicano del Seguro Social) is provided by employers. ISSTE (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado) is only for government workers. Even as a foreigner, you may be eligible for coverage under one of these three setups.

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This is where you apply for Seguro Popular in our town.

Here’s How to apply for Seguro Popular:The head of the household should take an official id (INE, passport, driver’s license) to the affiliation office which you can find by entering your state and municipal here. If you are not a Mexican citizen, you can use your temporary or permanent residency card. You will need to present a comprobante de domicilio reciente (proof of residency such as electric bill, phone bill or predial). If you live in an area with a population less than 250 residents, you can ask for a letter from the local authorities to verify your address. In our area, this letter can be requested from an office in the presidencia (town hall). You will also need the CURP (Clave Única de Registro de Población) for each member of the family. If including an unmarried son or daughter between the ages of 18 and 25, you will need to present a comprobante de estudios (proof that he or she is a student). If you are renewing your policy, you must present the expired policy. hospitals.jpgYou’ll get a sheet with a barcode on it. Keep this, it’s your póliza (policy). You’ll need it for every transaction. I’ve seen some people laminate their policy but just slipping it into a plastic sleeve should do the job. The policy has the expiration date, family members covered and whether there is a co-pay or not. No contributiva (non-contributive) means there is no co-pay for most treatments. You might also get a little booklet that lists what Seguro Popular will cover. It’s helpful but there seem to be yearly changes so your booklet might not be up to date. When you go for appointments, take the policy, your CURP (which also has a barcode) and your official ID. doctor2.jpgIf you do not qualify for coverage under these three groups, you can apply to a private insurance company. This is not a comprehensive list, just a place to start. Check each company’s requirements to see if it would meet your medical needs and if the private medical facilities accept that particular insurance.

If medical insurance still seems beyond your financial grasp, take heart. Medical procedures in Mexico are often a fraction of the cost when compared to the United States. In fact, the prices on some procedures are so good, a whole tourism industry sprouted up to take advantage of them.  And that’s just with major health issues. Most farmacias (pharmacies) have a doctor available for consult for around $40 pesos for minor medical emergencies like colds, stitches, scorpion stings, or a bean up the nose. specialists.jpgSo where can you go for treatment? If you live near Mexico City you are in luck. CDMX (Mexico City) has several high-quality hospitals including the Hospital de la Mujer and Hospital Nacional Homeopatío. Several states also boast having a Hospital Regional de Alta Especialidad. There are even three hospitales psiquiátricos in Mexico should you or someone you love need to avail yourself of their services. IM000805.JPGIf you live in a rural area and you have Seguro Popular, your first stop will be at the hospital comunitario (community hospital). Don’t expect to be able to waltz right in and see a doctor. Head to the information desk and ask what the procedure is. You ought to do this before anyone needs a doctor. Go in for a family checkup. Everyone will get a routine physical and a little booklet to keep track of appointments. More importantly, you’ll be in the system so making an appointment gets just a bit easier.

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Hospital Regional (General)  in Uriangato, Guanajuato

If your condition is more than that hospital comunitario can handle, you’ll be given a referral to the closest hospital regional or general. You’ll need to head there and find out what the procedure is for making appointments as well. You can ask the security guard to send you in the right direction. Odds are you’ll need to head to Archivos (archives) first. Be aware that each department has its own process. There’s one process for seeing the doctor but a different process for getting lab work done. Keep asking until you understand what it is you need to do. Expect this procedure to change. The newest little hoop to jump through at the hospital I go to is to have the head chemist sign off on your prescription before you can pick it up at the pharmacy. Of course, she isn’t always there. In fact, she’s only there about 2 hours in the morning. So getting your prescription filled is just that much harder. IMG_20180416_115204Pharmacies outside of the hospital don’t typically ask for prescriptions. This makes it much easier to avoid the long and tedious process in order to get medication, especially for chronic illnesses. The best approach is to have an empty bottle of the medicine you need and hand it over to the pharmacist. Ask if there is a generic version and you can save even more money. If you aren’t sure, take a list of the generic varieties that you’ve downloaded from the internet with you.

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Pharmacy with adjoining doctor’s office.

If you aren’t exactly sure what you need, ask the pharmacist to recommend something for the symptoms you describe or go ahead and get a consultation from the doctor next door. Wait time is typically less than 30 minutes. If there’s a long line, it’s not much effort to find another consultorio adjoining a different pharmacy. doctor3.jpgOf course, you can always find a private doctor if you have the means. You’ll get more personalized service and I’ve heard some doctors even make house calls. You might even have round-the-clock service via the doctor’s personal cell phone.CAM00659.jpg Some areas have a Red Cross facility. This might be your best bet if it is a real emergency. There is a paramedic on call at all times and usually an ambulance. Arriving at a hospital in an ambulance will cut through the red tape for admission. However, be aware that the Red Cross is not a charitable organization. There are fees involved for everything, including the ride to the hospital, and you’ll need to pay up front.

Another thing you might not expect is you’ll have to line up your own blood donors if you require surgery even if you aren’t going to get a blood transfusion. If you are in an accident, that requirement might be waived temporarily but know that you will be expected to get a certain amount of “replacement” blood before being released.CAM00656-1.jpg If there’s anything I’ve learned in navigation the medical ocean in Mexico it’s that you need to be your own best advocate. That may include getting your own blood work done at private laboratories, doing some intensive research on the internet, translating it into Spanish and handing it to your doctor.  Don’t meekly go along with diagnosis or treatments before checking out alternatives and in some cases, the facts. Don’t allow your level of Spanish mastery to interfere with your health. Bring someone to interpret if need be. Being your own advocate won’t make you the most popular patient in the waiting room, but it might just make you the healthiest.

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All Around the Health Care Bush–the weasel chased the monkey

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Hospital Regional in Uriangato, Guanajuato

Monday found me up at the crack of dawn to make the 30-minute commute to the Regional. I arrived just after 6 am again and the waiting room was full–again. I asked the place check question and took my seat. Everyone queued up when directed and handed in our appointment slip (stamped of course) or the specimen sample. Then we waited. It was after 8 when finally my name was called. The blood draw took less than a minute. All in all, I had waited 12 hours for that blood draw. It doesn’t do any good to complain. That’s just the way it is–this time. Who knows what the procedure will be in 6 months when I come back?

I had no problem picking up the lab results a day before the actual doctor’s appointment. I just butted in line and handed the clerk my paper and she gave me the results. My TSH numbers were looking pretty good–so that dose modification Dr. J gave me last time around seems to have done the trick.

And the actual doctor appointment process has changed. I no longer had to arrive at the crack of dawn to get a ficha (number), but a mere 30 minutes before the scheduled appointment. I didn’t even have to check in at Archivos (archives) for them to pull my file. It was already waiting for me at the nurses desk where I checked in and had my blood pressure checked and weight recorded. The nurses sent me along to Consultorio 5–Medicina Internal (Internal Medicine Consulting Office 5) and I sat down. It was only a 2-hour wait from there–record time actually.

The new doctor seemed to be about 25 years old. I’m not sure he was a doctor, maybe just a body to fill the chair.  I was a little put off that Dr. J wasn’t there, but those with Seguro Popular (Beggars) can’t be choosers I suppose. Anyway, he verified that my TSH levels were good. He asked for my previous prescription sheet from Dr. J. Unfortunately, I had left that at home. He seemed put out. He asked what medication I had been taking. Unfortunately, I couldn’t remember. He seemed even more put out. I asked if that information wasn’t recorded in my file there in front of him. That seemed to bother him too. He asked me what I would do if my file were lost. My Spanish failed me here and I understood that my file had actually been lost. Confused, I pointed out that my file was in front of him on the table. So he repeated his hypothetical sentence in the conditional tense. Oh, ok. I said that I still had my previous prescription page only had left it at home. Then the name of the medication hit me–Levothyroxine–and I garbled out what I thought might be the Mexican Spanish name. He understood enough to write it down and give me a new prescription.

He didn’t check for goiters, or any other thyroid like symptoms just sent me on my way. My appointment lasted a little less than 8 minutes. I suppose it’s a good thing that I’m so familiar with my condition because this dude didn’t seem to be.

So then, I headed to Archivos (Archives) to make an appointment for 4 months from now. Four months? Well, as our Seguro Popular policy is up for renewal in 6 months, I suppose that will get me, at least, one more prescription in case we are rejected. Then I went to the Farmacia (pharmacy) to pick up my 4 month supply of medication.

Apparently it was Hypothyroid day at the old Regional.  The two ladies in front of me were there for their own supply of Levothyroxine boxes.  One of the women, an older woman carefully dressed and made-up, was asking the pharmacist about the pills.  The pharmacist didn’t know anything.  The second woman jumped in the conversation and told woman #1 that she shouldn’t take the medicine with coffee or juice or food.  Well, I knew the coffee bit. (See 11 ways coffee can impact your thyroid) Apparently it interferes with the pill’s absorption.  So I chimed in too.  The older woman said that would explain why she still didn’t feel better.  I betcha that kid in the doctor’s seat didn’t mention any of that, the weasel.

Well, I suppose it’s like anything else in Mexico–you need to be your own advocate.

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All Around the Health Care Bush–the monkey chased the weasel

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Regional Hospital in Uriangato.

I’m the monkey that’s doing the chasing of course. If you don’t remember, I have hypothyroidism which requires a blood test and doctor appointment every 6 months. Sounds relatively simple, but there’s a catch. We have Seguro Popular, (Mexican Health Care Insurance) and as such, must go to the Regional Hospital in Uriangato to have any and all procedures and doctor appointments.

It sounds like it would be a better deal right? After all, you’d expect the hospital staff to have better credentials than any Dr. Jose off the street (No offence meant to those Joses who are doctors). However, I’ve found it to be quite a frustrating experience overall (See Mexico’s Seguro Popular–A model of inefficiency). This time around was no exception.Apparently, there are now only 5 doctors during the week to attend to patients (Hay déficit de médicos en el Hospital Regional) which would explain the long lines and slow service to some extent.

Since my appointment 6 months ago, the rigamarole has been changed. In order to make an appointment to have a blood draw, you must arrive sometime after 6 am to wait for a ficha (number). The sign says that they only give out 30 fichas, but that isn’t true. The first attempt landed me number 43. The second attempt (I arrived a bit earlier) I received number 32. The first attempt was a failure. I was still waiting at 11 am–couldn’t wait any longer, and left the hospital without a blood draw appointment. The second attempt happened to be the day of the monthly teacher meeting (See Mexican Educational Reform and Political Wrangling) so I was determined to wait it out. I really didn’t mind that I’d miss the meeting.

When I arrived in the hospital waiting room, I gave out the customary holler–Quien es el ultimo para sacar citas para el laboratorio? (Who is the last to arrive to make an appointment with the lab?) I took note of the woman who claimed to be the last and her brown rebozo and sat near her. Others arrived asking who was the last for the laboratorio (for the actual blood draw or specimen deposit), who was the last for x-rays (the line was short for that) and for picking up resultados (lab results pickup). So there were several lines we all were trying to keep track of.

The blood draw and specimen deposit line formed at 7 am. A bit of pushing and shoving ensued, however as these people already had their appointment, it wasn’t too desperate. Once the 50 odd people were taken care of, the line for the appointments formed. The second line forming was more desperate since everyone knew there was a limited number of numbers available. I had to shoulder my way into the line and ended up pressed up against the back of the woman with the brown rebozo until the line advanced.

When we reached the window, each person received a laminated number. Real high tech here. Then we sat down again. The lady at the window called the numbers and set up the appointments. This process was slowed down as she attended those who had come to pick up lab results. It was now 9 am. Lab result pick-ups are from 9-10. You don’t need a number for this–you just head to the window and butt in line in front of those with numbers waiting to make their appointments. It’s a nice change to the routine when it comes time to pick up results, but while you are waiting for the appointment, it’s a bit frustrating.

So it wasn’t my turn until a bit after 11 am. As my appointment with the doctor was less than a month away and my blood work results take 2 weeks to come back from the lab in Leon, my blood draw was scheduled for Monday. Halleluiah!

Since my lab appointment was the next working day (no blood draws on Saturday or Sunday) I headed to the caja (payments office) for their approval. Last time around I was given a yellow receipt that verified that I this procedure was covered through Seguro Popular. This process has been streamlined with a rubber stamp instead of the yellow receipt. A bit of paper-saving here that shows an improved concern for the environment possibly?

Once I received the official stamp of approval, I was free to go for the day. It was now nearly noon, and I wasn’t in a hurry to head to the teacher meeting, so I set about my second health quest of the day–new glasses. (See I can see!–Getting glasses in Mexico)

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