I’m so lucky and happy that I don’t have to work as a customer service agent (claim officer) at one of the local insurance agencies here in Peru. Having stood in line at my insurance company too many times I’ve been observing how their clients have to spend a lot of time to fight for their basic rights to get refunded for the treatment or medicine subscribed by their doctor. I’m not surprised that people get tired, upset and sometimes want to raise their voice to get through to these people. Of course I personally don’t know all of these insurance companies, but before writing this note I spoke to a couple of doctors, who confirmed my suspicion that most of them are the same and when discussing this subject among my friends, there is no magic fairytale story, that makes you say – that’s the insurance company I want for my family and myself.
Personally, my family and I have health insurance with RIMAC. It is supposed to be one of the best, but I get so disappointed every time I go to claim a refund for my receipts. The girls in the front line are doing a good job to submit all my receipts and numbers, but then someone behind the scenes’ takes over to analyze whether I’m trying to rob them or if I’m as sick as my doctor claims, allowing them to get away with refunding me less money.
For the last two years, I’ve been receiving a pill that both my doctor here in Peru and my doctor (friend of the family) in Denmark claims is absolutely necessary to fix my condition . Nevertheless, the first time I asked for a refund, I had to fight with the doctor from the insurance company for about 25 minutes to convince him that my doctor was right and I therefore was entitled to a refund. At the end he accepted, but trust me, I really had to challenge him to make the insurance company refund for this medicine. How? I asked him what he would subscribe me instead to save my life’ and when he was unable to answer that question I knew I had him or at least for now.
Nevertheless RIMAC continues to make me suffer, as I still have to fight with the insurance company every three to six months to get reimbursed for this prescribed medicine. On top of this I have to pay my doctor, who is part of their network, to make a report telling them that I’m still sick, so they eventually can refund me. I imagined that the prescription was enough.
What I find really annoying, is all the hassle and that I have to argue my case between the two doctors, who are both part of the same network. If the doctor from the insurance company doesn’t believe me, the prescription and my receipts, why doesn’t he call my doctor and discuss with him whether I’m getting the right medicine or am sick enough to take these pills. I’m not a doctor and don’t have the necessary arguments to whether the medicine prescribed to me is correct or not, but I believe my doctors until someone else proves them wrong. So far that hasn’t happened, but again this week I had to spend almost an hour waiting to be attended, after which the doctor again ordered me to go see my doctor and ask him for a report, for which I of course have to pay the doctor for and for which there is no refund.
After speaking to my wife this evening, we believe there has never been one time during all the years, where we just walked into the RIMAC office, submitted our receipts and got refunded according to the contract we signed with them. There has ALWAYS been something extra that they needed and for which you always have to show up personally to fight for.
One doctor told me Just get used to it. It is their way to save a buck or millions and they’ll get away with it, as most of the other insurance companies do the same and at the end most people get tired, lose their receipts and give up fighting the insurance company .
Who can afford to give up fighting, when you’re sick?
Another doctor said Imagine this. You’ve had your health insurance for 20-30 years. According to your agent and your family doctor, it is the best in the market and it covers ‘everything’ including terrible diseases like cancer. Actually the police have a special paragraph that ensures your cancer is included. One day you wake up and the doctor tells you, you’re luck is up and you have cancer. While you’re trying to manage this terrible situation you’re insurance company informs you that it is correct that cancer is included in your policy, just not ‘your cancer,’ as it is so rare that no one knows what to do. This happens all the time
What can you do about it? Probably nothing! Can you complain? Sure. Can you find someone to listen? Maybe! Does anybody give a damn? Hm – good question. I mean, who is going to fire the doctor who is trying to save the insurance company a buck.
Does anyone know of an insurance company here in Peru, which offers the patient/client a better and more simple administrative service, where it is not necessary to stand in line for so long just to claim your refunds, where you don’t have to argue on behalf of the doctor and where they just believe that you’re a good and honest person, who every once in a while is sick and therefore needs the support of your doctor and the insurance company?What’s been your experience with health insurance companies in Peru? Mr. Living in Peru shares his.