Tag Archives: Healthcare

Worthwhile Read

Another prominent blogger, in Chiriquí, is Richard Dietrich, His current blog is probably a worthwhile read. I usually don’t direct people to his blog because I view it an a “for Profit” blog as evidenced by the $1,144,000 property he is selling, other ads and promotion of his books.

The fact that he spends more time on cruise ships lecturing than living in Panama makes his Panama experiences different than the majority of people moving from the U.S., thinking they are moving here for a slower paced and cheaper way of life.

Depending on one’s age, it may be neither of those.

In his current post, he touches on items such as the “Pensionado Discounts”, “Gringo Bingo”, “Healthcare” and a new chapter to his latest book called “Exit Strategy”.

It is the Exit Strategy, I would like to spend a little more time on. No book, magazine article, or blog should be sufficient for making the decision of a permanent move to Panama, or any other foreign country for that matter.

At best, they may provide a reason for a closer look. The closer look needs to be intensive. You have to live like a resident for a minimum of 6-10 months in both the rainy and dry seasons. The longer the better.

You need to experience waiting in lines to pay bills, waiting in lines to get over charges removed from bills, language and cultural differences, water outages from hours to weeks, electricity outages from hours to days, continuous electricity fluctuation (which may damage connected devices), non English TV, gringo pricing, Internet outages (assuming you can get Internet), healthcare, healthcare insurance, and on and on.

With those 6-10 months, you may not need an exit strategy. You will either realize that Panama is a mistake for you or you will know a few of the things you have to cope with. I have lived here going on 13 years and continue to have new experiences.

And yes, I do believe you shouldn’t move here without an Exit Strategy. I know people who are here, who want to move back and can’t do it.

It may be because they put all their life savings into moving and can’t pull together enough money to make the move back. It may be because they came here and a health problem hit and they had no option to return because their health wouldn’t permit it. Many have had health bills in Panama that totally depleted all their savings. Of course, that happens in the U.S. too, except no one ever told you that the U.S. had cheap healthcare.

As a disclaimer, when I moved here, my long term plan was to live here for a maximum of 20 years, sell my property for a $1,000,000 and return to the U.S. I moved with an exit strategy in mind. In that regard, I was no different than my fellow blogger Richard.

However, an error in judgement in a second marriage removed that as a possibility. No I didn’t marry after moving to Panama, but was married in the U.S. exactly 10 years prior to my move to Chiriquí. The good news is that I would never have met Lilliam and her family if I hadn’t moved to Panama.

This reminds me, don’t move here, because you think the move will be good for your marriage. If your marriage is on shaky ground before the move, this move will end the marriage.

Bottom line, buy all the books you can and take advantage of all the media on the Internet to better understand living in Panama. The cost and time will be insignificant compared to a permanent move.

Just remember this old saying my dad used to tell me “ I know you think you understand what you thought I said, but I am not sure you realize that what you heard is not what I meant.”

No article, book or blog will compare with your individual Panama experience. HERE is Richard’s book, if you want to assist him with part of his exit strategy.

TriCare Meeting at Hotel Ciudad de David

I stopped in to the meeting today. It was a packed room. I expect there were close to 90 people there including the TriCare representatives.
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Since most of the attendees at the meeting are retired and some over 65, two websites of interest are TriCare Standard and TriCare For Life.

I was happy to see that the meeting began with a statement of appreciation for those that had given service to their country.

Another early point that was covered is worth repeating. The speaker said he had talked to several people in the room that were new to Panama and not familiar with healthcare availability here.

He mentioned that many things that might be provided in the U.S. might not be available here and that if one had preexisting conditions, it was important to understand Panama’s capability prior to coming here.

For example some drugs in the U.S. may not be available here.

Medical coverage in Panama is different than CONUS. All medical care must be paid up front.

He advised that it was the individuals responsibility to manage his own health program, such as making treatment appointments.

He mentioned that to have coverage over 65, you had to be registered for Medicare part B and that you had to keep DEERS updated.

I thought the meeting was well managed and felt that everyone had an opportunity to get their questions answered.

I will most likely try to make the first part of tomorrow’s Embassy Outreach meeting.

Dr. Bullen’s Next Office Date – June 13

I received an email from Dr. Bullen asking me to let those in Chiriquí know that he will be in his David Office on June 13.

When Lilliam’s search for a skin cancer specialist resulted in finding Dr. Bullen in Panama City, she would tell him of the real need in David for a doctor with his capability. She was going to him every six months and on each follow up, she ask when he would open a David office.

You can than Lilliam for him being here.

The original post and the previous post have more information of his dermatology practice. I saw what the treatment by a doctor without Dr. Bullen’s experience can do and I have seen how he has taken care of Lilliam.

That is why I don’t mind helping him become known in Chiriquí.

Another Great Day

This morning we went to take supplies to Robert in Hogar Santa Catalina. He was in great spirits and the happiest I have seen him. He had had phone calls from both of his sisters. One had called him on Memorial Day to thank him for his service to his country.

I wrote his sister after we left to let her know how happy he was to hear from his second sister. His first sister calls him pretty frequently. I stay in contact with her and send her photos such as the ones I took on his birthday.

I think Lilliam gets as much enjoyment as Robert on our visits. She talks to many of the residents and asks how they are and tries to make them know that they are not alone. Lilliam is a rare person.

One of the ladies there has early Alzheimer’s disease and usually tells Lilliam that her home isn’t far off and someone is on their way to take her home. They aren’t and it is always a similar story. Still she is always happy to see Lilliam.

This morning we had stopped by McDonalds and picked up Robert a pancake and sausage breakfast. He said he would save it for tomorrow.

Seeing Robert in such a good mood really brightened my day.

S.O.L. In Paradise – Beating A Dead Horse

As I mentioned in the previous S.O.L. post, it will be worth following the thread in Boquete Ning.

Today, Bonnie Williams wrote a comment that I don’t want to get lost in the midst all the other comments on the ongoing thread. While she limited it to ExPats in Boquete, I would expand it to all of Chiriquí.

Here is her comment.

I think we’ve beaten this subject to death. To summarize, I see expats in Boquete having essentially four options for healthcare:

1) Have no insurance in Panama. Go to Hospital Regional for medical emergencies, but be aware that it may be difficult to receive timely attention. And you will be billed upon departure. Non-emergency surgery will be delayed, perhaps forever. Plan to return to the U.S. for any needed medical non-emergency services.

2) Enroll in the Hospital Chiriqui co-pay plan. This will pay for many routine, preventive procedures, but it will pay only part of the cost of hospitalization and/or surgery, and there is a relatively low cap on how much it will pay annually. It pays for no bodily appliances such as stents and pacemakers. This can result in the patient owing a significant amount of money.

3) Buy comprehensive national or international insurance. It is expensive. But it has a high payout limit and, after the chosen deductible, pays most or all medical expenses. There generally is no required deductible for emergency or pre-approved hospitalization or procedures.

4) Self insure and hope that you have enough put aside to cover a catastrophic medical event such as heart surgery, serious automobile accident, etc.
As routine medical care in Panama is relatively inexpensive, most expats can meet those expenses without incurring significant financial difficulty. When considering health insurance needs, it is my opinion that particular attention should be given to catastrophic medical events which, without good insurance, could subject one to no care, poor care, and/or financial ruin.

Dr. Bullen’s Office is Open

Like the butcher that backed into his blade, I have been getting a little behind in my work.

As I said I would in my previous post, I went by Dr. Bullen’s office on May 16 and took photos. Unfortunately I took them with my real camera and not my iPhone and forgot about the project and didn’t post them.

His office is easy to locate in Hospital Chiriquí. Take the hallway directly across from the Pharmacy and the first office on the right is his Office. The sign on the office follows:

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I talked to Dr. Bullen and asked if he could do everything as if he were in Panama City. He said he will be able to after he gets the pathology lab trained. He said some of the lab work is done differently than they are trained to do it, but that will change.

He said his charges are the same in Panama City as in David. $75 for the consultation. That is $60 for jubilados.

Dr. Bullen has two areas to serve patients. I am including two photos.

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I picked up a card in his office that takes about services he provides.

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I wish he had been in David when Lilliam first had her problem diagnosed. However, He was a god send when she was advised to see him in Panama City. See Previous post for office hours.

More Hospital Regional Experience

I thought I would pass on some more recent experience in Hospital Regional. I am assisting a family of an individual that was in Hospital Regional and died.

The funeral home quotation has been provided and and I am enclosing the bill so you can see current costs for cremation. The first charge is transportation charges to take the body to Panama City and return the ashes. You will also see there is a discount for being a jubilado. Continue reading More Hospital Regional Experience

S.O.L. In Paradise Discussion – Continued

The original S.O.L. In Paradise post I wrote provoked Lee Zeltzer to start a discussion on Boquete Ning called “Putting A Healthcare Rumor To Rest”.

I think healthcare is a necessary item to be discussed by foreigners living in Panama and those thinking about or in the process of retiring here. The discussion going on in Boquete Ning is very lively and I think it is worth your following the thread.

I do take issue with the way Lee framed his discussion.

What I take issue with is his saying,

“Don wrote about it, perhaps prematurely and then contacted the US Embassy to obtain verification.”

(“it” referring to Regional Hospital healthcare). That implies, that as an afterthought, I wrote the Embassy, which is not true. I wrote the Embassy prior to writing the post.

I felt that the information I had been given was of significant importance to be presented. I qualified that it might only be related to the fact that heart surgery would not be available in Hospital Regional after July 1.

Lee said that I should have talked to a second doctor before making the post. I have been in Panama since 2002 and know that you can get any number of answers from doctors. I would not trust the answer to this question being told by one, two or more doctors. The only way to get the real answer would be to ask the legal council of the hospital, and the Embassy is the best source to ask the question. Continue reading S.O.L. In Paradise Discussion – Continued

S.O.L. Post Updated

Just a note to let you know I received the U.S. Embassy response from the Regional Hospital.

Here is what the Embassy found out:

Good morning, Mr. Williams,

After several attempts, we finally got contact with the Legal Office at Hospital Regional in Chiriqui few minutes ago.

We asked the attorney there to please clarify if persons without insurance (referring to PNM Social Security Insurance -CSS) could be treated there. The attorney replied that Hospital Regional provides medical services to both the CSS beneficiaries and the non-CSS individuals, in the last case, referring to all individuals in Chiriqui that require medical attention. The attorney emphasized that it is expected that the non-CSS individuals pay their medical bills (–the attorney added that even if the individual does not have funds to pay, the Hospital is willing to accept partial payments until bill is totally paid).

We also asked the lawyer about the Hospital Regional sending or referring non-CSS individuals to Hospital Santo Tomas in Panama City. The lawyer denied this possibility saying that it is not true. Per the lawyer, Hospital Regional’s principles is to provide medical assistance to any person that needs it regardless of that person’s nationality.

Please let us know if you have any other questions regarding to this issue.

Saludos,

S.O.L in Paradise

UPDATED May 15, 2015. The Embassy response is at the end of this post.

I had an interesting call from a physician in David with a growing concern. His concern is related to the large number of immigrants coming to Panama without a plan for health insurance.

I am going to express what I think I understood from the conversation. I have also written the U.S. Embassy and asked if they can verify the official policy for the Regional Hospital.

Let me preface by saying that since my moving here in 2003 and from my experience working on Embassy cases, I have seen many people be transferred to the Regional Hospital after they ran out of funds in the Private Hospitals.

From what I was told, that is going to change. Persons without insurance or proof of payment, will no longer be admitted to the Regional Hospital. People without insurance will only be admitted to the public hospital in Panama City (Santo Tomas).

Getting from David to Panama City may not be possible in many health situations.

I had not heard of Santo Tomas Hospital and asked Lilliam about it. She said it had recently been on the news for not having enough beds to handle the needs or supplies and many surgeries were currently not able to be done. Not a pretty picture.

The price of poker just went up. I have harped many times that a plan for one’s healthcare needs to be in place before moving to Panama. I believe that is truer than ever before.

I hope I can get an official interpretation of the hospital policy from the Embassy, but in the meantime, you have been forewarned. If you don’t heed the warning, you may be S.O.L. in paradise.

As a side note, the information may only relate to coronary care since the doctor that called was a heart surgeon and after July 1, would only work in Hospital Chiriqui. I think he is currently the only certified coronary doctor practicing in Hospital Regional.

However, I thought I had recently heard of another case that was turned away from the Regional Hospital.

I will update this post when I hear back from the Embassy.

Following is the response I received from the U.S. Embassy:

Good morning, Mr. Williams,

After several attempts, we finally got contact with the Legal Office at Hospital Regional in Chiriqui few minutes ago.

We asked the attorney there to please clarify if persons without insurance (referring to PNM Social Security Insurance -CSS) could be treated there.  The attorney replied that Hospital Regional provides medical services to both the CSS beneficiaries and the non-CSS individuals, in the last case, referring to all individuals in Chiriqui that require medical attention.  The attorney emphasized that it is expected that the non-CSS individuals pay their medical bills (–the attorney added that even if the individual does not have funds to pay, the Hospital is willing to accept partial payments until bill is totally paid).

We also asked the lawyer about the Hospital Regional sending or referring non-CSS individuals to Hospital Santo Tomas in Panama City.  The lawyer denied this possibility saying that it is not true.  Per the lawyer, Hospital Regional’s principles is to provide medical assistance to any person that needs it regardless of that person’s nationality.

Please let us know if you have any other questions regarding to this issue.

Saludos,