The continuing saga of my personal experience with medical tourism (see Holes in the Head here and here). Before I went to Nicaragua I put in a call to my dental insurers to find out if there was any possibility of some reimbursement for whatever work would be done there. I was assured that I could claim reimbursement for services provided by an “out-of-network” dentist, and advised to keep all my receipts. Simple, right?
Well, apparently not so much. Once I returned, I was asked for all kinds of information: x-rays, a treatment plan or narrative, information about why the work needed to be done, tooth numbers, billing codes, and on and on. It’s hardly surprising that Nicaragua does not use the same billing codes as my dental insurance company in the U.S.—actually, my Nicaraguan dentist doesn’t use billing codes, period. Nicaragua is a pretty much a cash society, you get a printed estimate, you pay cash for the work as it’s done and you get a bill, or statement, showing what you paid for. So, with much email flying back and forth between me and my dentist, I was able to submit pretty much everything that was asked for, although the hiccup of trying to get a copy of my dentist’s “license” has still not quite been resolved—it seems as though, unlike in California, dentists in Nicaragua are not required to post a copy of their license on their premises. (Feel free to correct me if I’m wrong about this!) I have the license number, I can look it up in an on-line directory on the Ministerio de Salud (Ministry of Health) website, but so far, no scan of a physical “license”.
Fine. So then I think, that should do it—they hadn’t formally asked for the license, and I sent them everything they asked for. Now I sit back and wait for the claim to be processed.
Then last week, I get a fat envelope in the mail containing a letter asking even more questions: did I actually have the procedures shown below, did I pay the amounts indicated, and a double-sided page containing 28 questions asking for everything from the address where I stayed during the dental work, how far away this was from the dentist’s office, the dentist’s office address, how I got from the house to the dentist (um, I walked?), did I get follow-up care in the U.S., why didn’t I wait to get the work done in the U.S., copy of stamped passport page, my departure and return dates, which airport I flew out of, and my flight number.
Whew! Fortunately, by this time I had been assigned to a supervisor and he was extremely helpful in clarifying how to respond to some of the questions, although he could not make any promises about my claim being paid. So that packet just went in the mail, and now I wait and see, again. This claim is important because it is only for the first of three stages of work. If the insurance doesn’t pay for this small amount, I’m kinda screwed for getting the more expensive parts done next year.
On the residency research front, I recently had a very productive consultation with a Nicaragua relocation consultant, Nadene Holmes, originally from Canada, (www.detailsmanagement.posterous.com) who came highly recommended by other expats who had used her services. She clarified a number of things for me and suggested several options for how I might qualify for a different residency visa than the one for which I thought, erroneously, I qualified. Now I need to talk to my banks and possibly a financial planner about my options for qualifying for residency (Pensionado vs. Rentista visa). I’m months ahead of schedule on this, but knowing what documents I need to assemble when, which need to be apostilled or certified, how and when to get them notarized, when and where they should be translated, and when to get those six passport photographs taken (with ears showing!) helps me prioritize and make a start on the work required.
Other neither exciting nor sexy things I will need to do over the next year is to start selling stuff off: on ebay and Craigslist, and giving things away via my local freecycle. Experience has taught me that with some items it can be weeks or months before someone comes along who wants what I’m selling, so these things need to be decided about sooner, rather than later, and listed as soon as I can do it.
I can hardly wait to sort through my winter clothes and weed out everything but a suitcase-worth of warm things for possible future travels, but winter is coming in California and as I sit here in my microfleece sweats and sheepskin slippers, I know I have to wait to do this at least until springtime, or even later, at the last minute in the fall. The approach of winter reminds me of how much I long never to feel cold again! I will acclimate to heat and humidity, but as I get older, being cold just makes me increasingly miserable, and my fingers hurt. As my Spanish teacher reminds me when I’m impatient with my incompetence in Spanish, “Poco a poco”. Little by little I will get it all done, maybe with a mad rush towards the end, before heading out to my new expat, semi-retirement life!