Jump to content
Chapala.com Webboard

Health Insurance with Boomers in Paradise


Recommended Posts

WEA is new in Mexico not an authorized Mexican insurance if they go under or leave you are SOL. other insurance companies in Mexico if they leave the govt will make another company cover you. Something to think about

Link to post
Share on other sites

Speak with Ava Wilson, who set up the Boomers group, and also with Valerie Friesen who is the local insurance rep for the plans. The website for Boomers is:

http://boomers-in-paradise.org

On the site you will see a comparison between the two plans, Best Doctors and WEA.

In addition there have been many threads on this board regarding the Boomers plans. Enter "Boomers" into an advanced search looking in both the Ajijic/Chapala/Guadalajara and Mexico General forums. Read with an open mind.

Link to post
Share on other sites

Speak with Ava Wilson, who set up the Boomers group, and also with Valerie Friesen who is the local insurance rep for the plans. The website for Boomers is:http://boomers-in-paradise.org

On the site you will see a comparison between the two plans, Best Doctors and WEA.

In addition there have been many threads on this board regarding the Boomers plans. Enter "Boomers" into an advanced search looking in both the Ajijic/Chapala/Guadalajara and Mexico General forums. Read with an open mind.

it s really difficult thread the font you write with. FYI
Link to post
Share on other sites

I just switched from best doctors to boomers in Sept. Went to doctor for check ups. My husband needed gallbladder surgery. Then we both needed all kinds of tests. Then I needed hiatal hernia surgery and also a stress test and many med changes. All this right after joining boomers. Now let me tell you it was a chore, scanning and calling and pre-Certification request forms. Having to call them out many times on things. But was well worth the trouble. They are paying out. Took me 2 months to get my husbands return money after deductible was paid and into my account. Mine, 3 weeks from surgery, they are about to pay out soon. I don't give up and it was way worth dealing with the people who tried to sit on it. I just bugged the hell out of them, pointed out mistakes they made and took them to school. I had everything organized and ready to fight. Best doctors wouldn't have paid on either of our surgeries. wouldn't cover them and I knew it before I switched. Just didn't know till after we needed the surgeries. And its only about $80 more a year for real health insurance, I say we got all our money back from joining and our deductibles back, plus some in the end.

Link to post
Share on other sites

Boomers in Paradise is an organization, not a health insurance policy.

Best Doctors is one of the two policies they offer.

WEA is their new policy. It is a worldwide expat policy and is quite comprehensive, which Best Doctors is not.

Before subscribing to either one you must carefully read each policy as threre are marked differences in coverage. One size does not fit all.

  • Like 1
Link to post
Share on other sites

Before I bought my Best Doctors policy through Boomers, I wanted to read a copy of the policy, not a summary. I was told by the agent, Valerie, that the policy was not available until I purchased the insurance. I was not pleased with that response since I had read over 15 policies online from other insurers in the world. However, I bought the policy.

I've now switched to WEA insurance as it is more comprehensive and a little more expensive. Now I can't get my insurance packet including my insurance card and copy of the policy without sitting through a 1.5 hr. seminar. Nor can I expect to drop by Valerie's office to pick up the packet without a sit-down. I've worked with medical insurance while working at a hospital for 17 years plus have read many, many policies and don't need a lesson on what the policy contains; I'm capable of reading. However, I understand Valerie's need to answer the questions many folks will ask, at the same time, so her time is not taken with phone calls with folks asking the SAME damn questions over and over. I like the insurance; I just don't like being treated like a 13 year old in a condescending way.

  • Like 1
Link to post
Share on other sites

best Drs is through focus on Mexico. Boomers is WEA. Valerie doesn't know much about it. She tried to talk me out of boomers. I think I'm one of the first according to her to use WEA. The big thing about WEA is, when you have surgeries by 3 specialists like my husband and I did. The insurance is supposed to pay 100% to spec. But after submitting the bill the insurance says they only pay 20% of doctors assistants. They said no way does only specialists do the surgery without assistants. Well they don't know how the surgeries work here, and we argued about it. So they say they pay out less. So they think! Well the doctors go out of there way to talk to the insurance company and work with the patients so you get what you should back. And yes I had it out with Valerie too. I'm letting Vicky know the ins and out to let Valerie know how WEA works. And my bank won't take wire transfers under 1,000 us. Needs to be an electronic deposit.

You need to be pro active and organized. Don't expect WEA to go out of there way. Send in receipts and demand a confirmation on everything you send in. And ask for claim spreadsheets. And when they pay out small amounts, ask hem for which claims they go against.

Link to post
Share on other sites

Two BIG differences between Best Doctors and WEA are that WEA excludes the US (good for people with Medicare), and that is why you get much better coverage for the money.

The other difference is that the WEA group size is very limited (currently about 100), whereas BD combined all their groups for analysis purposes. The risk with WEA is that large claims within a small group can significantly affect premiums.

Having said that, I've bought WEA and will wait to see what happens with the premiums.

Link to post
Share on other sites

Best Doctors also requires a very proactive position on the part of the policy holder. My clearly covered procedure was denied twice until I intervened with their customer service folks in Miami who followed through and found the committee that denied my coverage had made an error which was then rescinded. Delayed my procedure by close to two months, but third time was a charm, and absolutely zero issues.

Link to post
Share on other sites

What Al Berca has described is and has been SOP for insurance companies in the US for 'decades'.... pretty much since Managed Care became the model. Take this from a person who has filed claims to many of them for professional services rendered. They will routinely deny the first claim.... routinely... often with the reason not being valid (claim not signed when it definitely was!). Then the re-filed claim gets a little farther into their labyrinth only to be denied again for an equally ridiculous/erroneous reason. If one was lucky, the third re-file makes it way through and payment is scheduled.... for 30 days later! By this time, much effort and 6-8 weeks has passed.

I'm quite sure that many people just give up... or assume that their claim wasn't valid under their insurance after all. This is exactly what the Insurance companies are hoping.... so don't give in.

  • Like 1
Link to post
Share on other sites

The one thing I did notice that I didn't like was the fact of the exchange rate calculator the insurance company uses is BS. Different from another exchange rates, like banks (Capital one) and even what the hospitals use. I don't understand that at all. Even if you show proof in USD from my CC company on what I paid. The ins. will use there own for the date of purchase. Always less USD than what you paid. But at least I get paid back most of it. But Yes never give up, because thats what they want you to do. Boomers also has a 2 Million USD cap. LOL And you have to switch to another ins before you turn 75 yrs old. So we will switch back to Best Doctors at 74 & 3/4 age. Which for me is a long time.

Link to post
Share on other sites

Boomers also has a 2 Million USD cap. LOL And you have to switch to another ins before you turn 75 yrs old. So we will switch back to Best Doctors at 74 & 3/4 age. Which for me is a long time.

If you go to Boomers-In-Paradise website you will find a summary of TWO policies that Boomers (gogulskis--who is the group not the name of an insurance company) offers. WEA insurance has a 2million LIFETIME cap; BestDoctors has a 750,000 YEARLY cap. You cannot sign up initially for either policy after you turn 75, however if you have either policy when you turn 75 you will KEEP your insurance intact.

Link to post
Share on other sites

This, of course, is based upon the extremely optimistic assumption that the group policies will remain for the foreseeable future and not ended by the insurance company when old age creates more claims and insurer starts losing money. It has happened here before.

Link to post
Share on other sites

Best Doctors is a catastrophic insurance policy.

WEA is a major medical insurance policy.

Those are 2 very different types of policies and you need to decide which one works best for you.

They are both offered as group plans through a membership in Boomers in Paradise; you'll need to take out a membership in that organization to purchase either one of these group policies.

There are other organizations you can join, to buy into their group insurance plans. Boomers has been very proactive in working to get good insurance plans for yes, the Boomer aged ex-pats here. I was denied health insurance coverage by many companies here in Mexico because of a pre-existing condition; Ava and Valerie managed to get me coverage under Best Doctors, and get that transferred to the WEA plan for me.

Link to post
Share on other sites

YES, I thought I explained that, but Best Doctors I had to join Focus on Mexico to get the policy.

I also received my Wea policy from Valerie, but had to join Boomers membership to get that policy. 60usd a year for each membership. If you already have Best Doctors and want WEA, you can jump right over without the whole past health issue.And jump back to Best Doctors same way. No waiting for a year or so for past conditions if you already went through it with Best Doctors. Very easy. Valerie and the other gal at Boomers do offer both policies Im sure. I only deal through Valerie and Vicki. So Im sure you know more than me.

Link to post
Share on other sites
  • 2 weeks later...

Before I bought my Best Doctors policy through Boomers, I wanted to read a copy of the policy, not a summary. I was told by the agent, Valerie, that the policy was not available until I purchased the insurance. I was not pleased with that response since I had read over 15 policies online from other insurers in the world. However, I bought the policy.

I've now switched to WEA insurance as it is more comprehensive and a little more expensive. Now I can't get my insurance packet including my insurance card and copy of the policy without sitting through a 1.5 hr. seminar. Nor can I expect to drop by Valerie's office to pick up the packet without a sit-down. I've worked with medical insurance while working at a hospital for 17 years plus have read many, many policies and don't need a lesson on what the policy contains; I'm capable of reading. However, I understand Valerie's need to answer the questions many folks will ask, at the same time, so her time is not taken with phone calls with folks asking the SAME damn questions over and over. I like the insurance; I just don't like being treated like a 13 year old in a condescending way.

I agree. Boomers should consider getting a different agent.

Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

×
×
  • Create New...