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On Thursday I visited LMG and  had an interesting experience...They said they were not seeing any cash paying patients..They only wanted  patients with a supplement NOB insurance .

I thought this very strange and some what suspicious of their motives ....could it be they have found a market niche  where they bill your insurance North American price(s) for any treatment

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I had been going to a certain clinic for years and they recently told me that my U.S. insurance was no longer paying for my office visits because the visits were no longer connected to my surgery. What one has to do with another I do not know? They would no longer see me for any visits. Shortly thereafter, I received a call from my insurance's fraud investigation department saying that they were investigating the clinic. Apparently, the clinic was charging my U.S. insurance company $450 USD for office visits, which is usually MUCH less in Mexico. They also charged them $45,000 USD for a surgery that they arranged, which really only cost $15,000 USD, a $30,000 mark up. The insurance company was also under the impression that the surgery and office visits were being done in the U.S. and not Mexico. They do not pay for office visits or surgery in Mexico unless it is an emergency, which they were was not. I had no idea this was going on. Fortunately, I am not being held responsible for any of the fraudulent charges. On an added note, if you do a Google search on a doctor that runs a clinic, you can find out his previous criminal background in the U.S. This may help you figure out what they are up to. 

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I too find their MO for medical care confusing.  I recently had a very good office visit with a physician who recommended an MRI. Because my NOB insurance didn’t cover it, I was told I had to take care of it my own.  Very confusing and time consuming process for me, a non professional.  After waiting for several weeks for the doctor to review the test, I was told he hadn’t had time to study it yet but to go get a colonoscopy.  And yes, I’d have to do that on my own too.  No idea how or with whom to schedule something like that.  Needless to say, I’ve gone to a different doctor and won’t be going back to I just don’t u derstand what kind of medical service they’re providing.

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They have been doing this for years ... not a new practice.  Used them once ... was ripped off royally.  When I commented on this several years ago I was ripped a new one by posters taking up for them and saying how great they were.  Guess the word is finally out.

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  • 1 year later...

I am considering moving to Jalisco state from Costa Rica to access LMG services, to access filing claims to my US insurance carrier under their Medicare Advantage program. A good decision? I cannot tell if the comments in this communication stream after 2/15/19 are describing LMG or some random clinic. 

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Medicare Advantage policies in the US are mostly of the HMO type although a few can also be PPO.  They are also very location centric meaning they cover a finite 'location' where they will cover Docs, Hospitals, Services and maybe Medicines. For example mine covers me 'only' within a few.... probably 25.... sq miles of my home where I have a specific PCP who can also refer me to an in-service specialist/service. Not state-wide and surely not out of the country! Advantage policies in less populated areas can cover as much as a state.  An Advantage policy WILL cover one for 'emergencies only' while traveling or on vacation out of your home jurisdiction, mostly out of pocket and on a reimbursement basis. You have suggested that you are 'moving to Jalisco', not vacationing there.

Traditional Medicare and a Medicare Gap policy, as well as Advantage policies, do NOT cover one in a general sense.... as in living/staying..... out of the United States and surely not IN MEXICO!    Others here may/will chime in to discuss what LMG may or may not be doing in this respect but whatever they are doing, if not for emergencies only while on 'vacation', can be considered Medicare Fraud.

YMMV

 

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On 2/15/2019 at 3:44 PM, lakeside7 said:

On Thursday I visited LMG and  had an interesting experience...They said they were not seeing any cash paying patients..They only wanted  patients with a supplement NOB insurance .

I thought this very strange and some what suspicious of their motives ....could it be they have found a market niche  where they bill your insurance North American price(s) for any treatment

Many in the medical profession prefer cash and no bill to avoid paying taxes, depriving the government of much needed cash!

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7 minutes ago, joco69 said:

Many in the medical profession prefer cash and no bill to avoid paying taxes, depriving the government of much needed cash!

Yes, if you ask for a bill they often charge you more.

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I used to know a person in Mazatlan that got caught in the business of billing the insurance companies in the U.S. at U.S. codes prices for procedures performed at Mexican price , then the Dr. would take "care" of her for doing this.  I do understand that there need to be coding for both worlds of pricing.....how to fix this?  It turned into a true mess for all involved and was caught by the military medical system so you know messy it got!  Just beware.

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On 10/3/2020 at 2:54 PM, RickS said:

Traditional Medicare and a Medicare Gap policy, as well as Advantage policies, do NOT cover one in a general sense.... as in living/staying..... out of the United States and surely not IN MEXICO!    Others here may/will chime in to discuss what LMG may or may not be doing in this respect but whatever they are doing if not for emergencies only while on 'vacation' can be considered Medicare Fraud.

RickS above is correct. I have sold Medicare Supplements in my past life and have starred at the billboard outside San Antonio Hospital in disbelief, advertising for patients with US and Medicare insurers. Absolutely, if you live here in MX and are not just travelling through, you'd better understand what your Medical provider in MX is doing with your insurance and what you are allowing them to submit, otherwise for residents you may be participating in a form of Medicare or Insurance fraud! 

Most Medigap and Medicare Advantage Plans (Part C) state directly from Medicare.gov:

  • Covers foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn't otherwise cover the care.

  • Pays 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet a $250 deductible for the year.

Foreign travel emergency coverage with Medigap and Advantage Plan policies has a lifetime limit of $50,000.

Check your Medigap, Advantage Plans and US Health Care insurance in detail so you don't get yourself in hot water by a medical facility trying to bend the rules to their benefit. From experience on the Insurers side, they don't care and won't care if you say, "well I didn't know", and neither will Uncle Sam.

 

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8 hours ago, Jubilacion said:

RickS above is correct. I have sold Medicare Supplements in my past life and have starred at the billboard outside San Antonio Hospital in disbelief, advertising for patients with US and Medicare insurers. Absolutely, if you live here in MX and are not just travelling through, you'd better understand what your Medical provider in MX is doing with your insurance and what you are allowing them to submit, otherwise for residents you may be participating in a form of Medicare or Insurance fraud! 

Most Medigap and Medicare Advantage Plans (Part C) state directly from Medicare.gov:

  • Covers foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn't otherwise cover the care.

  • Pays 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet a $250 deductible for the year.

Foreign travel emergency coverage with Medigap and Advantage Plan policies has a lifetime limit of $50,000.

Check your Medigap, Advantage Plans and US Health Care insurance in detail so you don't get yourself in hot water by a medical facility trying to bend the rules to their benefit. From experience on the Insurers side, they don't care and won't care if you say, "well I didn't know", and neither will Uncle Sam.

 

Jubilacion I am not sure if you quite understand some peoples experience and that what you are saying is rather a broad generalization of the facts. But let me share our experience;

My wife has a Advantage Plan and I have a supplementary coverage with Aetna

We took our respective polices into the the very efficient young lady at SAH and she took all the details and long story short, my wife does have coverage for treatment in MX, mine will only cover  me for emergencies up 60 days from leaving the USA, regardless if I am in MX or traveling the world. To be doubly sure  I contacted my US Ins Broker who sent me a copy to verify the coverage. Now I do believe the hospital has to obtain consent / authorization etc.

The fact that I have this 60 days window is particularly good because I do not have to purchase "extra" polices when traveling

Now you seem to have experience in selling supplemental policies which appear to contradict what we have been told, and I will be interested for your observations as we maybe totally misinformed. 

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.... and lakeside7 I am not sure that you quite understand that Medicare w/supplement and/or Medicare Advantage Part C does not cover you, other than has been stated above, while on vacation or traveling outside of the United States.  It's just does not!  If it did, millions of people a day would be flocking to Mexico to live.

In another Post you said that you have IMSS. People traveling or on vacation in Mexico are not able to obtain IMSS coverage so you must be Residente. Does Aetna know that you reside out of the country?  When you need to 'use' your Medicare in Mexico are you going to tell the insurance company that you were 'just traveling'?

But believe what you want....  I just wish I could to be listening in on that call the Mexican hospital makes to Medicare "to obtain consent / authorization".

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18 hours ago, lakeside7 said:

Now you seem to have experience in selling supplemental policies which appear to contradict what we have been told, and I will be interested for your observations as we maybe totally misinformed. 

Lakeside7, I admit at one time I could say with 100% certainty you are being mislead, but today out of the business for a few years that certainty may be only 85-90%, but I'm fairly current since I have been reviewing lot of plans lately because I come of Medicare age in November.

What SAH told you was correct with your Medigap coverage, foreign coverage begins during the first 60 days of your trip, BUT I don't know how in the world it would ever cover you in MX you if you are living here unless you (or SAH which is also you authorizing the insurance charge) fictitiously claim you were only traveling. I'm aware of a Medigap insurer asking for proof of travel like the departure date with airline ticket, gas receipts, hotel recipts etc. Remember, insurers do not want to pay claims and are naturally suspicious of foreign travel claims. The intent of international emergency coverage is that your trip begins in the US, not in Mexico or another foreign country. It's essentially travel insurance only from the US.

Your wife's Medicare Advantage policy where someone (I think SAH) told her she has routine coverage in Mexico outside of similar emergency coverage as your Medigap policy... I just don't believe it.

I highly encourage you to call her Advantage Plan insurer (not your broker/agent) and get it straight from them. Play a "what if" game with them. Don't just ask if she has emergency coverage (she does) but spell out some questions like, "What if we snowbird in Mexico... or "What if we're going to spend a few months travelling internationally... etc. ...does my Medicare Advantage plan have coverage for non-emergency procedures? Followed by, "What coverage does my Advantage Plan have internationally if we're away from the US for OVER 60-days?"

If the answer is positive to either of the above from the insurer, please let us know the name of the insurer, it would certainly change my tentative decision on the Medigap or Advantage Plan for my personal Medicare. Good luck! I hope we're proven wrong.

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VERY straightforward, clear and valuable information Jubilacion!   Except I would maybe change your "fictitiously" word to "fraudulently".

And I second your request for the name of the Advantage Plan insurer if they cover his wife like the OP suggests that SAH says they will/do. Of course even if they did/do for some strange reason....Advantage Plans are 'regional or location centric' and that policy will not necessarily cover you or me in our US home location. My Advantage policy is not the same as one by the same exact company's offering in a city 60 miles away! The 'market' determines what they will/have to offer and how much they charge for 'each part'.

Again.... very nice response to this guy in his 'time of need'.

 

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Just to keep the pot boiling.....You may have heard and attended to days Seminar Hosted by LMG ( Lakeside Medical Group  to promote Advantage Plans. The main speaker was a Jeff Goble who I think operates out of Cal. Also on hand was a Dr. Ian who is on the medical staff of LMG. This doctor was a bit of a lose cannon who seemed to be over the top in his comments about the services and treatments that are currently being carried out for existing patients.

Let me emphasis that Jeff in no way made any "false" claims or suggestions. He reminded the audience that you must have Medicare Part A&B in order to qualify for a APlan and residence address

Many attendees like me do not have APlans are are paying significant amount of monthly premium fees. 

Now that we have your attention perhaps you can explain/share with "us" who many be considering switch to a APlan and "saving money" what are the Pro's and Con's of each policy.  

Whilst many people maybe circumventing the necessity of having a " residence address " in the US there are I believe a number who do have residence in both countries.

Rick, you mentioned "People traveling or on vacation in Mexico are not able to obtain IMSS coverage so you must be Residente". You can be/obtain Permenate and still have homes in both countries, best as I recall as long as you met the income requirements there is no other qualification..is there?

For myself I see it as a loop hole that you may or may not choose to take...and the longer you live in Mexico you begin to see and experience many loop holes as the normal everyday Mexican experience, a facilitator for this and for that... want to get to the head of the line ..who is the person to pay....taking too long to process your Probate, find a facilitator to help you and how much!!!. If you want to live out your dreams in Mexico then you better start thinking like a Mexican and not a Gringo...and lastly. but not to get political...... but many of us feel we have paid our dues and more, to the US Government and if there any "benefits" available then we want them...... and not hand outs to "others"

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Ask them to pay and not collect from you nor make you sign any promissory notes if they are so sure about things.  You have been warned

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36 minutes ago, Intercasa said:

Ask them to pay and not collect from you nor make you sign any promissory notes if they are so sure about things.  You have been warned

Spencer I very much value your legal options which from time to time you share with us..and your observation above is well taken

However it does  not seem that long ago when you mentioned that is was Illegal for Hospitals in Guad to prevent you from leaving until you settled your bill....BUT they did..and I guess still do!

I hope that any persons looking at this debate and have had any medical procedure done using their APlan at SAH will share their experience..not if the experience was good or bad but the cost was covered by their plan...also maybe if you have had any clients who may have had problems, please share

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Jubilacion

What SAH told you was correct with your Medigap coverage, foreign coverage begins during the first 60 days of your trip, BUT I don't know how in the world it would ever cover you in MX you if you are living here unless you (or SAH which is also you authorizing the insurance charge) fictitiously claim you were only traveling.

With respect I would suggest that there are quite a number of people with homes in the US and Mexico and are legit..why in the world would having a home/vacation place here or any place overseas disqualify you?   Yes I agree the insurance companies are looking for reasons/excuses not to pay...much like having a pre conditions...my god most of the Gringos here have some sort of pre condition and may as well never buy any insurance. likewise  having S Dakota plates this is an other loop hole that is being exploited.

I think this discussion is great to have and share, but as I previous mentioned living in Mexico begins to show you another side of living your life...and as I type another example of MX life comes to mind...all drivers are expected to carry car insurance...how many do....how many just take off when involved in a accident...to us gringos this deplorable ... but in the real world it happens frequently

Let me digress.... and share my experience with using Mexican Notaria in preparing a will, you give him all you details etc, only to find out latter that when  your partner dies there is a huge Probate bill..but why you ask  only to find out that the first Notaria screwed up..how many friends do you know or have heard of have similar issues..you try your best to cover all bases BUT....

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Yes illegal for hospitals to do that and some retain documents, people will do illegal things unless challenged and with an overburdened and underfunded legal system with a 1% conviction rate for reported crimes many with low moral standards will take their chances. 

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I think that this discussion, while interesting and with many twists and turns, has drifted from the basic thought:  

Can a US citizen use either their Original Medicare w/Supplement coverage or the newer (2003) Medicare Advantage Part C insurance coverage for other-than-Emergencies while traveling abroad. That's it. That's the question.

And the answer is a resounding NO!  There are no Medicare programs or laws or policies that are in place.... and ever likely to be put in place.... that will allow it.

No matter how much we wish we could, or how many people think/hope/have been told they can, and even have 'authorities abroad' telling them that they can 'arrange it', it just isn't going to happen outside of the allowed Emergency option.  And any attempt to pretend like they are traveling when they are really living Abroad, even if for only several months out of the year, and then attempt to use use their Medicare coverage could be construed by the insurance company and/or Medicare to be Insurance Fraud.  

Lakeside7, we are just trying to help, but WE aren't the ones who will/can determine your fate if you try to use Medicare other than as described. Jubilacion has given you the 'golden recommendation'. And IT is the only way you are going to be sure about any of this. His recommendation started off by saying "I highly encourage you to call her Advantage Plan insurer (not your broker/agent) and get it straight from them, etc etc..."

Peace

 

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