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Lakeside Medical actual US Insurance policy service


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The large sign in front of San Antonio Hospital states "we accept USA insurances". 

As a US citizen, when a business states they accept our health insurance, to us, this means we don't pay for the medical service upfront.  The medical expenses are billed directly to the insurance provider. 

Here is the information that two people obtained from Lakeside Medical (located within San Antonio hospital )regarding their claiming acceptance of US Insurance.

From several communications with them, this is what became obvious.

The service they actually provide is to file a claim for the patient based on the person's policy, providing it is a policy on their list.  The fee schedule shown in their office has various names, however, they are all actually a filing service fee.

Medicare and any US supplemental policy are not accepted and cannot be used in Mexico.

In some cases, your policy may state that you can be reimbursed for emergency services provided within the first 60 days of entering a foreign country.  What Lakeside Medical actually does is file those receipts for you and as mentioned above.

Their very large sign in front of the hospital is totally misleading based on what I clarified above as to what this actually means to a US citizen.

 I don't have a problem with a service offering to file forms on behalf of patients, but this method of marketing is a bait and switch, and in no way reflects what they actually do.

I am posting this as a public service so people will know what the real story is.

Also, when providing feed back to the facility regarding the method and implication of that big sign, they were totally disinterested.

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Actually, if you look closely when you go by next time, I think you will see that the sign says "We Accept Most USA Insurances".  At least, that's what I saw last time I passed by and confirmed via google street view just now.

Their process might be different than what you have come to expect elsewhere, difficult, time consuming, confusing, and even heavily bureaucratic, sure.  But not everyone is going to see it as misleading.

Another view would be, "Hey, this is great, I might be able to use my USA Health insurance down here!"

Or not.

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I don't know what the sign says now but it used to mention the word "Medicare". That is what most of the comments prior to now have been about..... offering to take US Medicare insurance in Mexico!

 

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1 hour ago, AlongTheWay said:

Actually, if you look closely when you go by next time, I think you will see that the sign says "We Accept Most USA Insurances".  At least, that's what I saw last time I passed by and confirmed via google street view just now.

Their process might be different than what you have come to expect elsewhere, difficult, time consuming, confusing, and even heavily bureaucratic, sure.  But not everyone is going to see it as misleading.

Another view would be, "Hey, this is great, I might be able to use my USA Health insurance down here!"

Or not.

It's been a while and it may have changed but a few months ago I saw what you did. It had the word "Most"

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I don't see the relevance at this point.  I may have misquoted the sign, however, my post does state that your policy has to be on their list.  My point was they do not take US insurance for payment. 

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7 hours ago, Zeb said:

My point was they do not take US insurance for payment.

Thank you for making this point clear. There is a major difference in accepting US insurance for payment vs. filing a claim with US insurance. 

I have spoken to people who have been duped by this and are then left with a bill they cannot afford to pay when their insurance declines payment.

I have also spoken to one veteran who was presented with numerous bills for services he did NOT receive, that were billed and not paid by the government agency overseeing healthcare for vets with service connected disabilities. He was beside himself trying to get it all sorted.

 

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57 minutes ago, oregontochapala said:

Thank you for making this point clear. There is a major difference in accepting US insurance for payment vs. filing a claim with US insurance. 

I have spoken to people who have been duped by this and are then left with a bill they cannot afford to pay when their insurance declines payment.

I have also spoken to one veteran who was presented with numerous bills for services he did NOT receive, that were billed and not paid by the government agency overseeing healthcare for vets with service connected disabilities. He was beside himself trying to get it all sorted.

 

And they also have tried to double bill on services for which they had already charged and received payment. For us, it was at least eleven times the last time I checked and that was over a month ago... 

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People have been told ad nauseum that medicare isn't going to pay here except for emergencies for visitors of less thn 60 days. How can anyone not understand that?

 

You need to check with your northern insurance company BEFORE you come here. We did and made sure that we had a policy that pays.

 

Why blame Lakeside med for your mistakes? They have two agencies in the US working to submit insurance claims and it still takes them up to a year to get paid!

 

I personally dealt with Blue Cross/Shield before they LM came into business. They are absolutely amazing at avoiding paying! Whatever LM charges to handle this nightmare is well worth it. 

I have never paid anything other than a 100p co pay. I have had a half dozen operations in the best hospitals as has my wife. We've had colonoscopies in hospital . We get excellent primary care and referral to specialists as needed.

 

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I'm getting a completely different answer from the Lakeside Medical people, and I have no idea as to what would be their financial incentive to mislead me. Yes, its true that " Medicare and Medicare supplements" do not pay for services in Mexico, except for emergency services in the first 60 days. But " Original Medicare" and " Medicare Supplements " ( that pay the 20% Medicare shortfall) are paid under Medicare Part B. Medicare Advantage plans are Part C plans. A person, in effect, assigns the Part B premium ( presently about $148 I think) to a third party provider, such as United Healthcare. That third party provider agrees to cover you under whatever are its rules for the $148 mo premium under their HMO rules. Basically the trade off, is Part B supplement plan costs mo premium, but choose your doctor. Part C is usually no mo premium, but accept HMO rules.

Specifically, I was told today, that if I go in for emergency heart surgery, I do not pay a deductible or pay for services in advance. I pay the co-pay only. And after insurance provider pays Lakeside, if a balance remains due, Lakeside waives the balance. Now, if anyone finds out this example is not true, then we have a lot more problems than a sign. 

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Everything I have ever read about Advantage plans is that they require the participant to live in their assigned Medical Coverage area.  If you lie you will be inevitably be liable for huge bills, at the very least.  Worst case scenario: guilty of insurance fraud.  

https://www.ehealthmedicare.com/medicare-advantage-articles/what-are-the-pros-and-cons-of-switching-to-a-medicare-advantage-plan/#:~:text=Medicare Advantage plans have specific service areas.&text=To enroll%2C you must reside,6 months of the year.&text=The trade-off is that,receive payment for covered services.

"Medicare Advantage plans have specific service areas.
Most Medicare Advantage plans have regional (rather than nationwide) networks of participating providers. To enroll, you must reside in the Medicare Advantage plan’s service area at least 6 months of the year. If you divide your time between homes located in different areas, this requirement may be difficult to meet."

https://www.pbs.org/newshour/economy/retired-expats-question-remains-keep-medicare-coverage-not#:~:text=Medicare generally does not cover,cover emergency foreign medical expenses.&text=However%2C they do need a,Part D prescription drug plans.

"Establishing faux residency in the U.S. may provide comfort to some Medicare enrollees. But I would not use it to maintain Medicare Advantage or Part D coverage and risk having an insurer reject a huge claim. And believe me, these are the kinds of claims that insurers are motivated to question."

 

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The way the poster posted his observation, suggested to me that the hospital was trying to mislead you...which I find troubling.

My experience has been quite  different. The lady in charge(who's name escapes me) is very efficient and will research and clearly explain to you if the Advantage Plan that you have, out of the country urgent or emergency coverage and for how long a period, gives you coverage.

For example my wife's plan doesn't have the same 60 day limit that mine has. Actually during this open enrollment period, I have opted to change my plan to that similar to my wife

If there is a problem, I would suggest it is "ours" for not reading the small print on our policy's as to the benefits available. For many of us this "extra" coverage maybe adequate for us not to take out travel insurance for other vacations like taking a cruise.

The other issues raised by other posters regarding residency, has nothing to do with the hospital...  but with "us" trying to cheat the system

So please lets have a "fair and balanced" reporting

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16 hours ago, lakeside7 said:

 

For example my wife's plan doesn't have the same 60 day limit that mine has. Actually during this open enrollment period, I have opted to change my plan to that similar to my wife

Lakeside, can you tell us WHAT Medicare Advantage company your wife has that you just also joined por favor.  And if you will, what 'location' this particular policy was written for.... like maybe Tarrant County Texas or Larimer County Colorado.  And if not a 60-day limit, is there any time limit for "out of area" coverage on this plan? 

18 hours ago, Michael Sapp said:

Specifically, I was told today, that if I go in for emergency heart surgery, I do not pay a deductible or pay for services in advance. I pay the co-pay only. And after insurance provider pays Lakeside, if a balance remains due, Lakeside waives the balance. Now, if anyone finds out this example is not true, then we have a lot more problems than a sign. 

Michael Sapp your description of the differences between Original Medicare with a Supplement and a Medicare Advantage policy are indeed accurate. That, however, does not suggest that a Medicare Advantage policy will cover one in Mexico... or anywhere outside your 'home' area....for anything other than an Urgent or Emergency situation and 'with most policies' that coverage is within the first 60 days of a vacation somewhere and is on a reimbursement-to-the-policy-holder arrangement only, meaning you pay the hospital, surgeon etc up front and when/if you recover and are back home you will file for reimbursement of those big dollars... and then pray!

I presume that you were "told today" (the above) by someone in Mexico... maybe the above mentioned hospital. I STRONGLY suggest that you ask not them but your insurance company 'back home'. Then get it in writing from them.

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3 hours ago, RickS said:

Lakeside, can you tell us WHAT Medicare Advantage company your wife has that you just also joined por favor.  And if you will, what 'location' this particular policy was written for.... like maybe Tarrant County Texas or Larimer County Colorado.  And if not a 60-day limit, is there any time limit for "out of area" coverage on this plan? 

Michael Sapp your description of the differences between Original Medicare with a Supplement and a Medicare Advantage policy are indeed accurate. That, however, does not suggest that a Medicare Advantage policy will cover one in Mexico... or anywhere outside your 'home' area....for anything other than an Urgent or Emergency situation and 'with most policies' that coverage is within the first 60 days of a vacation somewhere and is on a reimbursement-to-the-policy-holder arrangement only, meaning you pay the hospital, surgeon etc up front and when/if you recover and are back home you will file for reimbursement of those big dollars... and then pray!

I presume that you were "told today" (the above) by someone in Mexico... maybe the above mentioned hospital. I STRONGLY suggest that you ask not them but your insurance company 'back home'. Then get it in writing from them.

Absolutely agree.   I have been told many things by "authorities" which turned out to be false.

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8 minutes ago, elevator said:

I have a friend who has a medicare advantage plan. He is covered for emergency services. He has used the plan several times. I called Lakeside and asked if I could get the service with a supplemental plan and they said no, so I did too.

Would you share the name of your advantage plan?

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On 12/18/2020 at 11:06 AM, RickS said:

Lakeside, can you tell us WHAT Medicare Advantage company your wife has that you just also joined por favor.  And if you will, what 'location' this particular policy was written for.... like maybe Tarrant County Texas or Larimer County Colorado.  And if not a 60-day limit, is there any time limit for "out of area" coverage on this plan? 

Michael Sapp your description of the differences between Original Medicare with a Supplement and a Medicare Advantage policy are indeed accurate. That, however, does not suggest that a Medicare Advantage policy will cover one in Mexico... or anywhere outside your 'home' area....for anything other than an Urgent or Emergency situation and 'with most policies' that coverage is within the first 60 days of a vacation somewhere and is on a reimbursement-to-the-policy-holder arrangement only, meaning you pay the hospital, surgeon etc up front and when/if you recover and are back home you will file for reimbursement of those big dollars... and then pray!

I presume that you were "told today" (the above) by someone in Mexico... maybe the above mentioned hospital. I STRONGLY suggest that you ask not them but your insurance company 'back home'. Then get it in writing from them.

Rick I am trying to send you a message but it seems your box is not open!!

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