Re: OUT OF POCKET FOR CAJA SERVICES / VETERANS COVERAGE
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Several years ago I fractured my wrist—an open wound that required a plate and pins. The ambulance took me to Hospital Calderon Guardia; I had been knocked unconscious by the fall. I did not have Caja insurance at the time. As the ambulance pulled up to the hospital and I woke up and saw where I was, I decided I would give socialized medicine a chance. They were very good in their emergency services, took care of the wounds to my face (including some stitches), and scheduled me for immediate surgery. I spent the night in a recovery room and left the next day, the surgeon proud of his work. They gave me a bill for about $900 for the work, and I and my friend waited around while they prepared it. It definitely wasn’t free and they made it clear that it would not be, since I wasn’t an enrolled member.
Not too long after that, the wound became infected and the plate they inserted failed to do its job; the fixed fracture fell apart. The Caja doctor said he could admit me for treatment of the infection, but he didn’t think I would be very comfortable because my bed would be in a hall; he recommended I go the private route at that point if I had insurance and/or could afford it. I made my way through several private orthopedists to a specialized hand surgeon. Before he could do anything I had to be admitted to Clinica Biblica for three days of intravenous antibiotics under the supervision of an infectious disease specialist. That plus 30 more days on two oral antibiotics cured the infection. The surgeon scraped away part of the bone to get a biopsy on the nature of the infection. This exercise cost my U.S. insurance company $9,000, which they paid directly to Clinica Biblica. A month or so after that the bone was re-broken by the hand surgeon and the correct plate and pins were used. It turns out that the Caja frequently doesn’t have the budget to keep on hand the hardware required to treat compound fractures. I needed a plate and 15 pins due to the nature of the fracture, not one with a couple of pins suitable for a simple fracture. Re-breaking the bone and inserting the proper plate/pins cost another $4,000 or so. After grousing about it to myself for about a year, I went to the Caja and paid my $900 bill because it was about time for me to get required Caja insurance, and I didn’t want any dirty marks on my record of permanent residency or ambiguity about my relationship with the Caja.
As a member of the Caja, I have been treated well by my neighborhood EBAIS. Once I fell down and thought I had broken my finger. They sent me to Calderon Guardia after an initial examination. The young bilingual doctor there had some x-rays taken and then popped my finger back into joint, followed by more x-rays. I was in and out in less than 4 hours. It cost me nothing out of pocket. The doctors at EBAIS had just told me to go home and wash my wounds with soap and water and put on a band aid if necessary. I am sure those scrapes would have required “dressing” at a private hospital, and my deductible is $500 for urgent/emergent care outside the United States. I am betting that the suspected finger fracture would have cost more than $500, considering the scrapes here and there and the x-rays.
Draw your own conclusions. In my case, if I have the flu or a cold or cut my finger while slicing tomatoes, or want an annual physical to get a second opinion on what U.S. doctors are saying, I’m headed to EBAIS. If I have a heart attack or another fracture, I’m headed for Clinica Biblica. BTW, I’ve learned to look down at the sidewalk when taking my “health walks.”