PR health insurance and pre-existing conditions

Triple-S Salud has a new affordable care act policy that accepts pre-existing conditions with excellent premiums.  I'm not a representative of the company, just a customer.

Web address:

https://www.ssspr.com/SSSPortal

Tel. (787) 774-6060
1-877-357-9777 (Toll Free)

I hope you find the coverage you need.

Great! Thank you so much,we will definitely look into SSS.

Hi there, I myself have pre-existing conditions and will be moving to PR next month.  I am also concerned about  it. The company that I have now United Healthcare also has policies in PR, if I am correct.  So I will try to get the same type of insurance in PR. 

I know that you can go on the Health Marketplace and request services in PR.

Good luck.  If I get any more info, I will post it to you.

Thank you. I am more worried about health ins than anything, so I appreciate any and all info.

I would caution anybody with complex medical problems about moving to PR. I am a doctor (internal medicine) here serving my payback time for a scholarship I received from the federal government. I have been dismayed by the healthcare system here, and I'm part of it! You will wait long times to see doctors, get referrals, etc. There are a lot of poorly educated generalists or just out of date doctors here; a lot of older doctors because the younger ones are all moving to the US for better pay and opportunity. There are also some really good doctors, but I find that they seem to be few and far between. If you don't have private insurance, your wait time for specialists will be huge. And you better hope you have no medical emergencies, because the hospitals here are very scary places, and I personally don't ever want to be a patient in them. I have had patients with complex illness who I have sent back to the US because we just couldn't coordinate even medium quality care for them here due to the difficulties of working within the medical system here. It is really crazy.
There are a lot of nice and beautiful things about living in PR, but health care is not one of them. That being said, I live and work in the east side of the island, so maybe things on the west coast are better given there are more gringos over there. If your conditions are pretty stable and self-controlable, you could be just fine, but if you expect to need major procedures, surgery, specialist care, etc. I'd really reconsider moving here.
That's my 2 cents from the inside perspective. Hope it helps.

You don't know how glad I am that you wrote this. I have been tempted many times to write about the state of medical care in PR. But everytime I write something negative I'm dismissed as a "naysayer". I especially want to warn those who are thinking of retiring there and are of advanced age or already have chronic medical conditions. We lived in Moca near the hospital and my wife had abdominal pains. After waiting hours to be seen, they wanted to fly her by helicopter to San Juan because they thought she had appedicitis and didn't have a surgical staff. Turns out that's not what was wrong with her. She ended up going to Ponce a few days later and they couldn't find out what was wrong. So they had to admit her. I had to bring blankets, pillows, sheets and a bed pan because the hospital doesn't supply them. Had I not been there she would have slept on a bare mattress with no pillow or blankets. And the hospitals are very cold. My son in law works at that same hospital and he took a picture of the thermostat in the operating room. It was 53 degrees! Needless to say they didn't find out what it was.We moved back to the states not too long after that and she had another episode. She went to ER and almost right away determined it was her gall bladder. She had it removed and now she's fine. I'm 62 and in reasonably good health. I had a small stroke while I was here and am thankful it didn't happen in PR. If you are old and have chronic illnesses, stay in the states.

Agree, agree, agree. Emergency rooms, at least in western pr, are scary and dangerous places. Instances:
1. I recently has severe abdominal pains and went to energency room three time sin three days at what is suppose to be the best hospital in the area, Bella Vista in Mayaguez. They mad two mistakes, one serious and the other life threatening. First they did a CT scan WITHOUT contrasting dye. It came back negative. If they'd used the dye it would have shown colitus which would have then been treated with antibotics. Second they gave me Demarol as a pain killer even though I'd told them I was taking Lamictal.  Combining these two drugs can cause Serotonin Syndrome where the body temp goes to around 110 and the brain is fried. When I told this to my NJ physician he nearly jumped off his seat and told me I was lucky I didn't die. Feeling hopeless and adrift, and with almost intolerable abdominal pain, I flew to NJ where I was properly diagnosed and treated. As an aside the ERs in PR are freezing (think colder than a supermarket) and are therefore extremely uncomfortable; further they do not supply blankets - seems common knowledge that you bring your own blanket and pillow. Also note that before going to the ER I'd tried to see a GI specialist. I tried calling to make an appointment, but no answer. I went to the office to make an appointment in person, doors locked, no information outside about hours. Since then I've learned that it is common for doctors not to have answering services.
2. A friend of mine had an accident while riding his motor scooter - he ended up with severe road burn, large areas of skin scraped away. He went to Mayagruz Central. They hooked him up to an IV and Demerol (by the way Demorol hasn't been used in the USA for years, it is an ancient drug), and after 5 hours of no treatment he pulled his IV and left. During his time there they hadn't even cleaned his woulds. They later became infected. He went to a hospital in Aguadilla (year this guy is riding around PR with sever wounds trying to get help) and was told they would not treat him there (I don't know they reason), he then went to an urgent care center (not even a hospital) and luckily there was a doctor from Canada there (I am not saying there aren't any good PR doctors, but that's not my experience so far) in Moca and finally got proper treatment.

I could go on with a half dozen more stories like this.

I plan to get my ducks in a row concerning my medical care while in PR. From experience my suggestions:

1. If you don't have one already establish a relationship with a doctor you trust in the USA. He or she should serve as your main doctor and a "clearing house" for all of your medical treatment. I have one, but with the way medical practice in the USA is going this is not easy to do. Many people have rotating doctors with none getting to know you that well.  If you develop a serious medical problem while in PR contact him or her immediately to discuss.

2. If you anticipate or have a condition requiring a specialist do research and find them in advance. After my episode (see above) I was playing tennis and met a good one who happened to be taking a tennis lesson. Find competent specialist any way you can.

3. Try to avoid the emergency rooms if possible. If you must go know that they offer very few options, common ones are Demerol for pain (check potential side affects with any drugs you are taking), laxatives, and enemas. If you go bring a blanket and pillow. Be aware that they do 8 hour shifts (12 hour shift in the USA) which is bad for continuity of treatment. By the time you get going a new shift will come in who knows little about you.

Glad to hear you are OK now Victor. Anybody that goes to the ER or hospital just tell them you are allergic to Demerol, because that's the first pain killer they automatically go to. It's quite often stone age medicine you get there. They don't even clean you during your hospital stay. You or a relative has to do that. Sometimes you will luck out and get a competent Doctor. But it's always a crapshoot. You were fortunate enough to be able to leave the Island and go to NJ to see a Doctor. Too many people on this forum want to move to Pr on a dream and a shoestring budget. Victor's story is exactly the kind of situation why this isn't such a good idea. Everybody wants to come to PR and live the dream life. Meanwhile the people who are smart and competent are leaving the island for a better life. Think about it. It's funny that on this thread I haven't heard anything from those who say there is absolutely nothing wrong with PR and I'm full of crap for saying anything negative. Just be honest with people. Give them both the good and the bad information and leave yourself with a clear conscience.

I appreciate your honesty and perspective. Thanks again for your comments. Eyes wide open!

I've had the same kind of experiences with the medical system here on the island.You won't see me in an ER unless I'm forced at gunpoint.
Many locals I know don't really have problems to go to an ER, I guess if you never seen something else and are used to this system you deal with it.

Hi kubla, As a physician within what sounds like a pretty messed up medical system, do you find that there is any correlation to the type and level of medical insurance to the quality of medical care? Or have you found that It doesn't matter what type of insurance you have, the quality of care is still pretty bad as a general rule?  Just wondering if better insurance has anything to with better care. Looking for some sort of silver lining I guess, not sure one exists from all the replies....

I think that in term of planned care, yes you can typically get faster and maybe more competent care if you have better insurance but for any type of emergency it is truly luck of the draw. The thing is that most ERs here are staffed by generalists which are doctors that never did any residency an a lot went to med school in the DR and I find their knowledge and decisions severely lacking. Not all the time, but enough to make me terrified to need I be at a hospital here. And even if you find or luck into a competent doctor, he/she is still functioning witching a very strange and illogical and sometimes downright wrong system. I won't even begin to go on about the amount and severity of hospital acquired antibiotic infections here. That's the biggest reason I want nothing to do with the hospitals, they are teeming with horrible infections that can kill you, even if the reason you are there in the first place doesn't. I've seen that firsthand many times in my 1.5 yrs working here.
I unfortunately did have to seek ER care here once, when I had severe dengue. Like mentioned, it was freezing in the ERs and luckily I knew enough to bring my own blanket. I also brought evidence of my medical license to prove I knew what I was taking about but I still got horrible, substandard care. I first went to the hospital with the best reputation, Presby in Condado, but after waiting for 4 hrs with blood coming from my nose and vomiting (both sign that you should be in an ICU when you have dengue) they still had me waiting in line behind people that were waiting to be seen for anxiety. So I left, the next day found a different ER w fewer patients and was able to get in and get the iv fluids I knew I needed but had to continuously beg for labs to be done, and had to have someone bring me food and drinks from the outside, take myself to the bathroom across the ward, and fight with the doctors about what should be done. I even had to pull up the CDC guidelines for dengue treatment to prove they were not even close to giving adequate care, and still they just made it more difficult because that is the predominant culture here. By the next morning I luckily was having my platelet count improve and was rehydrated so I went home, but that was also a fight. Never once did anyone actually examine me or take an adequate history. And this is with them knowing I'm a doctor. The only reason I got the things I did was bc I knew enough to demand it but this experience only served to reinforce my terror of hospitals here. Probably the VA is decent bc it is held to mainland standards but I've even heard horror stories about it.
Sorry to be so glum about it, but these are my honest, unfiltered thoughts about the medical system here. Ask me about living on the beach, or exploring the many fun things to do here, and I'll have a much more positive tone.
But I also don't plan to stay longer than my obligatory service time lasts. Despite the good things. I agree w the others who say the best thing you can do is spend as long as possible visiting down here before moving to be sure it will work for you. Some people are really happy and set down here, so keep an open mind, but also try to do some of the things you will have I do, like go to a doctors appt and you may see that it is very different to what you expect.

Again I thank you for your honesty. Through my research online it seems as though the most highly regarded medical centers etc, are HIMA facilities. Need to do more reading about it but it almost appears that they are a cash only set of hospitals that people can go to to have procedures done less expensively than on the main land. Obviously I need to read more, but I thought the concept was kind of strange given the medical care on the island, and their website is not that informative.  Thanks for your thoughtful comments.

I took a look at HIMAHEALTH.com and I surmise they would not take emergencies. I believe they are "health tourism" only, meaning procedures and stay are planned in advance, patient comes to PR specifically for the procedure, and since they tout much lower costs (than in USA) I'd guess no insurance would be accepted. By the way there are these type of services in other countries such as Thailand. As an aside it seems that dental care is much cheaper in PR and there are competent practitioners there. I have a friend who had major dentistry done and preferred to have it done in PR not only for the lower cost but because they like the dentist very much and became friends with them and even invited him to USA to visit with them.

Also if you had a heart attack or stroke in PR you might be dead meat.

I've been to the HIMA hospital in Caguas a couple of time with an aged relative. They do have an ER and  it's one of those ERs that you don't want to find yourself in as a patient.

The relative was (she died in the ER of HIMA) an aunt of my wife. After she fell at home and was brought to the ER they failed to find a couple of broken bones and said she was basically OK and sent her home. It took six hours to get an ambulance to transport her home and all that time she had to wait in a wheelchair without water, food etc.
Two days later she was brought to same ER and died within a couple of hours; we still don't know what caused her death.

Geeze. If you're really concerned about your health a good idea is to pick a place to live where excellent medical is a short distance away. That wouldn't be PR. This is especially true for seniors and those with known, significant health problems. I am 65 years old, really like living in Rincon PR, and this is a conundrum. As an aside my downstairs neighbor told me there is a true trauma center in San Juan and if you need to go you should take an ambulance and in very serious cases a helicopter. I don't know if the trauma center exists, but this is what I was told. As an aside health care in the USA can be hit or miss too. Until I went on medicare my doctor took no insurance but I used him anyway since he is extremely good and I've seen him for about 25 years. He takes medicare but only breaks even. I have a friend who is an Israeli and if he has a health in the USA he would fly to Israel to handle it because he feels the health care in the USA is not that good. By the way when I was vacationing in St. Martin (French side) I split my head open and got excellent care in the (French) emergency room and it cost a mere $125.

The trauma center would be part of the Centro Medico in San Juan, the UPR medical campus. If you can get there in time and if they start working on you straight away you might get lucky when you're in a medical emergency.
My wife was operated there 7 years ago and I must admit they did a good job and the care wasn't too bad as well.
Of course you need to bring your own blankets etc. but that seems to be normal here. Also a family member should be there 24/7 if possible to care for the patient.

To anyone's knowledge are there any countries in the Caribbean, Central America, or South America having good medical care, that is if one had an emergency or needed substantial medicare care? I'm rethinking my PR situation. May be California would be better and I could still surf, albeit in a wet suit.