Allianz Health/Medical Insurance experience

William Lawson, aka The Neurotic Foreigner posts at Lawsons Yucatan,  he has several blogs all under this one site so poke around and see what's there!

Lawson recently posted a blog about  a 2 year old experience he had with Allianz Insurance

So just which is it by the way?  Medical Insurance or Health Insurance! 

We have had our health coverage policy with Allianz now for 4 years and have never had cause to use it.  For us it is a 'Major' Medical, or catastrophic event policy.

We recently had to put our policy, its coverage, and our Agent to the test. (by the way, as a result of this experience we found out that our 'Agent', wasn't really an Agent, just a Seller.  He has now done whatever he needed to do and is an 'Agent'.)

We had to have a pre-arranged procedure - the doctor wanted to move right away with it, but we had to wait a bit for our busy social schedule to clear, and good thing because we needed the extra time for our coverage to, well, cover. 

According to our Agent you need to give 3-days notice for an arranged/scheduled procedure. This is to get the paperwork sbmitted and ensure all necessary forms are submitted to the Hspital for proper coverage.   No problem,  we have all the correct forms, one set which must be filled out by the doctor.  So off to the doctors office -  Okay, we got that done - now with the other set we're off to the Allianz office to get the assistance of our Agent with the Agency forms, which naturally are in Spanish.  Now we have enough Spanish to deal with most of the questions, but still, for security, we had some questions and clarifications.  OKAY, so now all the forms are filled out, Thank goodness the secretary at the Allianz office knows what is going on, because everyone in the office was coming to her to get info and to ask questions!  Which could explain why some of our answers from our Agent were/are a bit vague.

It took 5 days to get the approval for the procedure, thank goodness it wasn't seriously urgent.

So the day of the procedure, we turn up with all our paperwork, who by the way had not received prior notification from the Insurance Group, which is of course why they require you to fill out all the paperwork in advance, hmmmmmmm.   Thank goodness the Doctor had turned in his requests for the procedure so that room, and services were in place.

The entire procedure; all Doctor and Anesthesiologist costs, surgical room and supplies, hospital stay and room supplies were covered.  A lab work procedure was not covered (because it was sent out to a separate lab and not done at the hospital lab) which caused me to have to go home to get money upon check out.  Most inconvenient.

We turned in paperwork for reimbursement of that lab work expense, as well as for the follow up Dr visits, and the prescriptions.   That paperwork was turned in and we were told 1 week to process. Oh, by the way, you must get a factura for any prescription, medical appointment, or coverable expense to be considered for reimbursement.  Regular old receipts(notas) won't do. (this only means anything to us living in Mexico).  A factura is an 'Official' receipt.  It guarantees that that the cost has been properly documented and reported to Hacienda(equivalent of the US's IRS).  Typically you pay a small premium for a purchase or payment when you request a factura, and you must request the factura BEFORE the purchase/service is paid.

Okay, after 3+ weeks and hearing not peep one,  we call our agent to follow up on the reimbursement.
Yee gads it's in!  When we inquired as to why our Agent didn't contact us that the check was in we were told it wasn't his department and he didn't know.  OK?

So overall, the coverage was 5star.  Dealing with the paperwork and our Agent was 3stars. But now we know stuff, so IF there is a next time we'll be better prepared.