(Updated December 30, 2006)
At long lastÖhere is my report on the IMSS medical insurance system. These are my observations, and I welcome response from other list members who would be willing to share their IMSS experiences with the group. I donít claim to be an authority on IMSS. Iím just reporting my experiences.
What is it? IMSS stands for Instituto Mexicano del Seguro Social. Itís about as close to socialized medical coverage as you can get. Many working people qualify for IMSS and many employers make a contribution toward the IMSS coverage. Mexico has allowed retirees and other visiting residents to buy the IMSS coverage. They base the cost on what the payment would be if you were working full time at minimum wages. This year I believe I paid around $3,180 pesos. It goes up slightly each year. (Update note, see current rates below. The way they charge is now based on a different system per person instead of per family.)
What do you get? IMSS gives you complete coverage including prescription meds except for certain preexisting conditions that have varying time periods before they are covered. This is an excellent article that explains the preexisting conditions: http://www.mexconnect.com/mex_/dt/dtimssregs.html
When you apply for IMSS, you fill out a questionnaire and you answer general health questions and health history questions. There are some preexisting conditions that would prevent you from coverage by IMSS. The official IMSS government site is at: http://www.imss.gob.mx/
My opinion/suggestion: Buy the best medical coverage your budget will allow. My budget wouldnít allow for more than IMSS, so thatís why I went that route. But I would highly recommend that if you have IMSS coverage, also pay to get a second opinion for any important issues and/or research as much as you can for yourself on the internet. I've had IMSS coverage since 1999 or 2000 mainly as a major medical fallback. Iíve ended up using it also for periodic ďrunny noseĒ doctorís visits. I think they do a fine job with run-of-the-mill ailments, but two major concerns Iíve had were misdiagnosed and due to the second opinions, I was able to get the proper treatment. Saying that, Iím sure if I were to have a heart attack tomorrow, Iíd be glad I was covered with IMSS and Iím sure my treatment would be good enough to offset the cost I would have to put out if I werenít covered.
Words of warning for newbies to IMSS coverage: This is NOT medical care like youíre used to up north. (Which is good and bad.) Your first clue is when you are asked for a urine sample and they hand you a small mayonnaise jar (sans label) with a big ďMĒ on the red lid (McCormick). Iím sure they are sterilized, but still it is different than the sterile cups up north that come complete with instructions for a ďclean catchĒ and include a handy wipe, all sealed in plastic.
I would not recommend IMSS for those who speak no Spanish. Even though Iíve had a few doctors in the emergency room who speak some English, almost everything else from getting your appointment, to speaking with your family doctor, to picking up prescriptions is in Spanish. Most staff have been very helpful, but there have been a few that showed their impatience with my stuttering Spanish. If you can afford coverage at Sharp, I understand they have more English speaking personnel. But if your budget demands you choose IMSS, either enroll in a Spanish class, or be sure to take along a friend who can translate for you.
The system is similar to HMOs in the US (and I assume to the socialized system in Canada) where the starting point for everything is the family doctor. If the problem is something the family doctor canít handle, he approves your visit to a specialist. The IMSS specialist clinic is halfway between Ley 1 and Ley 2. Your first time there, you need to stand in line to create your patient file. After that, you donít need to fetch it yourself. If they have an appointment for you, theyíll have the file there and waiting. But be prepared the first time. Obtaining your turn in line is like doing battle at the market or getting stamps at the post office; you have to elbow your way to the front.
My first brush with IMSS care was during an elevated blood pressure crisis that took me to four emergency room visits, two of them being all-night stays. The last trip there, their treatment was making me worse. It was after paying for a specialist visit to a cardiologist that he diagnosed that my blood levels were low in potassium and prescribed a potassium supplement that I paid for out-of-pocket, but it solved the problem.
A couple of interesting observations: Many of the IMSS doctors are also in private practice and many also work at Sharp. So it doesnít necessarily mean that because you have cheap insurance, youíre getting substandard doctors. Itís true that their hands are sometimes tied because of what IMSS will cover. For example, Iíve had a few doctors tell me that there are better blood pressure meds, but there are only certain ones within the approved IMSS line-up.
Also, within IMSS, like most of Mexican culture, it does make a difference in who you know. On my second emergency room visit, I developed a friendship with a surgeon who was on duty but who wanted to practice his English. After treating him and his wife to breakfast and after invitations to their home for breakfast, I had a friend who gave me his cell number, home number, consultation office number, etc. During my last blood pressure/irregular heart beat crisis, he was happy to come to my home, assist as he could and phone a cardiologist friend who saw me later that day and immediately brought me back to normal. I gladly paid 250 pesos for the visit. But he pointed out that he was also an IMSS doctor, and should I need additional cardiology care, just request him through my friend (the IMSS surgeon) and he would phone my IMSS family doctor to make the necessary arrangements to make sure I got the paperwork in place to get to him.
Two last notes: For on-going monthly care such as blood pressure medicine, the system wonít allow issuing a prescription for more than a monthís worth of meds. It means a monthly trip to the family doctor, but it is very simple. The receptionist will set up the next monthís appointment while you are there. It takes ten minutes to meet with your doctor, and pick up your meds, and youíre out the door. No need to go to another pharmacy.
Another word of advice: Contrary to our image of ďMexican time,Ē when they say 7:30, Iíd show up at 7:15. Only certain activities such as X-rays or lab work are on a first come first served basis, i.e. when you get an authorization slip that says show up at 7:30 for lab work, there will be a line of people at 7:15 and youíll be treated in order of arrival. I have to say, they move very fast. They have the system down pat for processing bodies quickly.
For regular appointments, if you phone or stop by to set up an appointment, they ask that you arrive 15 minutes prior to the assigned time. Itís a good idea. You usually get whisked in and out early or at least by the time of your appointment.
If you have an unforeseen problem like a sore throat and want to see the doctor without an appointment, show up at 7:00. They say 7:30, but that means you are at the end of the line. The system is very efficient at seeing and treating everyone showing up by 7:30 prior to their treatment of patients with appointments that start at about 9:00. There have been a couple of times I didnít know the night before that I needed a doctor visit the next morning so I didnít plan to go at 7:15. I showed up mid-morning. And even though the receptionist will give you the lecture about how you need to be there at 7:30 if you have no appointment, they seem to always work me in within a half hourís wait. Not bad.
Overall, I think they provide an excellent service and now that I'm on monthly medications, I certainly get my moneyís worth. Just the amount I would spend on monthly blood pressure medicine covers the annual amount I pay for coverage. But it isnít perfect and isnít all-inclusive. If you have IMSS, Iíd suggest you also set aside a small amount to cover your second opinions or out-of-pocket expense for meds outside the IMSS system.
Iíd love to hear from those who have been through surgery or more intensive coverage situations.
Please post your experiences on the MazInfo list. It is also a good place to ask questions since their procedures do change from time to time. If you're not on the list, it's easy to join at www.yahoogroups.com/group/mazinfo and click on "join this group." Iíd be happy to answer any other questions I can if you want to contact me direct at email@example.com.
Addendum 7/18/02, updated 5/19/03, updated 3/25/05, update 3/ 31/06.
Good news for singles; possibly bad news for
couples depending on your age.
IMSS coverage is now priced differently than in the past. Last year I paid 2,500 pesos for one year as a single. This year, they have done away with a "one price family" deal and everyone pays depending on age and it means I'm saving 1,000 pesos over last year!
Rates for 2006
0-19 1,062. pesos
60 & over 2,791.78.
(These are rates for those "without restrictions." They now have a second set of rates, slightly higher for those "with restrictions." Usually, a new person in the system has "with restrictions" stamped on their card for the first year, then the card says "without restrictions" from that point on.
They have a sign saying that with the new structure they need a copy of your birth certificate, but FYI, they accepted a copy of my FM-3 which has my birth date. They also request two photos; a copy of your marriage certificate, if married; your social security number if you have one in Mexico; and if renewing, a copy of your original application.
Addendum: December 30, 2006
A few new notes to add to my IMSS experiences. I had never tried the dental services which are also provided by and covered through IMSS. A Mexican friend assured me their services were good and they provided Novocain just like regular dentists. I'm a baby when it comes to work in my mouth and I've always equated "spend more money and have less pain." So, until now I've paid for a private dentist to do my dental work. A cleaning and check up costs about 400 pesos from my regular dentist. I decided this time to try the IMSS service. I stopped by to make an appointment and was able to have one for the very next day. The dental hygienist used ultrasound just like my other dentist. The differences were, she didn't use a polishing cream to buff the surface of each tooth like my regular dentist used. And she and her assistant worked very fast. This was the "fifteen" minute tooth cleaning experience. I have to admit, after the experience, my teeth felt just as clean as the 45 minute version that costs 400 pesos.
Another note. I experienced a respiratory infection and after trying antibiotics by mouth that didn't do the trick, my doctor gave me a prescription for 8 doses of some type of penicillin. Two shots per day for the first two days, then one shot per day for four more days. The on-site pharmacy gave me the vials for 8 doses. They gave me the first one at the emergency room area. I stopped by later in the day for the second shot and they told me they were only supposed to give the first shot. I'd have to go elsewhere for the rest of the shots. Since I was there and obviously confused, they gave me the second shot. I tried the same thing the next morning (on a Saturday) and the emergency folks once again explained they can only give the first shot. The rest were up to me. They suggested finding a pharmacy that would administer shots or a clinic. I went to four pharmacies they said they don't do it, and two clinics. Finally, one pharmacy sent me to a private person two doors down (I assume a nurse who works elsewhere since she was well equipped and knew what she was doing) and for a ten peso charge, she gave me my third injection. Next trip to the doctor I intend to ask if this is standard procedure, because he sure didn't explain that to me when he prescribed the shots. Sure enough, I'm feeling much better already, but thought I'd share the experience so others can be prepared if the doctor recommends injections.
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Copyright 2006, MazInfo