Medismart (Prepaid Medical Plan)

I have been trying to find the best way to use all the medical resources available to me here in Costa Rica. This country is blessed with many talented, affordable medical practitioners and several options from public to private doctors, as well as pharmacists, and independent labs. My challenge has been to piece all these parts together in the best, most affordable solution.

I first laid out my initial healthcare plan in this article.  The summary is: get healthy, use the pharmacist first for burns, rashes, bites, etc., followed by a public /private doctor followed by a public / private hospital.  Some folks feel you are “cheating” on the CAJA if you use private doctors or labs, but really each person has to make choices on what is right for them, which might include using a combination of the best of all options.

The problem I had with my initial plan was I am not keen on searching for the best doctors, gynecologists, dermatologists, nutritionists, ultrasound, etc. when I need one.   There are not many resources for finding medical resources in Costa Rica. A question on Facebook might result in plenty of doctor recommendations all over Costa Rica, many of whom would be difficult to reach without a car. One resource I found useful and would recommend is Hulihealth which lists many doctors (not all) with their bio, charges and customer ratings. You can even set up an appointment electronically if calling on the phone intimidates you.  But even using Huliheath can involve running all around Costa Rica from doctor to specialist to lab to pharmacist trying to address a medical issue. Since we do not have a car, working with doctors spread across Costa Rica is problematic, and I was hoping for a more centralized solution.

I first heard about about Medismart from “The Real Costa Rica Blog” in which the author recounted his cancer treatment in Costa Rica  Post.  I was drawn to Medismart because the program appeared to have all the doctors, tests, and specialists I might need in one place under one plan that offered a discount for using them.  For folks not familiar with Costa Rica currency, here is the trick.  In round numbers, the exchange rate is 500 colones to $1. So, below, a gynecologist’s normal price in Costa Rica of c45,000 is about $90, but through the Medismart plan you pay c9,000 or $18 and save c36,000 or $72.  The same appointment could cost $150 in the US (for reference).

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Note, Medismart is NOT an insurance program. MediSmart is a Prepaid Medical Plan that offers a wide range of medical services through the Metropolitan Hospital with discounts that will save up to 80% of your bill.  Here is an example of the specialties and the discount offered for each.  Again, using the conversion trick, General Medicine c6,940 is about $13.88.

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MediSmart is a company of Grupo Montecristo. I noticed similar programs in Nicaragua and Panama where you affiliate with a specific hospital, pay a monthly fee and get discounted services. Think of Medismart like a Costco membership. The deal is UNLIMITED usage, $12 plus $3 per dependent per month with NO restrictions, age limits, etc. I notice they offer optometrist exams, dental and veterinary service too. Since I do not have any pets, I cannot vouch for the veterinary services.  The discount by speciality is listed here.

I started my journey by sending an email to the contact address on their website. It took a week to get back to me. I figured they were searching for someone who spoke English to respond. Nancy Solis sent me an email answering my questions. We corresponded back and forth until I decided to just call her. Unfortunately, I discovered Nancy could read and write English but not speak it, so I was happy to stay with the email. After feeling satisfied that my questions had been answered, I went online and registered. Medismart charges your credit card monthly. If you want to cancel, you have to give them two months’ notice. My monthly cost is $15 ($12+3) for my wife and me.

I emailed Nancy to make my first appointment and she told me I had to call the appointment phone number. My heart was beating fast thinking, will anyone speak English? I called the appointment number and said hello in English, which caused a long silence and lots of commotion until Jeffery came on the line. Jeffery speaks great English. He noticed my wife’s details were not correct and fixed them.

One thing I like about the Medismart program is they use Hulihealth’s medical appointment software which sends me an email with the appointment details that can easily be added to my calendar so there is no confusion over dates and times.

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Of course, when you join any group plan, they assign you a number and give you a membership card. Medismart’s process to is “mail” your card. I put quotes around mail because I had never seen mail delivered in Costa Rica. I provided my “Tico address” which is based on landmarks. My address is “across from the electric company substation, 300 meters north and 50 meters east in an apartment with #1.” As fortune would have it, the motorcycle messenger came to my house while I was outside and we connected. That was a good sign.

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I started our Medismart journey with an easy test of having my wife see a general doctor about some concerns she had. Jeffery set up the appointment for Thursday at 2pm. Normally, because of the rain, I prefer to do things in the morning, but I sucked it up and accepted the time slot. We headed over at 1pm to give ourselves plenty of time since we had never been in that part of town before. Hospital Metropolitano is a little south of Parque de La Merced and not hard to find.

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The Hospital has two buildings across the street from each other. The smaller building on the east side appears to be an ER and is open 7×24. We also went there for the ultrasound. There appears to be plenty of parking around the hospital, though we take the bus and walk so cannot comment on the cost. We went through the parking lot of the west side building for our appointment. So entering the building might not be obvious to folks from the States since you go through the parking lot and then through the cafeteria to get to the receptionist’s desk. The receptionist directed us to the cashier.

The casher took our information and charged my credit card BEFORE the appointment. The discount (descuento) was clearly shown.

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We sat in the comfortable and uncrowded waiting room until the doctor came.

The appointment was at 2pm and the doctor called my wife in at 1:57, so right on time. After the appointment, the doctor came out to the clerks and helped set up appointments for some tests she wanted done. Thank God I didn’t have to call the appointment number and hope Jeffery was in the office.

We came back the next week, again pre-paid at the main building and took the appointment and receipt across the street and presented them to the receptionist. I thought it would be pretty clear what we were having done using the appointment document and the receipt, but there was slight confusion and luckily one person spoke English and got us set up. We accidentally walked into the ultrasound area. I think we were supposed to wait for our name to be called, but they took my wife anyway 20 minutes early.

The specialists and technicians were professional and friendly and spoke English. The one technician who did not still was able to give clear instructions. Unlike in the US, they gave immediate feedback and gave Jeni her x-rays and ultrasound photos before we left.

After receiving the test results, we walked back across the street to review them with the doctor. I think we should have made an appointment beforehand. The doctor saw us waiting and scheduled a follow-up appointment. We waited an hour for that time slot and the doctor reviewed all the results, gave my wife some options and a prescription. I was prepared to pay for another visit; this visit did not cost anything. We decided to use the convenient hospital pharmacy, which had all the medications the doctor prescribed, and the 7% Medismart discount was applied. Again, I am not a fan of running around town trying to fill a prescription, so I liked that convenience, though I cannot say whether or not it was a deal. Another thing I like about the comprehensive arrangement is when the pharmacist has a question, he can walk down the hall and ask the doctor.

Having accomplished test #1, we took another baby step and scheduled a dermatology appointment. I called the appointment line and got Jeffery again. He set up the appointment with the dermatologist the following week. He was very helpful and made sure we got an English-speaking doctor.  In addition, he gave me his email so I would not need to call in and could handle appointments electronically.

When I went in for the dermatology appointments and tried to prepay like previous times, the cashier directed me to the dermatologist’s office which is on the first floor directly behind the cashiers. The dermatologist’s receptionist spoke great English. We had our appointment, had our questions answered, were examined, paid our bill and left. So, very easy and inexpensive.  If you are a stickler for details and predictability, the only “glitch” was that we got the discount for the consultation as listed above, but burning off the suspect spots was extra.  Also, if you want any plastic surgery, botox, or tummy tucks, those procedures are not discounted under the Medismart plan.

So, here is what I have spent so far.  For $15 first month’s fee, I have saved $160.

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I am happy with this solution so far.  Medismart offers me all the doctors, specialists, tests, and drugs I need in one location.  The plan is a low $15 a month for my wife and I, conveniently charged to my credit card each month.  The two-month cancelation policy seems low risk. The prices and discounts are available on their website, and making an appointment is very easy by phone or email. And email confirmation makes adding appointments to my calendar easy.

I think this is a good plan for anyone who wants to take control of their healthcare where convenience (location, specialists, appointments and payment) is important.  Remember my initial plan was to get healthy and be proactive, which this plan allows me to do.  Since we do not have a car, going to one location to get everything done is perfect for us.

Here is another article on the company link

A final note.  Since we are typically at the hospital for our appointments around lunch we have been happy to find this place to get a meal and would recommend it to anyone doing the same.


San Jose to Grecia and back

San Jose to Grecia

Today, we went to visit friends in Grecia which is about an hour west of San Jose.  It was an easy trip.

The first step in any bus trip is to find the right bus station.  In Costa Rica, a bus company applies for a monopoly to provide transportation between point A and B.  They negotiate a fare with the government and build a bus station.  As a result, there are many bus stations all over San Jose, and the trick is to find the right one.  The Grecia station is located conveniently in the middle of San Jose with many other important stations near by.  I marked the station with stars on the map below.  Normally, you can just tell a taxi driver you want to go to “terminal Grecia” and they will get you there.

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You can see from the schedule below that there is only one option between Grecia and San Jose, that the route is owned by Tranportes Grecia, and the buses run every 30 minutes and take an hour between points.

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Here is what the San Jose-Grecia bus station looks like.  Just head to the back hanger.

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The schedule is posted on the wall.  Note the individual schedules for Monday to Thursday, Friday, Saturday and Sunday.  Generally, there are only slight variations with a few missing times on low traffic days, especially Sunday.  Overall, you can see the bus is leaving frequently.

Once you get to the hanger, there are a number of benches to wait for the bus.  I think there was a queue, but since I was not anxious about the bus filling up, I waited at the end.  I figured, why piss people off trying to get up front?

Here is the bus, which was quite modern and comfortable.  There is no AC on this bus, so if air is important to you, secure a seat with a window which will actually open.  Of course, I love those huge side mirrors poking out in front of the bus which remind me of bug antennae.

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I had not seen the little scanner by the driver before which is used to scan the cedulas of senior citizen who get a discounted fare.

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Here is the route from San Jose to Grecia, which under ideal conditions should take 58 minutes.

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Boy, did I make a mistake on the fare.  Five, 50 and 500 in Spanish still confuse me.  The San Jose to Grecia fare is c1055 **.  I thought is was c1500 and gave the driver c2000 which freaked him out and he told me to move on which I later learned was because he did not have enough change at that time.  Once everyone was on, the driver collected my correct change and came to my seat and gave it to me.

The bus made several stops after leaving the San Jose station, and eventually it had standing room only.

Next time, I might consider getting on part way.  I noticed that the bus stopped near my home by the Crown Plaza which would be more convenient than going all the way into town to the station.  But, I will mention, there were fewer seats open by the time it reached even this early stop.

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Another main midway stop for most buses is Hospital Mexico stop on the Pista.

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Finally, the bus stopped west of the airport on the Pista.  For anyone flying into SJO, you could take a taxi to this stop and catch the bus here instead of going all the way into town.

A note of caution: I saw a woman try to flag down the bus along the way and the bus driver passed right by–because either he was not allowed to stop there, he could not be bothered, or the bus was full.

Once you arrive in Grecia, my advice is to initially head to the main church and the central park to get your bearings.  Traditionally, the church will be on the east side of the park, giving you east-west bearings.  Similar to most Costa Rica towns ,there are two bus stations – long distance and local.  I came into the long distance station north of the park shown on the map below.

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Here are some photos I took of the long distance station with the schedules posted on the walls.  Facebook Album

Returning to San Jose

The Grecia long distance station is easy to navigate.  I have taken the bus to Naranjo which is  on one side and the San Jose bus parks on the other side.

Look for this sign to get on the right bus to San Jose

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Again, the fare is c1055** and it takes an hour to get back to San Jose.  Important note for some is the bus stops at the airport in case you want to catch a flight.

I wanted to show the change in elevation traveling from San Jose on the right to Grecia on the left.  So, the bus goes from about 3200ft to 3800 ft.  The airport is at the low dip between the end points.

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** fares can change over time.