Medical treatment abroad can save patients money


    In the past I have written articles and comments regarding the cost of health care in the United States and whether we should support the Obama PPACA legislation. I’ve also discussed the potential of getting services done outside the country for significant cost savings. I’ve further pointed out that if Medicare allowed payment for such services, the country would save a tremendous amount on its health care costs.

    Most have heard the phrase “Put your money where your mouth is,” or maybe it was “Put up or shut up.” Well, I decided the time had come for me to put my money and my mouth together. I am currently near Jaco, Costa Rica, and have been here for a few weeks, coming with a chipped molar and an old filling that was cracked. Surprise: I have regular checkups, have had some periodontal work and I have dental insurance.

    I expect that for the filling and the tooth repair with a crown, the cost would be around $1,600 in the U.S. With deductable and my co-pay, it would cost me close to $900, even with my insurance.

    On a previous trip to Costa Rica, I spoke with a U.S. colleague who was having all his fillings replaced by a local dentist. I called him when I arrived to see how things went. He was very pleased and did not hesitate to recommend the doctor. Unfortunately, he was not in Jaco.

    So, I was forced to find an alternative. If possible, it would help show that the system has a range of good providers, just like the U.S. I began to ask around. I was surprised at the amount of choice I had in Jaco, a town of probably 15,000 people. One of the options was a practice that included three females all trained at local universities.

    The doctor I met with at the Premier Dental Care Center was Dr. Selena Cubero, a dental surgeon who is on the national board. It should be pointed out that in Costa Rica dental doctors and medical doctors are all together in the practice of medicine, not separate like in the U.S. Dr. Cubero’s practice is associated with CIMA Hospital, one of three private hospitals certified in Costa Rica by JCAHO, the same organization that certifies U.S. hospitals.

    My first visit was exploratory: meet the doctors, learn the services, how they operate and who the clientele is, their English language skills, etc. I believe it is very important in health care that mistakes or misunderstanding don’t occur as a result of language skills. In U.S. hospitals, there is a requirement to assure translation services are available through organizations such as Voices for Health in West Michigan.

    Dr. Cubero took a fair amount of time answering my questions, gave me a short tour of the facilities and then examined my teeth. We talked about what she saw that needed to be done. I didn’t give her any details, as I wanted to see how her review would line up with my dentist — a second opinion of sorts. She hit all the key points, including a question of getting periodontal work. I was impressed. A half-hour later I left without charge, but with another appointment.

    In preparation for the work, Dr. Cubero asked if she could receive recent X-rays from my U.S. dental team. No reason to incur additional expense if they were available, and they were.

    With the first procedure, replacing a rather large cracked filling, I was given a shot after some modest numbing substance was applied. The filling replacement cost $50.

    Next she took impressions for the bigger job of repairing my broken molar. She used a half plate for top and bottom impressions, taking each independently. The initial intent was to do an inlay procedure, the cost of which would be about $300-$400, considerably less than a crown in the U.S. at an approximate cost of $1,500.

    It turns out that after further review of X-rays and mold impressions, the inlay would likely be unsatisfactory for an extended period. A crown was a more suitable solution. At this point I wondered if I was getting the bait-and-switch strategy. However, it seems that the crown is generally the same cost. It was the same with a discussion regarding gold versus porcelain. Gold was less but more durable.

    Now, however, a time factor came into the picture. I would be leaving Costa Rica in three weeks, not long enough to complete the work and have time for follow-up procedures. My return schedule to Costa Rica was also unclear. In the end, it was decided that Dr. Cubero would file the tooth a bit and add some material to protect it, with the expectation it would last 6-9 months, followed by a periodontal check.

    The next appointment is yet to be decided, but total cost for the above services was $60. I will be submitting the two charges for a total of $110 to my dental insurance carrier to see what, if any, reimbursement I will get. Even if they deny everything, I’m still ahead, and I feel very positive about my encounter with the Costa Rican dental system.

    Ardon Schambers is president and principal of P3HR Consulting & Services LLC.

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