Interview with my friend “J”
I interviewed my friend “J” as she probably has more experience with the Nicaraguan medical system than anyone. She has Polycystic Kidney Disease and is waiting for a kidney transplant, so she’s had to have all sorts of tests, biopsies, etc., and also has a husband with Type 1 (childhood) Diabetes, who has required Emergency Room services more than once. I once asked her why she didn’t return to the U.S. in light of all the medical requirements, and she said “Are you kidding? It’s much better and easier here!” So I thought I’d interview her for my blog and get her experiences and thoughts.
What kind of medical services have you been receiving, and how have the service, quality and standards been?
All of my tests and appointments have been very quick, and the care is so personalized. I can easily arrange any test I need, including MRIs, and other high-tech services, within a week. I’ve had every kind of blood and urine test, MRIs, ultrasounds, radiology, biopsy, etc. Full batteries of all kinds of tests and very full check-ups are easily scheduled and arranged, and are very comprehensive. The only kind of testing/treatment not available in Nicaragua is nuclear medicine.
The private labs, especially those in Managua, are all clean, and they meet first world standards. The equipment is new. The doctors are highly trained and most have done residencies in other countries such as the U.S., Canada, France, Mexico, etc. Many, if not most, are bi-lingual in English. And, they spend time with you. An appointment is 40 minutes, not 5 minutes. They are not heavily over-scheduled and rushed, like the docs in the U.S. You sometimes have to wait for an appointment due to an emergency, but the wait is never unreasonably long. And, the doctors always give you their private cell phones so they’re very accessible.
The private hospital (and lab) I usually frequent is Vivian Pellas Metropolitano in Managua. It’s new and immaculate. When I have to stay overnight, I get a very nice private room and the food is excellent. The nurses are RNs and are not only competent, but very warm and friendly as well. They can arrange a translator if you don’t speak Spanish.
What about prices and insurance coverage?
Here are some sample prices at the high end of the scale, i.e. Vivian Pellas hospital, which is the newest and most expensive in the country:
• Blood Tests range: . . . . . . . . . . $5-10 each
• Ultrasounds range: . . . . . . . . . $40-50
• MRI: . . . . . . . . . . . . . . . . . . . .$450
• Surgical Anesthesia, 3 hr: . . . . $120
• Comprehensive Cardio Profile: $80
• Electrocardiogram: . . . . . . . . . $20
• Echocardiogram: . . . . . . . . . . . $75
I have a very comprehensive (U.S.) Blue Cross/Blue Shield policy, which actually covers all my tests, treatments, and prescription drugs here. The Vivian Pellas lab is accredited by Blue Cross/Blue Shield. For prescription drugs, the original prescription has to be written by a US doctor for coverage, so I just take the prescription to a pharmacy and buy what I need. Technically you don’t need a prescription to buy any kind of medicine here, and you can buy it by the pill rather than the package. Medicare does not cover services outside of the U.S., but if you have secondary insurance, they will often cover international treatments and medicines and you can deal with them directly for coverage (unlike the U.S., where you have to deal with Medicare first). Of course, every policy is different.
If you live in Nicaragua, you can become a member of the Vivian Pellas Hospital for around $15/month, and you receive discounts on many tests and services. The longer you’re a member, the higher the discount. This is a good option for people who have no insurance. Interviewer’s Note: I’m a member of this hospital and my emergency laparoscopic appendix surgery, including ER services, meds, 4 nights in a private room, follow-up, cost $2,000 instead of $3,000. So the $15/month is very good value.
What about getting the medicine you need?
It’s available here with or without prescription. Prices vary. Many are less expensive, and some are just as expensive as the U.S. I can also get medicines that are not available in the U.S. yet. For example, the medicine I take for osteoporosis is European and doesn’t yet have FDA approval at home. I think it’s better than what’s available in the U.S. As I said before, my insurance covers any U.S. physician prescribed medicine. What I can’t get here, I have sent from the U.S.
How has your husband’s care been? (he has childhood Diabetes)
We’ve had very good doctors and the Emergency Room care has also been excellent with no waiting. When specialists are needed, they are called in immediately. As I said, his doctors are accessible, available and we have their cell phone numbers – they actually do return our calls. I find the doctors here to be much more caring and available.
Have you had any other medical experiences here that you want to comment on?
I’ve had excellent dentistry here as well, especially in Managua. You can find dentists with the latest equipment, and specialists such as periodontists, odontologists, etc. The prices don’t even compare; they are so much cheaper. You can easily get implants, bridges, crowns, etc., in addition to routine services such as cleaning and fillings. (Interviewer’s note: I’ve had crowns for $150-200, fillings $25 each, checkups and cleaning $20).
My husband had laser eye surgery here and this experience, too, was excellent. The eye surgeon had the latest equipment and the results and follow-up were very good.
Are there any medical situations where you would choose to be in the U.S. rather than Nicaragua?
I wouldn’t even think of going back to the U.S. for medical care unless there was something very specific that I couldn’t get done here; for example, transplants or open-heart surgery, or nuclear medicine (Open heart surgery is done here but not as frequently as in the U.S. The hospital Salud Integral in Managua began doing open-heart surgery in 2004 and to date has performed just over 100 operations.)
Interviewer’s Note: Keep in mind that Nicaragua is the second poorest country in the Americas, after Haiti, yet private medical care is very good. Medical services and hospitals are even more developed in countries like Costa Rica and Panama, but prices are also higher. The Vivian Pellas hospital referred to here is about as modern and efficient as any that you’ll find in Latin America.
Do you have similar stories to share about expat life and living abroad? We’d love to hear from you.
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