Dear Tico Times:
Private hospitals in Costa Rica have long required patients to pay or demonstrate ability to pay before providing care. The recent incident involving Elissa Merritt and CIMA Hospital in Escazú (TT, Feb. 13) has raised some questions about the practice of requiring payment before providing services.
Mrs. Merritt had a serious accident while riding an ATV on a trail near Jacó. The accident left her with three broken bones, including a compound fracture. The Costa Rican Red Cross rescued Merritt and brought her to a clinic in Jacó. Officials at the Jacó clinic said they were not equipped to assist her, and she was moved by ambulance to CIMA in San José. Upon arrival at CIMA, hospital officials asked for a $5,000 payment before treating her. This requirement by private hospitals of payment before services has irked a number of people here in Costa Rica and elsewhere. We have been involved in two situations with private hospitals in Costa Rica where payment for services was required up front. The first case involved a North American friend, John, who purchased trip insurance with medical coverage before coming to Costa Rica. While here, John became very ill with stomach pains, and his Tica fiancé took him to the public hospital in Heredia, north of San José. John was admitted and placed on a gurney in the emergency room for observation. No request for payment was made.
We arrived a few hours later to see how he was doing, and he was still on the gurney. John did not look well and we decided to take him to a private hospital, La Católica Hospital, in Guadalupe in northern San José.
Upon being admitted, John showed hospital staff his medical trip insurance. The hospital, however, wanted assurance that its bill would be paid in the event that the medical insurance would not cover all of his expenses. John was being prepared for surgery and I was asked to sign a note for $7,000 to guarantee payment of his hospital bills. I signed the note and the hospital operated on John later that day. John later submitted his hospital bill to his U.S. medical insurer, and the insurer paid the Costa Rican hospital bill in full.
Another older North American friend, also named John, fell while walking in our neighborhood. John had a large gash in his leg and we took him to a nearby doctor’s office, where the doctor cleaned the wound, stitched it up and gave him an antibiotic shot. A few days later the doctor visited John and decided that his leg was infected.
The doctor suggested that we take John to Clínica Bíblica Hospital in San José. John was moved by ambulance, and upon admittance, he was asked to provide evidence of his ability to pay. John was unable to provide such evidence, and my Tica wife, Bivina, provided her cédula (ID) and debit card to guarantee payment. John assured us that his family in the United States would reimburse us for his medical expenses. Having helped our other friend with his medical bills, and having been given assurance of reimbursement from the second John, we were not concerned about stepping up to guarantee payment of his bills.
John was in Clínica Bíblica Hospital for a week, where the doctors operated on his leg twice to prevent the infection from spreading. The doctors later told us that if we hadn’t brought him to the hospital when we did, they would have had to amputate his leg. John’s doctors and hospital bills came to more than $17,000, which my wife paid.
We submitted the paid hospital bills to John’s sons, who insisted that we also provide a copy of our bank statement, confirming that we had paid his medical bills. They were also looking to see if we had received a referral fee or kickback from the doctors or the hospital. We had not.
At no time did John’s sons offer to pay his medical bills. Instead they suggested that John reimburse us at the rate of $573 per month from his $1,500 monthly Social Security and private-pension income. When we protested that it would take us 30 months to be repaid for John’s medical bills, at zero percent interest, the sons broke off discussion. John’s sons then arranged for him to leave the country, and he flew to California a year ago, leaving us holding the bag on his $17,000 medical bills.
It’s no wonder that private hospitals in Costa Rica ask for payment or proof of ability to pay up front. These hospitals don’t want to be left with unpaid hospital bills when Gringos skip the country!
James Twomey
Santo Domingo de Heredia
