San Jose CAJA Hospitals Question

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  • #200992
    bogino
    Participant

    If an individual [b]ONLY[/b] has CAJA insurance and lives in the San Jose area and needs to go to the hospital whether it be on an Outpatient basis or involves being admitted is there a single “major” (what I mean by that is NOT a short-term Emergency Clinic with limited resources) hospital that they would go to? Let’s assume someone had a heart attack.

    My understanding is that hospitals such as CIMA or Clinical Biblica would not be options if you are reliant on CAJA since those are private hospitals.

    Am curious as to which specific hospitals are available to CAJA members. Thank You.

    #200993
    barbara ann
    Member

    Check with your insurance from the states about emergencies.

    My husband had dengue last year and was admitted as an emergency to Clinica Biblica in san jose. they require a deposit, you can use your credit card. If you don’t use the full amount they refund the difference.,there is some time before you are credited on your card if I remember right.

    We have Humana and because it was an emergency we got the necessary paperwork from Humana and submitted the claim. It took probably three months for approval for an emergency.

    Humana paid everything except the drugs that were used because they were foreign. the bill was 1500 for either 2 or three days with a private room for his care for Dengue. I think they required 3000 or 3500 on your credit card for admittance.

    A friend of mine had Blue Cross and was reimbursed for an emergency also. Caja does not cover any private hospital to my knowledge. the private hospitals are terrific.

    their care and concern was surprising because as a foreigner you never know if you have not been there before.

    #200994
    bogino
    Participant

    Thanks but my question relates to a situation where a retiree is living in Costa Rica who’s primary insurance is through the CAJA system.

    #200995
    costaricafinca
    Participant

    You are only [i]entitled[/i] to use the CAJA facility in your [u]immediate neighborhood[/u] that you are signed up with.

    You cannot pick and choose which hospital, clinic or doctor you prefer.

    If it was a [u]real[/u] emergency, in another district, I would suggest going to the nearest CAJA facility.

    It would depend on the staff whether they would provide treatment or not, although I expect they would.

    Very important to keep your most recent receipt in your wallet, showing your payments are ‘up to date’.

    Only CAJA hospitals are available to CAJA members, at no additional cost.

    If you go to one of the private hospitals, you will, more than likely, be asked to pay a portion of the ‘bill’ up front before they will admit you.

    If you go to a CAJA hospital, [u]without[/u] being a member, they are now requiring the same, unless it is a ‘life and death’ situation. This was reported recently in La Nación.

    #200996
    bogino
    Participant

    [quote=”costaricafinca”]You are only [i]entitled[/i] to use the CAJA facility in your [u]immediate neighborhood[/u] that you are signed up with. You cannot pick and choose which hospital, clinic or doctor you prefer.
    If it was a [u]real[/u] emergency, in another district, I would suggest going to the nearest CAJA facility. It would depend on the staff whether they would provide treatment or not, although I expect they would. Very important to keep your most recent receipt in your wallet, showing your payments are ‘up to date’.

    Only CAJA hospitals are available to CAJA members, at no additional cost.

    If you go to one of the private hospitals, you will, more than likely, be asked to pay a portion of the ‘bill’ up front before they will admit you.
    If you go to a CAJA hospital, [u]without[/u] being a member, they are now requiring the same, unless it is a ‘life and death’ situation. This was reported recently in La Nación.[/quote]

    Are there “many” CAJA hospitals in San Jose then? Lets assume I were living in Grecia: what is the name of the CAJA hospital for that area? Thx.

    #200997
    costaricafinca
    Participant

    There are both large and smaller CAJA hospitals in and around San Jose.
    In Grecia, it would be the [i]Hospital San Francisco de Asís de Grecia[/i] (CCSS)

    Grecia is quite a distance from San José, possibly an hour in heavy traffic.

    #200998
    barbara ann
    Member

    we are retired and have humana advantage as part of our medicare.we have our residency. I just mentioned the insurance because if you are American and have coverage you might be covered for emergencies.

    You can use the private hospitals here with cash or credit card even if you have caja. You will get a ten percent discount if you get your pensionado(gold) card from costa ricas social security. just make sure you show it. by the way the gold card is free, free entry in national parks, etc.

    #200999
    waggoner41
    Member

    [quote=”bogino”]If an individual [b]ONLY[/b] has CAJA insurance and lives in the San Jose area and needs to go to the hospital whether it be on an Outpatient basis or involves being admitted is there a single “major” (what I mean by that is NOT a short-term Emergency Clinic with limited resources) hospital that they would go to? Let’s assume someone had a heart attack.

    My understanding is that hospitals such as CIMA or Clinical Biblica would not be options if you are reliant on CAJA since those are private hospitals.

    Am curious as to which specific hospitals are available to CAJA members. Thank You.[/quote]

    Here is a list along with the Wikipedia link where I obtained the information:
    [b][url=http://en.wikipedia.org/wiki/Costa_Rican_Department_of_Social_Security#San_Jos.C3.A9]Hospitals in San Jose[/url][b]
    http://en.wikipedia.org/wiki/Costa_Rican_Department_of_Social_Security#San_Jos.C3.A9
    San José
    • Hospital Nacional de Niños Carlos Sáenz Herrera, in the city centre
    • Hospital San Juan de Dios, in the city centre
    • Hospital Mexico, west of San José
    • Hospital Rafael Ángel Calderón Guardia, in El Carmen district
    • Hospital de la Mujer (Antigua Maternidad Adolfo Carit), in San Sebastián district
    • Clínica Doctor Carlos Durán Cartín, in Zapote District.
    • Clínica Doctor Ricardo Moreno Cañas
    • Clínica Marcial Fallas, in Desamparados canton
    • Clínica Doctor Solón Núñez
    • Hospital Dr. Fernando Escalante Pradilla, in Pérez Zeledón

    #201000
    costaricafinca
    Participant

    [b]Barbara Ann,[/b]not all private hospitals will give a 10% discount if you present your [i]Ciudadanos de Oro.[/i]

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