You can check out other companies providing such services by
Googling on "medical evacuation". Some of these companies
also provide medical insurance for persons traveling abroad,
and there are some companies based in Europe and elsewhere.
Acquiring permanent residency is not a
prerequisite for acceptance into a local health insurance
plan in brazil. if you find yourself spending about half
your time in brazil, you may want to consider a local plan
as a complement to your home-country plan, especially if it
does not cover overseas emergencies or hospital stays, with
the added benefit that any routine visits, which would
definitely not be covered in your home plan, to medical
doctors, first-aid posts, and specialists are covered. if
you find yourself spending MORE than half of your time in
brazil, in this case probably but not necessarily as a
permanent resident, you may want to consider the more
radical step of complete substitution of yr home plan for a
local plan, supplemented by an overseas option in the local
plan covering overseas emergencies and hospital stays,
covering you for visits back to your home country or any
third country for vacation stays.
Individual health plans in brazil
are generally less expensive than in the U.S. and are
closely regulated by the ANS (associacao nacional de saude).
unlike in the u.s. where insurance companies will rarely if
ever share with you the "faixa etaria," or a grid
demonsrating the cost of care based upon your age, in brazil
you will know the faixas etarias for all of the insurance
companies when you shop around, usually but not necessarily
through a corretor or broker. of course, these grids change
all the time but cannot change once you are accepted into a
plan. the only subsequent cost increases to yr plan are your
falling into a new age bucket and the annual adjustments by
an inflation index approved by the ANS. in rio the choice of
health carriers for an individual plan is limited. the
market is mainly oriented, just like in the u.s., to
corporate plans. however, there are two established carriers
that stand out for individual plans: amil (assistancia
medica internacional limitada) AMIL - www.amil.com.br
and Unimed, a cooperative of medical practioners,
www.unimed.com.br. they both offer options for "urgencias
em viagens ao exterior" and you can tailor your plan - and
the cost- as to whether you want routine coverage confined
to certain large metropolitan areas in brazil, for example,
with urgent care everywhere else; or routine coverage
be sure to evaluate the private
hospital network that is included in your plan, because each
carrier and each plan within each carrier permits covered
visits to only certain private hospitals. for example,
certain plans of amil and unimed may cover visits to the
copad'or hospital, referred to in this forum, for first aid,
emergency, and long-term stays (internacoes), as well as the
samaritano. copad'or, located in copacabana (along with the
samaritano, in botafogo) is generally considered the best
hospital in rio. several banks, such as bradesco, unibanco,
and itau, offer health plans as well. you obviously need to
consider the medical practitioner and specialist network of
your potential carrier. once you have been referred to a
doctor from a friend, your consulate, or another doctor, be
sure to ask in which plans he participates. often they will
participate in a variety of plans. just like in the u.s.,
there are plans in brazil that will allow you to choose "out
of network," but these are very expensive, with generally
low reimbursement rates.
This is how
Brazilian health plans work! Many readers who spend
extensive time in Brazil (or want to do so) will find this
very interesting! (My boyfriend has Unimed, with the
overseas care option, and it's network of doctors and
hospitals is extensive.) If anyone opts for a Brazilian
health plan, be sure to look over the various levels of
coverage carefully to be sure nothing that is of interest to
you is excluded. There are independent insurance brokers in
Rio who can go over your needs and all the plans and help
you select the one that's right for you.
For U.S. readers, Blue Cross/Blue Shield, which I have, will
cover you fully outside the U.S., even for routine care.
Members of Kaiser Permanente (which I had when I lived in
California) are similarly covered. Both are largely on a
reimbursable basis, so you'll have to pay for your care in
Brazil and then submit a reimbursement request to the
insurer. Blue Cross, though, does have agreements with some
Brazilian hospitals and doctors to pay them directly. My
understanding is that they have such an agreement with the
Copa d'Or hospital, so if you're covered by Blue Cross and
need care there, follow the instructions in your membership
materials to call BC and have them arrange payment. That way
you don't have to pay the hospital yourself, except for any
required co-payments under your plan.
Worldwide coverage may be limited or non-existent under many
other U.S. insurance policies or HMO plans, so check yours
carefully. If it doesn't provide coverage, a Brazilian plan
is a good alternative, coupled with a medical evacuation
policy to be sure you can be treated in the U.S. if that's
what you prefer in an emergency. Brazil has very good
doctors and private medical facilities, but there is always
the problem of language for many (perhaps most) foreigners,
so you need to think carefully about what you would want to
do in case you needed extensive surgery or care while you
were living or on an extended stay in Brazil. As you can
see, though, there are many ways to ensure that you're not
"on your own" when you need health care in Brazil.
The good and the bad
One part of the whole Brazil
experience have been my fears concerning the level of the
health care system. Really, who knows anyone who has
actually had a major health issue/crisis in Rio de Janeiro
or Sao Paulo? And what were the results? And by this, I am
not referring to nips and tucks, or a little injection of
the juice. And definitely not thinking along the lines of
dental surgery. I am talking surgery, IV's, in-patient
hospital stuff, round-the- clock nursing care, etc.
As I live out on the island, the local hospital is run by
the Prefeitura and my friends have always told me what a
good place it is to receive care. In fact, with a population
of only around 3500, our hospital has a registration base of
over 10,000. This is due to the fact that residents from
various cities around the northern end of Guanabara Bay such
as Maua, Sao Goncalo and Itaoca come over to Paqueta by boat
for a supposed, better level of health care and more
plentiful prescription drugs!
For major surgery, everyone heads to a hospital in Rio. So
until this trip, I always felt fairly safe. Luckily, before
this departure, called up the health care agent and found
that I had fairly good coverage at any private hospital.
Anyway, I came down with a high fever and a very large tumor/inflamation
on my upper arm. Think avocado/mango size! After a couple of
days, went to the hospital and received a script for
amoxicillin and rest. This was all new for me. In the US of
A we are taught to listen to the docs and be good little
girls and boys. So after two days, went back to the hospital
as instructed for a second visit and was admitted to the
hospital with a staph infection and heard the two physicians
talking about an ex-president of Brasil, Tancredo Neves, who
died of septic shock brought on by a staph infection. Scary
Went on an IV drip, antibiotics every four hours, and
thought (ha,ha...THOUGHT!!!) I was getting good care. After
a day of this I started to have some doubts when I saw the
IV start dripping (one of my favorite words in Portuguese by
the way is "pingando or dripping", but just not in this
context) slower and slower. And I wasn't feeling a whole lot
better. And they were not very good about taking BP,
temperature, etc on a regular basis.
I had a sneaking suspicion that the hospital was trying to
save a few Reais on the necessary amount of medication for
my treatment, or even worse, that they did not have the
correct types of medication. Very scary!!! For some reason,
I decided to check myself out and go the the ER of a private
hospital. But which one? Copa D'Or, Barra D'Or or elsewhere?
A friend in the US looked on an expatriate site and found
Hospital Adventista Silvestre above Cosme Velho. Hey! Right
near Christo Redentor. God's son. What could be better?
I think I made a good choice. Although not a doctor, the
care was similar to what I have received in the US. BP,
pulse and temp every two hours. My doctor normally visited
me twice a day. My wound post surgery was checked every two
hours. It turns out that the public hospital was treating me
with the incorrect meds. At Silvestre, the treated me with
the exact meds and dosages that my US surgeon would have
recommended and also what the internet also recommends. IV's
injected every 4 hours. Oral every 4 as well.
And I had a daily visit from the hospital's nutritionist
every day to see how they could tailor the menu to my likes
and dislikes. Very nice to get fresh squeezed juices
throught they day. And they make an incredible carrot soup.
But certainly not a good enough reason to check into the
hospital. And my private room was really nice with air
conditioning, TV and frigo bar. Super large, clean and
quiet. Modern bathroom. And they have a twenty_four hour
medical center in Botafogo on dezenove de fevereiro just a
couple of blocks from the Metro stop.
After a week in the hospital I continued with two weekly
visits to my doctor and then came back to the states to find
that the private care was up to the US standards back home.
This made me feel good!
I am now off the heavy doses of antibiotics. My wound is
almost healed. The fatigue is almost gone. And unfortunately
now that I am feeling up to it...unable to enjoy this year's
Carnaval. Going to a churrascaria back here in the states
while wearing my Vasco jersey and speaking Portuguese to the
waiters does not quite cut it. Oh well.
My friends came through with help taking care of my dog.
Phone calls and visits. Escort and company to the doctor’s
office on Botafogo.
...and the adventures continue.
It kind of depends on your HOME health
insurance and their rules concerning how far in advance you
can purchase medication. My plan has a vacation rule where
you are able to purchase 60 days in advance. And then my
pharmacist, if my physician's prescription hasn't expired,
will issue the medication and charge my credit card, and
then every thirty days, put in to my insurer for payment and
at the same time credit my card less the co-pay difference.
Brazil has many of the generic matches to the US or
Europeans meds. And at much better prices. The price for
Brazilian Lipitor is less than my US co-pay for example.
Same for Digoxin. Until the new drug law for Medicare in the
US, I bought a number of drugsin RJ and brought them back
for my Mom. No script needed. But no possibility of buying
sleeping pills/narcotics such as Ambien, diazepam/flurazapam
without an MD's script, as far as I have experienced. No
reimbursement by my health insurance, except when in the
I find the number of farmacias in Rio quite fascinating.
In Centro, just east of Rio Branco on Sete de Setembro there
are three Pacheco's in one block. Two of them side by side.
I was told that they are franchises. This explains the
location. A friend's son, who works as a pharmacist in Rio,
related that they work on salary plus commission, so a
larger purchase, after some bargaining, will net you a
bigger discount, and then also questioning about a payment
in cash, will add on another discount. Also, every pharmacy
has their own price lists. Also, each company's computers do
not update with price increases on the same day, so for a
larger purchase, it pays to go to two or three different
chains. After a recommendation from a friend, I have found
that Farmacia Nacoes normally has lower prices.
The lowest prices can be found at one of the government
pharmacies. A Brazilian friend with a friendly Brazilian
doctor who will write your script with a friend's name can
save you big bucks.
I was told that the charge from a government outlet for the
drugs is about ten percent of what is charge commercially.
There can be long lines at times, but from personal
experience, I have seen times when the lines are not bad,
and other times when they can be horrendous.
I have experienced both the best of
pivate and worst of public hospitals.
The private hospital hospital I stayed in is called
Adventista Hospital in Silvestre. Most everyone knows it.
For aftercare, they aslo have a 24 hour amubulatry clinici
in Botafogo. When I showed my charts back in the US to my
doctor she told me that the level of care was the exact same
thing that she oulf have done here. PRrocdures, exams,
tests, etc. And the price was much, much less. MY insurance
compnay picked up the entire bill as approved.
Less the deductible on my policy, of
Base fee was 300Reais/day for a
private room. No extra charges
for aspiriin, antibiotis, etc. Included.Ditto on toothrush
and toothpaste. The nutristionist visited everyday to see
how they cold tailor the menus to fix my dietary needs as
well as likes and dislikes. As it was Adventists, there was
limited staffing on Saturday, and no pork. Coffee was Sanka,
no caffeina inn the land of coffee.
Treamtment was really good. One of my
heart meds is not availbable in Brasil, but my interenist
checked her books and found somehing acceptable(oe so I
hoped) The claimed to NOT speak English. Included in my
bill were two after care visits at Botafogo amubulatory.
And they run buses up the hill frequently to the hospital in
Silvestere under Christ's open arms.
The evening before checking in, I was
unsure where to go, Copa d'Or. Or Adventista. The people at
Copa d'Or were not very nice on the phone. Adventista
very. I felt the care level wonderful. Abouth the only
major difference between Adventitsa and a US Hospital where
the location and number of times temperaturse were checked.
Blood pressure and pulse as well. I had the standadrd
admittance testing. Blood work, questionaire. meeting with
dietician, questions about visitation from someone of my
religious afiliation(the whole world is not adventist) a
nice room, frequent changes of bed linens, an array of
phlebotemists(both goof and bad)trying to find my veins,
When I returned to the US, my surgeon
looked at my records and agreed that the Brasilian level of
care would have been no different here in the US. Ditto
with my cardiologist as to the medication and care
When I went to my doctor's office,
English started to be spoken. I guess it was the old
Brasilian disease. They are all afraid that their accents
are not up to par. He English was wonderful. She was only
afraid of bad pronunciation.
NOW AS TO A
BRAZILIAN PUBLIC HOSPITAL:
I first spend two nights at a
prefeitura hospital and did not feel I was getting better. I
thought they were giving me the wrong drugs because I wasn't
feeling any better. I asked a friend visiting me to look on
the internet for the drug -regime being used. The
prefeitura (I assume due to the lack of funds) was using an
antibiotic that was no longer being used anywhere else put
the People's Recuplic of China. No where else. When I got
out, I looked it up my self. BEfore I checked myself out,
I asked to see my doctor, Waiting over two hours, by the
way. And there were very few patients at the hospital. No
x-ray machine, No MRI. No CAT. No blood testing equipment
for screening. Basic care with none of the diagnostics which
is now the norm. Just lots of open beds and meals of rice,
bean and a protein. Oy! And this hospital gets a lot of
people from off--island as the level of care there is better
than at other hospitals ringing the bay. Lack of supplies,
lack of diagnostic, lots of employees. must be the norm from
HOSPITAL RECOMMENDATIONS FOR THOSE IN RIO WITHOUGHT GOOD
Rio Bonito over in Niteroi is where a
friend goes and he swears by the place and/or Santa Casa
near Santos Dumont is where my Paulista has been when he
hurt his knee and needed surgery.
for non-emergeny care:
Very good is the Adventista
ambulatory clinic in Botafogo on Rua Dezenove de
Fevereiro, 140. And then if you needed admittance, they have
a bus service that circle back and forth up the hill to the
main hospital in Silvestre, at the feet of Christ the
Regferred experiences with the
emergency room at the Copa d'Or Hospital was very good.
Efficient, comfortable, clean, modern. It is located on
Rua Figueiredo de Magalhaes, past Avenida Tonelero, before
the Tunnel to Humaita.
I have seen the rooms are quite nice
since the hospital was a former hotel.
Those spending significant amounts of
time in Brazil may well want to consider a local plan,
depending on the degree of overseas coverage from their
plans back home.
In Rio, the two best providers for
individual plans are Amil and Unimed. Shop around for the
best plans on your own or with a broker. The most
important considerations aside from cost are which hospitals
are accepted in your plan, as well as the doctor network
naturally. A specifically good a plan which included
unrestricted and unlimited coverage is the Copa d'Or.
Nearly all plans in Brazil charge no
deductible, no co-payments, and have no yearly or lifetime
cap. Many on this board may be relieved to know that Aetna
tried and failed in Brazil to introduce the HMO concept and
have completely exited the country- Brazilians saw right
through that charade! - so no need for a primary care
provider to gatekeep specialist visits. Also, individual
plans, by law, can only increase annual premiums in two ways
- by a health inflation index; and by an age range table
that is fully disclosed upfront (increases once every five
years), so it is perfectly feasible for say an expatriate
retiree to budget medical costs.
I know some expat residents here that
have cancelled their home country coverage and instead pay
for a separate rider on their Brazil policy which would
cover emergency situations on trips outside of Brazil.