My Long Anticipated Confusing Premier Visit to a Caja Doctor in Costa Rica

We've been paying into Costa Rica's Seguro Social system aka Caja (KA-HAH) for at least 8 years now. It's Costa Rica's version of universal health care, cemented into the government and culture since the 1949 revolution. You want residency here? Then you are going to have to pay into Caja and keep it current or you won't get your residency renewed.

It has a lot of nice features, such as low-cost, free everything without co-pays or deductibles and the price is worth it even if you only use the emergency care. It's the best emergency care we have in San Isidro despite a few private urgent care clinics around.





However, it comes with costs besides the premiums (ours is about $80/month for the family, thanks for asking). You need patience and a lot of time on your hands and it doesn't hurt if you have someone on the inside to help navigate the maze. I've already outlined one failed attempt to use the system several years ago, but here I'm going to hit the highlights of my own personal, successful use of it to get treatment for my hypertension.

Phase I - Getting a Caja Appointment and Interim Meds

This mini-saga began in January 2018. This episode was an apropos setup for the entire Caja story (which isn't yet finished). It began by visiting our private family doctor (who also knows the Caja system inside and out having been one of the rotating directors for the local hospital) and a brief exam to verify my high blood pressure.

He then called a friend who runs the night shift at the hospital pharmacy to get me a one month's supply of the medicine I'd been taking up to that point that was helping but later turned out to not be effective enough.

He also wrote an order for an appointment with the Caja cardiology department, which I accomplished first with relatively little pain since the line was uncommonly short. They gave me a receipt with "Feb" in big letters and I was (naively) pleased that it was only a month away.

The next day I met the night shift guy at 6 AM in the emergency room and he accompanied me to the back door of the hospital pharmacy and told me to wait outside. Ten minutes later he returned, without the meds, but with a question about why there was no case file number on the prescription. I explained how I'd gotten the order and mentioned that I had an appointment in February, to which he asked with surprise, "This year?"

He went back and got me a month's supply of the drug and I went home and checked the appt. receipt and, sure enough, it was for Feb 2019.


Phase II - The Cardiology Appointment

Phase I seems like yesterday now, but at that time I really wondered if I'd remember my appointment 13 months later. I did. I went today about 20 minutes early. I knew there would be puzzles to solve, though I didn't know what they would be, so I gave myself extra time.

The first puzzle was to figure out why the consulting room doors in cardiology were closed. Was the department open? Should I just wait and see if someone comes out and calls my name? I had verified I still had an appointment on their new online system, which confirmed that I did.

There was a kiosk/window with a short line in front of rows of chairs, but no identifying sign except "GastroenterologĂ­a" on the side door. Yet, it was all that was available, so I stood there hoping to find someone with an answer. 

It was a short wait since a passing clerk offered to look at my paperwork and said indeed this was the right line and she went in to "process" it. After she handed back my papers, I selected a seat but in moments was called into one of the three consulting rooms.

After a few minutes a doctor showed up. I'll give him the benefit of the doubt and say he was having a bad day, but he seemed surprisingly annoyed at me even being there. He asked if I had an electrocardiogram, an echocardiogram and a blood test. Of course I didn't as this was my very first visit to address the issue.

The lowest point was when he nearly thumped his chest basically saying "Soy especialista" (I'm a specialist) and I don't have time for this stuff. He brusquely brushed off a few other questions I had but he did wrestle his computer and Caja software into giving out prescriptions for a better drug, an order for lab work and three more appointments.

I'll sum up what I thought of his attitude with this gif clip of Danny DeVito in Matilda:




Yeah, just like that. Seriously, he was very unprofessional in this interaction not to mention Un-Tico-like as well.


Phase III - To Be Continued ... Into Next Year!

The assisting nurse pulled out and sorted six pages of documents from the printer and I got a brief explanation of what they were: Three one-month prescriptions of the same (presumably better) drug, a blood test order and appointments for the ECG, the echo and the follow-up.


I took those to the little window again, which generated more shuffling, typing, mousing and waiting. They returned to me the appointments. The first was in early December for the ECG. Fortunately, this year! It's followed just four days later by the echo and finally the follow-up consultation in January of 2020.


I was at least thankful that they could issue the appointments on the spot so that I didn't have to stand in the general appointments line again, which today was SRO.


I actually had a few more questions, such as why if my first appointment is 10 months away I only got prescriptions to cover three months, but I held onto those as I was about to consult with a real expert when I got home, namely our Tica neighbor who was watching over my invalid mother-in-law while we made our journey to town.


It's Not All Bad News, They Are Improving ...

She explained that I didn't have to wait in the god-awful pharmacy line at the hospital to get the prescriptions filled. They can now be filled at our local EBAIS clinic 5 days a week (I'd picked up a week's worth at a private pharmacy before we returned so I'd have a buffer though) and they could be renewed up to my appointment times by an EBAIS doctor. So, why three and not one prescription sheet? Neither of us know the answer to that.

Picking up prescriptions at EBAIS is a relatively new and welcome feature as is a new online appointment system that didn't exist when I made my first appointment. There is also no more renewing the special Caja ID card (called a carnet), since they now tie your Caja record to your residency cedula (ID card). We also enjoy a brand spanking new emergency wing at the hospital, so progress is being made and there haven't (yet) been any huge premium increases.

So, really I'm not complaining, just noting some of the surprises, twists and turns. I'm hopeful the new medicine (free!) is going to be effective without uncomfortable side effects. In the meantime, it's buckle up and wait, wait, wait.

Hopefully, someday, this will be a thing of the past

 

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