What hospitals are included in a major medical insurance network in Mexico?

The medical network of a major medical insurance policy in Mexico is the group of hospitals, clinics, and doctors that have an agreement with the insurer to provide services to policyholders. Going to a hospital and doctor within the network simplifies the process and allows for direct payment.

What types of hospitals are included in the network?

It depends on the plan you’ve purchased. Some insurers offer:

• Open or unrestricted network: Access to almost all private hospitals (more expensive).

• Mid-tier network: Includes quality hospitals but excludes the most exclusive ones.

• Restricted or economy network: Only includes hospitals with lower negotiated rates.

How can I check which hospitals are in the network?

• Visit your insurer’s official website.

• Check the hospital directory by city, specialty, or tier.

• Ask your insurance agent or broker directly.

• If in doubt, call the customer service center before going to the hospital.

Common mistakes to avoid

• Assuming all private hospitals are covered: The insurer may apply penalties for going to an out-of-network hospital. These can include a higher "coaseguro" (coinsurance) rate or denial of coverage.

• Not checking if your doctor is also in the network.

• Using an out-of-network hospital without having funds available to pay out-of-pocket.

Recommendations

• Using hospitals and doctors within the insurer’s network can offer benefits like lower coinsurance and deductible, and help you avoid differences in medical fees.

• Before purchasing your policy, ask which hospitals are included in the network you’re considering.

• Keep in mind that the names and tiers of networks may vary between insurers.

• Always review the network before any scheduled treatment.

Key Concepts

• "Pago Directo" (Direct Payment): A process where the insurance company issues a letter confirming it will pay hospital services and medical fees directly to the service providers. For direct payment to apply, both the hospital and the treating physician must belong to the insurer’s medical network.

• "Deducible" (Deductible): A fixed amount paid by the policyholder, as stated in the policy, which applies to the initial medical expenses for each covered illness or accident. After this amount is exceeded, the insurer begins to pay.

• "Coaseguro" (Coinsurance): A percentage or amount stated in the policy that the policyholder must cover after the deductible is applied, calculated over the total of covered medical expenses.

• "Tabulador de Honorarios Médicos" (Allowed Amount): A list of medical procedures and treatments, indicating the maximum amount the insurance company will pay for each covered illness or accident.

At Sáas, we have a team of consultants who can guide you through the process of contracting and using your policy.