BPJS coverage

Shadrach

Hello everyone, I have not been visiting the forum for a while now. I had a moderate heart attack! They put in a stint to open an artery that was 80% closed. It worked great and now I feel fine. I am staying at Sada Jiwa Health Clinic near Mengwi. It is a nice place. Quiet and peaceful. The staff are all young and don't speak English so that makes it difficult to communicate. Luckily we have Google translate. I have been here for a little over a month now and making a patio garden with lots of Vegetables. I am using large pots, and digging out ugly decorative plants to plant food. I just got an Indonesian bank account and health insurance with BPJS. Which I pay 150,000 RP. A month which I'm told is the top bracket. I don't have a clue what that will cover. That is where all of you with experience with this can tell me what is covered. Does it pay for my medication? Does it pay for this clinic? It is a high cost of rent here, so I can't imagine they would pay for all of it. If I had to go to a hospital can I get a single room? Does it pay for Doctor visits? i don't have a clue, so if you can please help me out with information about this I would appreciate it. Thanks, Shadrach

Markit

I'm sorry (glad really) but I don't know what it all pays for from experience. It does pay for your doctor cover and a certain number of medicines - I've been prescribed a series of pills to take 2 a day for a month and given from the clinic only enough for the first week with the understanding that I will have to pay for the rest. That isn't as onerous as it sounds as the meds here are cheap as chips or even cheaper. With the 150k/month you are paying that is the highest range called VIP so presume you'll get a nice private room with balcony and swimming pool (joking). The locals all spend the day and night looking after their family members that are being treated in hospital and when I mentioned that's what the nurses are for they always give me that pitying look we all know, so I'll be interested to hear how your care works out. Good luck

Shadrach

Markit wrote I'm sorry (glad really) but I don't know what it all pays for from experience. It does pay for your doctor cover and a certain number of medicines - I've been prescribed a series of pills to take 2 a day for a month and given from the clinic only enough for the first week with the understanding that I will have to pay for the rest. That isn't as onerous as it sounds as the meds here are cheap as chips or even cheaper. With the 150k/month you are paying that is the highest range called VIP so presume you'll get a nice private room with balcony and swimming pool (joking). The locals all spend the day and night looking after their family members that are being treated in hospital and when I mentioned that's what the nurses are for they always give me that pitying look we all know, so I'll be interested to hear how your care works

Markit wrote Good luck

.Thanks for responding Markit! Yes I am curious also as to what they will cover. The Klinik asked me yesterday if I payed for the insurance and I said yes, so I guess they want to use it. They have me on 12 pills a day. One of which is Albumin. I take 6 of those a day. After the first month and another blood test they said I should take more Albumin. It is RP.600,000 for that. That's not cheap. I am curious as to what the insurance will pay for. I will let you know.

pantaiema

This is what is covered by BPJS. https://www.cnbcindonesia.com/news/20230819121655-4-464297/daftar-terbaru-operasi-yang-ditanggung-bpjs-kesehatan (use google translate). Typically include all of Major operations. But In order to obtain BPJS coverage for surgery, major operation, patients must seek treatment at a first-level health facility (faskes), such as a community health centre or clinic that has been approved by BPJS Health. https://www.kompas.com/tren/read/2023/08/16/120000565/apakah-ada-obat-obatan-yang-tidak-ditanggung-bpjs-kesehatan- It also cover some medication on the provided list. You will need to enquiry about this. I have not looked at it but presumably a person could not get erectile dysfunction (ED) such as Sildenafil, or PrEP (Pre-Exposure Prophylaxis) for free. :cool::cool:

harryopal1

I thought I posted yesterday but don't see it. Dennis, this has not been a great year for you what with the leg injury and now this. How long are you likely to stay in hospital? At least it seems you have mobility. I had a son aged 57 visit in October. He went home and a few days later had a heart attack. Not massive but it required a stent. He was out of hospital the following day. The trend these days is with public hospitals to get them out of the place as soon as possible. I guess private hospitals have an incentive to extend the stay. I recall you saying you were expecting a family visit from the US. Did that happen. When enquiring about BPJS you might ask if they cover a full body transplant. ![](https://balipod.com/uploads/attachments/3966-e9d98b816c9aa5e3e659035eed836be9.png

Shadrach

harryopal1 wrote I thought I posted yesterday but don't see it. Dennis, this has not been a great year for you what with the leg injury and now this. How long are you likely to stay in hospital? At least it seems you have mobility. I had a son aged 57 visit in October. He went home and a few days later had a heart attack. Not massive but it required a stent. He was out of hospital the following day. The trend these days is with public hospitals to get them out of the place as soon as possible. I guess private hospitals have an incentive to extend the stay. I recall you saying you were expecting a family visit from the US. Did that happen. When enquiring about BPJS you might ask if they cover a full body transplant. [ATTACH type="full" alt="1703124479299.png"]3966[/ATTACH]

Yes the kids came and went. They helped me set up a bank account with Mandiri and get set up with BPJS, and move to Klinik Sada Jiwa near Mengwi. The stent worked great. As for the heart I feel great. Now I have to get my legs strong again to handle all these damn stairs in Bali. Obviously there is no code here as for the distance between steps. Some of them are quite high. I just got my monthly bill for Klinik Sada Jiwa and was floored with the price. IDR. 19,500,000 for what I get here that is really high! It's nice and quiet and the room is adequate but the cooking is below par. The staff are all very young and don't speak English. Sometimes we have to pull out Google translate. I like that idea of a new body transplant. At this price I have to get really strong again and move out when I can. I have had enough of living with just the locals. When I move I am thinking of looking for a place near Ubud. I know it's crowded and crazy traffic, but there are good supermarkets and Cafes to have a chance to talk in English. Nothing is set in stone so I will see what comes. Thanks for your concern, Dennis

Markit

Shadrach wrote Yes the kids came and went. They helped me set up a bank account with Mandiri and get set up with BPJS, and move to Klinik Sada Jiwa near Mengwi. The stent worked great. As for the heart I feel great. Now I have to get my legs strong again to handle all these damn stairs in Bali. Obviously there is no code here as for the distance between steps. Some of them are quite high. I just got my monthly bill for Klinik Sada Jiwa and was floored with the price. IDR. 19,500,000 for what I get here that is really high! It's nice and quiet and the room is adequate but the cooking is below par. The staff are all very young and don't speak English. Sometimes we have to pull out Google translate. I like that idea of a new body transplant. At this price I have to get really strong again and move out when I can. I have had enough of living with just the locals. When I move I am thinking of looking for a place near Ubud. I know it's crowded and crazy traffic, but there are good supermarkets and Cafes to have a chance to talk in English. Nothing is set in stone so I will see what comes. Thanks for your concern, Dennis

I'm struggling to understand how you got such a high bill from BPJS? Or was that before?

Shadrach1

No Markit,

Markit wrote I'm struggling to understand how you got such a high bill from BPJS? Or was that before?

BPJS didn't charge me that. It is the price of the clinic I am staying after the hospital. I just wrote about going fo a check up with the Doctor and he prescribed 3 medications, and BPJS would only pay for one. It seems they find an excuse to not pay for all. They did pay to see the Doctor and one medication. The Doctor said the Medications were free! Well he was not accurate. I notice a huge lack of communication between the staff, BPJS, and Doctors. About getting the right procedures done.

Markit

Shadrach1 wrote No Markit, BPJS didn't charge me that. It is the price of the clinic I am staying after the hospital. I just wrote about going fo a check up with the Doctor and he prescribed 3 medications, and BPJS would only pay for one. It seems they find an excuse to not pay for all. They did pay to see the Doctor and one medication. The Doctor said the Medications were free! Well he was not accurate. I notice a huge lack of communication between the staff, BPJS, and Doctors. About getting the right procedures done.

I was also charged for a part of my meds - got a prescription for 3 days (free) but if I wanted any more after that I had to get them privately and pay. Wasn't much.

Shadrach1

Markit wrote I was also charged for a part of my meds - got a prescription for 3 days (free) but if I wanted any more after that I had to get them privately and pay. Wasn't much.

Thanks for your comment, yes some meds are cheap, but one of the ones I was supposed to get cost almost 1 juta. For 30 pills! That is not cheap to me. Obviously BPJS is a joke and I was the fool to think they would actually give a damn! I should have got international insurance from the States before I left, but at my age they want around $500 a month, and I only get &1000 a month for pension. That was five years ago when I left so just do the math and you'll see it would have been a fortune I would have paid before I needed it. I admit I don't like this and feel like I'm getting screwed. That is the price we pay to live in this rat race! I'm sure some will comment and give a negative response, but that's to be expected when a person puts themselves out there on social media. They all want you to say everyday is coming up roses, and if you say you are having a hard time, they don't want to hear it.

Foamcrest

Markit I think you might have misread or perhaps not fully comprehended what Shadrach was saying. The insurance in the States was $500 a month but he only gets $1000 a month pension so it was impractical to take it out. That was 5 years ago and “ if you do the math you’ll see it would be a fortune”. I could be wrong but I think he meant he’s better off now, even though he paying through the nose for his pills, than had he paid the insurance premiums all these years. Just my take.

harryopal1

My impression is that Ubud, Canggu are overwhelmed with digital nomads, Russians and trendies so that getting around is not so easy. I don't live at Sanur but again, the impression I have is that it might be easier to take a room in a multi room villa which has amenities including a pool and the area is mostly flat. Perhaps others more familiar with Sanur can give you some advice. Good luck.

Foamcrest

Shadrach1 your choice of the Ubud area in my humble opinion is an excellent one. We own a villa just outside in a village called Penestanan. Ubud is insanely busy however some of the surrounding villages are quiet and in some areas relatively inexpensive. There is a small self contained flat nearby to us which is leased on a permanent basis for $85.00 a week. I’m sure if you sniff around and speak to the locals you’ll find a suitable flat. Good luck and good health.

Shadrach1

Markit wrote You do realize you are paying the equivalent of $10 a month for your PBJS insurance?

Yes I realize that so what's your point?

Foamcrest

$10 a month is a bargain surely? Admittedly I’m in Sydney but I think I pay something like $180 a month. I realise you can get covered for far less than that but I wanted all the bells and whistles including no gap when you go to hospital. So Markit why question $10 a month in Bali? What do you pay?

Shadrach1

Foamcrest wrote $10 a month is a bargain surely? Admittedly I’m in Sydney but I think I pay something like $180 a month. I realise you can get covered for far less than that but I wanted all the bells and whistles including no gap when you go to hospital. So Markit why question $10 a month in Bali? What do you pay?

Yes $10 a month is a good deal for foreigners but a lot for locals. If you can get Australian insurance for &180 a month that is a good deal also if it covers you when you are out of the country. As I told you before if I wanted international coverage it would have been around $500 a month more or less. Remember BPJS doesn't cover all medications.

Shadrach1

Markit, my Raggedy old ass doesn't want to go back to the States! Health problems can come wherever you are. I find it's about the same wherever you live in Bali. I had a nice cheap room in Padangbai that suited my needs. I had friends with a warung that spoke good English and a few westerners would stop by there, so my experience there was not so bad. You have to admit the roads are crowded now with so many people. Where I am now the roads are packed with Indonesians, not tourists. At least that's what I observed with my tiny mind as you say,

Foamcrest

Shadrach my health insurance only covers me while I am in Australia. I have to take separate travel insurance which up until I turned 78 was relatively easy. I would just pay a portion of my travel costs on my credit card, say $250, and that was that. Now because of my age it’s going to be much harder. Anyway we’ll find a way.

Markit

Shadrach1 wrote Thanks for your comment, yes some meds are cheap, but one of the ones I was supposed to get cost almost 1 juta.[COLOR=rgb(184, 49, 47)] Sounds like you've been given the "special" meds - I always make sure to ask for the "generic" version of any meds I get prescribed. [/COLOR] For 30 pills! That is not cheap to me. Obviously BPJS is a joke and I was the fool to think they would actually give a damn![COLOR=rgb(184, 49, 47)] I was covered by Kaiser Permanante in California through my employer, NHS in Britain, Technica Krankenkasse in Germany and friend I have to tell you none of them care a shit for us, they're just doing their job the best they can. If you want someone to care for you - get a dog. [/COLOR] I should have got international insurance from the States before I left, but at my age they want around $500 a month, and I only get &1000 a month for pension. That was five years ago when I left so just do the math and you'll see it would have been a fortune I would have paid before I needed it. I admit I don't like this and feel like I'm getting screwed. That is the price we pay to live in this rat race! I'm sure some will comment and give a negative response, but that's to be expected when a person puts themselves out there on social media. They all want you to say everyday is coming up roses, and if you say you are having a hard time, they don't want to hear it.

You whinge about paying less than $100 for some meds here but in the same breath regret not paying $500/month for years for some insurane coverage that would prob have an excess over $1000. I'm going way out on a limb and guessing your meds are mood altering?

Shadrach1

Foamcrest wrote Markit I think you might have misread or perhaps not fully comprehended what Shadrach was saying. The insurance in the States was $500 a month but he only gets $1000 a month pension so it was impractical to take it out. That was 5 years ago and “ if you do the math you’ll see it would be a fortune”. I could be wrong but I think he meant he’s better off now, even though he paying through the nose for his pills, than had he paid the insurance premiums all these years. Just my take.

Yes Foamcrest you are absolutely right. I did the math and if I took out the travelers insurance four years ago, I would have payed $24,000! At the moment I am staying at a clinic near Mengwi that provides assistance while I recover from surgery. It's a nice place except the rent is way over my budget. RP. 19,500,000 a month! When I feel strong enough I want to find a cheaper adequate place near Ubud. I thought getting the insurance from BPJS would cover my medical needs but they only help so far. I am thankful for any help I can get. Sorry but I cannot say everyday is sunny with bluebirds singing that most people want to hear.