Sheryl

I have heard that there are actually 3 rate categories at that hospital: Thai rate, rate for resident expats, and tourist rate. But cashers may automatically apply tourist rate when they see a farang. So explain you are long term resident and show proof (e.g. retirement extension etc) and clearly ask for the resident expat rate. May need to see a supervisor for this. If possible have a Thai do the negotiating.

Moved to the wellness subforum.

Supplemental plans are far better than Advantage Plans, the latter limit your choice of doctors considerably and usually place roadblocks in treatment pathways (pre-approval to see a specialist, pre-approval for surgery etc...which may be denied). HOWEVER both Medicare Advantage and Medicare Supplement Plans require that you live in the specified coverage area at least 6 months per year. So really not an option for you. In addition, since the main point of a supplemental is to pay the deductibles and copays (or part of them), you are very unlikley to get your money's worth while living overseas even if you were otherwise eligible. I have Parts A & B but no supplemental or Advantage Plan. Recently had treatment that included specialized surgery in the US, my copays came to a total of about $2,200 out of a total bill of about $28,500. A good Medicare supplement would have cost me at least that, probably more, per year. One big advantage to Medicare is that, while there are copays in the absence of a supplemental insurance, the copay pertains only to the Medicare approved amount, which is always much less than the provider will otherwise charge. You can easily add a supplemental later if/when you start to live in the US at least half time.

About 50% of bladder tumors are malignant. If it is malignant, early diagnodis and treatment is important

Troll post removed

Arcoxia is already an NSAID so you would not take another NSAID on top of this. Can you explain what you mean by injection of KA 90? I am not familiar with any drug by that name. There are certainly other drugs that can be given for lower back pain (aside from NSAIDs) but several of the best options are only available in specialized spine clinics. If the pain persists and does nto respond to rest and the meds given, you really need an evaluation by a good spinal specialist, which would likely include an MRI, and need a trip to Bangkok. Best spine doctor in Thailand is https://www.bnhhospital.com/search-doctor/entry/4093/ Can save both time and money by getting MRI first here (there is a branch in Bang Na convenient if driving up from Pattaya, and also a branch near Silom) https://mrithailand.com Bring xray film on CD with you, though as Prof Wicharn has his own protocol for spine Xrays might still need to repeat films at BNH.

The OP has 2 threads open, one on his financial issues in the Insurance forum https://aseannow.com/topic/1373636-my-private-health-insurance-monthly-premium-cost-is-killing-me/page/8/#comments And this one asking for help with insomnia here in the health forum . To avoid confusion I suggest posting replies to each separately i.e. let's keep this thread in the health forum focused on insomnia.

You do nto mention your location, but for something this serious I would nto recommend other than Bangkok anyhow. Very highly recommend Prof. Charuspong https://www.bumrungrad.com/en/doctors/charuspong-dissaranan If cost is a constraint, he can also be seen at Ramathobodhi Hospital (government hospital). Can try calling their Premium Clinic to see if can see him there are otherwise hard to see him directly, you'd be seeing students under his supervision. Tel 0-2201-2211, little to no English spoken so have a Thai speaker do this. Another good option is Prof. Kamol https://www.bumrungrad.com/en/doctors/kamol-panumatrassamee who as @TonmaiYai noted, can also be seen at St Louis. https://www.saintlouis.or.th/doctor/assoc.prof.kamol-panumatrassamee/cf05e234-0a09-4466-b15e-949f6a61e4e9

Yes, I agree much to be said for PAE though its availability in Thailand is lso far imited. Siriraj does it.

I advise: 1. Getting second, or even third, opinion before considering surgery 2. If surgery is indeed necessary, have it done in Bangkok, not Pattaya. You can still recover in Pattaya, but don't do the surgery there. I highly recommend this doctor https://www.bch.in.th/find-doctor/72 Best colorectal surgeon in Thailand and also a very nice person. He is also at Bumrungrad but everything will cost more there. BCH (Bangkok Christian) is nonprofit hospital.

Reliable international insurers, such as the OP has, most definitely do pay claims at age 78 and well beyond. Age is irrelevant to payment of claims. (It is, however, very relevant tio premiums, which go up with age precisely because the insurer anticipates having to pay more for claims as you age). A newly issued policy to someone over 70 will often have exclusions for age related considerations but no a policy already held for a long time. OP has held his policy for 20 years, so not an issue for him.

If my math is correct, the 2000 pound deductible will pay for itself if you average less than 1 claim each 4 years. Seems worth it, the higher deductibles, at your age, not. And the 10% savings by paying annually is also surely worth it. Looks to me like you'd save at least 3K a month with those 2 measures, which, if you have been living on just 11K a month, would surely be a help. I would also definitely change to extension on grounds of retirement, freeing up another 400 k. in savings. You seem to be thinking that you must either keep paying the premiums out of your monthly income, or pay it entirely from your savings, but surely the most sensible course would be a mixture of both. Figure out what you can reasonably live on, put the rest aside towards your annual insurance premium and make up the difference out of savings. If for example you can live on an average of 20k a month, then put 10k aside each month for 120k annually, and take the rest (about another 60k if my math is right) from your savings each year, which at that point will be 2.4 million (400k saved by doing marriage rather than retirement extension). 60k a year from your savings will last a good while, even keeping in mind the need not to dip below 400k for visa purposes, have another 86k or so set aside for your deductible and then some safety margin. Pick a minimum savings amount number that you are comfortable with , say 1 million, as the point at which to seriously rethink things. That will still be about more than 15 years hence. You may not even be alive then (aged 90 !), if you are, odds are that you will have had reason to be glad of the insurance in the interval and that will alter your thinking on this enormously. You are putting too much stock on past experience rather than what not only may, but almost surely does, lie ahead. Your state of health up to age 75, and your state of health from 75 onward, very, very different matters even in best case scenario. The other option of course is to spend the full 30k each month, drop the insurance, and live knowing your savings (even the amount needed for visa purposes) could be wiped out at any time. Some people do exactly that, just assuming it just won't happen or deciding nto to worry until it does. But someone who is fretting as much as you are now over this, doesn't seem like that sort of person. The other thing to consider is how you will feel about having to use only government hospitals for anything not very minor, with the 6 AM queueing, long waits, red tape, crowds, care provided by medical students/interns etc. etc. Bothers some people more than others. Makes a difference to outcomes more in some situations than others. For me personally, the assurrance of being able to get the best available care, provided by experienced specialists of my choosing, and not having to worry about money when already stressed with a major illness or accident, is worth quite lot. I have had the experience of being at least as healthy as you are only to have a sudden major accident (unpreventable by me) leading to over 600k in hospital bills. And then to develop spinal problems (age related so actually long in the making but I had no idea, you don't until it reaches a certain tipping point and then the pain suddenly strikes) -- another close to 1 million in bills (2 separate surgeries - fully successful, I'm now fully active and pain free) etc. So I know firsthand that "past performance is not an indication of future returns". And I have had a close friend who suddenly needed major cardiac surgery, the wait list at government hospitals was 6 months and he would nto have lived that long. 1.4 million bill at private hospital (with ultimately excellent outcome). He, too, had "never been sick". It happens and the older you are, the more likely it is to happen. And in my years on this board, I have also seen a lot of foreigners having to repatriate because medical bills wiped out their savings. Not a good scenario.

it may cover to age 90 but I doubt it can be newly issued at OP's age of 75.

Off-topic and/or unhelpful posts have been removed. OP has made a serious request for advice. Yes of course, resolving his financial issues needs to happen, but being sleep deprived is not going to facilitate that. @Canoodler see these other threads https://aseannow.com/topic/1324514-top-5-cannabis-strains-for-sleep-disorders/ https://aseannow.com/topic/1308536-i-need-some-thing-to-help-me-sleep/ https://aseannow.com/topic/1365538-trouble-sleeping-solutions/ If you decide to go with a cannabis product, be a bit careful as law seems to be changing (I am not clear in current status). Getting from a clinic may be best.

probably not at as much less cost as you think, unless you were able to get to a tertiary level government hospital which would likely have necessitated travel to Bangkok. Titanium plates and screws are very expensive, even at government hospitals. As a point of reference, a household employee of mine covered by the migrant health care scheme (essentially same coverage as Thais under the universal scheme except they pay a modest annual premium for it) had spinal surgery at a government hospital. The doctor fees, OR charge, labs, meds, room etc were all free, covered under the scheme as were ordinary supplies but we did have to pay for the titanum plates and screws: 160K baht...and this was more than 12 years ago and may have been lower grade plates & screws than a private hospital would use. 300K under the circumstances is not at all high for complex ortho surgery with instrumentation at a private hospital, and it would have been close to 200K all in even at a government hospital since the bulk of the cost will have been the plates and screws. Which is not to say that there were not errors/inefficiencies in the billing process, obviously there were. This is very, very often the case. Not because of some organized plot to extort money from you, but rather due to either ineptitude or laziness or both on the part of low level staff. BTW there are alternatives to being "meek and accepting wrongdoing vs. "biting back". The former is obviously unwise unless there is very little to lose, but the latter is highly inappropriate in Thai culture and will often make matters much worse for you ... sometimes very dangerously so. Polite, patient persistence is the way to go here. Firm but cool and civil, never nasty or hostile. Bringing in a Thai friend or relative as mediator will also often help.

They too are probably titanium but you should confirm this, important for future reference. If you do nto want to ask, just get all your medical records from the hospital where the surgery was done, it will be in the operative notes somewhere.

Some flaming posts have been removed and other posts have been edited to remove flames. Please keep it civil.

Cigna Global has an excellent record for paying claims. OP, forgot to mention that there is an alternative Cigna Global policy called Close Care with loeer premiums than their standard policies (assuming that's what you have). I do not know if you can roll over from one policy type to another -- should discuss with a broker specializing in expat polivies. At your age changing insurers is not a good idea. What you describe of your finances does not sound very suitable for self insuring. You would be abandoning your policy at the time of lifr you are most likely to need it/ make use of it.

Usually titanium (no problem for MRI) but should ask to be sure.

With Cigna, you can lower premium by accepting a deductible (excess) and/or copay option. Of course, need to be sure you have enough savings to cover these out of pocket amounts. I believe there is also a saving if you pay annually instead of monthly. These measures will help, but it will still be a significant expense. My own health insurance (age 72) is my single largest exoenditure. Premiums rise sharply as you reach older ages but so does the likelihood of a major claim. How healthy you've been until now/whether you've had past claims, isn't what matters. It is what may lie ahead and at 75, very high odds of needing things like cataract surgery, prostate surgery, joint replacements. Abd much increased risk of heart disease, stroke, cancer.

For what its worth.... While recently in the US, I bought soem genuine N95 masks (I had confirmed COVID and was concerned about infecting v ery elderly relatives). Found it so stifling as to be impossible to wear. I git dizzy just trying. Had to revert to ordinary masks and basic ventilation and distancing.

Doesn't work that wsy. Will still need something in writing from the referring hospital.

Wegovy costs about half as much.

Off topic bickering posts removed

https://aseannow.com/topic/1338388-anyone-taking-mounjaro/