Sheryl

ART is NOT free to non-Thais (though anyone covered under Thai Social Security can get it under that scheme). I have no idea what you mean by "the World programme", there is no program by that name AFAIK. Thailand produces much of its own ART and the Thai HIV treatment program is almost entirely financed by the Thai government.

I would add that, aside from trying to maximize revenue, sometimes the issue is just a staff person in the third party payment office of the hospital trying to avoid work. What happens is that the hospital has to submit detailed estimated costs to the insurer; once approved, the insurer issues a "Guarantee of Payment". It is quite common that the insurer does not accept the first version submitted by the hospital, and sometimes rather than going ahead and revising it for re-submission the hospital staff will try to get the patient to pay the difference. This can happen even when total cost is not the issue. For example, I had surgery last year, there was a package price which was fine but when the hospital submitted the estimated cost to the insurer they failed to break out the room charge adequately (my policy limits reimbursement for private rooms to equivalent of US $75, but for room only, excluding meals and nursing). Rather than just break it out so as to show the allowable amount for room and list meals, nursing etc separately - still within the same total cost -- they called me first to see if I would just pay for the room myself and this save them the work of having to revise the paperwork to the insurer. Easy question to answer: NO. I told them to sort it out with the insurer. Magically the problem went away and the insurer paid the cost in full. I have also heard many cases of hospitals trying to pressure people into paying first and getting reimbursed later, again just to save them the paperwork. (Ironically this pressure comes from staff hired specifically to submit insurance claims, i.e. their job would not exist if everyone did as they asked). Needless to say anyone how makes the mistake of agreeing to that, will then find it very difficult to interest the hospital in providing them with the needed documentation to get reimbursed.

There are a number of different chemo protocols that can be used but none that, to my knowledge, would require 2 night admission per infusion. The fact that they also want an admission just to place the chemo port is also an indication of trying to maximize revenue. Insurers are used to this sort of thing and can spot it a mile away. Just hold firm and tell them they have to stay within what your insurer approves. Do NOT pay any hospital charges yourself - you need to conserve your resources as this will be a long haul and further down the line there may be things that you legitimately need to pay for.

As above. Temporary rises in BP are totally normal. It is only when the BP remains elevated at rest that there is an indication of vascular disease. In fact every time you simply cough or sneeze, your BP shoots up often to 200 systolic or more. Totally normal. Healthy blood vessels are very elastic, they readily constrict when they need to and then fully relax again. In hypertension the vessels are stiffer and unable to fully relax. The resulting prolonged elevated pressure then inflicts more damage on the blood vessels over time, a vicious cycle.

Easily bought OTC in locally made brands: Bacidal Macroban Muporin

No insurance will pay for medically unnecessary charges, there are provisions to that effect in all policies - treatment must be medically necessary and charges "necessary and usual". While chemo is certainly medically necessary in her case, what the hospital is proposing (overnight admission just too place a port under the skin in a 30 minute procedure; 2 night admissions for chemo infusions) is neither "necessary" nor "usual". Hence their problem. In fact it sounds like their insurance is more generous than most if it would pay for 1 night admission for each infusion. They need to be firm with the hospital. Aside from the cost/insurance aspect, most people find it unpleasant and inconvenient to have to spend unnecessary time in a hospital. Especially when going through chemo, which inevitably means a lot of time in hospital, one wants to maximum time with family at home, not spend excessive and unnecessary time at the hospital.

Absolutely she should do the chemo. Gastric cancer, by the time it is symptomatic, has a poor prognosis so requires aggressive treatment. What they have been told is correct. The "pod" you refer to (a port) does not require a real operation. It is a simple procedure done under local anesthesia as an outpatient (or should be). There is no medical reason to be admitted or stay overnight for this. And the cost mentioned seems excessive. There is no medical reason to be admitted at all, let alone stay 2 nights, for the infusions. Normally this is a day procedure. Most insurance, even if hospitalization-only, will cover outpatient chemotherapy. Is this woman Thai? Because if so she can get free treatment through the government health system. There is a government cancer hospital in Chonburi town which can do this. If she is foreign, she could also use the government cancer hospital (won't be free, but will cost much less than private hospitals) but: there will be very long waits and crowds, language barriers, less comfortable environment. Additional problem is that it won't be possible to arrange to direct insurance payment to government hospital and may be difficult even to get reimbursement as government hospitals are not good at completing the required documentation. Since they have insurance this is probably not worth pursuing. Other options would be: 1- continue to use BPH but insist on having the post inserted as a day surgery, and the infusions also done as day treatment. Be firm, tell them this is all your insurance will pay for. 2 - Use a less expensive hospital. In the Pattaya area options would include: - Phyathai Sri Racha hospital - contact Gavin Waddell in their marketing dept, he is an expat and very helpful in helping foreigners find the best doctors etc. [email protected] tel Tel: 089 7500293 or 03 831 7333 - Pattaya International Hospital (not 10% sure they can do this, but can ask) - Pattaya Memorial Hospital (not so much English speraking there) If it were me, given that she has started at BPH and other than the cost aspect what they have done sounds appropriate, I would try #1 first. If they make it clear they will otherwise go elsewhere, I think BPH will accommodate them and do all thus as day procedures without admission. But if not, then I would then try Phyathai Sri Racha.

Consult a good broker specializing in expat health insurance. Options aren't many past age 65 but there are some. Cigna global (not to be confused with Cigna US or Cigna Thailand) is probably the least expensive.

This seems to refer to April Thailand only, I suggest you get April Global issued out of France. A lot of reasons why never the best idea to get a Thai-issued policy. Yes, contact AA. Tell them specifically you want April Global issued out of France not April Thailand. As to type of policy most of us go for the Essential Plan (without OPD add on). You can read the options in this attachment April Benefits as of 2021.pdf Malaria prophylaxis is usually not necessary in India unless you are going to be overnighting in remote jungle. Where exactly in India are you going?

upcountry and Bkk are very different things. OP is in Bkk.

In Siriraj I would expect wars to have A/C. Upcountry govt hospitals are another matter. I have had friends in wards in Bangkok govt hospitals. Really not too bad.

This sort of requirement is for patients in private rooms. Tell them you have no one who can stay with you and that you need to be in a ward room. Which will also be cheaper. Not as comfortable but just for 1 night should be OK.

Some hospitals have dual pricing systems.

As he has (foreign) insurance that will cover this up to about 1 million baht he is better off going to one of the nonprofit or midrange priced private hospitals in Bangkok. Would be impossible to arrange direct third party payment to a rural government hospital and might not even be possible to get insurance reimbursement after the fact as rural government hospitals have difficulty meeting western insurance company documentation requirements

Listen to your body. You want to push yourself slightly each day but never to point of pain or risk of falling. As long as there is progress day to day -- even small progress - that is good enough. Do not think about equally anyone else's progress, everyone is different. A fall could be very, very bad to put it mildly. Don't try to walk without a walker solo, make sure someone is with you who can catch you if you fall (even if not strong enough to catch you, they could at least break the fall and held ease you down to the floor gently). The thing with walkers is not just strength but also balance. Is it possible to put railings in the hallway? Did the hospital give you exercises to do? As you need to tone your hip muscles and legs. If they did not provide (they should have, and you should have had a consult with a physical therapist) then see here https://www.allinahealth.org/health-conditions-and-treatments/health-library/patient-education/total-hip-replacement/after-surgery/home-exercise-program

You van buy topical antibiotics anywhere and most are dirt cheap, hardly worth seeking out the few government owned pharmacies. Specifically what antibiotic are you looking for?

Assisted dying/euthanasia is strictly illegal here. It is legal to refuse treatment and there is legislation on "living wills" (advance directives)(. Should note though that many hospitals have their own specific forms, and while they could be held legally liable to honor an advance directive not on that form it might take a lot of negotiation. If your friend has a serious medical condition he should discuss with the hospital where he is being treated and full out their specific form. He should also get under the primary care of a palliative care specialist, as this makes a huge difference both to comfort/adequate analgesia and to understanding of wishes re life support etc. Also it is very, very important that whoever would be there to advocate for him when he is unable to advocate for himself, fully understand and support his wishes. If he is married that would be his wife. If unmarried, he should in addition to an Advanced Directive make out a Health Care Power of Attorney for a friend or relative he trusts to advocate for him. No matter what is written on an advance directive, no hospital will not withhold life support if there is any possibility that the family will object. For the very simple reason that dead people can't sure or make trouble, but living ones can.

Or, equally likely, hospitals had to do something to get on the list (i,.e. provide some data, fill out some forms etc) Some hospitals may not have the needed data.. e.g. "Publicly available data from existing patient surveys" and "data on quality of treatment and hygiene measures". I really would not pay the slightest attention to lists and polls like this. Just chose the best doctor for your needs.

In that event I suggest you get quotes from Phyathai 2, Bangkok Christian and St Louis. I expect they will be less than Bumrungrad. And as mentioned there is an excellent cardiothoracic surgeon (Prof. Kittichai) who operates at both Phyathai2 and Bkk Christian. As you will be using insurance, disregard the suggestion of Chuklalongkorn as, being a government hospital, it may be difficult to arrange direct payment there. You can see Prof. Kittichai at Phyathai2 this Tuesday. He won't be at BCH for outpatient again until next month but could surely arrange admission there if you prefer it once you have seen him.

medical certificate.pdf I see. Can't tell you anything about Singapore but it seems odd they can't provide more than that. Certainly anyone with insurance would need it and some employers might also. Here is an example of a Medical certificate provided by a Thai hospital that was accepted by April (identifying info blocked out) in case that helps.

Every hospital in Thailand provides this. It is routine, as Thais often need it for their employers/schools to explain absences. What hospital is this? Maybe something lost in translation? Suggest you show them the one you got after surgery as an example.

@Lorry if the 2014 thread you refer to is this one I said 400-500k not 300k. Hasn't been as low as 300k in my memory. https://aseannow.com/topic/774804-heart-surgery-in-thialand/ Remember that this is open heart surgery requiring use of a heart-lung machine and team of trained perfusionists to operate it as well as a skilled cardio-thoracic surgeon etc. And a hospital stay of about a week including usually a night in ICU (more if any complications) Unless it is triple/quadruple vessel disease, stenting is usually preferred -cheaper, much less invasive. I doubt the full out of pocket cost in Western Europe is as low as you indicate. Average cost in US is around $125,000. While Europe would be less I don't think it can that much less. Assuming you do mean a CABG and not stenting, your best option in Bangkok (combining both cost and safety considerations) is probably to go through the semi-private channel at Chulalongkorn Hospital Suggest this doctor: http://www.chulacardiaccenter.org/en/cardiology/chaisiri-wanlapakorn-md/109-kittichai-luengtaviboon-md and see him through the "Nonofficial -hour Clinic : Wednesday 16.30-20.00 Por-por-ror Building FL 6" I cannot guarantee there won't be a long wait list though especially in these post-COVID times. But no harm in asking. Dr. Kittichai is also at Bangkok Christian Hospital though only once a month https://www.bch.in.th/find-doctor/doctor-profile/?smid=4563 Cost there is usually about half that of Bumrungrad And he is also at Phyathai 2 Hospital, whuch generally costs less 20-30% than Bumrungrad https://phyathai2international.com/doctor.php?pid=20&lang=en See him at Chula first, if impressed with him but the wait at Chula is too long you can ask him what it costs (approximately) at BCH and at Phyathai Another options that would certainly cost less than Bumrungrad et al would be: Saint Louis Hospital. I used to recommend people to see Dr. Kittichai there but he seems to have left, not sure who is there now but you could contact the hospital and ask who their cardiac surgeons are) I do not recommend getting this done upcountry. If you are in very stable condition (i.e. well enough to fly) then going to India might be an option and would certainly be much less expensive even including air fare etc. This is all assuming you really mean a CABG procedure and have for some reason determined it is necessary and stents not an option. If by chance you mean stenting that is a whole other matter, different costs, different doctors and I can give specific recs for that.

I would add, quite normal to issue these medical certificates at every visit. I often get them without even asking. I don't know what the hospital was talking about needing US $300 to issue, but it is certainly not this, nor would it be your medical records which by law they have to provide on demand either at no charge or just photocopy fee. The insurer simply needs to know what condition the visit was for (diagnosis - so that they can verify related to the hospitalization) and what care was given (in a few words -- e.g: consultation, dressing change, lab test, wound care, PT etc) . It is a good idea to make sure that somewhere it mentions follow up after hospitalization for X so that the linkage is clear.

A provincial hospital cannot do this. Most regional hospitals can. Cost depends on if it is single, double or triple (or even quadruple) bypass . I suspect the 2 million quote was for triple or quadruple bypass. It's on the high side, would be around 1 million I most hospitals these days. don't confuse cost of stents with cost of bypass, open heart surgery. how many vessels are blocked?

Yes you do have to mail them the original Bill's. Make copies for yourself. Medical certificate (usually 1 or 2 pages max) is sufficient and hospitals usually provide for free. Just something signed by doctor stating diagnosis and treatment given.