ole1291

2 minutes ago, Sheryl said:

Mesh is commonly used in adults, and sometimes in older children/teenagers. It is not used in young children.

Duly noted. Thanks.

And with regards to his age, would it maybe be better to wait a few years?

The hernia only 'descends' some days and the operation seems to be elective.

Also forgot to mention, the operation will be sewing only, no net, which I thought were common now. 

Again, not something you get to choose.

Thanks for your advice. Very valuable.

I'll definitely keep it all in mind next time we speak with them.

Umphang was enticing because of the proximity for all the follow up meetings etc... (once you choose a hospital for a particular problem, all the meetings take place there)

13 hours ago, Sheryl said:

To be completely safe in the (rare) event of complication you should have this done at a hospital with a pediatric ICU. 

 

The smaller hospital will not.  I'm not sure Mae Sot will either but you can ask. If not, the regional hospital in Nakon Sawang will.

 

 

I'm not sure that they would allow us to go to Nakhon Sawang, the choice given to us was either Umphang or maesot, and in my understanding, in the public system you don't get to choose so much... I will try nonetheless.

In any case, do you think this is an important thing to push for, or is the risk so negligible we can pass over it?

And assuming Maesot doesn't have a PICU, is there any reason to go there rather than Umphang?

Thank you for your input.

As we are doing this through the public  system, we have no say on who would perform the operation, but I'll keep this in mind.

My main concern however would have to do with any complications resulting from the anesthesia, as the doctor told us it's more delicate at this young age.

Is there any equipment (resuscitation?) might be missing in a local hospital vs a province capital one?

Hello,

My 4 years old son (turning five in a month) son has a inguinal hernia.

We've already been at the Umphang public hospital, met a very nice young doctor who told us that though these operations were previously done at maesot (bigger) hospital they have recently started doing them in Umphang as well ( a team of doctors and anesthetist traveling from maesot a few days a months to cary them out).

She also gave us the option to go all the way to maesot to do it but assured us there's no difference from a safety point of view, she made a good impression on me.

I just want to ask if someone knowledgeable knows if that is correct? Or is there some equipment (which one) in the bigger hospitals that makes these kinds of operations safer there?

16 hours ago, Sheryl said:

It is extremely rare for someone to be hospitalized in an acute care hospital for months for palliative care. In fact pretty much unknown nowadays. And not an appropriate use of an acute care hospital bed.

 

In the west there are hospices for this purpose. In Thailand it is usually done at home though a nursing home might also be an option. 

 

Costs are a tiny fraction of an acute care hospital. 

 

 

Then it is indeed different.

Thanks for clarifying those points. Very helpful.

3 hours ago, Sheryl said:

No, not at all. Ir means that if the care in question is labelled or described as palliative, it will be covered under the amount indicated for palliative care.

 

A person could, for example, have an ultimately terminal condition but still chose to undergo treatments to proling life (e.g chemotherapy, radiation). That eould nor fsll undef "palliative care" because the aim is nit palliation but prolomging life.

 

Palliative care means comfort measures only and it is logical for that to have lower level of reimbursement.

 

The issue is the type of care involved not the patient's prognosis.

 

 

I see.

I've known numerous people however whom either weren't offered any life prolonging treatments or turned them down, with months remaining to live. They still required extensive medical attention to (somewhat) control their symptoms and reduce the pain. Towards the end, they had to be hospitalized, the last few months.

In such a case, it is my understanding the insurance wouldn't cover those expenses (pain medication, home nursing, ultimate hospital stays).

I understand this varies and I've also known other people who were switched to palliative care only a few days from death. The whole point of an insurance however, is to avoid those kind of gambles.

20 hours ago, Sheryl said:

Palliative care is a very weak area in Thai health care. There are almost no hospices as such and no real hospice care. That includes at private hospitals.

 

About the only place that comes close is McKean Hospital in Chiang Mai.

 

That line item in insurance policies is for care in a hospice facility which (with possible exception of McKean) is not applicable here, since there are none. Insurance will not exclude care in a hospital because the prognosis is terminal (which they also likely won't know). Their coverage will depend on what thep urpose of the hospitalization is, which leads to the next point - it is hard  to imagine a scenario in which one would want to spend a month in a Thai hospital - private or otherwise - if in the terminal phase of an illness. Most people would much rather be at home, with hired-in carers if needed.

 

Government hospitals will give pain killers, and there are some with palliative care units (e.g. Khon Kaen University hospital). The big difficulty comes when  the patient is no longer able to swallow oral meds, as they will not provide morphine drips and the like outside the hospital. Typically this is within days of death and many people at that point go into the hospital.

 

 

Thank you Sheryl for this informative reply.

Previously, while corresponding with AAinsure, this is what they told me about the applicability of palliative care:

With regards to hospice care generally, is it so that once an illness is declared terminal, hospital stay will only be covered by the amount stipulated under "palliative care" or be paid by the insured own pocket? 

Whether or not a condition is qualified as palliative is evaluated based on medical reports and international medical definitions as regards to palliative care/treatment. Should it however come to a stage where the condition is labelled as palliative care, coverage is indeed limited to palliative cover of the policy.

It does seem to indicate that insurances would terminate normal coverage in case an illness is terminal.

I guess the crux is whether the hospital notifies the insurance... but one would assume the insurer would be eager to find out.

While browsing the benefit table for the different options for private health insurance in Thailand, I noticed a hospice/palliative care column.

This, it turns out, is the amount the insurance will pay for all the comfort/pain treatment you will be given once your condition is declared non treatable (with usually a 6 months max life expectancy).

As an example, April Thailand's extensive plan will offer ฿ 1,637,500 in such a case. 

The problem is I have no idea what the typical cost for such matters run at in Thailand, but I guess a multi month stay in a private hospital could run in the millions.

I realize this is something hard to estimate, depending on the condition, life expectancy etc... but a ballpark figure would help, perhaps someone who works in the insurance business here would have seen sample cases he can share with us?

I think it's important for people to realize that once an illness is declared untreatable, the insurance will only cover medical expenses up to the amount specified under palliative care (which is usually way  below the policy overall coverage, sometimes even zero). A little underhanded and could be a bad surprise for someone who thought he was covered.

That leads me to my second question which is how good is palliative care in Thai public hospitals (insurance would be for my Thai wife)? 

My feeling, at least in the country hospitals, not good. Huge wards, indifferent/rude nurses etc...

On 11/14/2022 at 7:24 PM, Sheryl said:

 

OR you might consider living elsewhere in Thailand, closer to better hospitals. Even with international insurance, you are not going to be able to get emergency care at the better private hospitals in Bangkok due to the sheer distance. And for non-emergent care it is going to be quite a hassle and expense to always travel to Bangkok from Umphang.

Yes, that's the thing I guess, being far from the big cities (12h from BKK, 9h from CM), health care options are pretty limited, one way or another, and there's no perfect solution

As we're both still under 40, I think we're fine here for now, but it might make sense to move as we get older. 

Thank you for advice. Very useful to have all this in mind before committing to something.

1 hour ago, Lorry said:

The insurance may know this. They will happily wait for you to sue them.

 

Sorry,  can't help you with this. 

Have a look what Europeiske Reiseforsikring has to offer, or their parent company. They are quite good in other countries. 

Will do.

Thanks for the advice. 

13 minutes ago, Sheryl said:

 

 

I think for your situation a big issue is your ages and how long you expect to be in Thailand (in other words are you locking yourselves into something you cannot later change or revoke without serious problem?)

Thank you for explaining.

The plan is to stay here long term, perhaps until we're old.

But it's not 100%, hence why a worldwide excl USA policy is appealing.

We're trying to get insured while relatively young and without preconditions as per your recommendations. That's why I'm trying to be so careful, don't want to pay 20 years of premiums only to be swindled later or have a company go broke on us just at the time we will need them. 

13 hours ago, Lorry said:

Should be possible. 

Can't she establish residency there? It's usually just 3 months. 

Then get insurance in that country (how was she insured when you were there, anyway?)  - but again, it won't be easy to find one that covers her in Thailand, too. If I knew which country you are talking about maybe I could give some suggestions,  but 27 jurisdictions is too much. 

They may ask for copies of flight tickets,  very common. 

If the claim is expensive,  they may ask for copies of all pages of her passport. 

If it's very expensive,  they may check the passenger manifesto of the airline (that's illegal,  but I have seen it happen).

 

Mostly, they will just ask some innocent sounding questions.  Like "where are you staying in Thailand?" And you or your wife naively answer "Oh, we have a house here." Then some insurance would say: "according to our policy,  you are not covered."

 

BTW European insurances are very suspicious when people from the third world make claims originating in their home country.  They smell corruption. Not so much in Thailand, though.

Depends on the policy.

Try to find a policy that covers her in her home country,  too.

Do not lie to them,  too risky. 

She has a residence permit valid to 2027.

The country is Norway, not technically EU but schengen EEA area (I think it's the same regs).

While there she was uninsured (I thought her being my wife entitled her to local health care, but it's not 100% clear).

Having a house shouldn't equal with permanent residence. We have a house in Norway too.

But I see how things could get dicey.

Frustrating because we wouldn't be technically committing fraud, just circumventing protectionist regs.

19 hours ago, Sheryl said:

To be fair, there is also real time pressure in the public system.

 

I have sometimes taken Thais to see their same doctor at a private hospital for 1 visit just yo have time to ask questions and talk. It's a pretty 4ushed assrmbly line in the public hospitals.

Sure that's a factor, though I think it's also cultural.

Perhaps you missed my question with regards to community rated plans, do you think this is just an empty promise made by insurers on which they could go back any time?

1 hour ago, howerde said:

i have had first hand experience of a rural hospital and have to say the older doctors DO not like to be challenged,  or even a query can end with ok, you can go now lol

That's another aspect of public vs private. In a private setting, you can at least try to discuss to things with a doctor.

Otherwise, I've often found out doctors here think they are part of a higher caste that cannot be questioned by the lower peasants (everybody else).

1 hour ago, lopburi3 said:

You are aware that any doctor will speak English to some extent?  Speaking some English in not an indication of foreign training.  Those working at the average upcountry private hospital are often not of the same quality as those working at adjacent government hospital (for the simple reason the government doctor is fulfilling a commitment - the private doctor is unable to obtain employment elsewhere.  (yes I know that is simplistic and often not true - but believe it is a factor to consider).

It's obvious when a Thai has spent time abroad or not. Maybe I wasn't precise enough.

And yes I have met doctors that could hardly speak English...

I thought most of the doctors in the private hospitals also worked in the public sector... anyway, I am well aware that the up country private sector is not so good.

When talking private, I mean the best hospital's in bkk or cm, they're not perfect too (no where is) but my experience there were much better than Umphang/Maesot.

11 hours ago, Lorry said:

Correct.

This has led to quite a bit of abuse.  Arbitrage between cheaper, less developed EU countries and rich countries.  Arbitrage between less regulated ones (it used to be the UK) and others. 

 

OP is unusual: a "poor" Thai looking for "expensive" Western insurance. 

 

The opposite is more common: people from rich countries trying to save money buying crappy insurance from a poor country which is recognized in their rich home country. Think of 

Austrians buying Slovak insurance. Saving on premiums, but not considering claims will be handled differently. 

A friend of mine has Turkish insurance and really believes it will help him if he needs surgery in Germany ????

Except with Thaï insurance you get the worst of both worlds because they cost nearly as much as that of big name international insurers, while offering smaller amount for coverage, and are not bound by very by good (from the customer point of view) regulations.

Which got me to think, me and my wife sometimes spend extended amounts of time in Europe, in fact stayed the last year in a half in a EU country for which she holds a 5 year residence permit.

Couldn't we, based on that, get her insured by a big international insurer as an expat in said EU country and then also use the policy in Thailand claiming we were just on a trip there?

How would the insurer know the difference? And if they did, would it be sufficient ground to deny a claim?

12 hours ago, Sheryl said:

 (And if it does not, no guarantee the private hospital's recommendation is the better of the two, could just as easily be the opposite case).

Maybe that's true for bkk area, but with regards to Umphang, I'd put a lot more faith in what an English speaking (and therefore I assume western trained) doctor says than one of the local ones.

That's based on multiple interactions with them.

You haven't commented on the snippets I provided from the AAINSURE website.

I'm not bringing it for arguments' sake but because I am genuinely not sure about who's right:

they state community rated premiums cannot be increased based on claim but you say the opposite...

Is it that the Thai regulations allow them to raise them but that they offer the customers of their community rated plan "a promise" ,not bound by law, that they will not do it?

18 minutes ago, howerde said:

As i understand she has selected the option to use any doctor she wants, she would use the social security as the first option, if there were delays or if she was not happy with the hospital doctor, then she would use FWD, not sure but i think that if tests etc were done at the hospital using the social security then the private doctor should use those tests, but these things never seem to be clear in Thailand

I actually was wondering about the feasibility of the reverse:

Doing scans, diagnostic etc privately (cause that's where the delays are) and then seeking treatment under universal coverage in the public sector.

But would public hospitals accept implementing a treatment based on the recommendations of a private  hospital?  

21 minutes ago, Etaoin Shrdlu said:

Yes, finding offshore medical insurance for a Thai national can be difficult. The reason is that only insurers licensed by the OIC can legally offer insurance to the Thai public. Technically, the "Thai public" is anyone physically in Thailand. The reality is that the OIC has not enforced this rule. The fact that almost the only persons seeking offshore health insurance are foreigners probably has something to do with it. It would probably be a different matter if offshore insurers actively sought to sell insurance to Thai nationals. Offshore insurers are aware of this regulation and will not wish to overtly go against.

Finally, an explanation on that subject that makes sense.

So it all comes down to Thai protectionism in the end.

I wouldn't mind, if their own regulations were better.

11 minutes ago, Etaoin Shrdlu said:

 

 

In looking for a non-Thai insurer, my preference would be to go with a major insurer that has acceptable S&P or AM Best ratings, is domiciled in a developed and well-regulated jurisdiction and has verifiable claims-paying history.

 

But to each his own.

 

 

 

Me too.

But major international expat insurers will not insure a Thai national residing in Thailand, that is because  "In general, international insurance plans are designed for expats living part of the year outside of their home country. If you are a Thai national, you are not."

Apparently it's that simple...

4 hours ago, Etaoin Shrdlu said:

VUMI's website states that its head office is in Dubai Outsource City. Dubai Outsource City is a free zone within the UAE. Companies in free zones in the UAE do not come under the regulation of the UAE Insurance Authority, so it is not clear which insurance regulator, if any, would oversee that operation, which is probably their distribution arm and not the actual insurance company. 

 

After further search, I believe VUMI's insurance company is domiciled in the Turks and Caicos Islands. I haven't been able to find any financial information on the Turks and Caicos company and I have searched Standard and Poors and AM Best. This leads me to believe that it is a small company compared with the likes of AXA, Cigna. Turks and Caicos requires just $100,000 in capital to form an insurance company.

 

Ole1291 has posted information above that indicates QBE reinsures VUMI. QBE carries a group rating of "A" from AM Best, which is good.  But policyholders do not have direct access to reinsurers in the case of insolvency of the primary insurance company and reinsurance will not necessarily prevent an insurer from becoming insolvent.  

 

 

Thanks for looking into it. 

Basically, we seem to reach the same conclusion that VUMI is small, somewhat shady, player with mixed reviews:

https://www.reviewcentre.com/health_insurance/vumi_group_-_wwwvumigroupcom-reviews_2512473

Getting insured with them seems a gamble as no one knows if they'll still be around in the medium to long-term future. 

5 hours ago, Sheryl said:

 

They absolutely can raise premiums based on claims and this is clearly spelled out in their policy documents. It has to be  because the Thai Insurance Commission so decrees and will not approve a policy without that language.

 

Then AAinsure, which is promoted by this website are misleading us:

Their faq pages:

https://www.aainsure.net/faq_health-insurance.html