80000 co-payment with 30 baht scheme?

[uhuh]

Gf's father was operated for a hip fracture in the government hospital at Surin.

He has no insurance, just 30 baht scheme. 

He lives in Surin

The hospital wants 80000 baht. 

Somehow this doesn't sound right ?

[Sheryl]

It isn't.

 

I suggest you yourself go to the hospital to verify if any money is being requested.

 

The only time someone would have to pay for this would be if they went to a hospital other than where they were registered, without a letter of referral from the hospital where they are registered (people living outside the ampur will be registered t a district hospital, which will have limited capacities, and will refer people needing surgery etc to a higher level facility like provincial hospital)

 

And even then -- or for someone not covered by the scheme e.g. a foreigner - cost would nto be 80,000 baht.

[uhuh]

Gf says it's not free because it was a (road traffic) accident,  not a disease. 

Still doesn't sound right?

(The other party of the accident doesn't acknowledge any responsibility, and police don't care)

[BEVUP]

Glad to see you asking the Forum & as I think you already knew the answer Sheryl is giving you the much needed advice for your current home work

I would maybe say the smaller amounts that you may have given prior wasn't much of a concern (usually starting of small ), but now that 80,000 smacks you in the face it is a difficult one to part with 

Don't worry I've come across many sick buffalo , & once I find out their cured they just keep coming back

I would really love to hear the out come of this

Edited December 6, 2017 by BEVUP

[Sheryl]

11 minutes ago, uhuh said:

Gf says it's not free because it was a (road traffic) accident,  not a disease. 

Still doesn't sound right?

(The other party of the accident doesn't acknowledge any responsibility, and police don't care)

No, it is not right. The 30 baht scheme is not limited to non-accidents.

 

It is the case that with road accidents, the compulsory 3rd party insurance of the driver or party at fault is supposed to pay but leave sorting that out to the hospital.

 

And as mentioned 80,000 would nto be the amount.

 

 

 

 

[Rally123]

A Thai is not covered for free treatment if involved in a traffic accident. The same applies for attempted suicide. Regarding the traffic accident the Por Ror Bor insurance should cover the third party's medical cost up to a limited amount. If no Por Ror Bor insurance was taken out then it's a police matter who will get all parties involved to go to the station and decide who was in the wrong and who pays the compensation.

[BEVUP]

1 hour ago, Rally123 said:

A Thai is not covered for free treatment if involved in a traffic accident. The same applies for attempted suicide. Regarding the traffic accident the Por Ror Bor insurance should cover the third party's medical cost up to a limited amount. If no Por Ror Bor insurance was taken out then it's a police matter who will get all parties involved to go to the station and decide who was in the wrong and who pays the compensation.

I' m interested in this as it may also concern us foreigners (even though I have 1 st class Ins ), & should not have to claim on that (sending next yrs premiums up )

So the other party is denying all ! (maybe not Licensed or doesn't care )

So the only other option is for the injured party to claim on his Gov. Compulsory Ins. ! (if Licensed )

& if that doesn't cover the bills then he's out of pocket

So why didn't they get police involved at the time who would of sorted all the above out & negotiate compensation if applicable 

[Rally123]

12 hours ago, BEVUP said:

So why didn't they get police involved at the time who would of sorted all the above out & negotiate compensation if applicable 

With regards to a farang being involved in an accident the police will, more than likely, side with the Thai based on him being poorer. I was involved an RTA and even though it was plainly obvious the Thai was at fault the police were leaning to putting me at blame. That was until I produced the video from my dashcam. They then wanted to fine the Thai 1400 Baht but decided he was so poor they never enforced it. He had to pay his hospital bill himself. I claimed my vehicle damage on my insurance. Farang lose, Thai win, in my book.

[uhuh]

16 hours ago, Rally123 said:

A Thai is not covered for free treatment if involved in a traffic accident. The same applies for attempted suicide. Regarding the traffic accident the Por Ror Bor insurance should cover the third party's medical cost up to a limited amount. If no Por Ror Bor insurance was taken out then it's a police matter who will get all parties involved to go to the station and decide who was in the wrong and who pays the compensation.

This is the way gf explained it to me.

Police seems to be not very helpful. 

 

It is hard to believe that the famous 30 baht scheme does not cover one of the most common reasons for hospitalization? 

[Sheryl]

First of all, understand how the 30 baht scheme works - it is on a capitation basis, not a reimbursement basis. Hospitals do not receive specific payment for specific services. They receive a flat amount each year based on the size of the population they serve regaldless of the care provided.

 

I am not aware of any provision in the National health Security Act that excludes care for traffic accident victims.  In fact, care for any accident is specifically listed as one of the benefits under the scheme.

 

However,  by law all motor vehicle owners must have insurance that covers injury to a third party, and there is in  addition a Victims Compensation Fund financed by the government to cover cases where the car was uninsured or fled the scene etc.  There is an umbrella group called  Road Accident Victim Protection Co that will provide compensation for persons injured regardless of which company the insurance was with, see  http://www.rvp.co.th/pay_insurance_en.php

 

I am not certain what the procedure is/whop to contact for compensation if the vehicle was uninsured or is unknown but the above company would know.

 

Hospitals of course know this and since their "30 baht" capitation payment is the same regardless of care provided (and always too little for the need, they all operate in the red) they have strong motive to try to access these funds. They can make a claim directly or the injured person may do so and then pay the hospital, as there is a fair amount of red tape the hospitals  prefer the latter.

 

The amount of compensation is capped at  I think 30,000 bahtif the vehicle had the mandatory insurance and only 15,000 from the Victims Compensation Fund if not. Details here http://www.rvp.co.th/rvp2011/faq.html

http://www.rvp.co.th/rvp2011/claim.html

 

I may be mistaken but I don't think hospitals are entiotled to deman additional money, beyond the insurance compensation, from patients who are covered by the  Universal ("30 baht") scheme.  You can verify this by calling the NHSO  https://www.nhso.go.th/eng/Site/ContentItems.aspx?type=Mw%3d%3d

In any event, if the family tells the hospital they do not have the money, that winds up being the case. However the hospital knows well that at15-30,000 baht can be gotten through the insurance or victim's fund so they are going to insist on at  at least that much.

 

I suggest they (or you) do as follows:

 

1. Contact RVP to find out what to do to get reimbursement to the hospital under either the compulsory insurance or (if the vehicle was uninsured) the Victims Fund (there is also info on how to do this on the website)  http://www.rvp.co.th/rvp2011/contactus.html

Before doing this, have at hand the details:

- accident details (date, vehicles involved etc)

- was the vehicle involved insured? (details - driver, vehicle, insurance company)

- has either the patient or the hospital already submitted a claim?

 

After arranging this, contact the NHSO and explain that the hospital is demanding payment in excess of the insurance compensation and see what they say.  https://www.nhso.go.th/eng/Site/ContentItem.aspx?type=Nw==

 

 

[uhuh]

In the meantime,  i have seen the admission sheet of the hospital. 

It is written,  that gf's father was drunk driving his motorcycle and run into a pick-up truck.  Quite drunk. 

In a later addition, they write that he had been drinking all day since 8 a.m.

 

(Gf disputes this. 

No alcohol test was done. And afaik no CT of brain,  no thorough neurological examination. It is not clear who wrote this and on which facts - smell? - it is based. )

 

Presumed he was drunk,  does this change financial responsibilities? 

 

 

[Sheryl]

I am no expert on Thai law but I would think it may make him, rather than the other driver, liable which, assuming he is the only one seriously injured, would explain the lack of interest/help from the police.

 

Now what I do not know is whether this changes his eligibility for reimbursement of medical costs under the compulsory insurance (assuming he had -it  it is required by law). As mentioned that would cover up to 30,000 baht.

 

Contact RVP as per prior post to find out. Ans also NHSO regarding balance of costs not covered by the insurance.