Insurance only covers Semi-private" rooms

[brewsterbudgen]

My (non-Thai) family are insured here with a well known international insurer, that, from its name anyway, specialises in Expat cover.  We live near Ekkamai and my family are registered at Sukhumvit Hospital which we use for outpatient treatment and for my 3 year-old son's vaccinations.  Sukhumvit Hospital is a mid-priced hospital.  My wife who is rarely sick and is 28 years old, had been complaining of stomach pains for a few days, so at 6pm we went to Sukhumvit Hospital. The doctor examined her and said it "could" be her appendix.  He recommended doing a CT scan and keeping her in overnight for observation and so that, if an appendectomy was necessary, she could be operated on quickly.

 

The insurance we have is only for inpatient treatment, so I provided the hospital with the policy details.  Sukhumvit Hospital has a range of rooms for inpatients, and we choose the cheapest option at 1,800 per day.  All the rooms at the hospital are private rooms.

 

The next day my wife's pain had subsided and no appendectomy was required and she was discharged from the hospital.  The total bill, including the CT scan came to 34,000 baht.

 

I was then informed by the insurance rep that the "Major Medical" policy we hold only covers inpatient treatment in a "semi-private" room, and as my wife had stayed in a "private room", the treatment was not covered. "In this case the type of room is not available and per the policy terms and conditions there is no coverage, however, *******  understands the needs of its’ clients and so instead of declining the claim we cover up to 70% of the total bill, a case to case consideration offered by the underwriters."

 

When I spoke to their Bangkok based rep, she advised me that in future we should only use hospitals in Bangkok that have "semi-private" rooms, like Bumrungrad.  "We would suggest the client to go to his/her preferred hospital that has semi-private room for future treatment to be fully covered up to the chosen plan benefits. To my knowledge, there are many hospitals which provides semi-private room. This includes Bumrungrad International Hospital, Praram 9 Hospital, Theptarin Hospital, Kluaynamthai Hospital, St. Louis Hospital, Petcharavej Hospital, Camillian Hospital, and many more."

 

I have no desire to change hospitals as we have used Sukhumvit Hospital for 3 years now, it is local to us (8 minutes drive), my family's records are kept there, we know some of the staff and they know us.  It seems ridiculous to me that we are being forced to use a different hospital which, certainly in the case of Bumrungrad, would be significantly more expensive than Sukhumvit. A "twin-room" at Bumrungrad is around 7,000 baht a night, compared to 1,800 baht for Sukhumvit's private room.

 

Is this "semi-private" room requirement normal for insurance cover in Thailand?  Does anyone else have experience of being restricted from using the hospital of their choice, due to a requirement like this?

 

 

 

 

 

 

[topt]

3 hours ago, brewsterbudgen said:

Is this "semi-private" room requirement normal for insurance cover in Thailand? 

I recently took out an International policy and had looked around at others and several mentioned "semi-private". However even though the policy I took out states this I was specifically told by the local broker that in Thailand, as there are not many semi-private rooms, I was covered for a private room - I don't think Pattaya hospitals for example have any semi private rooms.

 

In light of your experience I think I will now double check this. Thanks.

[impulse]

On 2/6/2019 at 12:18 AM, topt said:

I was specifically told by the local broker that in Thailand, as there are not many semi-private rooms, I was covered for a private room

 

Never rely on what a broker tells you.  They stand to lose absolutely nothing by mis-informing you.  And a lot to gain.

 

Edited February 7, 2019 by impulse

[simon43]

This is a topic of concern.

 

Many policies only cover for semi-private rooms.  Maybe insurance companies are well aware that private rooms are the norm, and have added this clause to reduce or even deny claims.

 

I checked the Cigna Close Care policy (I'm probably changing from HCI to Cigna).  Payment is only made for stay in semi-private rooms.  Cigna separates the room cost from medical costs and will pay the room cost that would have been charged had a semi-private room been available.

 

My current policy with HCI says that they will pay 100% of accommodation costs, and no mention of private or semi-private rooms.

 

It would seem prudent for those with medical insurance to ask their insurer to state in writing what their policy is concerning payment of room costs viz-a-viz semi-private and private rooms.

[topt]

9 hours ago, impulse said:

 

Never rely on what a broker tells you.  They stand to lose absolutely nothing by mis-informing you.  And a lot to gain.

 

I have had it confirmed in writing thanks.

[alfieconn]

31 minutes ago, topt said:

I have had it confirmed in writing thanks.

Confirmed by who ? broker or Insurance company.

[NCC1701A]

On 2/6/2019 at 9:46 AM, brewsterbudgen said:

The doctor examined her and said it "could" be her appendix. 

suggest you find a new doctor and hospital. the very basic test for appendicitis is to lie down and lift your right leg. No sudden increase in the level of horrible pain? no appendicitis. second test. stand up. jump up and down a few times. You should be in real pain. Not just stomach ache. 

Did the doctor push his fingers into your wife's side to see if the pain was localized pain?          

[brewsterbudgen]

22 hours ago, NCC1701A said:

suggest you find a new doctor and hospital. the very basic test for appendicitis is to lie down and lift your right leg. No sudden increase in the level of horrible pain? no appendicitis. second test. stand up. jump up and down a few times. You should be in real pain. Not just stomach ache. 

Did the doctor push his fingers into your wife's side to see if the pain was localized pain?          

I agree that it was a poor diagnosis.   A second doctor the next day, said "gastric".

[pontious]

On 2/6/2019 at 1:18 PM, topt said:

I recently took out an International policy and had looked around at others and several mentioned "semi-private". However even though the policy I took out states this I was specifically told by the local broker that in Thailand, as there are not many semi-private rooms, I was covered for a private room - I don't think Pattaya hospitals for example have any semi private rooms.

 

In light of your experience I think I will now double check this. Thanks.

Did you double check?

[NanLaew]

The insurance sharks will be messing around with semantics and re-defining what a 'semi-private' room is next.

 

"Does the room have a glass viewing panel or window on the door?"

 

"No, it's a solid door, no window." (like 99.9% of ALL hospital room doors in LOS)

 

"Oh sorry, that's a private room then, semi-private must have a viewing pane or window on the door. Please accept partial recompense."

[brewsterbudgen]

Regency for Expats apply this "semi-private" room restriction to all but their most expensive policies, and are currently in the middle of a huge advertising blitz. Buyers beware!

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[BestB]

My policy and “normal” policies stipulate private room up to certain amount per day. 

 

So semi or not policy usually states how much it would cover per day. 

 

Rather strange to refuse because not semi private when cost is a lot cheaper than their approved hospitals , if anything sounds more like a scam and way not to honour payments or make partial payment

[topt]

2 hours ago, pontious said:

Did you double check?

See post #5..........

[pontious]

3 minutes ago, topt said:

See post #5..........

May I ask if it was the broker or the insurance company? I contacted both for a new policy I  am considering and they gave different answers.

[topt]

6 minutes ago, pontious said:

May I ask if it was the broker or the insurance company? I contacted both for a new policy I  am considering and they gave different answers.

Then change your broker - and tell them why.

Can you say which broker so others can be aware?

[brewsterbudgen]

My policy and “normal” policies stipulate private room up to certain amount per day. 
 
So semi or not policy usually states how much it would cover per day. 
 
Rather strange to refuse because not semi private when cost is a lot cheaper than their approved hospitals , if anything sounds more like a scam and way not to honour payments or make partial payment

Apparently it is their standard policy. All their expat policies, except the Fully Comprehensive one, state "semi-private" room only.

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[Sheryl]

Most insurance policies say this for the lower end plans but usually will cover, at least up to a certain amount, private room in hospitals that do nto have any other type of accomodation.

 

In any case a  dispute over room charge should never affect more than reimbursement of the room charge, certainly not the entire claim as reported here.