USA style health plan with a primary care physician/online access to your doctor etc etc

[newarrior]

Any idea how one can get a USA style health plan (or even via a pay as you go plan) where you have a primary care physician and all of your work/labs/billing is at the same hospital/system and your healthcare is directed by a primary care physician ? Where you can view everything online (bills, tests) , pay bills online, view records, communicate with your doctor etc etc / Thanks !  Dave

[Sheryl]

Easy question
.
Nowhere.

No such systems in Thailand.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[newarrior]

15 hours ago, Sheryl said:

Easy question
.
Nowhere.

No such systems in Thailand.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

You mean easy answer not easy question. What leads you to believe no such systems exist here? Thank you David

[Sheryl]

30 some odd years of close exposure to the Thai health system helping people access it.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[NCC1701A]

16 hours ago, newarrior said:

Any idea how one can get a USA style health plan

I'm from Hollywood too.

 

Sheryl just gave you the best answer.

 

16 hours ago, newarrior said:

Where you can view everything online (bills, tests) , pay bills online, view records, communicate with your doctor etc etc / Thanks !  Dave

you don't leave the hospital without paying. 

Cash, CC card or Health Insurance. You will receive a detailed printout of all costs.  

Results are viewed at the hospital, you can have same emailed to you. 

I just got a MRI and asked for and received CD with a program to view on my PC.

 

What sort of health insurance do you have? 

 

[newarrior]

2 minutes ago, NCC1701A said:

I'm from Hollywood too.

 

Sheryl just gave you the best answer.

 

you don't leave the hospital without paying. 

Cash, CC card or Health Insurance. You will receive a detailed printout of all costs.  

Results are viewed at the hospital, you can have same emailed to you. 

I just got a MRI and asked for and received CD with a program to view on my PC.

 

What sort of health insurance do you have? 

 

I don't have insurance. This question is independent of Insurance. I'm just trying to get the same system I had in America so things don't get scattered. It may not be possible here but that's what I'm inquiring about. That's what's going to make me feel safe and structured. That being said yes I'm looking at getting Insurance here. The best thing maybe to do all your work at 1 hospital that's maybe the closest you're going to get to that sort of thing. And try to get digital copies of Records one possible. I often have the doctors give me jpegs or PDFs. I try to get doctors who will maintain some sort of email contact between visits. I do my labs in and outside lab that I'm comfortable with and I have PDF records of that as well.

 

Yeah I'm aware of the payment thing it's not like you do the building in America where they hit you after the fact right everything's paid on the spot I'm absolutely aware of that. It's the same the Philippines. It's a poor country and people don't want to risk doing the billing in the future. And then having people not pay.

[newarrior]

17 minutes ago, Sheryl said:

30 some odd years of close exposure to the Thai health system helping people access it.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

Thank you since you seem so knowledgeable. What are some of the best hospitals or medical treatment centers that you're aware of? Can you tell me anything about your insurance plan who's your agent which plan?

[NCC1701A]

17 hours ago, newarrior said:

your healthcare is directed by a primary care physician ?

In Thailand you don't have a primary care physician. If your shoulder hurts you walk into the hospital and say "My shoulder hurts." The next thing you know you are in the right department. You talk to a specialist right away.

[ThaiBunny]

3 minutes ago, NCC1701A said:

In Thailand you don't have a primary care physician. If your shoulder hurts you walk into the hospital and say "My shoulder hurts." The next thing you know you are in the right department. You talk to a specialist right away.

I found the same when I was living in the US in practice. I had a "primary care physician" but almost never saw him. A paramedic in the practice acted as a gatekeeper and decided whether I should trouble him. She could write prescriptions and took care of the usual minor ailments - ingrown dandruff, that sort of thing. If I needed a specialist I got to see one right away

[NCC1701A]

9 minutes ago, newarrior said:

 What are some of the best hospitals or medical treatment centers that you're aware of? Can you tell me anything about your insurance plan who's your agent which plan?

Bumrungrad Hospital Bangkok is sort of the no brainer choice.

 

But there are dozens of great hospitals. Sheryl is the expert on this.

 

I am covered by Aetna Insurance Thailand

[moontang]

What the OP described cost about 700 usd per month in the States, with a 5000+ deductible, and you still have to get referrals for specialists..and on your first visit, you may not even see an MD.  Bumrungrad has been taken over by Islam.

[NCC1701A]

12 minutes ago, moontang said:

What the OP described cost about 700 usd per month in the States, with a 5000+ deductible, and you still have to get referrals for specialists..and on your first visit, you may not even see an MD.  Bumrungrad has been taken over by Islam. 

well the richest people on this side of the planet go to Bumrungrad and I find it to be excellent so far.

[ThaiBunny]

Just now, NCC1701A said:

well the richest people on this side of the planet go to Bumrungrad and I find it to be excellent so far.

A friend of mine is the richest person I know on this side of the planet and he goes to BNH

[NCC1701A]

1 minute ago, ThaiBunny said:

A friend of mine is the richest person I know on this side of the planet and he goes to BNH

well my super rich friend is better than your super rich friend and he goes to Bumrungrad.

[moontang]

Singapore GH looked pretty good, but they tend to be all style and little substance,  food, or water.

[Sheryl]

There are no "best hospitals" it all depends on the individual doctor. In private hospitals in Thailand the doctors have complete autonomy and work as private contractors, and there is no hospital where there are not some sub-standard doctors. It is necessary to carefully research choice of individual doctor. For which reason getting all care at the same hospital doesn't work well. Though if you have no specialized needs might be possible to do  most things at the same place.

 

Medical care here is highly specialized and you will not find much that approximates what primary care physicians do in the US (the closest Thai corollary would be a Thai internist but they do not function in the same care-coordinating manner). Your best recourse would be Dr. Nick Walters, an American Family Care physician at Mission hospital (see below)

 

http://www.mission-hospital.org/en/component/k2/item/54-dr-nick-walters.html

 

There are no special plans of the type you mention and you will not have online access to your records but some doctors are willing to share their email address with you and can easily get copies of all results etc at each visit. You pay as you go unless it is covered by insurance.

 

Re insurance, inpatient cover of at least 3 million baht per event is a must but the added cost of including outpt cover is usually not worth it, greatly increases premiums and outpt costs here are very affordable. A consultation with a top specialist for example usually around 2000 baht. Di not get medications from a hospital pharmacy, there is a huge mark up and most medications that are prescription only in the US can be bought over the counter here. Narcotics, steroids and pysch meds are pretty much the only exceptions.

 

There have been dozens of threads about health insurance here and some are still running in the insurance forum. Suggest you do a search and read up. Personally I have April International (issued out of France not their Thailand office, there are differences between Thai and internationally issued policies) and bought through AAbrokers  <www.aainsure.net> buying through a broker definitely recommended as they can help with any problems that arise with claims

https://forum.thaivisa.com/topic/1077110-health-insurance-for-expats-over-65-in-thailand/page/4/?tab=comments#comment-14090891

 

https://forum.thaivisa.com/topic/1030783-pacific-cross-health-insurance/

 

 

[TallGuyJohninBKK]

33 minutes ago, NCC1701A said:

well my super rich friend is better than your super rich friend and he goes to Bumrungrad.

 

That's probably because Bumrungrad makes him feel right at home...by charging thru the roof prices for medical care suited to the super rich...and often seems to have staff and doctors more focused on their billing charges than their medical care.

 

[TallGuyJohninBKK]

Another quirk that American users of health care here need to get used to, at least in my experience, is when your care is all said and done and you go to the billing department, they'll often simply tell you the amount due, and not even bother to provide you with an itemized list of charges.

 

In my experience, you almost always have to ask them to provide such an itemized list, and specifically ask them to provide a version in EN instead of Thai, unless you're a TH reader. I've regularly run into that situation at BNH, Mission, St. Louis and others.

 

It's not that the hospital billing staff won't provide an itemized list of charges upon request. They will and do. The odd part to me is that they, by default and in the absence of an itemized bill, expect me to fork over X thousand or XX thousand baht for medical care without having any idea what I'm being charged for.

 

[newarrior]

5 hours ago, NCC1701A said:

In Thailand you don't have a primary care physician. If your shoulder hurts you walk into the hospital and say "My shoulder hurts." The next thing you know you are in the right department. You talk to a specialist right away.

Yes sir I have experienced that but I am trying to centralize all my healthcare under one umbrella so to speak)

[newarrior]

5 hours ago, NCC1701A said:

Bumrungrad Hospital Bangkok is sort of the no brainer choice.

 

But there are dozens of great hospitals. Sheryl is the expert on this.

 

I am covered by Aetna Insurance Thailand

I use Samitvej for most stuff.Camelian fo the small..Bangkok Hospital is good..Bumrungrad of course the best...Even the best privates are cheap compared to USA of A

[newarrior]

5 hours ago, moontang said:

What the OP described cost about 700 usd per month in the States, with a 5000+ deductible, and you still have to get referrals for specialists..and on your first visit, you may not even see an MD.  Bumrungrad has been taken over by Islam.

That 700 depends on many things...And yes there are hassles in the USA I DO NOT miss...1st the many layers--insurance agent if insured, pharmacy/mail in pharmacy, Obamacare if subsidized, the insurance company...Getting to from the appt//making the appt..Limited hours of doctor..  Co pays, deductible...Many cons but many pros as well..best if your employer sponsors the plan..Bumrungrad has been taken over by Islam. ? <deleted>..Explain

[NCC1701A]

1 minute ago, newarrior said:

Bumrungrad has been taken over by Islam. ? <deleted>..Explain

there are a lot of people with money who fly from the mid east to go to Bumrungrad.

very common to see women in full burkas with only their eyes showing. 

Bumrungrad is setup to cater to their belief system where women cannot be alone with a man, even a doctor.  

 

[newarrior]

4 hours ago, Sheryl said:

There are no "best hospitals" it all depends on the individual doctor. In private hospitals in Thailand the doctors have complete autonomy and work as private contractors, and there is no hospital where there are not some sub-standard doctors. It is necessary to carefully research choice of individual doctor. For which reason getting all care at the same hospital doesn't work well. Though if you have no specialized needs might be possible to do  most things at the same place.

 

Medical care here is highly specialized and you will not find much that approximates what primary care physicians do in the US (the closest Thai corollary would be a Thai internist but they do not function in the same care-coordinating manner). Your best recourse would be Dr. Nick Walters, an American Family Care physician at Mission hospital (see below)

 

http://www.mission-hospital.org/en/component/k2/item/54-dr-nick-walters.html

 

There are no special plans of the type you mention and you will not have online access to your records but some doctors are willing to share their email address with you and can easily get copies of all results etc at each visit. You pay as you go unless it is covered by insurance.

 

Re insurance, inpatient cover of at least 3 million baht per event is a must but the added cost of including outpt cover is usually not worth it, greatly increases premiums and outpt costs here are very affordable. A consultation with a top specialist for example usually around 2000 baht. Di not get medications from a hospital pharmacy, there is a huge mark up and most medications that are prescription only in the US can be bought over the counter here. Narcotics, steroids and pysch meds are pretty much the only exceptions.

 

There have been dozens of threads about health insurance here and some are still running in the insurance forum. Suggest you do a search and read up. Personally I have April International (issued out of France not their Thailand office, there are differences between Thai and internationally issued policies) and bought through AAbrokers  <www.aainsure.net> buying through a broker definitely recommended as they can help with any problems that arise with claims

https://forum.thaivisa.com/topic/1077110-health-insurance-for-expats-over-65-in-thailand/page/4/?tab=comments#comment-14090891

 

https://forum.thaivisa.com/topic/1030783-pacific-cross-health-insurance/

 

Amazing thanks..This is classic, "there is no hospital where there are not some sub-standard doctors. It is necessary to carefully research choice of individual doctor. For which reason getting all care at the same hospital doesn't work well. "..Thanks for the links and wisdom..So you think the cons of having insurance exceed the pros ?I 

 

" inpatient cover of at least 3 million baht per event is a must but the added cost of including outpt cover is usually not worth it, greatly increases premiums and outpt costs here are very affordable"..What is output cover ?)  What insurance do you have ? I am concerned in regards to pre existing conditions as well.

 

"A consultation with a top specialist for example usually around 2000 baht. Di not get medications from a hospital pharmacy, there is a huge mark up and most medications that are prescription only in the US can be bought over the counter here. Narcotics, steroids and pysch meds are pretty much the only exceptions:..yes the meds things is cool..Most you can get sans a scrip and can buy much cheaper at Tesco or a private pharmacy..Quality of meds here is good and prices low..Yes consults are cheap-1000 to 2000..

 

"

There are no special plans of the type you mention and you will not have online access to your records but some doctors are willing to share their email address with you and can easily get copies of all results etc at each visit. You pay as you go unless it is covered by insurance",  Agree understood

[newarrior]

4 hours ago, TallGuyJohninBKK said:

Another quirk that American users of health care here need to get used to, at least in my experience, is when your care is all said and done and you go to the billing department, they'll often simply tell you the amount due, and not even bother to provide you with an itemized list of charges.

 

In my experience, you almost always have to ask them to provide such an itemized list, and specifically ask them to provide a version in EN instead of Thai, unless you're a TH reader. I've regularly run into that situation at BNH, Mission, St. Louis and others.

 

It's not that the hospital billing staff won't provide an itemized list of charges upon request. They will and do. The odd part to me is that they, by default and in the absence of an itemized bill, expect me to fork over X thousand or XX thousand baht for medical care without having any idea what I'm being charged for.

 

Never run into that but that is not suprising given what we know of LOS

[TallGuyJohninBKK]

8 minutes ago, newarrior said:

What is output cover ?) 

 

That was Sheryl's shorthand for "outpatient" coverage for one's medical insurance policy.

 

I believe her broader advice here is that anyone who can afford it should definitely have health insurance coverage for Thailand, inpatient coverage at least at a minimum of 3M baht per episode.

 

I believe she was also suggesting above that adding outpatient coverage might not always be necessary, because the cost of outpatient care is relatively reasonable.... though...you do have to be careful because there can be some very expensive procedures like MRIs and such that hospitals may consider as outpatient procedures.

 

 

[moontang]

42 minutes ago, newarrior said:

That 700 depends on many things...And yes there are hassles in the USA I DO NOT miss...1st the many layers--insurance agent if insured, pharmacy/mail in pharmacy, Obamacare if subsidized, the insurance company...Getting to from the appt//making the appt..Limited hours of doctor..  Co pays, deductible...Many cons but many pros as well..best if your employer sponsors the plan..Bumrungrad has been taken over by Islam. ? <deleted>..Explain

For starters it is a short walk from "Soi Arab." A large number of their patients are Muslim, and a high percentage of the visitors are, too.  I was over there at a store called New City to buy something sexy for the GF, like they sell at New City Chiang Mai... I was the only white guy to be seen, and they only sell very conservative pajamas at the store.  They have been a big part of the somewhat successful medical tourism movement.  For the middle easterners it is a no brainer choice compared to Americans. The people flying in for specific treatments are mostly middle eastern. If you look at this area, the wealthy countries have equally good facilities, and the poorer ones could never afford BHI.  The Europeans mostly get nanny state care, as do the Oz.  But, there will be a sprinkling of them, just like Americans... maybe cosmetic, or maybe they are willing to pay for quicker service.  Good hospital, no doubt, but it is a money machine.  Like hotels here.. No need to go cheap, but no need to go to the most expensive.  There are private labs and imaging systems that will do the test and email you the results in an hour, no referral required.  Dr. Consultation is cheap here, and the outpatient insurance is relatively expensive.. and the best doctors may work at five different hospitals with all different pricing.  Check with Aetna for good inpatient coverage and manage yourself.   And in the meantime, you can get top notch accident and travel medical from Tokio Marine, which bought out Houston casualty a few years ago.  They are A+ rated by AM Best, unlike what the brokers here sell.. well let's just say I have never seen anyone state the rating of the insurance they bought here.. and often when I check, they won't even be rated.  But, the catch with travel medical is you may get into a battle about pre-existing conditions, but say you have a million usd in coverage, they might give you 10% of that for acute onset of pre-existing condition, which might be a lot more than blue cross, etc will give you.  But, evacuation would still be covered, and repatriation, too.  You can do travel medical and extend it up to 364 days, then you start again... but don't think for a second that you have any guarantee of long term coverage with pre-existing conditions with any of them... they can simply jack your rates up so high, it would be better to self_insure. 

 

https://www.tmhcc.com/en-us/

[newarrior]

2 minutes ago, TallGuyJohninBKK said:

 

That was Sheryl's shorthand for "outpatient" coverage for one's medical insurance policy.

 

Khao jai..thanks !

[TallGuyJohninBKK]

Someone above mentioned the notion of whether or not there are primary care physicians here, as there are in the U.S., and the answer was basically, no there are not... Almost everything here is via a "specialist."

 

That's one of the downsides I see to the Thai medical system, among other things.... Not so much the lack of a primary care physician in the insurance meaning of the term. But the lack of a primary care physician in the sense of someone who's really your "family" doctor who keeps your medical history, who knows you personally from recurring visits, and who can treat you for all the basic things... 

 

Here, because of the specialist focus, every time you want to be seen for something, you're often pretty much starting from scratch with a doctor, who most of the time may not know you or anything of your medical history beyond whatever he/she gleans in the brief appointment interview.

 

And then contributing further to that, is the approach that Sheryl rightly advised above, and that's that the patient basically needs to do doctor shopping every time something new arises... You can't just assume that you'd find a good doctor for malady A at your local hospital, because the best or better doctors for Malady A might be at the hospital across town, even though your local hospital may have very good doctors for Malady B....

 

So the result, in my view, is patients tend to get very fragmented medical advice and care... doesn't mean it's not good, just means, it's fragmented...IMHO....

 

Dr. Nick from the U.S. at Mission Hospital, on the other hand, is probably as close to a general family doctor as most expats are going to find here. And we're very lucky to have him practicing here in BKK.

 

[NancyL]

28 minutes ago, NCC1701A said:

there are a lot of people with money who fly from the mid east to go to Bumrungrad.

very common to see women in full burkas with only their eyes showing. 

Bumrungrad is setup to cater to their belief system where women cannot be alone with a man, even a doctor.  

 

For several years after we moved to Thailand, I'd go to Bumrungrad from Chiang Mai each year for an annual cardiac checkup needed since I have a congenital heart condition.  While I was there, I'd also have female checks and anything else needed.  The first couple years Hubby came, too, but decided he could get the check ups he needed in Chiang mai, so I made the trips to Bumrungrad alone.

 

Each year, the percentage of patients from the Middle Eastern countries increased and it got to where I didn't feel comfortable there as a woman on my own.  For example, in preparing for a mammogram, patients are asked to change into hospital garb and wait on chairs just outside the mammogram rooms.  The Arab woman would remove their street clothes under the burkas, put on the hospital garb and then put the burkas back on over their hospital garb and go to sit outside the xray rooms, WITH their husbands by their side, most often dressed in a sloppy tee shirt and cargo pants.  These men would eye me over like I was a Nana plaza bar girl instead of a grandmotherly lady feeling very venerable in hospital garb without underwear.  In the U.S. men are not permitted into the waiting area outside the mammogram machines for this reason.  Many woman aren't too keen about this test and they want to make the patients as comfortable as possible.

 

After a year or two of this, I brought a black cape with me to Bumrungrad and used it like a burka over hospital garb while I glared at the Arab oglers straight in the eye.  Eventually Bangkok Hospital-Chiang Mai opened and snared a couple top cardiologist professors who were retiring from CMU, so no need to go to Bumrungrad any longer. 

 

I did have one fun experience at Bumrungrad with the Arab men while preparing for an eye exam.  They had a darkened room where about 15 people were receiving eye drops to dilate their eyes ahead of their exams.  It was a series of three drops, administered over 15-20 minutes.  With each application the Arab men would whine and moan because the drops stung a little, while the only two who remained stoic where myself and the only other female patient in the room, an elderly woman from India.   

[NancyL]

19 minutes ago, TallGuyJohninBKK said:

Someone above mentioned the notion of whether or not there are primary care physicians here, as there are in the U.S., and the answer was basically, no there are not... Almost everything here is via a "specialist."

 

That's one of the downsides I see to the Thai medical system, among other things.... Not so much the lack of a primary care physician in the insurance meaning of the term. But the lack of a primary care physician in the sense of someone who's really your "family" doctor who keeps your medical history, who knows you personally from recurring visits, and who can treat you for all the basic things... 

 

Here, because of the specialist focus, every time you want to be seen for something, you're often pretty much starting from scratch with a doctor, who most of the time may not know you or anything of your medical history beyond whatever he/she gleans in the brief appointment interview.

 

And then contributing further to that, is the approach that Sheryl rightly advised above, and that's that the patient basically needs to do doctor shopping every time something new arises... You can't just assume that you'd find a good doctor for malady A at your local hospital, because the best or better doctors for Malady A might be at the hospital across town, even though your local hospital may have very good doctors for Malady B....

 

So the result, in my view, is patients tend to get very fragmented medical advice and care... doesn't mean it's not good, just means, it's fragmented...IMHO....

 

Dr. Nick from the U.S. at Mission Hospital, on the other hand, is probably as close to a general family doctor as most expats are going to find here. And we're very lucky to have him practicing here in BKK.

 

Here in Chiang Mai we do have a "family doctor" in Dr. Nisachon Morgan who has an independent clinic where she can handle many basic services and knows the best specialists in town for referrals.  Plus, she's well-respected by the area hospitals, so she can cut thru delays and red-tape for her patients when they need specialized treatment.

 

And there are several specialists who do a good job of taking on the role of Primary Care Physician if a patient communicates with them that they consider that doctor to be their PCP.  For example, if someone has issues with blood pressure and high cholestrol, his/her cardiologist could take on the role of PCP since the patient will be seeing the cardiologist a couple times a year for monitoring of those conditions.

 

My husband's cardiologist has done a good job of keeping on his case about monitoring his PSA, with long discussions that "watchful waiting" for someone with an elevated PSA reading doesn't mean ignoring the condition and ordering PSA testing at the same time he's having a cholestrol check.