Cost of health insurance

[OzMan]

I sympathies with the Government wanting retirees to have health insurance My experience with private health insurance in Australia is that I paid a lot of money but received very little in return. Many Australian's are now cancelling their private insurance because they realise that the only beneficiary is the insurance company. I am sure the same will happen in Thailand, pay for Government mandated health insurance and see how little you get back when you make a claim.

[scubascuba3]

The govt 440k is a waste of time but if you want insurance you need to look about for better value insurance.Its all a gamble though. Will they deny the claim?50/50 i reckon

[from the home of CC]

next to the legal profession the biggest mafia in the world..

[Sheryl]

3 hours ago, scubascuba3 said:

The govt 440k is a waste of time but if you want insurance you need to look about for better value insurance.Its all a gamble though. Will they deny the claim?50/50 i reckon

 

Hardly.

 

There is no uncertainty at all with a reputable insurer if you provided all required information honestly at the time of applications - unless the claim involves something the terms and conditions clearly exclude, which is spelled out clearly (and NOT in "fine print") in the policy.

 

Mind, I am not referring to the government mandated insurance here but to solid, reliable insurance companies with sensible policies that (unlike these 400/40 plans) offer meaningful coverage.

 

 

 

 

[scubascuba3]

 

Hardly.

 

There is no uncertainty at all with a reputable insurer if you provided all required information honestly at the time of applications - unless the claim involves something the terms and conditions clearly exclude, which is spelled out clearly (and NOT in "fine print") in the policy.

 

Mind, I am not referring to the government mandated insurance here but to solid, reliable insurance companies with sensible policies that (unlike these 400/40 plans) offer meaningful coverage.

 

 

 

 

I queried with a broker the exclusions and i questioned the vagueness of them, an interesting reply:

 

"I realize that exclusions of insurance companies can be quite vague[emoji852]. Unfortunately, the companies are bound to thephrasing of the exclusions set by the underwriter (in case of April this is LMG). In general I can say that it all really depends on the medical report your doctor would send out in case of hospitalization. For example: if the doctor’s letter mentions anything about there being a direct relation between the exclusion X and the condition for which you are hospitalized, it will fall under the exclusion set below. If the doctor’s report makes no mention of this, the insurance company will cover"

 

[Sheryl]

Since the standard  exclusions are limited to things like suicide, cosmetic procedures, results of illegal actions etc this is very rarely an issue.

 

If you have a specific exclusion (not standard, but rather applied to you specifically because of a pre-existing condition) then of course conditions due to it may not be covered. Most policies don't have such exclusions.

 

None of this adds up to "50-50 odds" of any claim being covered.

[oxysong]

For me self funding,not that in 20 odd years I have funding anything spectacular,and even that was selective where I had it done (India a very small fraction of Thailand)   Govt.hospitals here are mostly OK,  its when you step inside the for profit private hospitals that major problems,and they will occur,just stay well away. If I had insured I would have looked back and thought what a waste,even more so now ,too old for meaningful insurance cover

 

  Even with insurance you are not home and dry,the pot will run dry sooner or later,probably sooner, then govt.hospital beckons.  If UK or Aussie,just clear off back 'ome if it looks an expensive outlook,....its what you tell them on arrival home country that dictates

[BritManToo]

1 hour ago, Sheryl said:

Since the standard  exclusions are limited to things like suicide, cosmetic procedures, results of illegal actions etc this is very rarely an issue.

I had accident insurance through K-Bank, fell over and broke my jaw, they said it was 'cosmetic' so not covered.

The jaw was broken and the teeth forced back into my mouth.

They did pay for the wound to be stitched, but not the jaw to be set.

 

Only claim I ever had, and the last Thai insurance I will ever buy.

[Sheryl]

I had accident insurance through K-Bank, fell over and broke my jaw, they said it was 'cosmetic' so not covered.
The jaw was broken and the teeth forced back into my mouth.
They did pay for the wound to be stitched, but not the jaw to be set.
 
Only claim I ever had, and the last Thai insurance I will ever buy.

You should have appealed that to the OIC.

You would almost certainly have won.

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[BritManToo]

3 minutes ago, Sheryl said:

You should have appealed that to the OIC.
You would almost certainly have won.

Hardly worth it for the 1,700bht the 6 visits cost.

(1,700bht for fixing the jaw, 1,800bht to rebuild two teeth that had snapped in half)

More than made up the savings by not paying the 2,500bht premiums for the next four years. 

[Lacessit]

Disagree with the OP. I have top level private health insurance in Australia. I pay $2300 a year.

Over the past 12 years, I have had multiple cystoscopies and several other surgeries. Have not paid out a single cent.

If the OP needs something like a hip or knee replacement, he will find out agonizingly the waiting list for surgery under Medicare has waiting lists of up to 18 months. With private health cover, 1 month maximum.

[scubascuba3]

If the OP needs something like a hip or knee replacement, he will find out agonizingly the waiting list for surgery under Medicare has waiting lists of up to 18 months. With private health cover, 1 month maximum.

If need it quick can pay for it and consider Thailand and India

[oxysong]

42 minutes ago, Lacessit said:

Disagree with the OP. I have top level private health insurance in Australia. I pay $2300 a year.

Over the past 12 years, I have had multiple cystoscopies and several other surgeries. Have not paid out a single cent.

If the OP needs something like a hip or knee replacement, he will find out agonizingly the waiting list for surgery under Medicare has waiting lists of up to 18 months. With private health cover, 1 month maximum.

Knee Replacement Surgery by W Pratiksha Hospital

Variant: TOTAL KNEE REPLACEMENT - UNILATERAL (Implant Excluded) Rs. 158000.00

Variant: TOTAL KNEE REPLACEMENT - BILATERAL (Implant Excluded) Rs. 248000.00

 79000 baht guaranteed while 'plane does turn-a-round.   Surgical team awaiting at airport,nothing quicker than that

[Lacessit]

13 minutes ago, oxysong said:

Knee Replacement Surgery by W Pratiksha Hospital

Variant: TOTAL KNEE REPLACEMENT - UNILATERAL (Implant Excluded) Rs. 158000.00

Variant: TOTAL KNEE REPLACEMENT - BILATERAL (Implant Excluded) Rs. 248000.00

 79000 baht guaranteed while 'plane does turn-a-round.   Surgical team awaiting at airport,nothing quicker than that

Well, if you want to trust yourself to third world surgeons, be my guest. Jayant Patel ring a bell? If they screw up the operation, please explain what recourse you will have.

 

[BritManToo]

1 minute ago, Lacessit said:

Well, if you want to trust yourself to third world surgeons, be my guest. Jayant Patel ring a bell? If they screw up the operation, please explain what recourse you will have.

 

if the NHS screw up, there's not much come back either.

They killed my mom on the operating table, and just said, "she had cancer she was going to die anyway"

 

[oxysong]

1 minute ago, Lacessit said:

Well, if you want to trust yourself to third world surgeons, be my guest. Jayant Patel ring a bell? If they screw up the operation, please explain what recourse you will have.

 

Had this time immemorial,  one guy (not a clue)  just google/Facebook various hospitals wherever the need is or wants.  Cannot do that in thailand,even infection rates cannot quote on,all very very secretive,...like to see the Aussie hospitals,bet they are packed with Indians.....at gold coast airport observing incoming Indian flights,could see bunches of Aussies congratulating themselves as they stepped into airport lounge

[from the home of CC]

3 hours ago, scubascuba3 said:

I queried with a broker the exclusions and i questioned the vagueness of them, an interesting reply:

 

"I realize that exclusions of insurance companies can be quite vague. Unfortunately, the companies are bound to thephrasing of the exclusions set by the underwriter (in case of April this is LMG). In general I can say that it all really depends on the medical report your doctor would send out in case of hospitalization. For example: if the doctor’s letter mentions anything about there being a direct relation between the exclusion X and the condition for which you are hospitalized, it will fall under the exclusion set below. If the doctor’s report makes no mention of this, the insurance company will cover"

 

An unscrupulous doctor could be a gold mine to one of these companies. I remember my company doctor where I worked many years, decisions invariably went in the company's direction prompting outside consultations.

[Lacessit]

1 minute ago, BritManToo said:

if the NHS screw up, there's not much come back either.

They killed my mom on the operating table, and just said, "she had cancer she was going to die anyway"

 

I must admit there is a cover-up culture in Australia too, although incompetents do get weeded out. The only place where recourse is really available is America. However, the lawyers and huge awards for malpractice mean medicos there pay out a fortune in medical indemnity insurance, which then gets passed on to patients. We have to be careful what we wish for.

[scubascuba3]

An unscrupulous doctor could be a gold mine to one of these companies. I remember my company doctor where I worked many years, decisions invariably went in the company's direction prompting outside consultations.

Exactly, puts me off sealing the deal with the insurance co. I'm still in favour of self insuring

[DaRoadrunner]

2 hours ago, BritManToo said:

Hardly worth it for the 1,700bht the 6 visits cost.

(1,700bht for fixing the jaw, 1,800bht to rebuild two teeth that had snapped in half)

More than made up the savings by not paying the 2,500bht premiums for the next four years. 

Cheap, where did you get that done? (And you are correct, insurance companies are known world wide for finding excuses not to pay).

[DaRoadrunner]

1 hour ago, BritManToo said:

if the NHS screw up, there's not much come back either.

They killed my mom on the operating table, and just said, "she had cancer she was going to die anyway"

 

Sounds familiar. The NHS killed my Dad too, he had a history of heart attack and the doc prescribed drugs that were contraindicated for someone with history of cardiac conditions. Bye Dad.

 

There is a saying.... "Doctors bury their mistakes."

[Lacessit]

4 hours ago, DaRoadrunner said:

Sounds familiar. The NHS killed my Dad too, he had a history of heart attack and the doc prescribed drugs that were contraindicated for someone with history of cardiac conditions. Bye Dad.

 

There is a saying.... "Doctors bury their mistakes."

Apparently the best specialisation is dermatologists. Their patients never die from skin diseases, and they never get better.

[OzMan]

Two further points. My ex-wife was a lawyer for an insurance company in Australia, and she said I would be astonished how much effort insurance companies put into rejecting legitimate claims. In my post I was not commenting on how much an insurance company would give me back, but how much insurance would cost per year compared to paying for it myself. In Australia I had top cover at about $10k per year, which I had for 15 years. Each year my claim for the family was about $2k. Serious issues would come under Medicare at not much cost. My daughter had a kidney transplant last year and received my kidney. How much do you think my $10k a year comprehensive health insurance paid in return? Zilch, zero, nothing, FA. Leaving me significantly out of pocket.

[scubascuba3]

Two further points. My ex-wife was a lawyer for an insurance company in Australia, and she said I would be astonished how much effort insurance companies put into rejecting legitimate claims. In my post I was not commenting on how much an insurance company would give me back, but how much insurance would cost per year compared to paying for it myself. In Australia I had top cover at about $10k per year, which I had for 15 years. Each year my claim for the family was about $2k. Serious issues would come under Medicare at not much cost. My daughter had a kidney transplant last year and received my kidney. How much do you think my $10k a year comprehensive health insurance paid in return? Zilch, zero, nothing, FA. Leaving me significantly out of pocket.

Majority of people will pay more than they get back, that's how insurance is profitable to companies

[Sheryl]

6 minutes ago, scubascuba3 said:

Majority of people will pay more than they get back, that's how insurance is profitable to companies

 

Of course.

 

Same is true of fire insurance, car insurance, any type of insurance.

 

And those people who pay more than they get back are not unlucky, they are lucky.

 

What makes insurance worth getting is that no one knows, in advance, which group they will fall into. A catastrophic illness or accident could befall any of us at any time; insurance transfers the associated risk from us to the insurance company.

 

Another advantage of insurance is guaranteeing the ability to pay out a  potentially large sum at any time without advance notice. That you may, over time, pay more into a policy than it pays out to you does not mean you would have had ready access to the needed cash every time you did have a claim.  That would be true only of people with very large amounts of money set aside.

 

For your average person living paycheck to paycheck (or pension to pension etc ) it is possible to make monthly insurance payments but not possible to meet unexpected unplanned medical expenses of any size. Same idea as house buying: it is vastly cheaper in the long run to buy for cash than to get a mortgage but most people simply can't front that amount of cash, and a mortgage, despite the added cost over time, is their best option.

 

I just a year ago changed insurance policies and signed on with a new company after careful research. Paid about USD $2,800 for 1 year premium, with a $500 deductible. Perfectly healthy at that time and with no risk factors -- don't drink, don't smoke, healthy diet, normal lipids etc etc.And family history of longevity.

 

I could very well have gone a decade or more without a single claim, but as it happened a motorcycle slammed into me at high speed while crossing the street (in a designated crosswalk, yes I looked both ways, broad daylight, the nearest vehicles were 200 meters away as I started across, for all you 'she must have done something wrong or it wouldn't have happened' -ers). Without going into all the gory details of the resulting injuries,  the hospital  bill slightly exceeded USD$20,000, about 8 times the premium paid. (I do not consider myself lucky for that!!!). All  but the $500 deductible was paid directly to the hospital promptly with no problems and enabled me to get care at the only halfway decent hospital in the place where this happened (Cambodia).

 

The hospital was not going to touch me without either money up front or insurance guarantee. Had I been uninsured it would have delayed urgently needed emergency surgery with bad consequences and also taken a big chunk out of my savings. I am very, very  grateful I had the insurance and it certainly greased the wheels in getting me the care I needed very fast. And it made an already difficult  time less traumatic not to have any associated money worries.

 

But I took it out the policy fully expecting not to have any large claims any time in the foreseable future. And, of course, most people in the insured pool with me had no claims this year or only really small ones, and it is their premiums which paid for my care while still leaving the insurance company in the black.

 

With luck I will still end up paying more in premiums than I get in payouts by the time I die...though it will take some before I draw even.

 

You never know.

 

99% of the people on this board who say they prefer to self insure are not remotely

self-insured i.e. they do not have 1-3 million baht cash immediately on hand for medical expenses and means of replenishing it. They are simply uninsured.  If someone does have that kind of money fine, but in my experience most such people will still opt to insure if they can as a way of protecting their assets.

 

[scubascuba3]

With accidents its quite straight forward, no quibble from insurers, although they are meant to check if you are over the alcohol limit. They don't need to check pre existing conditions

[onera1961]

I must admit there is a cover-up culture in Australia too, although incompetents do get weeded out. The only place where recourse is really available is America. However, the lawyers and huge awards for malpractice mean medicos there pay out a fortune in medical indemnity insurance, which then gets passed on to patients. We have to be careful what we wish for.

Yes awards are huge but it was invariably due to the negligence of doctors or hospitals. Malpractice insurance costs only add to 1% of the US health care expense which is almost 17% of the GDP, highest in the world. It is also extremely difficult to win these cases and very few even reach to the trial level. If the awards are not huge, why. Lawyer will take it pro bono?

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[Sheryl]

3 hours ago, onera1961 said:

Yes awards are huge but it was invariably due to the negligence of doctors or hospitals. ...

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Actually I would disagree with this. Juries tend to conflate bad outcomes with malpractice and they are not always (or even usually) one and the same.

 

The most egregious malpractice I've seen in the US (and I saw plenty) never went to court.

 

And I've certainly heard of cases where, although the patient suffered an unfortunate outcome, malpractice was in no way proven yet large award given.

 

One of the difficulties is that, for lack of other viable mechanisms, lawsuits are the only recourse for people seeking damages related to medical treatment (except in the case of vaccines where there is a model system in place by govt)  and also the only effective avenue for going after a doctor for malpractice.  Note that these 2 things are not the same and can occur independent of each other.

 

What is needed is

 

(1) a no-fault reimbursement system for people who suffer harm as a result of medical care irrespective of whether that care was properly given or not. A medical panel would review the case and determine whether or not the alleged harm occurred and was likely the result of the medical care, and its severity.  Based on this compensation would be awarded. Physicians and hospitals etc could be required to pay into this system, it would certainly cost less than malpractice premiums do now.. No lawyers needed. The review panel would also be asked to indicate whether they considered there to be a possibility that  care given was not up to minimaly acceptable standards and if they so indicated that would trigger a separate investigation (see below) but have no impact on the damages paid.

 

(2) a robust system of investigating medical malpractice that is completely separate from compensation claims and aimed at safe-guardng the public. This would be much harder to construct given the poor track record of medical boards etc in disciplining their own, but removing the issue of financial compensation and associated emotive aspects would help focus things.

 

 

 

 

[BritManToo]

4 hours ago, Sheryl said:

99% of the people on this board who say they prefer to self insure are not remotely

self-insured i.e. they do not have 1-3 million baht cash immediately on hand for medical expenses and means of replenishing it. They are simply uninsured.  If someone does have that kind of money fine, but in my experience most such people will still opt to insure if they can as a way of protecting their assets.

Without hospitals overcharging insurance companies, you'd probably only need 300-500kbht of your own money.

This is why the American model hospital system is not accepted in the rest of the civilised world.

 

Without insurance and rich foreigner pricing, your bill would have been more like $2,000 for a Cambodian native.

You and your 'big insurance' are the problem, not the solution.

You're destroying affordable healthcare for the rest of the world.

[Sheryl]

I assure you, the care I received - inclusive of 2 specialized surgeries and 14 days inpatient care, PT etc - could not be delivered anywhere in the world for only $2,000.

 

The hospital in question does not have two tier pricing, Cambodians are charged the same and most of them are uninsured (but of course, wealthy). Ditto the many Chinese treated there - usually uninsured too, though well off.

 

In fact, my bill contained a discount negotiated by the insurance company.