CT Scan/ Lung Biopsy Cost & Health Insurance

[Tricksy]

I had an annual check up at Samtivej Hospital, Bangkok Soi 49, yesterday and they saw differences in my chest x-ray of my lung blood vessels versus x-ray 17 months ago.  They didn't mention spots just general enlargement of blood vessels or lymph nodes if I understood correctly.

I'm 50 and never smoked, very light drinker, very slightly over weight do a little daily jogging.  No real symptoms.  Never any serious health issues, had some small cysts on my kidneys that were not a concern but now a big larger and slight concern. Also Cholesterol high in the 222 to 244 range.

They said I should have a CT Scan with contrasts on my chest which cost 25k baht which I have had done this morning.

They were also talking about a lung biopsy. I enquired about price and they are saying generally about 50k to 80k depending on the type.

I am Irish, no medical card, and don't have any medical insurance apart from normal travel insurance.

Just want to find out if I need this lung biopsy should I do it here or is there a cheaper option worth going for in a different hospital.

 

I had heard the Pattaya City Hospital was good value so I rang them about price of CT scan but they couldn't give me a price and said their machine was out of action.

I don't really know about health insurance here, (or anywhere) but if there is anyway to reduce the cost of this treatment or any future treatments would appreciate any advice.

Thanks

Tricksy

[Tricksy]

Just a more specific update...

 

They don't see any problem with the lungs but with the lymph nodes around the lungs & thorax...mediastinal lymphadenopathy from the CT Scan.

 

Now they wish to take a biopsy of the lymph nodes down the throat I think.  

 

EBUS-TBNA for tissue diagnosis.

 

The cost here in Samitavej is 200k to 220k they are saying.

 

They said it is not urgent but should be done asap.  They said it would be difficult for me to get it done in a govt hospital due to language & waiting.

 

They said the private hospital Rama 9 should be capable and cheaper.

 

So any advice on where to do it and how to reduce the cost would be much appreciated.

 

Cheers

 

Tricksy

[Sheryl]

You can't get insurance for this as it is a pre-existing condition.

 

It will be cheaper in a government hospital but waits will be considerable and there will be language barriers with all but the doctors. They ate not easy places to navigate.

 

How long are you here for? Can you not get this done in yout home country?

 

What they are proposing to do is down the throat and then piercing the lung tissue with ultrasound guidance to get a sample of the nodes.

 

It is a fairly new approach less invasive than alternatives but dies need specialized equipment and training. What is the name of the pulmonologist?

[Tricksy]

Hi Sheryl,

Thanks for taking the time to reply.

My own circumstances is that I've just arrived in Thailand for a week en-route to China (Macao). I wasn't intending to return to Ireland or Europe until July next year. I'm just back from Ireland after being called back there for a month due to a family emergency.

The doctor who has attended me in Samitavej was Dr Kanya Vorakitvat.  I am meeting her professor later today Dr Anan Wattanathum who I believe would be performing the proceedure if I go with them.

I have read in other posts here that alot of these Drs would also be doing the same work in Govt Hospitals at a lot cheaper price if you could negotiate that system.

I am going to Param 9 hospital as well to see what they say & their costs.

As you said it is a newer proceedure and I don't know the cost/benefits compared to older more invasive proceedures.

If this proceedure is necessary then I need to find the best solution on cost for a good job.

200k to 220k is a lot for what is ultimately just a test and not a treatment.  And the results of which will, I am hoping, be confirmativly benign (given no other symptoms). 

They were also asking about exposure to Tuberculosis and I said no but just thinking about it I have been in a relationship with an Asia woman who had several health issues when she was younger so I may have to revisit that.

 If there is a large price difference with other locations (I hope????) then maybe I do need to hop on plane back to Ireland... or Europe or.. somewhere else in Asia. 

I have no idea what other countries would be more cost effective to do this in so if you or anybody has any experience/ideas I am all ears.

Thanks again for any input. 

I'll also keep updating this post so as it may be useful for someone with a comparable issue in future.

Cheers

Tricksy

[Sheryl]

It is unlikely to  be cheaper at acceptable quality elsewhere in the region.

 

It will be cheaper at a government hospital and Prof. Anan can be seen at the military hospital Phramongkutklao (open to the general public, government facility). Possibly he can be seen through an after hours clinic there. But there will be waits and  possible delays and you need a Thai speaker with you to help navigate the first time at least.

 

This really is the best diagnostic approach. Other options risk not sampling the right area and involve either chest surgery or piercing the lung through the chest with a large bore needle which carries risks.

 

This is unlikely to end with just a "benign" finding. Mediastinal lymphadenopathy is abnormal and something is wrong. May be benign in the sense of not cancer but it will probably be something.  The differential diagnosis for this includes lymphoma, sarcoidosis, and TB among other things. Sarcoidosis  (an autoimmune disease) is more common in Irish people than elsewhere and can be asymptomatic initially so certainly on the list of possibilities.

 

The procedure will hopefully yield a diagnosis but then there will be the question of where to get treatment.  And depending on what it is, treatment could be expensive.

 

 I just noticed you have travel iNsurance. Check the policy it might pay for a flight home for this.

[Tricksy]

Thanks again for another helpful & informative post.

I went to Parama 9 hospital today and spoke with Dr Pornchai who looked at my records and then he referred me to another doctor, whose name I didn't get unfortunately, who gave me an even more detailed explanation of everything and the possibilities.

As you suggested he said the most likely cause was Sarcoidosis stage 1 which if true would no require treatment.

The Ebus-Tbna was still recommended however the costs would be significantly different.  He said it should be no more than 100k baht perhaps 80k.  Costs would include an ambulance trip from Parama 9 to Chulalongkorn Hospital for the proceedure and back plus 1 nights stay in Parama to monitor me.

I understand that the ambulance trips can be very expensive and this would seem to include at least one unnecessary one.

He said the Ebus-Tbna costs 20k to 30k in Chulalongkorn Hospital it being a govt hospital.

I had to wait on for this Dr and was unable to reschedule my appointmant with Prof Anan so I haven't met him yet.

So it seems I have 3 realistic options in Thailand...

1. Go with the Parama 9 for 80k to 100k

2. Find a suitable English speaking Thai and pay them 2000 baht to come with me to Chulalongkorn Hospital for x hours.

3. Same as above but to military hospital Phramongkutklao you mentioned for Prof Anan.

I will also investigate the costs in Ireland.

Cheers

Tricksy