Hospital Billings/ self-payor vs insurance

[THAIPHUKET]

Assumptions: Age 70+

To keep premium low 

H. insurance policy has a high deductable and a finite amount.

In the hospital you're being asked: cash or insurance?

Question: regardless what my answer is I should have the right to see the final charge to the insurance and and make then a final decision.

The reason is insecurity if the cash charge will be fair.   Does one or does one not? Goal: to use the finite insurance limit only for major procedures and not to waste cover.

[scubascuba3]

it may effect premiums either way once they know what condition you've got

[THAIPHUKET]

4 minutes ago, scubascuba3 said:

it may effect premiums either way once they know what condition you've got

Very true. That condition is evidenced clearly in the final invoice . That's why I should have the right to make an educated decision.

Otherwise I could be exposed to hefty overcharges.

[Sheryl]

I am not clear what your question is?

[THAIPHUKET]

2 minutes ago, Sheryl said:

I am not clear what your question is?

I try again.

I speak from experience. For a minor procedure I went to a private hospital and at the end had to pay an outrageous, unverifiable Bill.

I want the option to pay the lower amount, for that I must see the amount that would be charged to the insurer. 

No way they could have charged to the insurer.

 

Transparency if all I want.

[lopburi3]

1 hour ago, THAIPHUKET said:

I try again.

I speak from experience. For a minor procedure I went to a private hospital and at the end had to pay an outrageous, unverifiable Bill.

I want the option to pay the lower amount, for that I must see the amount that would be charged to the insurer. 

No way they could have charged to the insurer.

 

Transparency if all I want.

You just ask for a detailed receipt - any cashier can provide - all items will be line item expensed just as they would be to insurance company.  The cash receipt does not include anything but general categories but the detailed receipt will list everything and you can always question charges you feel are not valid.

[Etaoin Shrdlu]

I think insurers negotiate reduced prices for hospital services when concluding agreements for direct billing.  You can get a detailed receipt showing the costs that you incur, but you may or may not see any discounts that would be applied when the insurer actually settles the bill via direct settlement. I doubt either the insurer or the hospital would disclose this information. No harm in asking, however.

[THAIPHUKET]

That is helpful. Nevertheless, that doesn't give an Idea if cash payor is any better off than what a insurance is being charged.

[Etaoin Shrdlu]

16 minutes ago, THAIPHUKET said:

That is helpful. Nevertheless, that doesn't give an Idea if cash payor is any better off than what a insurance is being charged.

Insurers with direct billing agreements may receive discounts that won't be available to the patient if the patient settles with the hospital. This is the reason that insurers often have co-pays or higher deductibles when patients pay the hospital first and then submit bills for reimbursement. Those who pay cash probably pay more than an insurer does if the insurer has a direct billing agreement with the hospital. 

[scubascuba3]

i would have thought the more important point is how much will it cost over the deductible, if not too much pay cash and don't claim, if much more than deductible claim thorough insurance.

 

Usually though this is all agreed in advance, not on your way out, so ask for estimated costs which should be ball park. Also ask your insurer

[scorecard]

11 hours ago, THAIPHUKET said:

Very true. That condition is evidenced clearly in the final invoice . That's why I should have the right to make an educated decision.

Otherwise I could be exposed to hefty overcharges.

 

And keep in mind that some hospitals (especially some of the so called 5 star hospitals add a hefty surcharge if you use your health insurance to pay the bill (pay cash and the total bill is X, pay using your health insurance and the total bill is X plus 30, 40% more). 

 

A few years back my Thai son did comprehensive research before taking health Ins., plans for himself, his wife and 3 kids. Two famous global health insurers made a strong point of mentioning that there's a small list of hospital that the ins., companies will not reimburse, no reimbursement at all.

 

My son asked why, both insurance reps (direct employees of the ins., companies said the same thing 'they try to rip off policy holders claiming that there's a very large amount of additional manual administration work for the ins., company, which is untrue, it's fully automated.

 

In fact there's way less admin., work than manually processed claims, so the ins., companies have blacklisted them to protect policy holders. Plus if the ins., companies did accept and pay the additional pay out costs it would ultimately increase premiums. So these hospitals have been blacklisted').

 

Plus one case where: a). Hospitals adds a surcharge to accept insurance card, b). Ins., company reimburses the medical costs to the patient but doesn't cover the surcharge, therefore hospital tells the patient (at the time of the visit) they will receive another bill later for the surcharge costs, or patient can pay the surcharge in cash at time of visit.

Edited June 23, 2021 by scorecard

[BritManToo]

12 hours ago, THAIPHUKET said:

I try again.

I speak from experience. For a minor procedure I went to a private hospital and at the end had to pay an outrageous, unverifiable Bill.

I want the option to pay the lower amount, for that I must see the amount that would be charged to the insurer. 

No way they could have charged to the insurer.

 

Transparency if all I want.

I once had accident insurance ..... then a small accident.

Went to the hospital ....... charge 500bht for cleaning and stitching ........ handed them my accident insurance card ........ signed the paperwork 3,200bht charged to the insurance company.

[bojo]

13 hours ago, THAIPHUKET said:

Assumptions: Age 70+

To keep premium low 

H. insurance policy has a high deductable and a finite amount.

In the hospital you're being asked: cash or insurance?

Question: regardless what my answer is I should have the right to see the final charge to the insurance and and make then a final decision.

The reason is insecurity if the cash charge will be fair.   Does one or does one not? Goal: to use the finite insurance limit only for major procedures and not to waste cover.

For insurance in Thailand, I always choose the highest 'Excess' possible to get the lowest annual premium. When you live in an area you get to know which hospitals are rip offs and how they operate through chatting with fellow expats and locals............... use that info to your advantage...........................................and as Britmantoo highlighted, it's pretty cheap for minor stuff and you wouldn't claim anyway for minor stuff as you would lose your 'no claims bonus'.................I don't think you would ever see the final charge to the insurer really, can't see that figure being divulged to you...............................

[lopburi3]

As point out insurance can both increase and decrease paid bill to hospital - and so can you if you feel some charges are high they can be questioned.  Expect local insurance will receive better rates but insurance does create extra administrative and oversight in my experience at Bangkok Hospital for major surgery stay.  Hospital would only get a day or two and then had to report to get more time and have assigned oversight doctor review everything for US insurance claim direct payment.  

 

I have found for personal payment/claim later that total bills are consistently lower that admission estimates over my years of declining health.  Guess old age is a thing.????

 

Obviously people will have different experiences and needs that will vary by hospitals used to some extent.  But being from USA where health costs are very high (although never had any myself) may have more tolerance for charges than those from paid health care countries.

[lopburi3]

4 minutes ago, bojo said:

I don't think you would ever see the final charge to the insurer really, can't see that figure being divulged to you...............................

Don't know for Thai insurance but for my US insurance always got final bill information on direct payment.

[bojo]

1 minute ago, lopburi3 said:

Don't know for Thai insurance but for my US insurance always got final bill information on direct payment.

I mean that if the OP was asking for a comparison between cash and insurance that they wouldn't tell you the final bill invoiced to the insurance company..................

[lopburi3]

2 minutes ago, bojo said:

I mean that if the OP was asking for a comparison between cash and insurance that they wouldn't tell you the final bill invoiced to the insurance company..................

As said not sure of Thai but quite sure I viewed and signed bills at Hospital for direct payments before leaving (exactly what they were billing insurance company and my deduction that I had to pay).  At one time also had direct payment for out patient service also and same procedure - signed bill and paid deductions at hospital - and had choice to pay same amount myself (if a delay getting insurance approval and did not want to wait).  

[Yellowtail]

Why don't you call Coca-Cola and tell them you want the same price they give to Lotus?

 

I used insurance here for twenty years. I paid cash and sent the bill to be reimbursed and never had any problem. I learned never to tell them I had insurance because it just turned into a big GF.

 

The hospitals on the insurer's "approved" list were the most expensive in the county, I assume because these were able to communicate and provide billing in English.

 

What insurance company do you have?

[Sheryl]

15 hours ago, Etaoin Shrdlu said:

Insurers with direct billing agreements may receive discounts that won't be available to the patient if the patient settles with the hospital. This is the reason that insurers often have co-pays or higher deductibles when patients pay the hospital first and then submit bills for reimbursement. Those who pay cash probably pay more than an insurer does if the insurer has a direct billing agreement with the hospital. 

 

As above.

 

You have to sign papers before discharge in order for your insurance to be billed, and these papers will contain info on what they propose to charge the insurer.

 

However what the insurer will finally pay may differ, it is not unusual for there to be some  back and forth negotiation if the insurer feels the charges are excessive.

[THAIPHUKET]

3 hours ago, Sheryl said:

 

As above.

 

You have to sign papers before discharge in order for your insurance to be billed, and these papers will contain info on what they propose to charge the insurer.

 

However what the insurer will finally pay may differ, it is not unusual for there to be some  back and forth negotiation if the insurer feels the charges are excessive.

I do understand! Thanks everyone

[NancyL]

This is why you should have an international company for your health insurance, not a Thai company that will raise your rates or drop you if you make a claim.  International companies are governed by western rules that prevent these sort of things from happening.

[Sheryl]

55 minutes ago, NancyL said:

This is why you should have an international company for your health insurance, not a Thai company that will raise your rates or drop you if you make a claim.  International companies are governed by western rules that prevent these sort of things from happening.

Exactly.

 

There is no reason not to use insurance if you have it and it is a policy with a western company. You gain nothing at all by self-pay in that situation.

 

 

[Yellowtail]

1 minute ago, Sheryl said:

Exactly.

 

There is no reason not to use insurance if you have it and it is a policy with a western company. You gain nothing at all by self-pay in that situation.

 

 

 

Not arguing, but I have had much better success with paying and submitting for reimbursement than trying to get hospitals to take my insurance card. I had Cigna for years and then Blue Cross for a few years and paying and submitting worked best. 

[THAIPHUKET]

I would have thought so.

Cash down means. No long reimbursement wait. ( Would be very surprised if Thai would be prompt payors )

And no arguing over certain items with a sophisticated insurer . Much tougher than with the insured.

 

 

[THAIPHUKET]

For whatever it's worth.

I got since 2 years WRLife (advertiser here)

They were very flexible. The agent very straightforward and prompt  .

Didn't have any claims yet.

What convinced me that at the height of COVID-19 I had asked RAM hospital to use my brand new member card to get confirmation that I'm covered for Covid. The answer was yes