Question Regarding Public Hospitals in Thailand - and Health Insurance

[BangkokBaksida]

About seven years ago, when I was between jobs, broke, and without health insurance, I developed bladder stones that needed to be removed.  As a foreigner, my first inclination was to try to get the issue resolved at one of those fancy private hospitals.  But the $5,000 cost at a nothing-special private hospital was unaffordable to me.  So, with the help of a Thai nurse English-student friend of mine, I went to a Thai government hospital.  I had to wait for a couple of months to have my procedure done, but boy was it cheap!  $300 for the whole thing, including three nights in the hospital and three meals a day.  (About the same price as the quarantine hotel that I'm staying in right now - without the operation.)  The doctor was wonderful and he did a great job; the nurses were pleased to have a chance to interact with a (handsome) farang patient.  All in all it was a surprisingly good experience.

 

I spent the intervening years since then outside of Thailand, but now I am back - and considering my health insurance options.  Again, as a farang, I tend to think in terms of expensive insurance to be used in expensive hospitals.  I have also heard that government hospitals no longer allow foreigners to pay the "Thai" price.  (Is that correct?  And if so, is there a standard multiplier that they apply to the Thai prices for foreign patients?  Are these prices transparent?  Or is it a matter of what they think they can squeeze out of me?)

 

Anyway, my thinking is as follows:  Even if I had to pay triple the Thai price in this example, it would have still cost just $900 at the government hospital vs. $5,000 at the private hospital.  And my point is that if I could have such an operation done for $900, I could essentially forgo the expensive foreigner insurance and self-insure, thereby saving three or four thousand dollars a year.  Does anybody have any thoughts about/experience with this option?  Is there anything that would prevent me from doing this?  Am I missing something?

 

Thanks very much.

[Pravda]

Yes, you are missing quite a lot.

 

The key word being "emergency"

[scubascuba3]

For accident emergency you could get PA insurance or have the cash ready. There are good govt hospitals so you can compare prices if you have time. With self insure you do need money available quickly. The thing about health insurance is they can easily deny the claim, so all those years of paying can kick you in the balls, most people don't know yet as they haven't claimed 

Edited December 3, 2021 by scubascuba3

[Why Me]

25 minutes ago, scubascuba3 said:

The thing about health insurance is they can easily deny the claim, so all those years of paying can kick you in the balls, most people don't know yet as they haven't claimed

International operators like April, Cigna, Pacific etc. have a good rep. Local ones not so much. You get what you pay for. Like Pravda says it's emergencies you want to take into account when you want access to the best care, no questions asked. Which won't happen without insurance.

 

For planned procedures another option is India. Kolkata and Chennai (10k b. return air) have excellent hospitals costing a fraction of Thai private.

[BangkokBaksida]

30 minutes ago, Why Me said:

International operators like April, Cigna, Pacific etc. have a good rep. Local ones not so much. You get what you pay for. Like Pravda says it's emergencies you want to take into account when you want access to the best care, no questions asked. Which won't happen without insurance.

 

For planned procedures another option is India. Kolkata and Chennai (10k b. return air) have excellent hospitals costing a fraction of Thai private.

Very good point regarding India.  Thanks for reminding me of that option.  I have good friends there whom I can stay with, and I even once had a colonoscopy in Chennai - for less than a hundred dollars.  So yeah, it can be an option for planned procedures.

[BangkokBaksida]

32 minutes ago, Why Me said:

International operators like April, Cigna, Pacific etc. have a good rep. Local ones not so much. You get what you pay for. Like Pravda says it's emergencies you want to take into account when you want access to the best care, no questions asked. Which won't happen without insurance.

 

For planned procedures another option is India. Kolkata and Chennai (10k b. return air) have excellent hospitals costing a fraction of Thai private.

I used April for the last six years while working in Vietnam, and yes, they were fantastic.  So here is an option:  I could get a policy from them with a high deductible - to cover myself for expensive emergencies, and then go to India for anything planned that might not be covered by the April policy.

[scubascuba3]

53 minutes ago, Why Me said:

International operators like April, Cigna, Pacific etc. have a good rep. Local ones not so much. You get what you pay for. Like Pravda says it's emergencies you want to take into account when you want access to the best care, no questions asked. Which won't happen without insurance.

 

For planned procedures another option is India. Kolkata and Chennai (10k b. return air) have excellent hospitals costing a fraction of Thai private.

Yes International operators are better but most go with thai companies to save money, false economy really

[Sheryl]

Do not underestimate what a major event could cost you at a government hospital and do not extrapolate from your simple hospitalization in the past to what hospitalization in the case of a major accident (requiring for example long ICU stay, neurosurgery etc) or catastrophic illness (heart attack/stroke/cancer likewise with specialized surgeries and ICU stays) could cost.

 

A single hospitalization for the sort of things just mentioned in a government hospital can exceed 1 million baht. In a private hospital, 4 million.

 

If you can afford to put aside 1 million baht, and replenish it as used, and are happy to always use government hospitals (understanding there will at times by long wait lists for surgeries etc and that there are some drugs/treatments not available at government hospitals) then yes you could self insure.

 

An important point to keep in mind is that the longer you wait to get insurance, the greater the chance you may find it impossible to get. Past a certain age, or with any chronic health conditions, it becomes difficult to impossible to get insurance. So look at the decision you make now as one that will pertain through the years.

[BritManToo]

2 hours ago, Why Me said:

International operators like April, Cigna, Pacific etc. have a good rep. Local ones not so much. You get what you pay for. Like Pravda says it's emergencies you want to take into account when you want access to the best care, no questions asked. Which won't happen without insurance.

I bought accident insurance (green bank) thinking that, then when I had an accident they refused to pay.

Leaving me to visit the cash machine before they glued the broken bones back together.

Don't assume because you purchased insurance that they will pay. 

Edited December 3, 2021 by BritManToo

[BangkokBaksida]

1 hour ago, BritManToo said:

I bought accident insurance (green bank) thinking that, then when I had an accident they refused to pay.

Leaving me to visit the cash machine before they glued the broken bones back together.

Don't assume because you purchased insurance that they will pay. 

Yes, even worse than being uninsured is being insured by an insurer who doesn't pay when you need them!

[Sheryl]

4 hours ago, BangkokBaksida said:

I used April for the last six years while working in Vietnam, and yes, they were fantastic.  So here is an option:  I could get a policy from them with a high deductible - to cover myself for expensive emergencies, and then go to India for anything planned that might not be covered by the April policy.

That is certainly an option.

 

Though you might want to recall the travel bans of the past 2 years before counting on going abroad for treatment.

 

The only thing to be wary of with deductibles is that while you can always add or increase one, lifetime renewal guarantees do not include the right to drop one. So if you have, since originally getting your policy, developed any chronic conditions (which an international insurer cannot raise your rates for or drop you for) they can, and likely would, refuse to let you drop or decrease your deductible. In other words, when selecting a deductible, think of it as a long term decision and make sure it is an amount you will be able to afford for the long term, after retirement etc.

 

I have April (Global, out of France) and have been very happy with them. I have a US $500 deductible because when I priced it, I found that I'd have to have a claim virtually every year for it not to save me money. I also found that the savings with higher deductibles was not proportional (i.e. not ten times the premium reduction to have a $5,000 deductible compared to a $500 one). Though of course the premiums do go down as deductible goes up.

[BangkokBaksida]

This is all very useful information, Sheryl!  I had no idea about a lot of the things you mentioned, such as not being able to reduce the deductible later, etc.  I am really glad that I asked - and I am glad for the willingness of people like yourself and the others here to share your knowledge.  So, as you advised, I will take this as a long-term decision.

 

I have been in contact with an April representative here in Bangkok, and she provided me with a link to their website where I can check the changes in price of the policy by changing various parameters.  One thing that I noticed is that the minimum amount of coverage appears to be around US$100,000.  Is that much coverage really necessary in Thailand?  Or is this another case of needing to think about the long term?  

 

Also, what about outpatient coverage?  From what I can see, the cost of outpatient coverage increases by around the amount of the coverage, so essentially I would be paying in advance for outpatient coverage that I might not need.  So my feeling is that it doesn't make sense at all to get outpatient coverage.  Do you concur with this?

[sandyf]

15 hours ago, BangkokBaksida said:

I have also heard that government hospitals no longer allow foreigners to pay the "Thai" price. 

This is something i have heard claimed, but not the case at the hospitals I use. You need to do some research on the hospital you plan to use.

When I started to get my blood pressure tablets from the hospital it saved me 30% against the discounted Fascino price.

[BangkokBaksida]

3 minutes ago, sandyf said:

This is something i have heard claimed, but not the case at the hospitals I use. You need to do some research on the hospital you plan to use.

When I started to get my blood pressure tablets from the hospital it saved me 30% against the discounted Fascino price.

A very good point!  Maybe it's not true, at least not everywhere.  I will get my Thai nurse friend to call a government hospital for me and ask this question.  Thanks.

[scubascuba3]

41 minutes ago, BangkokBaksida said:

This is all very useful information, Sheryl!  I had no idea about a lot of the things you mentioned, such as not being able to reduce the deductible later, etc.  I am really glad that I asked - and I am glad for the willingness of people like yourself and the others here to share your knowledge.  So, as you advised, I will take this as a long-term decision.

 

I have been in contact with an April representative here in Bangkok, and she provided me with a link to their website where I can check the changes in price of the policy by changing various parameters.  One thing that I noticed is that the minimum amount of coverage appears to be around US$100,000.  Is that much coverage really necessary in Thailand?  Or is this another case of needing to think about the long term?  

 

Also, what about outpatient coverage?  From what I can see, the cost of outpatient coverage increases by around the amount of the coverage, so essentially I would be paying in advance for outpatient coverage that I might not need.  So my feeling is that it doesn't make sense at all to get outpatient coverage.  Do you concur with this?

Sounds like you are referring to April Thailand not to be confused with April International based in France, best to get an International company insurance to avoid disappointment later

[brianthainess]

I find the government hospitals better (the 'specialists' also worked at private hospitals), as someone (i.e. wife/gf) can stay with you 24/7 if wanted, i spent a total of 5 weeks in isolation (TB). My gf at the time now wife was able to go out and buy me, a soft pillow, soft mattress cover, and a fan. bread and cheese 3in1 coffee etc. total cost with 'falang' food, isolation room, meds, was around $6k..

[BangkokBaksida]

23 minutes ago, scubascuba3 said:

Sounds like you are referring to April Thailand not to be confused with April International based in France, best to get an International company insurance to avoid disappointment later

Aha, another thing that I didn't know.  I just assumed that the local office of April was a representative of the main office, and that I would get the same policy from both.  I have just sent an email to the one based in France.  Let's see what they can offer me.

 

Do you happen to know the main differences between using April Thailand vs. April International in France?

 

Thanks again.

[BangkokBaksida]

Hm, I just sent an email to what I thought was April International in France, and I got an automatic response from the same lady in the Bangkok office of April as I got when I thought I was writing to the Bangkok office.  So does that mean that I would be able to get the "International" policy from the local office?  Again, what would be the difference between the Thai policy and the International one, assuming there is a difference?  Thanks again.

[scubascuba3]

1 hour ago, BangkokBaksida said:

Aha, another thing that I didn't know.  I just assumed that the local office of April was a representative of the main office, and that I would get the same policy from both.  I have just sent an email to the one based in France.  Let's see what they can offer me.

 

Do you happen to know the main differences between using April Thailand vs. April International in France?

 

Thanks again.

FYI Sheryl is a big advocate of April France vs Thailand one. 

 

Big difference is the regs they follow, Intl will be a lot better for the customer, but of course will cost more but worth it if buying insurance

[BritManToo]

18 hours ago, BangkokBaksida said:

I have also heard that government hospitals no longer allow foreigners to pay the "Thai" price.  (Is that correct?  And if so, is there a standard multiplier that they apply to the Thai prices for foreign patients?  Are these prices transparent?  Or is it a matter of what they think they can squeeze out of me?)

I'm still paying 50bht + consumables at my local government hospital.

Best to avoid the places most used by tourists.

[BritManToo]

2 hours ago, sandyf said:

When I started to get my blood pressure tablets from the hospital it saved me 30% against the discounted Fascino price.

I've always found Fascino to be the most expensive pharmacy outside the private hospital pharamicies.

[lopburi3]

2 hours ago, brianthainess said:

I find the government hospitals better (the 'specialists' also worked at private hospitals), as someone (i.e. wife/gf) can stay with you 24/7 if wanted,

Perhaps it is my reading but it is normal in most hospitals for family member to say with patient not in multi person ward and in private facilities bedding and towels are provided for such.

 

There are downsides to government hospitals, beyond language.  Often long waits for operations (which could become serious issue) and most care will not be by the primary physician (only a junior member of his team).  Insurance and option to use private facilities can be a life saver and as said getting that insurance before issues is very important.   

[Sheryl]

3 hours ago, scubascuba3 said:

FYI Sheryl is a big advocate of April France vs Thailand one. 

 

Big difference is the regs they follow, Intl will be a lot better for the customer, but of course will cost more but worth it if buying insurance

To clarify - I do think April Thailand is one of the best of the Thai-issued policies. And a particularly good choice for those needing to meet O-A extension requirements (as they are underwritten by LMG, one of the "listed" companies). But the fact that they come under Thai insurance regs is a disadvantage and the fact that April only administers the policies but is nto the underwriter (that is LMG) is another.

 

Very little cost difference between April Thailand and April France, by the way.

 

Taking into account the level of coverage, foreign policies do not cost more than Thai ones, and even excluding the level of cover, past a certain age the foreign policy premiums are often lower (Thai insurers jack up prices dramatically in the older age brackets).  That so many get Thai policies is more due to lack of awareness of options I think -- that and the O-A visa requirements. Many people -- usually ones form countries where private health insurance is not the norm -- assume that to be insured in Thailand requires buying a Thai policy.  And likewise assume that the performance of Thai insurers with respect to claims is typical of all insurance, everywhere.

[BangkokBaksida]

Thanks Sheryl.  So can you provide me with a link - or some other connection - to get April's French International policy?  As I mentioned, I searched for it on the internet and I wrote to what I thought was the French office, but I got an automated response from the Bangkok office of April.  It looks like somebody is trying very hard to steer me towards the Thai office/policy.

[Sheryl]

The local April office will only sell you the April Thailand policy.

 

While you migjt be able to buy directly from April France you should never get insurance on your own. Aleays go through a good broker as they will not only help you select a polucy but they will also help with claims afterwards. I use AA brokers www.aainsure.net  my broker thete is Jenny  [email protected]

 

Be sure to specify Aoril France not Thsiland. If you are young they may have other suggestions as well.

 

Outpatient coverage is not worth it in Thailand as long as your inpatient only policy covers day surgeries, outpatient cancer treatment and dialysis (that being where outpatient can be expensive).

 

Most international polucies cover to US 1 million. That is more than you need but US 100k would be too low for using private hospitals. Note that maximums may be either per event or per year and there is a big diffetence between the two things.

 

[blackprince]

I think it's quite hard to make generalisations...

 

Last year was the first time in my life I stayed overnight in hospital - I was there 5 weeks. In the first week I tried two different private hospitals, but I moved to the regional government hospital because it had better facilities for my illness, and the service was much better - I felt that I was being viewed more as a human being than as an ATM.

 

The medicines were less expensive in the government hospital (for the same brand), but the private room was about twice as expensive in the government hospital, the technology I needed was roughly similar in price as far as I remember. The total bill was around 1 million baht, which my Thai health insurer paid promptly to the hospitals. Apart from verifying who I was I didn't have to get involved in the payments at all.

 

A friend of similar age has racked up well over 1 million baht as an outpatient over a longer period of time. He paid himself as he did not have insurance.

 

I'm sure people living in different regions have different experience, but as I said "I think it's quite hard to make generalisations..."

 

 

 

 

 

 

Edited December 5, 2021 by blackprince

[sandyf]

21 hours ago, BritManToo said:

I've always found Fascino to be the most expensive pharmacy outside the private hospital pharamicies.

Depends where you go, there are 3 Fascino's in Pattaya and they had different prices. I found the one on North Road and using their discount card to be cheaper than my local pharmacies. But then the hospital was about a third cheaper than them.

[scubascuba3]

4 hours ago, blackprince said:

I think it's quite hard to make generalisations...

 

Last year was the first time in my life I stayed overnight in hospital - I was there 5 weeks. In the first week I tried two different private hospitals, but I moved to the regional government hospital because it had better facilities for my illness, and the service was much better - I felt that I was being viewed more as a human being than as an ATM.

 

The medicines were less expensive in the government hospital (for the same brand), but the private room was about twice as expensive in the government hospital, the technology I needed was roughly similar in price as far as I remember. The total bill was around 1 million baht, which my Thai health insurer paid promptly to the hospitals. Apart from verifying who I was I didn't have to get involved in the payments at all.

 

A friend of similar age has racked up well over 1 million baht as an outpatient over a longer period of time. He paid himself as he did not have insurance.

 

I'm sure people living in different regions have different experience, but as I said "I think it's quite hard to make generalisations..."

 

 

 

 

 

 

Did your premium go up following the claim? and is your condition now preexisting and so excluded?  the reason I ask is it's often said that is what happens with thai insurance

[blackprince]

23 minutes ago, scubascuba3 said:

Did your premium go up following the claim? and is your condition now preexisting and so excluded?  the reason I ask is it's often said that is what happens with thai insurance

It's a good question and one that might help others.

 

No, my condition was not pre-existing. And the premiums did not go up. In fact they will never go up, because...

 

The policy is a life assurance investment product. It lasts for life, and I purchased it around 14 years ago. There are no annual premiums.

 

This type of policy is quite common in my native UK. Back in 1990 I was a middle manager in a Life & Pensions company (that's assurance rather than insurance), so I felt pretty confident in what I was buying, although the contract was only in Thai, but I did have good translator lawyer to assist, plus a genuinely knowledgeable saleswoman.

 

This type of product, being essentially an investment product, is offered during a fixed time window. The window for my particular policy was 3 or 6  months, I can't remember exactly, and closed c 14 years ago. Again, this is, or was, quite common in the UK.

 

Needless to say, it wasn't cheap, but it does have a good investment return in addition to comprehensive health cover for life.

 

 

Edited December 5, 2021 by blackprince

[scubascuba3]

10 minutes ago, blackprince said:

It's a good question and one that might help others.

 

No, my condition was not pre-existing. And the premiums did not go up. In fact they will never go up, because...

 

The policy is a life assurance investment product. It lasts for life, and I purchased it around 14 years ago. There are no annual premiums.

 

This type of policy is quite common in my native UK. Back in 1990 I was a middle manager in a Life & Pensions company (that's assurance rather than insurance), so I felt pretty confident in what I was buying, although the contract was only in Thai, but I did have good translator lawyer to assist, plus a genuinely knowledgeable saleswoman.

 

This type of product, being essentially an investment product, is offered during a fixed time window. The window for my particular policy was 3 or 6  months, I can't remember exactly, and closed c 14 years ago. Again, this is, or was, quite common in the UK.

 

Needless to say, it wasn't cheap, but it does have a good investment return in addition to comprehensive health cover for life.

 

 

Ah ok i remember now you mentioned this before, so can't really be compared with Thai health insurance as it's different