Insurance reimbursement?

[AP2019]

Hi - would appreciate to hear about other people's knowledge and/or experience with insurance claims for hospital stays.  My wife was recently in the hospital and was told by her insurance (AIA) that she needed to pay up front and would be reimbursed after they review the charges.  Is that typical?  Do all insurance companies in Thailand have that policy?

 

Thanks for any input!

-a

[scubascuba3]

It's something you need to find out when signing up with an insurance company, both types are available

[Sheryl]

It can also vary with the hospital. Most insurers have direct pay arrangements with some hospitals but not necessarily all. It is possible the particular hospital your wife is at, does not have a direct pay arrangement with her particular insurer.

 

In future,  if it is a private hospital she should provide her insurance information to their finance office and ask them to get a Guarantee of Payment from the insurer first before admission (or urgently call for it, if it is an emergency). Most private hospitals have whole departments for 3rd party payment. It is in everyone's best interests to follow that procedure rather than taking pot luck on what the insurer will or won't consider reasonable charge after the fact.

 

Also, once the hospital has been paid it can be difficult to get them motivated to supply all the paperwork needed for a claim after the fact.

[Don Chance]

You have to be careful with insurance companies. They will try everything possible not to pay, they have a tricky policy wording.  Once you submit your claim they will put it through their wringer!

 

You need to call them before  you go to the hospital and check everything. In my policy they would not cover a specialist. When i arrived, they listened to my problem, then said do you want to see a specialist? The insurance company said they would only cover the specialist after regular doctor had recommend to see one. Very tricky. Otherwise i would have been on the hook. 

 

He's then next twist.  Thai doctors only have a 6 year degree and the doc i say was pretty fresh. So they would not be qualified in my country, where doctors have a 10 year education level at a higher standard. So probably the same as a Thai specialist.

[Sheryl]

1 hour ago, Don Chance said:

You have to be careful with insurance companies. They will try everything possible not to pay, they have a tricky policy wording. 

Not at all my experience.

 

I have yet to see a policy - and I have read most of them - that has wording that was not clear. No tricks. No "fine print". Just clearly stated policy terms.

 

One does have to read one's policy, of course. An amazing number of people do not.

 

Reputable international insurers readily pay claims, within the terms of the policy.

 

5 claims over the past 10-15 years (with 2 different companies). Not a single issue with any of them, all paid direct to the hospital.

[AP2019]

9 hours ago, Sheryl said:

Not at all my experience.

 

I have yet to see a policy - and I have read most of them - that has wording that was not clear. No tricks. No "fine print". Just clearly stated policy terms.

 

One does have to read one's policy, of course. An amazing number of people do not.

 

Reputable international insurers readily pay claims, within the terms of the policy.

 

5 claims over the past 10-15 years (with 2 different companies). Not a single issue with any of them, all paid direct to the hospital.

Thanks everyone!  Good info and advice.

 

Sheryl - can I ask who you have for your insurance?

 

-a

[Don Chance]

13 hours ago, Sheryl said:

Not at all my experience.

 

I have yet to see a policy - and I have read most of them - that has wording that was not clear. No tricks. No "fine print". Just clearly stated policy terms.

 

One does have to read one's policy, of course. An amazing number of people do not.

 

Reputable international insurers readily pay claims, within the terms of the policy.

 

5 claims over the past 10-15 years (with 2 different companies). Not a single issue with any of them, all paid direct to the hospital.

That is my direct experience with a  big international travel insurer not a Thai insurance company. 

 

I went to a private hospital in Bangkok. I gave them my policy print out. They listen to my case, they called the insurance company. They came back with some forms to sign. I was about to sign them blindly but read them over. Then ask what did the insurance company say? They admitted that they would not be covered. OH. So I left and called the insurance company, they explain i have to pay and they will reimburse me later. Then i ask about other issues and they disclosed about specialist clause.

The blood tests were like 6000 baht, the doctor only 700. Total about 10,000 baht for the work up. I guess they make their money from blood test and prescriptions.

 

I wonder if the Thai insurance companies get a discount from the hospitals? I imagine they do.

[Sheryl]

2 minutes ago, Don Chance said:

That is my direct experience with a  big international travel insurer not a Thai insurance company. 

 

I went to a private hospital in Bangkok. I gave them my policy print out. They listen to my case, they called the insurance company. They came back with some forms to sign. I was about to sign them blindly but read them over. Then ask what did the insurance company say? They admitted that they would not be covered. OH. So I left and called the insurance company, they explain i have to pay and they will reimburse me later. Then i ask about other issues and they disclosed about specialist clause.

 

Most travel insurance is on a reimbursement basis, only a few have direct payment arrangements.

 

If there is a limitation on specialist consultations it would have to  be stated in the policy document. Did you obtain and read the policy itself when you enrolled in this insurance?

[Sheryl]

4 hours ago, AP2019 said:

Thanks everyone!  Good info and advice.

 

Sheryl - can I ask who you have for your insurance?

 

-a

Currently, April Global (out of France, not April Thailand). Quite satisfied with them.

[scubascuba3]

13 hours ago, Sheryl said:

Not at all my experience.

 

I have yet to see a policy - and I have read most of them - that has wording that was not clear. No tricks. No "fine print". Just clearly stated policy terms.

 

One does have to read one's policy, of course. An amazing number of people do not.

 

Reputable international insurers readily pay claims, within the terms of the policy.

 

5 claims over the past 10-15 years (with 2 different companies). Not a single issue with any of them, all paid direct to the hospital.

Some hospitals appear only will deal with certain insurance companies, when i went to RSU Healthcare in Bangkok that you recommended they only had a small number

[Sheryl]

1 minute ago, scubascuba3 said:

Some hospitals appear only will deal with certain insurance companies, when i went to RSU Healthcare in Bangkok that you recommended they only had a small number

Direct pay arrangements have to be negotiated between hospital and insurer.

 

Government hospitals often have none.

 

Insurers can provide listing of hospitals they have such contracts with.

 

 

[AP2019]

7 hours ago, Sheryl said:

Most travel insurance is on a reimbursement basis, only a few have direct payment arrangements.

 

If there is a limitation on specialist consultations it would have to  be stated in the policy document. Did you obtain and read the policy itself when you enrolled in this insurance?

I only got a Thai version of the policy, did a google translation, and I read that as best I could.  My wife reads Thai and didn't see anything regarding paying first.  I plan to go back to the agent and ask for an english version and ask all these questions.

 

I appreciate everyone's feedback, all very helpful!

 

-a

[AP2019]

7 hours ago, Sheryl said:

Currently, April Global (out of France, not April Thailand). Quite satisfied with them.

Thank you!  Never heard of that one, but will explore it if I decide to switch.

 

-a

[Sheryl]

16 hours ago, AP2019 said:

I only got a Thai version of the policy, did a google translation, and I read that as best I could.  My wife reads Thai and didn't see anything regarding paying first.  I plan to go back to the agent and ask for an english version and ask all these questions.

 

I appreciate everyone's feedback, all very helpful!

 

-a

In future I strongly recommend against taking out any insurance policy that does not have an official policy document in English. Chances are that even if you can get an English version (may not exist) it will be only the Thai version that is legally binding.

 

In general I also recommend against Thai-issued policies. They are not as well regulated as policies issued out of western countries.

[AP2019]

On 12/11/2021 at 11:50 AM, Sheryl said:

In future I strongly recommend against taking out any insurance policy that does not have an official policy document in English. Chances are that even if you can get an English version (may not exist) it will be only the Thai version that is legally binding.

 

In general I also recommend against Thai-issued policies. They are not as well regulated as policies issued out of western countries.

Thanks Sheryl.  I originally wanted to go with a European company but they excluded everything as pre-existing. For example:  I stated that I went to a chiropractor twice for sciatica so they excluded all back injuries even those from any future car accident.  After I read their exemptions there was no point in their insurance policy.  My wife's entire Thai family uses AIA and have said they have had no issues, so we ended up signing with their agent.  But after this incident I'm just a little skeptical and plan to re-examine everything.

 

Your comments and advice are very much appreciated!

 

Regards

-a