Thailand Hospitals - Not as cheap as you might think. Septoplasty story

[wasabi]

I've noticed inflation in general healthcare at private hospitals in Thailand, mostly Bangkok, over the past 2 years. But I still find the treatment and care high quality and reasonably priced relative to my home country the United States so I have begrudgingly accepted the slowly inflating prices for things like skin care and blood tests.

 

Recently I was diagnosed with a deviated septum and what is called hypertrophic turbinates at one of the major hospitals in Bangkok (not to be named). All of this together means you can't breathe well through your nose and may suffer from sleep apnea which I do. A surgical resolution called a Septoplasty combined with turbinate reduction was offered to me via a "package deal" that offered the surgery itself, the usual nurses doing blood pressure and temperature checks, and a hospital room for 2 nights for the equivalent of $6,000 USD. It was further explained I would require general anesthesia for up to 2 hours while the surgery was performed and would need to have packing and splints in my nose for up to 3 weeks. I decided I needed to do more research and declined.

 

I recalled a video from a popular Thai Youtuber who had septoplasty surgery in Kon Kaen for $3,000 USD. Furthermore he only had to have the postsurgical splints for 6 hours (not 3 weeks) and was released the same day via outpatient surgery, though he did need general anesthesia. Now I'm willing to pay a premium if I am getting better care but I suspected the care I'd get in Kon Kaen would be the same as Bangkok so I contacted the hospital and set up an appointment for the next week. Later that night I watched several more Youtube videos and read about the surgery where people described their septoplasty experience. A common refrain was the misery of having the splints and packing in their nose for weeks. I recalled the guy I saw in Kon Kaen who only needed such devices for 6 hours and started to wonder if there was a more minimally invasive variant of the surgery.

 

That night I started getting worried about having general anesthesia coupled with sleep apnea which can cause stroke if not handled correctly and canceled the appointment in Kon Kaen. I have US health insurance so I decided though It'd likely cost 3 times as much, plus the cost of travel I just would feel safer having it done there. I called various doctors in the USA. Most surgeons in America also wanted to use General Anesthesia and also wanted to place the packing and splints in the nose but for shorter time periods. The costs were higher than Thailand but my insurance would cover it. I still was not satisfied.

 

After searching and searching I finally found a Dr in Austin, Texas who uses Twilight Anesthesia and requires no splints or packing for septoplasty in a more modern minimally invasive method. He explained general anesthesia and packing for typical septoplasty surgery were outdated techniques from the 80s. Twilight anesthesia is a lighter form of anesthesia that doesn't require a tube in the throat, and various machines to keep you alive during the surgery. You recover much quicker after the surgery too. He explained he only required a single dissolvable suture and the whole surgery would likely take 15-20 minutes. If I paid out of pocket  the total cost would be $2000. $1000 for the septoplasty, $300 for the twilight anesthesia and $700 for a CT Scan.

 

I flew from Thailand to Austin TX and went to the clinic. I was very happy with the bedside manner and skill of the Dr and felt confident moving forward. After getting my CT scan he explained my surgical needs were typical and the surgery would only last 15 minutes. Furthermore he utilized a device that kept airways open during surgery that would prevent all risk of breath cessation. Twilight anesthesia already lowers that risk and this device with the twilight brought the risk to near zero. My surgery was the following day. It went very smoothly and I'm now sitting at home in Florida quickly recovering. I have no splints or packing in my nose and am very comfortable as I heal. I'll be back to Thailand at the end of the month.

 

I remain appreciative of the healthcare I typically get in Thailand and the correct diagnoses of my problem in a hospital there. But for me the moral of the story is don't think just because it's Thailand you are getting the best price and these packages may be inclusive of nonessential services relative to your case. There is no reason this surgery in typical cases should require overnight hospitalization or should take 2 hours for most people and certainly not for me. Furthermore some of the surgical techniques may be outdated (this is also true in other countries including America)

Edited May 14, 2022 by wasabi

[The Hammer2021]

Yes non essential  services  and  payment for every cotton swap, plastic  glove etc and maybe charged for the full box

[John Bird]

Many private Thai hospitals are just ripoffs. 

[wasabi]

3 minutes ago, John Bird said:

Many private Thai hospitals are just ripoffs. 

I want to start exploring clinics and lower cost options in Thailand that offer the same care with less of the "pampering premium" I have been paying at private hospitals.

[mudcat]

The  overnight stay allows a hospital to charge insurance companies for policies which do not cover outpatient procedures

[The Hammer2021]

3 minutes ago, John Bird said:

Many private Thai hospitals are just ripoffs. 

How many are there that  are just  ripp offs?

How do you define a ripp off?

Please give  some examples  of 'a complete  ripp off'

How have you been ripped off?

[The Hammer2021]

I get charges a 'service  charge' which I find unacceptable

[DrDave]

@wasabi I had the exact same procedure (septoplasty and turbinate reductions) done in the US about 6 months ago. This was the same procedure that you had in Austin, no splints and minimal dissolving packing. The procedure was done in a modern outpatient "surgery center" that was very much like a hospital. Pre and Post-op nurse, Anesthesiologist, a couple of OR nurses and my ENT specialist to do the surgery, which took all of about 30 minutes.

I was planning on having the surgery in Thailand, but with Covid, and being in the US, I wasn't sure when I'd be able to return so I decided to have it done in Florida. The requisite CT was billed to my insurance company (medicare advantage plan) for $700, of which the plan paid $70 and I paid $10. The fees for the outpatient surgery center, anesthesiologist, and surgeon totaled $19,962. Insurance paid $2,262, I paid $20. and that was the end of it.  If I would have had this done in Thailand, I'm guessing it would have cost me somewhere between 150,000 and 200,000 baht.

Edited May 14, 2022 by DrDave

[The Hammer2021]

13 minutes ago, wasabi said:

I want to start exploring clinics and lower cost options in Thailand that offer the same care with less of the "pampering premium" I have been paying at private hospitals.

Depends on the city. The teaching hospitals and public  hospitals  have good reputations for some procedures

[Chris.B]

24 minutes ago, wasabi said:

I want to start exploring clinics and lower cost options in Thailand that offer the same care with less of the "pampering premium" I have been paying at private hospitals.

Well if you go to a top rated hospital in Bangkok, the prices are going to be high.

 

[dingdongrb]

22 minutes ago, DrDave said:

The fees for the outpatient surgery center, anesthesiologist, and surgeon totaled $19,962. Insurance paid $2,262, I paid $20. and that was the end of it.  

Who sucked up the rest of the costs (approx. $17,000)?

[DrDave]

51 minutes ago, dingdongrb said:

Who sucked up the rest of the costs (approx. $17,000)?

The providers.  Insurance companies (and Medicare) negotiate fees with providers in their network. Kind of like "list price" versus "negotiated price". The providers bill the "list price" to the insurance companies, who will in turn make payment at the negotiated rate. Interestingly enough, the surgeon's fee was $3,617 for which the insurance company paid only $632, which I thought was kind of lowball.

 

If you don't have insurance, you'll be billed the "list price" which you most likely will be able to negotiate significantly down.

[DrDave]

1 hour ago, The Hammer2021 said:

I get charges a 'service  charge' which I find unacceptable

The hospital we use, which is a member of the BDMS group routinely adds a couple of "service charges".  For example, my wife wanted to have a consultation with a dermatologist, and of course they require you to have blood pressure and temperature recorded (300 baht) before you talk to the doctor. They also add some sort of other generic "nursing services" charge to the bill for another 300 baht. All this just to have a 5 minute conversation with a doctor at 1,000+ baht. No exam, procedure, or services.

[Lorry]

2 hours ago, wasabi said:

I've noticed inflation in general healthcare at private hospitals in Thailand, mostly Bangkok, over the past 2 years.

Yes, many prices have doubled in the last 2 years. 

At the same time,  service at the international hospitals has deteriorated incredibly.

 

They have adjusted and don't live off the foreigners anymore,  their customers are rich Thais.

Bumrungrad is full (with Thais) whereas the foreign insurance companies cringe at these new prices. 

[The Hammer2021]

33 minutes ago, DrDave said:

The hospital we use, which is a member of the BDMS group routinely adds a couple of "service charges".  For example, my wife wanted to have a consultation with a dermatologist, and of course they require you to have blood pressure and temperature recorded (300 baht) before you talk to the doctor. They also add some sort of other generic "nursing services" charge to the bill for another 300 baht. All this just to have a 5 minute conversation with a doctor at 1,000+ baht. No exam, procedure, or services.

Yes its 280 baht a visit and not covered  by insurance

[Jerno]

7 hours ago, wasabi said:

I want to start exploring clinics and lower cost options in Thailand that offer the same care with less of the "pampering premium" I have been paying at private hospitals.

Double rip offs for those from normal western countries where health care is more or less free.  Comparisons to USA healthcare not that relevant (except to Americans) because their system is Ultra Capitalist and horribly over priced thanks to pure capitalism (privately owned Healthcare services throughout their country).  Dozens of European countries and Canada have social healthcare, not profit driven.  

[wasabi]

5 minutes ago, Jerno said:

Double rip offs for those from normal western countries where health care is more or less free.  Comparisons to USA healthcare not that relevant (except to Americans) because their system is Ultra Capitalist and horribly over priced thanks to pure capitalism (privately owned Healthcare services throughout their country).  Dozens of European countries and Canada have social healthcare, not profit driven.  

I agree that the US Healthcare system is badly flawed and typically very overpriced. That is why I was shocked the cost of my surgery in Texas was even cheaper than Kon Kaen and for an a higher quality, less painful, less risky result than I could've gotten in Thailand. Even with the cost of round trip airfare the cost was still cheaper than it would've been in Bangkok.

 

And that is why I've learned it's not safe to assume I am getting a good deal in Thailand without checking prices in my home country first.

Edited May 14, 2022 by wasabi

[RmcaIssan]

15 hours ago, John Bird said:

Many private Thai hospitals are just ripoffs. 

Potential sequence ..maximise profit following by 'upselling' level of care 

[RmcaIssan]

Wonder where places like India and Turkey fit in in terms of service and cost?

Only experience is, some dental work in Turkey that was significantly cheaper than UK..

[jonesthepost]

Over charging for for drugs trying to get your to take scans without first checking your full condition 

[Chris.B]

14 hours ago, DrDave said:

If you don't have insurance, you'll be billed the "list price" which you most likely will be able to negotiate significantly down.

Anyone here ever been able to negotiate a hospital significantly down?

 

[ding]

Thanks to all who contributed to this thread, especially wasabi. Very useful!

 

My wife's breast cancer care in the US is awful. We're moving to Thailand this month - she's Thai.

She may need a hysterectomy now and I don't blame her for wanting it done in Thailand after the abysmal care in the US.

I can provide specifics if anyone wonders.

 

My question:

Where is the best place for my Thai wife to get a hysterectomy in Thailand

...if her upcoming MRI in America confirms she needs it?

 

(I should post my own thread I suppose, don't mean to hijack)

 

[lopburi3]

5 minutes ago, ding said:

Thanks to all who contributed to this thread, especially wasabi. Very useful!

 

My wife's breast cancer care in the US is awful. We're moving to Thailand this month - she's Thai.

She may need a hysterectomy now and I don't blame her for wanting it done in Thailand after the abysmal care in the US.

I can provide specifics if anyone wonders.

 

My question:

Where is the best place for my Thai wife to get a hysterectomy in Thailand

...if her upcoming MRI in America confirms she needs it?

 

(I should post my own thread I suppose, don't mean to hijack)

 

She what to use a private or government hospital?  She plan to pay for government hospital or want free treatment?  Bangkok is the center for medical care in Thailand and Chula is one of the biggest and best of the government facilities and they have both normal and pay systems.

[dddave]

21 hours ago, DrDave said:

The providers.  Insurance companies (and Medicare) negotiate fees with providers in their network. Kind of like "list price" versus "negotiated price". The providers bill the "list price" to the insurance companies, who will in turn make payment at the negotiated rate. Interestingly enough, the surgeon's fee was $3,617 for which the insurance company paid only $632, which I thought was kind of lowball.

 

If you don't have insurance, you'll be billed the "list price" which you most likely will be able to negotiate significantly down.

US Citizens with Medicare trying to decide if "Part B" is worth it should take note of this.  I foolishly elected not to have Part B as I am a veteran and could get almost anything done at a veterans hospital. 

Some deep research showed my local veterans hospital did not have a good knee replacement record but I found that I could not get a knee replacement done under Medicare because I didn't have part B. 

Although when you first read about "A" & "B" it appears "B" is only for out-patient and medications, it doesn't work that way in real life.  The whole Medicare billing process is so complex that there are many features of any hospitalization and procedure that must be billed through Part B. 

Now I face a difficult re-enrolment process and a hefty re-enrolment charge.  

[ding]

13 minutes ago, lopburi3 said:

She what to use a private or government hospital?  She plan to pay for government hospital or want free treatment?  Bangkok is the center for medical care in Thailand and Chula is one of the biggest and best of the government facilities and they have both normal and pay systems.

She liked her care at BNH years ago and we both think Bumrungrad 's glory days are gone.

Chula is a great suggestion, thanks lopburi. I didn't know we could pay for government hospital vs free treatment.

 

We were going to move to Samui but the MRI results may force us to cancel the flight and stay in BKK.

 

We don't mind paying for great private care if it's actually significantly better, but that's not always the case.

[dddave]

21 minutes ago, lopburi3 said:

She what to use a private or government hospital?  She plan to pay for government hospital or want free treatment?  Bangkok is the center for medical care in Thailand and Chula is one of the biggest and best of the government facilities and they have both normal and pay systems.

Last month, a huge, uncontrolled staff. infection suddenly appeared on my foot and leg.  I ended up hospitalized for 22 days;  seven nights in a Pattaya City Hospital twenty bed ward (less said about the better) and fourteen nights in Maharaj Government Hospital in Korat.  After two nights in a ward, I was able to get a private room at Maharaj. 

They immediately put me on an antibiotic that got traction and worked, something the other hospital wasn't able to do.  Although communicating with the nurses was a bit difficult, every Doctor on my case spoke excellent English.  I received what I believe to be excellent care.

My foot & leg got progressively better.  I did have a Doppler ultrasound and later a CT scan of my legs.  After two weeks, I was discharged, my foot to a point I could walk on it.  

I was not asked for a deposit nor did they request to hold my passport which the other hospital did along with a B20,000 deposit. 

My total charges at Pattaya City Hospital was B39,000 for the seven days in the ward and treatment.  BTW, they were not happy when I checked-out and refused to give me a copy of my records, only the labs.

My bill at Maharaj for 15 days was B41,000 which included the CT scan Ultrasound and medications which included an expensive IV antibiotic.   A much lower price than I was expecting.

I would go there again.

[DrDave]

8 hours ago, Chris.B said:

Anyone here ever been able to negotiate a hospital significantly down?

 

Yes. About 8 years ago, my wife went to the ER in Florida with acute abdominal pain. After running some tests, it was determined that she needed to have her gall bladder removed sometime in the near future. After 90 minutes in the ER, she was released. We were never presented with a bill - they just took her name and address (and maybe SSN) when admitted. Well, it turns out that for uninsured patients, the hospital makes up a bill and turns it over to a third party agency for payment. We got the bill a few weeks later from the agency - over $5,000 baht for 90 minutes in the ER which consisted of a quick doctor's exam, an IV,  a vastly overpriced blood panel and potassium pills. I just sat on the bill for a few weeks, and surprise, surprise a new bill arrived with a total amount due of about $1,700 noting "discount for uninsured patient".  I didn't even have to negotiate.

Edited May 15, 2022 by DrDave

[ivor bigun]

On 5/14/2022 at 7:32 PM, The Hammer2021 said:

Yes non essential  services  and  payment for every cotton swap, plastic  glove etc and maybe charged for the full box

I spent one night in a private hospital ,when i left i was given a bag with everything that had been in the room ,90% of which had not been touched i had to pay for it all .

[Chris.B]

1 hour ago, DrDave said:

Yes. About 8 years ago, my wife went to the ER in Florida with acute abdominal pain. After running some tests, it was determined that she needed to have her gall bladder removed sometime in the near future. After 90 minutes in the ER, she was released. We were never presented with a bill - they just took her name and address (and maybe SSN) when admitted. Well, it turns out that for uninsured patients, the hospital makes up a bill and turns it over to a third party agency for payment. We got the bill a few weeks later from the agency - over $5,000 baht for 90 minutes in the ER which consisted of a quick doctor's exam, an IV,  a vastly overpriced blood panel and potassium pills. I just sat on the bill for a few weeks, and surprise, surprise a new bill arrived with a total amount due of about $1,700 noting "discount for uninsured patient".  I didn't even have to negotiate.

This discussion is in a Thailand forum and relates to Thai private hospitals. Not hospitals in the US.

 

 

[Chris.B]

41 minutes ago, ivor bigun said:

I spent one night in a private hospital ,when i left i was given a bag with everything that had been in the room ,90% of which had not been touched i had to pay for it all .

Well, if I was the next patient to be using the room, I would be happy to hear that. ????????

 

Surely, you are not suggesting that you were being ripped off?

 

Edited May 15, 2022 by Chris.B