How to use and claim non Thai private medical insurance

[topswijaya]

Dear all,

 

How to use and claim private medical insurance for non Thai?

So, is it like : you are basically coming to a private or a government hospital and presents a medical insurance card and a passport?

Thanks

[KhunLA]

Read your policy, and at admission, simply ask if & how they accept said policy.  There is no 1 way.  Different hospitals have different policies and do or don't accept some policies.

 

Many want payment, then you have to get reimbursed from policy.  Some simply take your info, and all is good, file it all for you.

 

Good Luck

 

If you don't have a policy yet, and thinking of using a certain hospital, you may want to ask them which insurer they prefer & accept.  They may even offer their own coverage, under written by a competitively priced insurer.

Edited July 21, 2022 by KhunLA

[cnx1204]

KhunLA was correct.  If the hospital you go to recognizes your insurance company, has experience with them, they may bill directly.  If not, you should be prepared to pay cash and then you bill the insurance.

 

In some cases, insurance policies have deductible and or co-pay.  If the hospital will bill directly and your insurance has a deductible or co-pay, you should expect to pay that even if the hospital direct bills.

 

[swm59nj]

I’m 67 years old retired and pay for my health insurance from my previous job in USA at a reduced rate. The insurance company covers me anywhere internationally and in America. They use a contract company for overseas claims. 
But yes you need to contact the specific hospital to see what type of payment they accept.  And of course check with the insurance company regarding specific coverage options. 
For example.  I only go to private hospitals here in Bangkok. I contact my insurance provider and they send a guarantee of benefits letter to the hospital guaranteeing payment.  The two private hospitals accept the guarantee and my insurance takes care of it. 
But other private hospitals won’t accept the guarantee for out patients services. Only inpatient services.  So for outpatient you have to pay.  Then get reimbursed from the insurance company.

I realize this all might not pertain to you.  I’m just giving an example how different it can be. There is no general answer.

[ifmu]

33 minutes ago, swm59nj said:

I’m 67 years old retired and pay for my health insurance from my previous job in USA at a reduced rate. The insurance company covers me anywhere internationally and in America. They use a contract company for overseas claims. 
But yes you need to contact the specific hospital to see what type of payment they accept.  And of course check with the insurance company regarding specific coverage options. 
For example.  I only go to private hospitals here in Bangkok. I contact my insurance provider and they send a guarantee of benefits letter to the hospital guaranteeing payment.  The two private hospitals accept the guarantee and my insurance takes care of it. 
But other private hospitals won’t accept the guarantee for out patients services. Only inpatient services.  So for outpatient you have to pay.  Then get reimbursed from the insurance company.

I realize this all might not pertain to you.  I’m just giving an example how different it can be. There is no general answer.

what is your ins company        thanks

 

[internationalism]

Ask your insurance for a list of hospitals they accept in thailand. Thai issued policies do give a list of hospitals you are allowed to use. Some top ranked hospitals might be excluded. 
Some hospitals won't accept your policy. For example piyavate hospital would blank not accept pacific cross policies. They have stated it publicly. 
The sure bet are the governmental hospitals. The problem with smaller of them they don't have insurance department. My local hospital told me that strait at admission.  Secondary care hospitals might have insurance department, not sure how they are good in communication with foreign insurers. Language barier and different working rules. 
if you are thinking about a major treatment, do shop around for at least 2 private, as well as one governmental hospital, to be certain you won't be forced to co-pay if exeeding limit of your policy.  Some people mentioned that doctors from private hospitals were working also at the governmental one and were able to offer treatment there at fraction of private. Bear in mind that you might need regular check ups, tests after your treatment and your condition might reapear within a year, or treatment wasn't fully successful or there might be complications, expensive medicines prescribed over a long time. Top rated private hospitals are known for inflated prices and  not needed  additional charges, above those quoted. 
Some cheaper, better value thai issued policies would increase their premium 25% (as pacific cross) to 100% (as Thai Health Insurance PLC) for 2 years if you have a large claim. I would imagine some foreign issued policies might have similar rules, double check small print of yours

Edited July 22, 2022 by internationalism

[Sheryl]

First of all it will vary with the insurer and the specific policy. 

 

Not all policies cover outpatient care. And not all policies will cover you while in Thailand.

 

Some offer direct payment and some will only reimburse afterwards. Some will do direct payment for hospitalization but not for outpatient.

 

Some policies limit which hospital you can use.

 

Secondly -- assuming your policy doess  cover you in Thailand and for the type of service in question  and does direct payment-- it will then depend on whether the hospital in question has direct payment arrangement with that  insurer.

 

The larger private hospitals here have arrangements with most insurers. Very very few government hospitals do. You will usually have to pay  yourself at a government hospital and then seek reimbursement and it is often  difficult to get the necessary documentation from the hospital. 

 

Most  insurance picked require pre-authorization for inpatient hospitalization. Private hospitals have third party payment departments that handle this. You just show them your card and they contact the insurer and work it out. Can take a week or so in non emergency situations