How to know if a procedure will be covered by inpatient only insurance plan?

[timoti]

Hi,

 

Basically I have IP only plan but I am still confused when I get some outpatient procedure done. Because some of these procedures are similar to day surgeries then how to know which one is which?

 

For example is I&D considered day patient procedure?

 

I know hospitalizations are covered but some of the procedures can be done without having to stay overnight. If I am not wrong, some of those are eligible too?

 

Perhaps @Sheryl can comment on this since we have the same insurance for IP treatments.

 

Thanks a lot everyone.

[Sheryl]

It generally depends on whether or not operating room facilities are used with a period (even brief) of observation afterwards.

 

Cataract surgery as a day procedure is definitely covered, so is any other surgery requiring use of an Operating Room.

 

I had epidural spinal injections covered as a day surgery.

 

Simple incision & drainage, if done in doctor's office/outpatient clinic, would not be covered. A large I&D requiring use of OR would be.

 

Some policies cover endoscopies. I am not sure that April does, but you should ask broker.

 

 

 

 

[timoti]

1 hour ago, Sheryl said:

It generally depends on whether or not operating room facilities are used with a period (even brief) of observation afterwards.

 

Cataract surgery as a day procedure is definitely covered, so is any other surgery requiring use of an Operating Room.

 

I had epidural spinal injections covered as a day surgery.

 

Simple incision & drainage, if done in doctor's office/outpatient clinic, would not be covered. A large I&D requiring use of OR would be.

 

Some policies cover endoscopies. I am not sure that April does, but you should ask broker.

 

 

 

 

Thx a lot. The use of operating room makes sense. Endoscopy is a good question i will check with them.

 

My assumption was they weren't covered since they are some kind of diagnostics but if they give something that needs operation then they would be.

 

But the out of pocket OP expenses are still tiny compared to buying it in insurance. 

[JayClay]

If you ask the hospital they will check with your insurance provider if any particular procedure is covered.

 

I find this is better than asking a staff member of your broker or insurance company who may end up giving incorrect information (either due to error or misunderstanding).

 

It's in the hospital's interest for you to be covered so you can be reasonably sure that they'll give the correct information to the insurer.

[JayClay]

4 hours ago, timoti said:

But the out of pocket OP expenses are still tiny compared to buying it in insurance. 

Maybe it depends on age but the worst mistake I ever made was getting a policy without OP cover. It's cost me tens of thousands of baht over the last few years. ????

[timoti]

5 hours ago, JayClay said:

Maybe it depends on age but the worst mistake I ever made was getting a policy without OP cover. It's cost me tens of thousands of baht over the last few years. ????

Yes but April OP costs a lot more than that. I see it 100K for this year alone if I had to pay due to my zone of coverage. It would be hard for me to hit that.

[KannikaP]

5 hours ago, JayClay said:

Maybe it depends on age but the worst mistake I ever made was getting a policy without OP cover. It's cost me tens of thousands of baht over the last few years. ????

And what would it have cost to add IP to your policy? 

[internationalism]

6 hours ago, JayClay said:

Maybe it depends on age but the worst mistake I ever made was getting a policy without OP cover. It's cost me tens of thousands of baht over the last few years. ????

lower policies do have limit 2-3k per visit.

OP premium is some 25-30% more expensive than inpatient.

And if somebody has deductible it only covers above that.

Further, if you make a large claim many thai policies will raise premium from 25 % (pacific cross) to up to 100% (Thai Health Insurance Plc) for 2 years. And you might lose no claim discount (up to 20% pacific cross, 10% some other insurers).

 

[JayClay]

28 minutes ago, KannikaP said:

And what would it have cost to add IP to your policy? 

Far less. Otherwise I wouldn't have made the point, would I?

[JayClay]

10 minutes ago, internationalism said:

lower policies do have limit 2-3k per visit.

OP premium is some 25-30% more expensive than inpatient.

And if somebody has deductible it only covers above that.

Further, if you make a large claim many thai policies will raise premium from 25 % (pacific cross) to up to 100% (Thai Health Insurance Plc) for 2 years. And you might lose no claim discount (up to 20% pacific cross, 10% some other insurers).

 

I don't have a Thai policy, there is zero deductable, and premiums for this policy do not alter based on claim history. And there would have been no per-visit  limit if I'd selected OP care. It's pretty difficult to manage a 3000bt bill on a single OP visit, anyway.

Edited September 11, 2022 by JayClay

[marin]

10 hours ago, timoti said:

Thx a lot. The use of operating room makes sense. Endoscopy is a good question i will check with them.

My AIA policy covers endoscopy because you have to be sedated. Once that wristband goes on you are covered. My last checkup I arrived at BKK hospital at 8am and was on my way home at 10:30am. 

[internationalism]

5 minutes ago, JayClay said:

I don't have a Thai policy, there is zero deductable, and premiums for this policy do not alter based on claim history.

yes, there are many variables and you haven't mentioned any details.

Many have cheaper thai policies, large deductibles.

As I now understand you probably used private hospitals. The governmental one would be a fraction of that, you can think of doing there at least check ups. Just a suggestion.

Probably too late for you to upgrade to OP, they might exclude some as preexisting 

[KannikaP]

19 minutes ago, JayClay said:

I don't have a Thai policy, there is zero deductable, and premiums for this policy do not alter based on claim history. And there would have been no per-visit  limit if I'd selected OP care. It's pretty difficult to manage a 3000bt bill on a single OP visit, anyway.

give an idea as to which company please

[JayClay]

17 minutes ago, internationalism said:

Probably too late for you to upgrade to OP, they might exclude some as preexisting 

This is precisely the issue and exactly why I felt I was mis-sold the policy.

 

Don't get me wrong, in general they've been pretty good when it came to in-patient treatment, but the broker advised me that out-patient was basically a waste of money. Which it wouldn't have been.

 

14 minutes ago, KannikaP said:

give an idea as to which company please

ACS is the provider of the policy. I won't mention the name of the broker because, firstly, I don't recommend them and, secondly I don't want to fall foul of defecation laws.

[KannikaP]

1 minute ago, JayClay said:

This is precisely the issue and exactly why I felt I was mis-sold the policy.

 

Don't get me wrong, in general they've been pretty good when it came to in-patient treatment, but the broker advised me that out-patient was basically a waste of money. Which it wouldn't have been.

 

ACS is the provider of the policy. I won't mention the name of the broker because, firstly, I don't recommend them and, secondly I don't want to fall foul of defecation laws.

cant you go to ACS directly? who are ACS anyway?

[JayClay]

Just now, KannikaP said:

cant you go to ACS directly?

I'm sure you can. Which is why I named the company and not the broker as they are not significant.

 

2 minutes ago, KannikaP said:

 who are ACS anyway?

?? An insurance company 

[KannikaP]

15 minutes ago, JayClay said:

I'm sure you can. Which is why I named the company and not the broker as they are not significant.

 

?? An insurance company 

According to their website, they are BROKERS.

 

Travel and Expatriate Insurance Solutions | ACS (acs-ami.com)

[internationalism]

26 minutes ago, KannikaP said:

According to their website, they are BROKERS.

 

Travel and Expatriate Insurance Solutions | ACS (acs-ami.com)

no, they are french insurers https://www.aainsure.net/acs/

[KannikaP]

1 hour ago, internationalism said:

no, they are french insurers https://www.aainsure.net/acs/

There must be two ACSs then.

[couchpotato]

1 hour ago, JayClay said:

This is precisely the issue and exactly why I felt I was mis-sold the policy.

 

Don't get me wrong, in general they've been pretty good when it came to in-patient treatment, but the broker advised me that out-patient was basically a waste of money. Which it wouldn't have been.

 

ACS is the provider of the policy. I won't mention the name of the broker because, firstly, I don't recommend them and, secondly I don't want to fall foul of defecation laws.

ACS is the provider of the policy. I won't mention the name of the broker because, firstly, I don't recommend them and, secondly I don't want to fall foul of defecation laws.

 

Did you really mean to write "defecation laws"????

 

[KannikaP]

1 minute ago, couchpotato said:

ACS is the provider of the policy. I won't mention the name of the broker because, firstly, I don't recommend them and, secondly I don't want to fall foul of defecation laws.

 

Did you really mean to write "defecation laws"????

 

There used to be a laughing emoji for posts like this, but sadly its gone, as has SAD. 

 

   

 

 

[JayClay]

1 hour ago, couchpotato said:

Did you really mean to write "defecation laws"????

Lol. Typo of the century! ????

[couchpotato]

25 minutes ago, JayClay said:

Lol. Typo of the century! ????

But a good laugh for the day--thanks for that

[CanNot]

In my experience with forseable bigger bills the hospital will ask the insurance for a guarantee of payment. Then you know in advance what is covered. As the insurance response is quiet detailed about what it's not covered and why. 

 

Also some procedures are outpatient or when discussed with the doctor an inpatient option can be offered for observation for example. 

[timoti]

I think OP seems like a good benefit on paper and also it might be better to have it when young and potentially drop it when old but unfortunately if you have one of the higher tier plans and very wide coverage area like worldwide or worldwide excluding USA, the premiums combined with IP was around 30K USD at age ~80. This is too expensive to maintain.

 

Another thing is, I don't know if the insurance will be very lax if you wanna go see doctors anytime you want and basically get over-excessive checkups.

 

For this insurance the biannual checkup allowance was like $200 which is nothing, so the way I see it, it's not an empty cheque for anything medical.