pls recommend Bangkok doc for ablation for (paroxysmal) atrial fibrillation

[Sheryl]

2 minutes ago, timoti said:

Thx i will do that. I lift weights every day but never had afib episode during those times only after eating some big meal. BPH doctor didn't comment on this so i hope the bkk doctor have insight on this. I heard acid reflux or gerd can also cause afibs.

First need to find out if paroxysmal afib is what you have.  As opposed tp paroxysmal atrial tachycardia. V-tach etc. 

[timoti]

4 minutes ago, Sheryl said:

First need to find out if paroxysmal afib is what you have.  As opposed tp paroxysmal atrial tachycardia. V-tach etc. 

BPH doctor quoted my diagnosis from my ecg so i guess there is some error there already.

 

I also felt like he just glanced at them when i provided 30 pages of ecg. I am not sure if these things are very easy to spot or need careful looking at the graph regardless of ecg quality so it feels hasty to suggest ablation from this.

[Sheryl]

32 minutes ago, timoti said:

BPH doctor quoted my diagnosis from my ecg so i guess there is some error there already.

 

I also felt like he just glanced at them when i provided 30 pages of ecg. I am not sure if these things are very easy to spot or need careful looking at the graph regardless of ecg quality so it feels hasty to suggest ablation from this.

Just glanced because not skilled in interpreting rhythms.  

 

Disregard that whole consultation. 

 

It does sound from your symptoms thst something significant is occasionally going on  but no telling at this point exactly what.  And without knowing that cannot proceed to treatment options. 

 

If for example what you are having is runs of v-tach treatment would be first medications then if not effective implantable defibrillator. 

[timoti]

1 hour ago, Sheryl said:

Just glanced because not skilled in interpreting rhythms.  

 

Disregard that whole consultation. 

 

It does sound from your symptoms thst something significant is occasionally going on  but no telling at this point exactly what.  And without knowing that cannot proceed to treatment options. 

 

If for example what you are having is runs of v-tach treatment would be first medications then if not effective implantable defibrillator. 

Thanks a lot I will do that, hope it's not v-tach.

[domdom]

Hello

Regarding Sririraj, as pointed out by Sheryl, they did not accept payment from insurance (I think they do for thais with Thai insurances but not sure).. Again it was public side and we had to deposit 300.000 bahts when entering and pay the balance before exiting next day.. Then had to get refund ourselves from the insurance

I don't know if private sector accepts insurance payment as we didn't use it..

Other point on public side in Sririraj few people speak English (except OR nurses/doctors who are quite fluent for some of them)....

Have a good weekend 

[domdom]

Another point regarding Sheryl s comments, my husband had been diagnosed 15 years ago and was with anti arythmia medication .. Slowly medication had to be increased and finally ablation procedure when the highest medication dose was not avoiding the crisis..(he was followed for 4 years by the electrophysiologist before being told it was now time for ablation)

They only advice when medicine is not functioning (according to our experience)..

Have a good weekend 

.

[david_je]

On 10/18/2023 at 10:50 PM, Sheryl said:

Of course. Why wouldn't they?

 

In Thailand they usually admit overnight for this but even if they did not, it would be a day surgery, which is covered under IP policy.

Has anyone in this forum recently had catheter ablation done in Thailand that was covered by an April Intl inpatient policy? I have Essential policy.

[Sheryl]

28 minutes ago, david_je said:

Has anyone in this forum recently had catheter ablation done in Thailand that was covered by an April Intl inpatient policy? I have Essential policy.

I have not had ablation but I have twice had day procedures that required use of an OR (epidural injections) which were covered without problem.

 

There is nothing specific to an ablation I can think of that would be an issue assuming of course there is clear medical indication. Reasonableness of cost will of course be reviewed and might lead to some back and forth between insurer and hospital if estimate is considered unreasonable. And if hospital submits paperwork which does not show a clear medical justification, given how costly this elective procedure is, that would surely lead to some question.

[timoti]

If you go to hospital A to get diagnosed and then go to hospital B to get second opinion, and decide to do the procedure there, would April pay for both outpatient visits at both hospitals if the visits are within a few days of each other? I don't know if they would consider hospital A's outpatient visit irrelevant to the procedural done at hospital B?

 

Not sure if anyone has done this?

 

I reckon it's always good to get second opinion if a better doctor is not within reach for the first diagnosis.

[Sheryl]

6 hours ago, timoti said:

If you go to hospital A to get diagnosed and then go to hospital B to get second opinion, and decide to do the procedure there, would April pay for both outpatient visits at both hospitals if the visits are within a few days of each other? I don't know if they would consider hospital A's outpatient visit irrelevant to the procedural done at hospital B?

 

Not sure if anyone has done this?

 

I reckon it's always good to get second opinion if a better doctor is not within reach for the first diagnosis.

 

I did this before back surgery in 2019. Paid with no issue.

 

They will know it is relevant to the hospitalization from the medical certificate as this includes diagnosis. Note that a medical certificate is required for all outpatient costs claimed . Also note that the outpatient visit must have been within 30 days before or after an approved hospitalization.

[timoti]

On 10/25/2023 at 8:37 AM, Sheryl said:

 

I did this before back surgery in 2019. Paid with no issue.

 

They will know it is relevant to the hospitalization from the medical certificate as this includes diagnosis. Note that a medical certificate is required for all outpatient costs claimed . Also note that the outpatient visit must have been within 30 days before or after an approved hospitalization.

Thanks Sheryl that's helpful. Also I noticed the hospital that treated me filled the insurance form the way they saw fit like they said they were first specialist that I saw about this issue. So I hope if I were to submit the real first specialist a few days prior, April won't create issues. Because hopsital's own claims dept fills these forms. Not sure if you closely inspected the same filled forms after the fact.

 

Also April's 2023 changes are a bit confusing, not sure if you have seen them?

 

"We provide you with a network of healthcare professionals who charge Reasonable and Customary costs. If You receive treatment in a medical facility that is not recommended and is nota member of the APRIL International network, You will be subject to a 20% Deductible applicable to the amount of your claim if the cost of your treatment exceeds local standards (except for vital emergencies).You will find information on the APRIL International healthcare network- in your Guide and in your Easy Claim mobile application- by contacting our team: they are available to help you with all your healthcare needs"

 

Finding these is a bit tricky. In the app there is no such guide. I guess you can try to submit a claim and see if the hospital is listed there?

I found this but some links are broken:

Healthcare Networks and Direct Billing | APRIL International (april-international.com)

 

They have this but also not sure if it's April France:

pdf-network-specified-inpatient-providers-list-and-guide.pdf (april.fr)

 

"In Thailand, your treatment will be subject to a 40% co-insurance for any service in Bumrungrad International Hospital, BNH Hospital, Bangkok International Hospital, MedPark Hospital, Bangkok Hospital Pattaya, Bangkok Hospital Chiang Mai, and Bangkok Hospital Samui. Members insured under a policy issued in Hong Kong or Singapore are not subject to this restriction and can choose any medical facility in Thailand subject to the clause below. You can enjoy full coverage in all private hospitals in Thailand except for the above-mentioned providers"

 

They also increased the copay from 20% to %50 if you fail to inform them prior to treatment. Fair enough but I hope they dont make their terms worse year after year.

Edited October 29, 2023 by timoti

[Sheryl]

9 hours ago, timoti said:

Thanks Sheryl that's helpful. Also I noticed the hospital that treated me filled the insurance form the way they saw fit like they said they were first specialist that I saw about this issue. So I hope if I were to submit the real first specialist a few days prior, April won't create issues. Because hopsital's own claims dept fills these forms. Not sure if you closely inspected the same filled forms after the fact.

 

 

this is not how it works, and the claim will be rejected since you do not have outpatient cover.

 

For outpatient claims related to a hospitalization:

(1) You must first have had  an approved hospitalization (approved and already completed i.e. you have already been hospitalized.) An outpatient visit cannot be related to a hospitalization if there has not as yet been a hospitalization.

(2) You must then submit the related outpatient charges for reimbursement, having paid them first yourself. This is also try of discharge medications upon leaving the hospital after hospitalization, though the rest of the hospital bill can be direct pay.

 

I suggest you contact the hospital in question at once and explain you do nto have outpatient cover and need to pay the bill yourself. Then do so.

[retarius]

I'm always a bit careful with new procedures....not an early adopter. Have you been receiving treatment prior to this? If so what, amiodarone? warfarin? What has prompted the mention of surgical ablation at this time? New symptoms? 

I am familiar with the clinical data but would ask Sheryl if the data are compelling with regard to reduction in stroke risk and mortality?

[Sheryl]

9 hours ago, timoti said:

Also April's 2023 changes are a bit confusing, not sure if you have seen them?

 

"We provide you with a network of healthcare professionals who charge Reasonable and Customary costs. If You receive treatment in a medical facility that is not recommended and is nota member of the APRIL International network, You will be subject to a 20% Deductible applicable to the amount of your claim if the cost of your treatment exceeds local standards (except for vital emergencies).You will find information on the APRIL International healthcare network- in your Guide and in your Easy Claim mobile application- by contacting our team: they are available to help you with all your healthcare needs"

 

Finding these is a bit tricky. In the app there is no such guide. I guess you can try to submit a claim and see if the hospital is listed there?

I found this but some links are broken:

Healthcare Networks and Direct Billing | APRIL International (april-international.com)

 

They have this but also not sure if it's April France:

pdf-network-specified-inpatient-providers-list-and-guide.pdf (april.fr)

 

"In Thailand, your treatment will be subject to a 40% co-insurance for any service in Bumrungrad International Hospital, BNH Hospital, Bangkok International Hospital, MedPark Hospital, Bangkok Hospital Pattaya, Bangkok Hospital Chiang Mai, and Bangkok Hospital Samui. Members insured under a policy issued in Hong Kong or Singapore are not subject to this restriction and can choose any medical facility in Thailand subject to the clause below. You can enjoy full coverage in all private hospitals in Thailand except for the above-mentioned providers"

 

They also increased the copay from 20% to %50 if you fail to inform them prior to treatment. Fair enough but I hope they don't make their terms worse year after year.

 

I had not seen  pdf-network-specified-inpatient-providers-list-and-guide.pdf   before and will have to check with my broker. It sounds like it is a specific option people can  choose to take in exchange for a lower premium.  "You can save on your premium by choosing a Hospital and Surgery module with a Specified Inpatient Providers restriction."  I have not elected to do that, and would not.

 

You need to go by the terms listed specific to your policy which you will find posted on the online patient portal. Mine does not  refer to or link to this document. Rather it refers to a PPO network in the US. But I have emailed my broker for full clarification.

 

 

[timoti]

1 hour ago, Sheryl said:

 

I had not seen  pdf-network-specified-inpatient-providers-list-and-guide.pdf   before and will have to check with my broker. It sounds like it is a specific option people can  choose to take in exchange for a lower premium.  "You can save on your premium by choosing a Hospital and Surgery module with a Specified Inpatient Providers restriction."  I have not elected to do that, and would not.

 

You need to go by the terms listed specific to your policy which you will find posted on the online patient portal. Mine does not  refer to or link to this document. Rather it refers to a PPO network in the US. But I have emailed my broker for full clarification.

 

 

Let me know please. Because i see this in the general conditions document it's updated for 2023 they use blue text for the new changes right from the first page. There other ones i find from Google because the pdf doesn't say anything more.

 

I also didn't elect for this for cheaper premium so i hope it doesn't apply to us.

 

2022 edition didn't mention any of this.

 

1 hour ago, retarius said:

I'm always a bit careful with new procedures....not an early adopter. Have you been receiving treatment prior to this? If so what, amiodarone? warfarin? What has prompted the mention of surgical ablation at this time? New symptoms? 

I am familiar with the clinical data but would ask Sheryl if the data are compelling with regard to reduction in stroke risk and mortality?

 

No never. Doctor recommended it to me after first visit to him.

Edited October 30, 2023 by timoti

[timoti]

Also if you see another doctor for potential complication related to an inpatient treatment, would April cover that within 1 month of the operation?

[Sheryl]

13 minutes ago, timoti said:

Also if you see another doctor for potential complication related to an inpatient treatment, would April cover that within 1 month of the operation?

Outpatient care related to an actual (already took place)  approved hospitalization is covered for 30 days after hospital discharge. On a reimbursement basis. You pay first. Then submit medical certificate and receipt for reimbursement. 

[timoti]

18 hours ago, Sheryl said:

Outpatient care related to an actual (already took place)  approved hospitalization is covered for 30 days after hospital discharge. On a reimbursement basis. You pay first. Then submit medical certificate and receipt for reimbursement. 

Thanks a lot Sheryl. So a hospitalization related to a potential complication of a previous procedure, just for monitoring the patient and doing some tests would be covered on its own and it will allow future follow-ups related to this new hospitalization for a month with a different doctor in a different hospital, while being able to do follow up on the actual procedure with the original doctor?

[Sheryl]

54 minutes ago, timoti said:

Thanks a lot Sheryl. So a hospitalization related to a potential complication of a previous procedure, just for monitoring the patient and doing some tests would be covered on its own and it will allow future follow-ups related to this new hospitalization for a month with a different doctor in a different hospital, while being able to do follow up on the actual procedure with the original doctor?

 

All hospitalizations require pre-approval. Pre-approval process looks closely at medical necessity as well as reasonableness of cost.

 

IF  a hospitalization was approved and took place, outpatient visits directly  related to it are covered for 30 says.

 

I doubt a hospitalization would be approved just for monitoring and doing some tests as that sounds like something that could be done as an outpatient. 

 

It sounds like you are trying to arrange dubious/unnecessary hospitalizations just to get outpatient visits covered. That is not going to work.

 

Also please note my prior post about your outpatient bill submitted for direct payment. It will not be paid. 

 

 

[timoti]

1 hour ago, Sheryl said:

 

All hospitalizations require pre-approval. Pre-approval process looks closely at medical necessity as well as reasonableness of cost.

 

IF  a hospitalization was approved and took place, outpatient visits directly  related to it are covered for 30 says.

 

I doubt a hospitalization would be approved just for monitoring and doing some tests as that sounds like something that could be done as an outpatient. 

 

It sounds like you are trying to arrange dubious/unnecessary hospitalizations just to get outpatient visits covered. That is not going to work.

 

Also please note my prior post about your outpatient bill submitted for direct payment. It will not be paid. 

 

 

No the second hospitalization is related to a complication the arise from inpatient procedure and april approved it. Doctor said i should stay overnight so they can see if it will be better.

I was just curious because after discharge the specialist wanted to follow up on this later on after a week.

[david_je]

On 10/24/2023 at 4:03 PM, Sheryl said:

I have not had ablation but I have twice had day procedures that required use of an OR (epidural injections) which were covered without problem.

 

There is nothing specific to an ablation I can think of that would be an issue assuming of course there is clear medical indication. Reasonableness of cost will of course be reviewed and might lead to some back and forth between insurer and hospital if estimate is considered unreasonable. And if hospital submits paperwork which does not show a clear medical justification, given how costly this elective procedure is, that would surely lead to some question.

I was wondering if April Intl would consider ablation "medically necessary" and cover it since some people only take rate control or antiarrhythmic medicines and not all doctors go to ablation as first-line treatment. Last cardiologist I saw in Bangkok said I should go direct to ablation.

I am currently overseas, outside my April Intl zone of coverage, and if they would not cover it in Thailand, I may have procedure done overseas. How can I get good idea of whether they would cover -- or have covered it in the past -- before I return to Thailand in next few weeks? Ask the broker? Ask April (though I imagine they would say they would need to see the doctor's note and tests first, which of course I have not yet done for the procedure).

[Sheryl]

38 minutes ago, david_je said:

I was wondering if April Intl would consider ablation "medically necessary" and cover it since some people only take rate control or antiarrhythmic medicines and not all doctors go to ablation as first-line treatment. Last cardiologist I saw in Bangkok said I should go direct to ablation.

I am currently overseas, outside my April Intl zone of coverage, and if they would not cover it in Thailand, I may have procedure done overseas. How can I get good idea of whether they would cover -- or have covered it in the past -- before I return to Thailand in next few weeks? Ask the broker? Ask April (though I imagine they would say they would need to see the doctor's note and tests first, which of course I have not yet done for the procedure).

 

Whether they would cover it will depend very much on the information provided by the hospital in their request for GOP and the specific arrythmia being treated.

 

Ablation is generally indicated for atrioventricular re-entrant tachycardia, atrioventricular nodal re-entrant tachycardia (AVNRT), unifocal atrial tachycardia, and  atrial flutter. In atrial fibrillation, it is indicated only if medications have been unsuccessful in controlling the ventricular rate. 

 

Please see https://www.ncbi.nlm.nih.gov/books/NBK470203/

and note carefully the significant risks associated with this procedure. 

 

The other issue besides whether they would deem it medically necessary is the reasonableness of costs proposed which is often a problem with Bumrungrad etc.

 

There is no way to know if an insurer would pay for something until a hospital submitted the necessary paperwork.

 

But as you are overseas I do suggest you get a second opinion  from a cardiologist in your own country if possible. You may find they do nto concur with the idea of immediate ablation in which case, problem solved, at least for now. It appears doctors at some private hospitals in Thailand are deviating from accepted medical standards and urging people to have ablations who probably should not, at least nto as first approach.

[david_je]

On 10/30/2023 at 11:16 AM, Sheryl said:

 

I had not seen  pdf-network-specified-inpatient-providers-list-and-guide.pdf   before and will have to check with my broker. It sounds like it is a specific option people can  choose to take in exchange for a lower premium.  "You can save on your premium by choosing a Hospital and Surgery module with a Specified Inpatient Providers restriction."  I have not elected to do that, and would not.

 

You need to go by the terms listed specific to your policy which you will find posted on the online patient portal. Mine does not  refer to or link to this document. Rather it refers to a PPO network in the US. But I have emailed my broker for full clarification.

 

 

Wondering if you have heard back from broker on this? Assume it is AA? Thank you.

[Sheryl]

2 hours ago, david_je said:

Wondering if you have heard back from broker on this? Assume it is AA? Thank you.

AA no longer handles international policies. So I switched to AOC.

 

My broker confirmed that at this time the only network is in USA (actually not an April network, rather April uses that of Aetna). Also confirmed that when April issues a GOP to a hospital this assures that they consider the costs "reasonable" so cannot be any copay issue (other than any excess you chose in your policy). 

 

Since GOP is required for all inpatient direct billing I suspect the whole "network" bit is mainly for outpatient care....and currently just in USA. Though this latter could eventually change. 

[david_je]

39 minutes ago, Sheryl said:

AA no longer handles international policies. So I switched to AOC.

 

 

How did you know AA no longer handles intl policies? I did not receive any such notification from them. So that means we have to find another broker to deal with the April Intl (France) policy we bought via AA? How do you switch to AOC -- would you recommend them and whom to contact? Thank you.

[Sheryl]

3 hours ago, david_je said:

How did you know AA no longer handles intl policies? I did not receive any such notification from them. So that means we have to find another broker to deal with the April Intl (France) policy we bought via AA? How do you switch to AOC -- would you recommend them and whom to contact? Thank you.

My broker at AA (Jenny) emailed me to this effect. Others have found out after contacting AA regarding an international policy.

 

Supposedly international policies of former AA cluents are now handled by an affiliate called AA-World based in India. More than 6 months after this change, AA-World website is still not operational. They did not contact me when my premium was due.

 

To switch to AOC just go to their website and fill out contact request. They will send you the necessary forms. They are French based and handle many April Int policies. Written communication via email and Whats App is easy. They are happy to talk via Whats App or Google Chat  but  be forewarned very strong French accent can make it hard to understand (if you speak French then of course not an issue.).

 

Beyond that can't say anything as I have not had a claim since switching. 

 

 

[domdom]

Hello

After an ablation, is there a timing to respect to have a colonoscopy ?

I will ask the electrophysiologist but would like to have Sheryl s opinion as BPH of course just want to make 1 ton of exams before colonoscopy..CT scan etc... so, they can charge dozens of thousands bahts on top of colonoscopy cost....Reason given "check if there are no blood clots"....when I am on Xarelto for over 10 years..

My last time in BPH.(already go elsewhere for nearly everything but they contacted me as they did my last colonoscopy 5 years ago).. Fed up with the "cash machine" ... No more..

Have a good day

 

[Sheryl]

23 hours ago, domdom said:

Hello

After an ablation, is there a timing to respect to have a colonoscopy ?

I will ask the electrophysiologist but would like to have Sheryl s opinion as BPH of course just want to make 1 ton of exams before colonoscopy..CT scan etc... so, they can charge dozens of thousands bahts on top of colonoscopy cost....Reason given "check if there are no blood clots"....when I am on Xarelto for over 10 years..

My last time in BPH.(already go elsewhere for nearly everything but they contacted me as they did my last colonoscopy 5 years ago).. Fed up with the "cash machine" ... No more..

Have a good day

 

There is no particular timing between ablation and colonoscopy as long as your condition is now stable.

 

And no reason to have  a CT first.

 

However you  need to check with your cardiologist as to whether you can safely stop the Xarelto for 1-2 days before the colonoscopy (to decrease risk of bleeding in case if polyp removal). Suggest to get his recommendation in writing as otherwise BPH will insist you see one of their cardiologists first. 

[domdom]

Thank you.. BPH is over for us.. Even with reco from Bgk specialist they want to do as much tests as possible..

Gastroenterologist sent us to cardiologist..(which I can understand..) Before seeing the cardiologist they made a lung X Ray !!!! Then an ECG..

The cardiologist as soon as we told there had been an ablation 2 months ago said... No, you cannot do a colonoscopy before 6 months.. Then he said "but we will do anyway today an echocardio and a CT scan as you might have blood clot".. 

We told him..no way, as anyway he had said the colonoscopy could not be done before 6 months. Why an echocardio and CT scan..

I will add that before the 2nd ablation, a cardioversion had been necessary one day due to heavy tachycardy. We had the written reco from the specialist saying in case of tachycardy a cardioversion had to be performed.. In emergency BPH they wanted to first do a full blood check + X exams, and a one night stay before performing the cardioversion 24 h later.... more than 60.000 bahts

We paid, went to Sirikit..in 1 hour was performed in emergency room according to the medical reco of the specialist..12.000 bahts..

No more BPH..I checked and Sirikit performs colonoscopy..we will go there..good service, reasonable price and nice people..

I am now expecting answer from the BGK specialist but sure he will say colonoscopy can be done as after the procedure he gave full infos to follow during 3 to 6 months.. and he didn't say any procedure was forbidden..

Thank you

Have a good day

 

 

[david_je]

On 11/5/2023 at 4:40 PM, Sheryl said:

My broker at AA (Jenny) emailed me to this effect. Others have found out after contacting AA regarding an international policy.

 

Supposedly international policies of former AA cluents are now handled by an affiliate called AA-World based in India. More than 6 months after this change, AA-World website is still not operational. They did not contact me when my premium was due.

 

To switch to AOC just go to their website and fill out contact request. They will send you the necessary forms. They are French based and handle many April Int policies. Written communication via email and Whats App is easy. They are happy to talk via Whats App or Google Chat  but  be forewarned very strong French accent can make it hard to understand (if you speak French then of course not an issue.).

 

Beyond that can't say anything as I have not had a claim since switching. 

 

 

May I ask, how did you find/decide on AOC? Someone recommended? I'm wondering if it would be better to have a broker in Thailand or at least in same/closer time zone?