Unpaid Hospital Bills

[Mike Lister]

Several posts recently have suggested that unpaid hospital bills, left by foreigners, are a major financial problem in Thailand, at least one hinted at how easy it was to simply walk out without paying. I know this can be a big problem when it comes to workers from nearby countries, particularly in Phuket involving workers in construction and fisheries, but I think instances of non-payment amongst Westerners is quite rare, despite what the sensationalist media might suggest to the contrary! 

 

I had five days in hospital in November and had to leave a deposit and a credit card number before hand, my experience in Bangkok, fifteen years earlier was exactly the same.  In both cases the deposit matched the estimate and the final bill, or near enough. Plus every hospital I visit has my passport details on file which means that Immigration at the airport is very likely to be aware of the unpaid bill and refuse permission to leave. Years ago, an acquaintance became involved in a legal matter and tried to travel to Singapore but his Thai Immigration record had been flagged and he was turned back.

 

Unpaid medical bills by citizens of other Asian countries will be quite high I imagine, by Westerners they will be tiny, the habit of taking out health or travel assurance alone make this more probable.

[flyingtlger]

8 minutes ago, Mike Lister said:

I think instances of non-payment amongst Westerners is quite rare

Yes, the hospitals that I've been in Thailand will not even allow a doctor to see you unless they have all your information.

Now if someone was seriously injured and unconscious and rushed into the emergency room, that maybe a different story.

I see more media coverage of tourist or expats that are seriously injured asked for help via GoFundMe or begging for help from their countrymen....

[BritManToo]

I was a hit and run victim 3 months back, government hospital didn't ask for any money until I wanted to leave. Paid 6kbht on Sunday afternoon, which was handed back Monday when my m/c government minimum insurance agreed to pay all costs it to 30kbht.

[Mike Lister]

1 minute ago, BritManToo said:

I was a hit and run victim 3 months back, government hospital didn't ask for any money until I wanted to leave. Paid 6kbht on Sunday afternoon, which was handed back Monday when my m/c government minimum insurance agreed to pay all costs it to 30kbht.

I think this is one of the many differences between the private and government hospitals, government hospitals just want to practice medicine and treat people rather than focus on making money. I hope you're nearly fully recovered by the way, a big hand for Sansai hospital too.

[NicoBKK]

I think the unpaid bills are from foreigners which were transported to the hospital following an emergency e.g. accident, stroke.., not planning to go there for a disease. After life saving treatment the bill is asked and in some cases their funds or credit cards cannot sustain the expense.

[HampiK]

I think if we talk about unpaid bills by foreigner, then this are mostly tourists which not had an insurance or travel insurance when they come to thailand. And then drive a motorbike for example.

 

you can read a story (gofundme) almost every week.

[scubascuba3]

Problem is ambulance can take you to the most expensive hospital where they get paid the most and then that hospital will milk it for all they can, if that person has good insurance then fine

[Old Croc]

A few years ago, Vacchira Hospital in Phuket had a well-publicized whinge about a few million (15m. I think) of unpaid bills they attributed to foreigners. A mere drop in the budget bucket for such a huge, busy hospital.  Any thinking person would come to the conclusion the culprits would overwhelmingly be tourists falling off bikes, etc.

However, the government (Anutan) decided it was all the fault of long-term residents on O-A visas specifically, so they instituted a criterion for their future extensions that required health insurance bought from a few (favored?) Thai insurance companies.

I never saw any feedback on whether this fixed the problem.

Edited January 25 by Old Croc

[Mike Lister]

2 minutes ago, Old Croc said:

A few years ago, Vacchira Hospital in Phuket had a well-publicized whinge about a few million (15m. I think) of unpaid bills they attributed to foreigners. A mere drop in the budget bucket for such a huge, busy hospital.  Any thinking person would come to the conclusion the culprits would overwhelmingly be tourists falling off bikes, etc.

However, the government decided it was all the fault of long-term residents on O-A visas specifically, so they instituted a criterion for their future extensions that required health insurance bought from a few (favored?) Thai insurance companies.

I never saw any feedback on whether this fixed the problem.

I saw that also, I remember it very well. I think that whinge was passed upstream and used an excuse to impose a tax on tourists, to cover their unpaid medical bills, I think that's what happened.

[Old Croc]

1 minute ago, Mike Lister said:

I saw that also, I remember it very well. I think that whinge was passed upstream and used an excuse to impose a tax on tourists, to cover their unpaid medical bills, I think that's what happened.

Yes, an arrival tax which I think was never started in case it upset the Chinese. 

[prakhonchai nick]

• Am currently assisting a widow, whose husband died recently from cancer. Prior to death he received expensive treatment which he paid for by raiding his visa extension fund and he appeared better. However a few weeks later he was again hospitalised and after a few days he died. There was no money left to pay the hospital. The hospital have demanded payment by the widow, but since her husband died penniless, with no estate, I have told her that his debt is not her liablity.  She does not want to argue with the hospital, and will try and repay over the coming months from  her small pension.  Her choice, but I think she is wrong.

[Liquorice]

7 hours ago, Mike Lister said:

I had five days in hospital in November and had to leave a deposit and a credit card number before hand, my experience in Bangkok, fifteen years earlier was exactly the same. 

I highly suspect that was a private hospital, Mike.
I had a similar experience at a local private hospital, for a small surgical procedure, where they first asked if I had Insurance or a Thai bank account. I've always preferred to self Insure, but informed them I had a Thai bank account with sufficient funds. They then wanted to know how much in funds, at which point I walked away.

 

I'm a volunteer at a local Government hospital, where it's a different story.
No questions asked, they treat all in good faith, but foreigners do take advantage.
Although not a tourist area, we do get a lot of foreign visitors, who due to falls, accidents, or minor surgery, require medical treatment and visit the local government hospital.

Bills can vary from just a couple of thousand bahts to 25K, but quite a few don't have sufficient funds at hand, promising to return after a visit to an ATM. Many never return to settle their debt.

 

By far the worst culprits are long term stayers, particularly those on long term visas, or extensions of stay based on retirement.
Stroke, heart attack, road traffic accidents can leave patients in induced comas or in ICU, are incapacitated and unable to access any funds.

I personally know of a number of cases where the patients deceased, leaving huge unpaid bills.
In certain cases, the hospital can obtain a court order giving them access to any funds the foreigner may have in a Thai bank account, but that often doesn't cover the bill.

 

1 hour ago, Old Croc said:

However, the government (Anutan) decided it was all the fault of long-term residents on O-A visas specifically, so they instituted a criterion for their future extensions that required health insurance bought from a few (favored?) Thai insurance companies.

The reasoning behind that was simple. You're at more of a risk of having an accident or requiring medical attention in a twelve-month period (the length of stay permitted on an O-A visa) than a tourist averaging a 3 week stay.  There is also no requirement to have a Thai bank account with the O-A visa. If incapacitated or in the event of death, the hospital have no means of recovering the costs, hence they introduced a mandatory Health Insurance policy.

 

Why do you think in 2019, Immigration changed the financial requirements regarding funds in the bank for retirees?
Prior to 2019 the requirement was 800K for 2 months prior to the date of the very first application, and 3 months prior to the date of application thereafter.

In 2019 Immigration issued a new order 548/2562, which now required retirees using the funds method to have 800K in the bank for 2 months prior to the date of application, then maintain that balance of 800K for 3 months after the extension was issued, at which point they could withdraw half the funds, but must maintain a balance of 400K thereafter.

This was no fluke, it was to ensure as far as possible in the event of emergency, retirees at least had a certain amount of funds to cover bills.

 

There are of course still loopholes in the system.
I know of 2 foreigners cared for in ICU that eventually passed, but although they had a Thai bank account, there was little in either account.
They obtained extensions by virtue of an Embassy Income letter and only transferred funds as required.

 

In the course of a year this amounts to hundreds of thousand, even millions, owed to just one government hospital.

Edited January 25 by Liquorice

[Mike Lister]

8 minutes ago, Liquorice said:

I highly suspect that was a private hospital, Mike.
I had a similar experience at a local private hospital, for a small surgical procedure, where they first asked if I had Insurance or a Thai bank account. I've always preferred to self Insure, but informed them I had a Thai bank account with sufficient funds. They then wanted to know how much in funds, at which point I walked away.

 

I'm a volunteer at a local Government hospital, where it's a different story.
No questions asked, they treat all in good faith, but foreigners do take advantage.
Although not a tourist area, we do get a lot of foreign visitors, who due to falls, accidents, or minor surgery, require medical treatment and visit the local government hospital.

Bills can vary from just a couple of thousand bahts to 25K, but quite a few don't have sufficient funds at hand, promising to return after a visit to an ATM. Many never return to settle their debt.

 

By far the worst culprits are long term stayers, particularly those on long term visas, or extensions of stay based on retirement.
Stroke, heart attack, road traffic accidents can leave patients in induced comas or in ICU, are incapacitated and unable to access any funds.

I personally know of a number of cases where the patients deceased, leaving huge unpaid bills.
In certain cases, the hospital can obtain a court order giving them access to any funds the foreigner may have in a Thai bank account, but that often doesn't cover the bill.

 

The reasoning behind that was simple. You're at more of a risk of having an accident or requiring medical attention in a twelve-month period (the length of stay permitted on an O-A visa) than a tourist averaging a 3 week stay.  There is also no requirement to have a Thai bank account with the O-A visa. If incapacitated or in the event of death, the hospital have no means of recovering the costs, hence they introduced a mandatory Health Insurance policy.

 

Why do you think in 2019, Immigration changed the financial requirements regarding funds in the bank for retirees?
Prior to 2019 the requirement was 800K for 2 months prior to the date of the very first application, and 3 months prior to the date of application thereafter.

In 2019 Immigration issued a new order 548/2562, which now required retirees using the funds method to have 800K in the bank for 2 months prior to the date of application, then maintain that balance of 800K for 3 months after the extension was issued, at which point they could withdraw half the funds, but must maintain a balance of 400K thereafter.

This was no fluke, it was to ensure as far as possible in the event of emergency, retirees at least had a certain amount of funds to cover bills.

 

There are of course still loopholes in the system.
I know of 2 foreigners cared for in ICU that eventually passed, but although they had a Thai bank account, there was little in either account.
They obtained extensions by virtue of an Embassy Income letter and only transferred funds as required.

 

In the course of a year this amounts to hundreds of thousand, even millions, owed to just one government hospital.

Extremely useful and helpful insight, thank you for posting.

[Lacessit]

I have never been asked for money up front in either a private or public hospital in Chiang Rai.

 

Bangkok Hospital in Chiang Mai wanted money up front for a check cystoscopy. 18,000 baht, fair enough.

 

I keep 500K baht in an account separate to the 800K, specifically for medical emergencies.

 

During COVID, I was in quarantine for 14 days in a Thai provincial hospital. I was not charged a single baht.

 

IME Thai public hospitals are quite inexpensive, although long waiting times are par for the course.

[Mike Lister]

1 hour ago, Liquorice said:

I highly suspect that was a private hospital, Mike.
I had a similar experience at a local private hospital, for a small surgical procedure, where they first asked if I had Insurance or a Thai bank account. I've always preferred to self Insure, but informed them I had a Thai bank account with sufficient funds. They then wanted to know how much in funds, at which point I walked away.

 

I'm a volunteer at a local Government hospital, where it's a different story.
No questions asked, they treat all in good faith, but foreigners do take advantage.
Although not a tourist area, we do get a lot of foreign visitors, who due to falls, accidents, or minor surgery, require medical treatment and visit the local government hospital.

Bills can vary from just a couple of thousand bahts to 25K, but quite a few don't have sufficient funds at hand, promising to return after a visit to an ATM. Many never return to settle their debt.

 

By far the worst culprits are long term stayers, particularly those on long term visas, or extensions of stay based on retirement.
Stroke, heart attack, road traffic accidents can leave patients in induced comas or in ICU, are incapacitated and unable to access any funds.

I personally know of a number of cases where the patients deceased, leaving huge unpaid bills.
In certain cases, the hospital can obtain a court order giving them access to any funds the foreigner may have in a Thai bank account, but that often doesn't cover the bill.

 

The reasoning behind that was simple. You're at more of a risk of having an accident or requiring medical attention in a twelve-month period (the length of stay permitted on an O-A visa) than a tourist averaging a 3 week stay.  There is also no requirement to have a Thai bank account with the O-A visa. If incapacitated or in the event of death, the hospital have no means of recovering the costs, hence they introduced a mandatory Health Insurance policy.

 

Why do you think in 2019, Immigration changed the financial requirements regarding funds in the bank for retirees?
Prior to 2019 the requirement was 800K for 2 months prior to the date of the very first application, and 3 months prior to the date of application thereafter.

In 2019 Immigration issued a new order 548/2562, which now required retirees using the funds method to have 800K in the bank for 2 months prior to the date of application, then maintain that balance of 800K for 3 months after the extension was issued, at which point they could withdraw half the funds, but must maintain a balance of 400K thereafter.

This was no fluke, it was to ensure as far as possible in the event of emergency, retirees at least had a certain amount of funds to cover bills.

 

There are of course still loopholes in the system.
I know of 2 foreigners cared for in ICU that eventually passed, but although they had a Thai bank account, there was little in either account.
They obtained extensions by virtue of an Embassy Income letter and only transferred funds as required.

 

In the course of a year this amounts to hundreds of thousand, even millions, owed to just one government hospital.

Can you share with us what part of the country you're in please, it may help the context?

[findlay13]

11 hours ago, Mike Lister said:

Several posts recently have suggested that unpaid hospital bills, left by foreigners, are a major financial problem in Thailand, at least one hinted at how easy it was to simply walk out without paying. I know this can be a big problem when it comes to workers from nearby countries, particularly in Phuket involving workers in construction and fisheries, but I think instances of non-payment amongst Westerners is quite rare, despite what the sensationalist media might suggest to the contrary! 

 

I had five days in hospital in November and had to leave a deposit and a credit card number before hand, my experience in Bangkok, fifteen years earlier was exactly the same.  In both cases the deposit matched the estimate and the final bill, or near enough. Plus every hospital I visit has my passport details on file which means that Immigration at the airport is very likely to be aware of the unpaid bill and refuse permission to leave. Years ago, an acquaintance became involved in a legal matter and tried to travel to Singapore but his Thai Immigration record had been flagged and he was turned back.

 

Unpaid medical bills by citizens of other Asian countries will be quite high I imagine, by Westerners they will be tiny, the habit of taking out health or travel assurance alone make this more probable.

20 years ago had a bike spill and ended in Hospital for 2 days in Pattaya. When I got out a guy drove me in a mini-van Ambulance and accompanied me to my apartment complex . He was never more than two feet away from me until I got the money to pay the bill from my safety box. . I don't know how people skip hospital bills 

[The Old Bull]

I had my apendix out a few years ago before they had an ATM at the hospital.So when I went to leave they put me in an ambulance and headed to the nearest ATM with the lights and siren on ,wasn't too expensive around $1200. I think I was in the hospital three nights.

[richard_smith237]

I had a couple of MRI's in the past year... 

For Outpatient stuff (such as imaging etc) - my insurance covers everything, but is self pay and claim back.

 

 

The MRI at Bumrungrad was smoother... the nursing admin badgered me somewhat for payment, but I told them I wanted to pay in one bill, not 3 separate bills (initial consultation, MRI itself, follow up)...  they were ok with that after I'd explained.

 

At Bangkok Hospital (different issue)... they badgered me, I explained my insurance is self pay and claim back etc...  I was asked about 5 times by different staff how I'm going to pay - it seemed that was all they cared about and I started to get irritated,  they then asked for a deposit with my credit card which I refused and got annoyed...  I asked if they were going to do the MRI or should I go else where (not my finest hour by my buttons had be pressed)... 

 

I've been registered and have used both hospitals for well over 15 years and have full payment history.

 

 

It seems more than anything else these private hospitals are primarily concerned with payment, I get that. 

But when we've explained its self pay and we'll pay directly, have been registered for a long time etc it starts to stretch the meaning of 'care'...  (IMO).

 

 

 

 

[richard_smith237]

I just want to point out at this time that the medical burden of tourists on Thailands medical industry (i.e. cost of unpaid bills) is 300,000 Million Baht a year....   which is 1.5% of the income tourists bring to the medical industry which is 24 Billion Baht year.

 

So.. if foreigners stopped coming to Thailand, Thailands medical industry would be 23.7 Billion Baht per year worse off... 

 

 

[ukrules]

17 minutes ago, richard_smith237 said:

300,000 Million Baht a year

But that's 300 Billion Baht

[Mike Lister]

31 minutes ago, richard_smith237 said:

I just want to point out at this time that the medical burden of tourists on Thailands medical industry (i.e. cost of unpaid bills) is 300,000 Million Baht a year....   which is 1.5% of the income tourists bring to the medical industry which is 24 Billion Baht year.

 

So.. if foreigners stopped coming to Thailand, Thailands medical industry would be 23.7 Billion Baht per year worse off... 

 

 

Do you have a source for those stats, please?

[richard_smith237]

Just now, Mike Lister said:

Do you have a source for those stats, please?

 

Very easy to dig out...  with a quick google search.. 

 

 

[Mike Lister]

Just now, richard_smith237 said:

 

Very easy to dig out...  with a quick google search.. 

 

 

Richard, forum rules require you to post a link to factual statements such as yours! Do you have a link, please?

[richard_smith237]

Just now, Mike Lister said:

2 minutes ago, richard_smith237 said:

 

Very easy to dig out...  with a quick google search.. 

 

 

Richard, forum rules require you to post a link to factual statements such as yours! Do you have a link, please?

 

There...  5 seconds...  

 

https://www.nationthailand.com/in-focus/30365540

 

https://www.statista.com/statistics/1311335/thailand-market-value-of-medical-tourism/

 

 

 

[drkenchao]

thai govt should require every
tourists to buy health insurance
or contribute to a broad fund
set up by the govt for this
purpose. There are always
news that Thai public health
system spent too much on
foreigners or default withouT
settling the bill after treatment. which led to
immigration required OA retirees to buy
mandatory health insurance, however, the particular case in nov 2023
of a british man，tourist, suffered from leukemia and unable to settle Thai hospital bill of about 10000 british pound sterling (reported in bangkokpost and thaiger)shows that mandatory
insurance for retirees simplily could not help
govt to reduce public health expense, but the
retirees suffer due to extremely high
insurance fee (comes with old age) and the
exclusion on pre conditions and all illness
that may arise from pre conditions, but are
retirees more susceptible to the latter illness
than other new medical problems, for
example, if common healtH priblems such as
diabetes, high blood pressure, and chlestrol
are all excluded from protection, maybe the
health insurance only useful for some cancers
such as lung cancer or PSA problem?

[richard_smith237]

2 minutes ago, drkenchao said:

thai govt should require every
tourists to buy health insurance
or contribute to a broad fund
set up by the govt for this
purpose.

 

Thats been in discussion numerous times...  with announcements that they are implementing a tax... 

Numerous announcements of such last year... 

 

But, as always, the announcements jump the gun and the practicalities are not considered, the 'plan' falls by the wayside. 

 

IMO - something like this could be implemented.

 

- Travel insurance is included in the cost of a Visa.

- Visa Exempt Entires pay a nominal insurance fee upon entry.

- Visa on entry pays a nominal insurance fee upon entry.

 

Enforced existing law that 'any hospital' (nearest) treats emergency cases (for at least 72 hrs or until moving them to a government facility is not threatening to life) - if they can't be moved the 'government insurance' (paid for on arrival covers this).

 

Those who have their own medical insurance can of course be transfer to or stay at their private medical facility of choice

 

etc etc...

 

The issue as always... is the money... who gets it ???  nothing is done or improved here without someone getting their cut.

 

 

[NoshowJones]

10 hours ago, NicoBKK said:

I think the unpaid bills are from foreigners which were transported to the hospital following an emergency e.g. accident, stroke.., not planning to go there for a disease. After life saving treatment the bill is asked and in some cases their funds or credit cards cannot sustain the expense.

What happens then?

[Paris333]

The Embassies of the European Union and America are responsible for this unacceptable situation.
1.Health is not a "tourist product". 
2.Embassies should have contracted hospitals in Bangkok-Phuket for emergensy treatment of western tourists.
3.Western tourists are the victims of the medical mafia which after the corona they want to be compensated for the damages they suffered during the corona.

European Union and America Embassies are responsible for this horrible and unacceptable situation.

Health is not a "tourist product". ......we play "corona game" but now the game is over!

[Lopburikid]

21 hours ago, Mike Lister said:

Several posts recently have suggested that unpaid hospital bills, left by foreigners, are a major financial problem in Thailand, at least one hinted at how easy it was to simply walk out without paying. I know this can be a big problem when it comes to workers from nearby countries, particularly in Phuket involving workers in construction and fisheries, but I think instances of non-payment amongst Westerners is quite rare, despite what the sensationalist media might suggest to the contrary! 

 

I had five days in hospital in November and had to leave a deposit and a credit card number before hand, my experience in Bangkok, fifteen years earlier was exactly the same.  In both cases the deposit matched the estimate and the final bill, or near enough. Plus every hospital I visit has my passport details on file which means that Immigration at the airport is very likely to be aware of the unpaid bill and refuse permission to leave. Years ago, an acquaintance became involved in a legal matter and tried to travel to Singapore but his Thai Immigration record had been flagged and he was turned back.

 

Unpaid medical bills by citizens of other Asian countries will be quite high I imagine, by Westerners they will be tiny, the habit of taking out health or travel assurance alone make this more probable.

If you can't snow medical insurance when you attend hospital, they usually ask if you have the funds to pay (out patient) If an inpatient, they will usually ask for a deposit and/or keep your passport. been in hospital twice since moving here, both times showed medical insurance, never had a problem. morale. get medical insurance, you know you have to pay.

[Classic Ray]

Held hostage for extra day in private hospital in Chiang Mai after knocked off mcycle until at fault driver’s insurance agreed to pay.

 

Now have Govt cover with wife’s job at public hospital in BKK. To see doctor takes all day but consult plus drugs is 50 baht, so worth the wait. They always quote real cost of drugs for my condition, over 24k every 3 months. High standard of care, they also take cash for foreigners, have several ATMs.