How to avoid Health Insurance claim denials in Thailand

[CharlieH]

 

Health insurance can be a lifesaver until your claim gets denied. In Thailand, research shows that 85% of insurance claim rejections happen due to simple, preventable mistakes. Whether you're a long-term expat or a frequent visitor of the Kingdom, knowing how to manage your health insurance claims can save you time, money, and frustration.

Why health insurance claims get denied in Thailand

1. Missing or incorrect documentation

Simple paperwork mistakes are the most common issue, such as:

• No diagnosis or unclear treatment descriptions

• Unitemised bills

• Missing doctor’s name or hospital stamp

2. Ineligible or uncovered treatment

Claims are denied if:

• Your policy expired

• The treatment falls under a waiting period

• The condition isn’t covered

3. Procedural mistakes

Common slip-ups include:

• Filing late

• Duplicate submissions

• Misspelled names or incorrect policy numbers

• Skipping pre-authorisation

4. Coding errors

Incorrect medical billing codes or treatment codes can confuse insurers and result in partial or denied reimbursements.

5. Exclusions

Services that exceed policy limits or fall under exclusions, such as pre-existing conditions, may not be covered, leading to a claim denial. Similarly, claims may also be denied if the insurer determines that the treatment or service was not medically necessary.

How to prevent health insurance claim rejections

Be sure to stay consistent with how and when you file your records. It may help to build a claims checklist and keep records of:

• Previous claims

• Medical certificates

• Receipts and policy numbers

Confirm coverage before visiting the doctor

 

Check your coverage status, make sure your treatment is included, and ask if pre-authorisation is needed, especially for surgeries or specialist visits.

Network hospitals and clinics of your health insurance providor will know how to handle insurer paperwork and can help process claims faster, often through direct billing.

Remember to ask for:

• Full medical reports

• Bills with service breakdowns

• Translated documents if they’re in Thai

It may also be wise to keep them safe and backed up digitally.

Don’t delay your submission

Always submit within the 30-day window after treatment. The sooner, the better. And remember to triple-check everything. One type can cause weeks of delays. Before submitting, verify your:

• Name and policy number

• Medical codes

• Dates and receipts

Use tech to your advantage

• Online claim submission: Most insurers now offer online claim forms—quicker, cleaner, and fewer mistakes.

• Track claims in real-time: Use your insurer’s portal or app to check claim status and get alerts if something is missing.

• Automated coverage checks: Some platforms instantly check if your treatment is eligible before you even visit the hospital.

Choose your insurer wisely

When choosing your provider, look for:

• Transparency: Pick a provider that clearly explains policies, avoiding any confusion around the claims process.

• Strong hospital networks: Wider coverage means easier direct billing, shorter wait times, and less paperwork.

• Responsive support: Choose insurers with multilingual support teams who respond quickly and actually help when you’re in a pinch.

 

For expats in Thailand, Cigna health insurance remains a top choice not only for their responsive support and strong hospital networks, but their comprehensive and tailored plans also provide world-class care. Coverage includes:

• Hospital stays: Coverage up to $1,000,000 annually for major health conditions.

• Doctor visits: Up to $25,000 per year for check-ups and specialist care.

• Chronic illness care: Full coverage for long-term treatments.

• Emergency evacuation: Global emergency assistance.

• Preventive care: Screenings, vaccinations, and routine check-ups to detect and manage health issues early on.

• Custom add-ons: Additional coverage for dental, vision, or maternity care.

 

Getting your health insurance claims approved in Thailand doesn’t have to be stressful. With a little planning, attention to detail, and the right insurer, you’ll avoid costly denials and get the coverage you deserve.

 

 

 

[James65]

The best way is to self insure, save and invest the money you would have wasted on premiums......

[Grumpy one]

To avoid Health Insurance claim rejection--- DONT GET SICK or ride a bike or drink or breath

[Ben Zioner]

On 3/30/2025 at 5:44 PM, James65 said:

The best way is to self insure, save and invest the money you would have wasted on premiums......

"self insure" is an oxymoron, insurance is a mutualising a risk. You can't mutualise anything with yourself.

[BigBilly]

2 hours ago, Ben Zioner said:

self insure" is an oxymoron, insurance is a mutualising a risk. You can't mutualise anything with yourself.

Who cares?  When you self insure, you don't buy insurance, but instead set aside cash of at least the same amount of the insurance policy maximum coverage.

 

Certainly a winning strategy if you can comfortably afford to set aside that much cash.

[JoseThailand]

2 hours ago, Ben Zioner said:

"self insure" is an oxymoron, insurance is a mutualising a risk. You can't mutualise anything with yourself.

 

You can. You mutualize a risk with yourself in the future. You set aside some money now so that in the future you can be "insured" with that money

[JoseThailand]

9 hours ago, Grumpy one said:

To avoid Health Insurance claim rejection--- DONT GET SICK or ride a bike or drink or breath

 

To avoid health insurance claim rejection, don't make a claim

[Ben Zioner]

5 hours ago, JoseThailand said:

 

You can. You mutualize a risk with yourself in the future. You set aside some money now so that in the future you can be "insured" with that money

And you do that with all insurances? Car, house, sports, loss of income..

[JoseThailand]

20 hours ago, Ben Zioner said:

And you do that with all insurances? Car, house, sports, loss of income..

 

How much do you pay for these insurances?

[Ben Zioner]

5 hours ago, JoseThailand said:

 

How much do you pay for these insurances?

About 7 to 8% percent of my income.  I know, that's over 200 Heineckens a month..

[jerrymahoney]

CIGNA policies offer $1 million PER YEAR in coverage. Do self-insurers set aside that much?

[JustinT]

2 hours ago, jerrymahoney said:

CIGNA policies offer $1 million PER YEAR in coverage. Do self-insurers set aside that much?

But that 1 million doesn't include pre-existing conditions, and they can just end your insurance after a year if you are costing too much, so it's nearly worthless to me.  

[Pinot]

Just had a claim rejected for 350,000 baht for a rotatorcuff injury. They decided it was elective surgery. Two torn tendons and limited use of the left arm is elective surgery. 

 

Don't use Regency for Expats or Regency Assurance as a healthcare provider. This was my first claim I've had in four years with them. Useless. 

[Cardano]

On 4/6/2025 at 1:45 AM, BigBilly said:

Who cares?  When you self insure, you don't buy insurance, but instead set aside cash of at least the same amount of the insurance policy maximum coverage.

 

Certainly a winning strategy if you can comfortably afford to set aside that much cash.

Even better if you stick that cash in to investments, which is exactly what the health insurance companies do with your premiums.

[Cardano]

On 4/6/2025 at 7:27 AM, Ben Zioner said:

And you do that with all insurances? Car, house, sports, loss of income..

Some insurances' are mandatory the rest are optional.

[Cardano]

On 4/8/2025 at 5:40 AM, jerrymahoney said:

CIGNA policies offer $1 million PER YEAR in coverage. Do self-insurers set aside that much?

How many people can you name that needed to claim $1 million in a year, even in the US the average annual claim is less than $600 per year, go figure.

[jerrymahoney]

CIGNA Global maybe uses an annual maximum of $1,000,000 for inpatient and daypatient treatment for its Silver Policy

... because there is NO annual maximum claim limit for its Platinum Policy.

[jas007]

How to avoid health insurance?  Don't buy it.  

 

If you have the type of visa that doesn't require it, then you're all set.  Just don't get sick.

 

That means staying healthy.  Eating right. And good genes.

 

Accident insurance probably isn't a bad idea, though.  In case some motorcycle runs you over. 

[topt]

On 4/8/2025 at 8:04 AM, JustinT said:

But that 1 million doesn't include pre-existing conditions, and they can just end your insurance after a year if you are costing too much, so it's nearly worthless to me.  

There are very few policies that include pre-existing or you have to take out an IMF loan to fund..........

Termination of Insurance - Do you know that from personal experience because if that is referring to a Cigna International policy then I thought that they could not act like that?

Plus I have not heard it happening with them or other major International insurers.