I need rotator cuff surgery my insurance turned me down where to go for less than 350,000b?

[Pinot]

I had a bicycle crash and screwed up my shoulder. My insurance company said it was an optional surgery and turned me down. I have two ruptured tendons and need a four-hour operation to fix this. Four screws, four days in the hospital. My arm elevated for six weeks. Vischara in Phuket quoted 350k. The surgeon is excellent. Looks like I need to pay for this myself. Are there any options? 

[NickyLouie]

Quote

My arm elevated for six weeks.

 

Brah 

[Yellowtail]

I had a rotator cuff done By Dr. Mason at Burumgrad about 10-15 year ago, but I do not imagine that would be cheaper. It is still great though. I would not skimp. 

 

I would message Sheyrl directly for a suggestion were it me. 

 

Are you working? I had my right arm in a sling for a couple months, and physical therapy three times a week. You do not have to have the PT at the same place you have the surgery, so you could have the surgery in Bangkok, and see a local physical therapist. 

[JoseThailand]

20 minutes ago, Pinot said:

I had a bicycle crash

 

Bicycle? How fast were you going?

[Yellowtail]

What insurance company do you have? I would have it done, submit a claim, and fight if it's rejected. The doctor will write you a medical certificate saying it was necessary. 

 

Unless you have bad insurance, they should pay. My insurance paid, but I never tried to get pre-approved. 

 

 

And make sure the hospital is on their approved list. 

[MadAtMatrix]

If you are that severely banged up, go see this guy. https://www.bangkokhospital.com/en/bangkok/doctor/cdr-dr-pornthep-mamanee

He is the top dog in orthopaedics, having done surgeries on many Thai olympians, pro football players, badminton players etc. 

https://en.wikipedia.org/wiki/User:TineMethavee/Pornthep_Mamanee

[Pinot]

30 minutes ago, JoseThailand said:

 

Bicycle? How fast were you going?

 

Unsecured construction fabric blew out in front of me, tossing me to the ground. Wind. It wasn't the shoulder I landed on. Tore ligaments on the other shoulder. 

[Pinot]

28 minutes ago, Yellowtail said:

What insurance company do you have? I would have it done, submit a claim, and fight if it's rejected. The doctor will write you a medical certificate saying it was necessary. 

 

Unless you have bad insurance, they should pay. My insurance paid, but I never tried to get pre-approved. 

 

 

And make sure the hospital is on their approved list. 

 

I hadn't thought of that. Have it done and resubmit it. Thanks

 

[Pinot]

10 minutes ago, MadAtMatrix said:

If you are that severely banged up, go see this guy. https://www.bangkokhospital.com/en/bangkok/doctor/cdr-dr-pornthep-mamanee

He is the top dog in orthopaedics, having done surgeries on many Thai olympians, pro football players, badminton players etc. 

https://en.wikipedia.org/wiki/User:TineMethavee/Pornthep_Mamanee

No, I have the MRI, this is straightforward now. I'm looking for a great place to save some money. I assume I'll have to pay for it. 

[Furioso]

I'd go to India they've got fine surgeons for 1/10th the cost. 

[NickyLouie]

Just now, Furioso said:

I'd go to India they've got fine surgeons for 1/10th the cost. 

 

It's filthy there 

[NoDisplayName]

8 minutes ago, NickyLouie said:

 

It's filthy there 

 

The airport is (mostly) clean.

The VIP car is clean.

The VIP section of the hospital is sparkling.

The hotel you stay in after is clean.

 

Problem might be insurance declining payment because you traveled to another country for treatment.

 

If you must pay yourself, India is a bargain even with airfare.

 

Rotator Cuff Surgery Cost in India - Get Cost Estimate. Minimum Cost 5500 USD. Average Cost 6000 USD

[richard_smith237]

2 hours ago, Yellowtail said:

What insurance company do you have? I would have it done, submit a claim, and fight if it's rejected. The doctor will write you a medical certificate saying it was necessary. 

 

Unless you have bad insurance, they should pay. My insurance paid, but I never tried to get pre-approved. 

 

 

And make sure the hospital is on their approved list. 

 

It doesn't work like that...   The insurance has to pre-approve... 

 

Or.. If you have it done pay yourself, then make the claim and they reject, Op is out 350,000 baht...  even if he fights....   he could get the surgery for much less in India, so its a good option.

 

 

That said: The Op should first get another 'more insistent letter' from is Surgeon / Doctor and re-submit the pre-authorisation claim.... unless there is a pre-existing condition the Op has not mentioned.

[richard_smith237]

2 hours ago, MadAtMatrix said:

If you are that severely banged up, go see this guy. https://www.bangkokhospital.com/en/bangkok/doctor/cdr-dr-pornthep-mamanee

He is the top dog in orthopaedics, having done surgeries on many Thai olympians, pro football players, badminton players etc. 

https://en.wikipedia.org/wiki/User:TineMethavee/Pornthep_Mamanee

 

How's that money tree of yours looking ???

 

A good surgeon is great advice - but the Op's insurance has refused to pre-authorise his claim, so going to a more expensive hospital is not going to help him at the moment.

[richard_smith237]

2 hours ago, Yellowtail said:

What insurance company do you have?

 

Valid question - that would be good info for many shopping around for insurance.

[scubascuba3]

I have a labral tear, when the surgeons said it's a 50/50 op, all that downtime and may not work, decided not to bother, and that would have been paid by insurance 

[Yellowtail]

7 hours ago, richard_smith237 said:

 

It doesn't work like that...   The insurance has to pre-approve... 

 

Or.. If you have it done pay yourself, then make the claim and they reject, Op is out 350,000 baht...  even if he fights....   he could get the surgery for much less in India, so its a good option.

 

 

That said: The Op should first get another 'more insistent letter' from is Surgeon / Doctor and re-submit the pre-authorisation claim.... unless there is a pre-existing condition the Op has not mentioned.

My family was insured here for over twenty years. First by Heath Net, then by Cigna and finally by Blue Cross Blue Shield. I never got anything pre-approved. I paid for the service, and filed the claim, and I got reimbursed. 

 

A few times claims were denied, I contested the denial, and every claim was ultimately approved. Supplements were not covered, but they would sometimes be approved anyway. 

 

They used to nitpick my annual physical and say some of the things were not covered, and only partially reimburse. Resubmit explaining it was a package, and it was approved. 

 

I had twenty years of medical, including a rotator cuff and two knee replacements. 

 

 

 

If you don't ask, the answer is no. 

[MadAtMatrix]

8 hours ago, richard_smith237 said:

 

How's that money tree of yours looking ???

 

A good surgeon is great advice - but the Op's insurance has refused to pre-authorise his claim, so going to a more expensive hospital is not going to help him at the moment.

You get what you pay for. Too many people wanting “cheap” done. Then they end up having to have it fixed again a year or two later because they cheaped out. I’m in the same situation (not because I was cheap, I paid about 300k at a reputable hospital chain that has Bangkok in its name, but because the surgeon screwed up) and now I need it fixed again. 
 

if you want cheap, like mentioned above, go to India or go to Vietnam