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

[PJ71]

7 hours ago, Yellowtail said:

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. 

I've been here 25 years and like you have used various insurance companies, everything that required and overnight stay or an operation has required pre-approval.

 

Visit hospital see a GP, get referred to a specialist and then contact insurance with the referral before going ahead. I've had friends go straight for operation, submit claim and then get denied.

[Yellowtail]

19 minutes ago, sometimewoodworker said:

For an umbilical hernia India was roughly the same cost as a local Bangkok hospital without travel. However the main northeastern teaching hospital’s private wing was half the cost with the operation performed by the top consultant surgeon. The main difference was in nightly room costs with the the amounts being 26,000 per night vs 3,500

That must be for ICU, yes? 

 

Single inpatient room at Bumrungrad <B15,000

 

 

 

[Yellowtail]

2 minutes ago, PJ71 said:

I've been here 25 years and like you have used various insurance companies, everything that required and overnight stay or an operation has required pre-approval.

 

Visit hospital see a GP, get referred to a specialist and then contact insurance with the referral before going ahead. I've had friends go straight for operation, submit claim and then get denied.

I have been here over 25 years as well. I had:

Rotator cuff at Bumrungrad

Left knee replacement at Bumrungrad

Right knee replacement at Bumrungrad

Kidney stones at Bangkok Hospital 

Wife had three surgeries at Bumrungrad

 

All inpatient, all reimbursed

 

Had to resubmit one knee and one of wife's surgeries. 

[PJ71]

1 minute ago, Yellowtail said:

I have been here over 25 years as well. I had:

Rotator cuff at Bumrungrad

Left knee replacement at Bumrungrad

Right knee replacement at Bumrungrad

Kidney stones at Bangkok Hospital 

Wife had three surgeries at Bumrungrad

 

All inpatient, all reimbursed

 

Had to resubmit one knee and one of wife's surgeries. 

I'm amazed that you can just rock up to hospital, get diagnosed and get the required work done and then the first your insurance provider knows about it is when they get the invoices for the claim, very strange.

 

 

[Magictoad]

17 hours ago, NickyLouie said:

 

It's filthy there 

Not in the operating theatres!

[Magictoad]

4 minutes ago, PJ71 said:

I'm amazed that you can just rock up to hospital, get diagnosed and get the required work done and then the first your insurance provider knows about it is when they get the invoices for the claim, very strange.

 

 

It's how I do it with my insurance company.

[Magictoad]

Have you given any thought to why you were cycling?

[NoDisplayName]

1 hour ago, scubascuba3 said:

But how did you vet the good from the bad to make a decision? 

 

You research hospitals and individual doctors.  Just about all you need can be found online.

 

I cheap charlie'd out and selected the second-best cardiac surgeon in India, with only a few thousand surgeries under his sherwani.

 

A significant bump in price would have obtained the services of the PM's personal physician, yet still cheaper than the then current cost in Thailand.

 

[GreasyFingers]

OP, cannot help you with pricing but I hope someone has fully explained the length of the rehab even with good physios. I had one done in Australia 20 years ago, only spent 2 nights in hospital but the recovery was over 6 months with minimal use of the arm. You are very limited in what you can do so be sure that the length of rehab time is fully explained to get full use of the arm.

Also check out the internet as there are reorts that it can mend itself. I tore mine again 7 years ago and just carried it in a sling for 2 weeks and very careful with it after that. I can do most physical work but again being careful with only the odd pain twinge.

[scubascuba3]

16 minutes ago, NoDisplayName said:

 

You research hospitals and individual doctors.  Just about all you need can be found online.

 

I cheap charlie'd out and selected the second-best cardiac surgeon in India, with only a few thousand surgeries under his sherwani.

 

A significant bump in price would have obtained the services of the PM's personal physician, yet still cheaper than the then current cost in Thailand.

 

I reckon there's a good job for someone in Pattaya and elsewhere as a facilitator and can arrange healthcare trips to India

[MadAtMatrix]

1 hour ago, madone said:

 Rather contradictory remarks -- you get what you pay for, I paid lots, now I need to fix it doesn't make much sense

I fell cycling in 2021, tore the rotator cuff.  A year later, I had a slip and fall and the anchor tied to the tendon, pulled through the tendon, and now it is "re-torn", so it is a second injury. Now you won't have to lay awake at night being puzzled anymore, unless that is what gets you a thrill.

[madone]

Just now, MadAtMatrix said:

I fell cycling in 2021, tore the rotator cuff.  A year later, I had a slip and fall and the anchor tied to the tendon, pulled through the tendon, and now it is "re-torn", so it is a second injury. Now you won't have to lay awake at night being puzzled anymore, unless that is what gets you a thrill.

Sure, snap at me because you are unclear

[NoDisplayName]

10 minutes ago, scubascuba3 said:

I reckon there's a good job for someone in Pattaya and elsewhere as a facilitator and can arrange healthcare trips to India

 

Why would you need an agent?

 

Make your selection, contact the hospital direct.  The bigger hospitals or hospital groups will have an office dedicated to serving foreign medical tourism.

 

It's almost as though they were a "Hub of Medical Tourism"!

 

They'll help you get the medical visa, arrange transportation in country, arrange recovery lodging at a suitable resort after the surgery, confirm pricing and payment options.

 

All you need to do is visit the embassy for the visa and book your flights.

 

Nowadays you can get the visa online.  When I did this, had to physically attend the consulate in Guangdong.

 

Now its "super easy, barely an inconvenience!"

[MadAtMatrix]

2 minutes ago, madone said:

Sure, snap at me because you are unclear

Just read a summary of your replies to comments. It is clear you Cant Understand Normal Thinking. 

[Sheryl]

18 hours ago, Pinot said:

 

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

 

Careful if your insurance requires pre-approval. Most do, at least above a certain cost threshold, and have significant penalties if not obtained. 

 

Is this travel insurance or regular insurance that you have? Travel policies indeed will only pay for emergency/urgent care, not elective procedures. A  regular insurance policy would not / cannot disallow a procedure just because it is elective, provided it is still medically necessary.

 

Can you clarify type of insurance, and share the exact wording of the disallowal notification?

 

If it is regular health insurance (not a travel policy or otherwise limited to emergency care) then I would suspect that the hospital failed to provide sufficient information/justification, which would not surprise me. In which case a re-submission by a different hospital, providing more complete information and medical justification, might do the trick.   

 

Keep in mind the expertise of the surgeon is of paramount importance, this is not a simple procedure and it not always successful, either. Likelihood of success is very much dependent on the choice of surgeon. Cost aside, I would hesitate to do this outside of Bangkok, to be frank.

 

You will certainly nto be able to get this for less than 350k at a private hospital.

 

Vachira is a government hospital but has a private channel and I assume that is where your quote came from. You might investigate whether it can be done through regular public channel, but if so there may be a wait list and again, need to consider the skill and experience of hte doctor -- whom you might not be able to choose if using the public channel.

 

There is no better shoulder surgeon in Thailand than Prof. Mason at Bumrungrad. You might try consulting him and having that hospital  try to get the insurance approval, explaining the need for detailed medical justification (assuming he concurs that surgery is unavoidable). https://www.bumrungrad.com/en/doctors/mason-porramatikul

 

 

 

 

[Sheryl]

A flaming/unhelpful post has been removed

[richard_smith237]

3 hours ago, Yellowtail said:

One problem with going to India for rotator cuff, is the long recovery. It takes months, and you go back every other day, then every week. Flying in a sling, and risking bumping your shoulder would be a nightmare. 

 

There is also the DVT risk after surgery which is elevated when flying - so there may be some recommended 'recovery time' before flying is advisable. 

 

[Felt 35]

20 hours ago, Pinot said:

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? 

 

I Had an accident similar in 2022 with a full width tear of the supraspinatus tendon which is one of the four rotator cuff muscles. I got a quote at Bumrungrad shortly after Thb 425,000, - My insurance did not cover and I was anyway scared about recovery time so I returned home  and both my general practitioner and an orthopedic shoulder specialist did not recommend that I undergo any surgery due to the long recovery time and, not least at my age, the chances of my shoulder recovering completely were slim. They did however recommend physiotherapy. I returned to Thailand and did the training myself, as I do regular strength training anyway. At that time, I had pain even when I was lying in bed, could not lift my arm out to the side and even swimming was impossible - Today, three years later, I can load 8kg on each arm and do lateral raises, swimming is painless, and I sleep without pain.

Felt

[sometimewoodworker]

3 hours ago, Yellowtail said:

That must be for ICU, yes? 

 

Single inpatient room at Bumrungrad <B15,000

 

 

 

No it wasn’t. It was purportedly for a similar room as at the Khon Kaen Srinagarind teaching hospital. A Laparoscopic umbilical hernia surgery would not require the ICU unless something went drastically wrong.

 

[Celsius]

My wife's father had the same injury 3 years ago. He went to a famous hospital in pinklao and had it completely fixed using 30 baht scheme. That hospital also has a private department which i imagine would be cheaper than hospitals mentioned in this thread. 

 

For the life of me I can't remember the name of the hospital and I wrote about it here and I can't find the thread. Anyway he completely recovered and paid next to nothing, so the doctor must be good. I criticize and laugh at Thai Healthcare, but that hospital proved me wrong. 

 

 

 

[Magictoad]

11 hours ago, MadAtMatrix said:

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

India can be BOTH cheap and excellent.  Many surgeons trained in the States but chose not to stay there because of the racism.  Some also trained in the UK.

[Magictoad]

15 minutes ago, Celsius said:

My wife's father had the same injury 3 years ago. He went to a famous hospital in pinklao and had it completely fixed using 30 baht scheme. That hospital also has a private department which i imagine would be cheaper than hospitals mentioned in this thread. 

 

For the life of me I can't remember the name of the hospital and I wrote about it here and I can't find the thread. Anyway he completely recovered and paid next to nothing, so the doctor must be good. I criticize and laugh at Thai Healthcare, but that hospital proved me wrong. 

 

 

 

Thai healthcare is very good compared to the UK where waiting lists are shocking.. For the injury we are talking about here the waiting list would be at least three years and then by an Indian surgeon. A&E is appalling with waiting times of several hours.

[Magictoad]

3 hours ago, NoDisplayName said:

 

Why would you need an agent?

 

Make your selection, contact the hospital direct.  The bigger hospitals or hospital groups will have an office dedicated to serving foreign medical tourism.

 

It's almost as though they were a "Hub of Medical Tourism"!

 

They'll help you get the medical visa, arrange transportation in country, arrange recovery lodging at a suitable resort after the surgery, confirm pricing and payment options.

 

All you need to do is visit the embassy for the visa and book your flights.

 

Nowadays you can get the visa online.  When I did this, had to physically attend the consulate in Guangdong.

 

Now its "super easy, barely an inconvenience!"

There is often an Agent in situ at these big international hospitals 

[Yellowtail]

21 minutes ago, Celsius said:

My wife's father had the same injury 3 years ago. He went to a famous hospital in pinklao and had it completely fixed using 30 baht scheme. That hospital also has a private department which i imagine would be cheaper than hospitals mentioned in this thread. 

 

For the life of me I can't remember the name of the hospital and I wrote about it here and I can't find the thread. Anyway he completely recovered and paid next to nothing, so the doctor must be good. I criticize and laugh at Thai Healthcare, but that hospital proved me wrong. 

 

 

 

Siriraj? I had leg ulcer from an old injury that would not heal. I used the "express" system and received great treatment at low cost. 

[richard_smith237]

15 minutes ago, Celsius said:

My wife's father had the same injury 3 years ago. He went to a famous hospital in pinklao and had it completely fixed using 30 baht scheme. That hospital also has a private department which i imagine would be cheaper than hospitals mentioned in this thread. 

 

For the life of me I can't remember the name of the hospital and I wrote about it here and I can't find the thread. Anyway he completely recovered and paid next to nothing, so the doctor must be good. I criticize and laugh at Thai Healthcare, but that hospital proved me wrong. 

 

The 'real famous' on in that area is Siriraj...