Health Insurance Worth The Cost?

[Ricohoc]

I've read about a few health policies in Thailand, but haven't been able to figure out if health insurance is worth the cost. From what I've seen, they won't write you if you're over 60 years of age, and your policy is over at the age of 65 even if you beat the 60-year-old deadline.

I'm a healthy living and breathing male who goes to the gym 5 days per week and have never had any major surgery or problems of any kind. Don't smoke, lungs are crystal clear, and other than a couple of swigs of alcohol per week I don't partake in that either.

Does anyone have any experiences that they can share? I'd be much obliged.

[Westerner]

I've read about a few health policies in Thailand, but haven't been able to figure out if health insurance is worth the cost. From what I've seen, they won't write you if you're over 60 years of age, and your policy is over at the age of 65 even if you beat the 60-year-old deadline.

I'm a healthy living and breathing male who goes to the gym 5 days per week and have never had any major surgery or problems of any kind. Don't smoke, lungs are crystal clear, and other than a couple of swigs of alcohol per week I don't partake in that either.

Does anyone have any experiences that they can share? I'd be much obliged.

Okay, you're a healthy male who takes good care of himself. I feel the same but still wouldn't dream of being here without insurance. Who knows, you might be involved in an accident, get smashed up and end up having to pay half a million baht hospital bill . To me, it's not worth the risk .

[robint]

Ive asked around, and the concensus of my findings is

If you can afford the premiums for a top quality insurer then you can afford to pay for yourself. These top insurers can find all kinds of reasons not to pay using the pre-exisitng conditions clause. Yes they can work for accident cases (but wont pay if you are on a motor cycle taxi!)

If you are a wolrd traveller then you need world cover

If you are a long term senior resident here, the save your money, have a pot of cash set aside (full cover would have cost you 100,000 pa btw). Get to know you local good hospital (like sircha or sattahip naval - for pattaya residents). Have a back up plan for emergencies. Dont take unnecessary risks (like motorcys)

If it all goes tits up, well thats life, hope you had a good one

[ProThaiExpat]

Richoh: Listen to robint. I came to Thailand at age 66 and while I found a worldwide insurer who would insure me, the monthly rate at that time was 12K.

I am now 72 and always ask advertisers to quote me a policy for hospital only in Thailand and rarely even get a reply.

I did get a quote from Thaivisa Insurance last year for 18K a month.

I didn't have any choice so "self insure". In six years, other than minor scrapes with max cost of 1800 Baht to fix, I did have a broken leg, fall off ladder, and after four surgeries, am almost well. Total cost of this major medical problem was 230k Baht. Add up the 12k a month policy quote of five years ago and you can see how far ahead I am. Still, you should have a half million baht available and replaceable in the event you have major heart surgery. BKK hospitals advertise bypass surgery for 500k. Yes, many can come with a cancer or liver disease problem that can cost more than a million baht and continuing, but those are not the norm.

If you are healthy and active, which you seem to be and can get over the "fear factor" that sells most insurance, join the group of us that pay our own way and don't pay for the many who are off to a doctor on every symptom. I have essentially home country health care so that is my backup if I get a very expensive and long term medical problem.

Edited February 7, 2008 by ProThaiExpat

[Tammi]

You can never have had a day's illness in your life and then suddenly find you have a cancer that can set you back 12 million plus baht in 3 - 4 years.

[Ricohoc]

These top insurers can find all kinds of reasons not to pay using the pre-exisitng conditions clause. Yes they can work for accident cases (but wont pay if you are on a motor cycle taxi!)

That is a huge concern. Like the US, insurers can make up pretty much anything to get out of paying a claim.

You can never have had a day's illness in your life and then suddenly find you have a cancer that can set you back 12 million plus baht in 3 - 4 years.

Yes, Tammi, that's true. I agree with you. That would be very expensive for anyone and could wipe anyone out financially. And the agency can also tell me it was "a pre-existing condition" and not pay a dime. I doubt that I would be able to maneuver through Thai courts (or have the money to even accomplish anything in US courts if it happened to me here) to get my due.

[Ricohoc]

Richoh: Listen to robint. I came to Thailand at age 66 and while I found a worldwide insurer who would insure me, the monthly rate at that time was 12K.

I am now 72 and always ask advertisers to quote me a policy for hospital only in Thailand and rarely even get a reply.

I did get a quote from Thaivisa Insurance last year for 18K a month.

I didn't have any choice so "self insure". In six years, other than minor scrapes with max cost of 1800 Baht to fix, I did have a broken leg, fall off ladder, and after four surgeries, am almost well. Total cost of this major medical problem was 230k Baht. Add up the 12k a month policy quote of five years ago and you can see how far ahead I am. Still, you should have a half million baht available and replaceable in the event you have major heart surgery. BKK hospitals advertise bypass surgery for 500k. Yes, many can come with a cancer or liver disease problem that can cost more than a million baht and continuing, but those are not the norm.

If you are healthy and active, which you seem to be and can get over the "fear factor" that sells most insurance, join the group of us that pay our own way and don't pay for the many who are off to a doctor on every symptom. I have essentially home country health care so that is my backup if I get a very expensive and long term medical problem.

Thanks for sharing your experiences, PTE.

One thing I will have throughout my retirement, and failed to mention, is rather inexpensive premiums (less than $200 annually) through Blue Cross to deal with medical expenses. This will be provided by my current employer. I will also be eligible for Medicare upon reaching that age for care. While it is true that neither will help me much in Thailand, I guess that I could fly to the US for major medical surgery and weigh the cost against paying out of pocket in LOS.

It's all definitely something to think about, and I appreciate everyone's experiences and advice.

[Phil Conners]

I'm curious about that "pre existing condition" clause - does anyone actually have first hand experience with this, having had an insurer refuse to pay claiming something was a pre existing condition even though it wasn't and get away with it? Scary!!!

[ProThaiExpat]

Phil: The refusal to provide coverage for a condition under a pre-existing clause or an exclusionary clause is the "name of the game" and is found most often in insurance carriers that are on bad times.

The remedy is litigation and you can use your own judgement whether you would be able to remedy a "bad faith" refusal to pay in Thai courts.

A good friend had such a refusal for his medical flareup in Thailand from a Canadian Travel Insurance company and that case is in the Canadian Courts.

The leading case in the U.S. involved a Japanese American gardener who had low back trouble and made a claim. The adjuster (a fairly new one) looked up the condition as described in the medical records "inflammation of the cauda equina" in a dictionary and found "horses tail" as the translation of the Latin. He then refused the claim on the health insurance policy as follows "Condition caused by contact with horses so excluded by the excluded risks which included horse back riding" The cauda equina in your body is where the nerve roots exit your spinal canal and branch out over you buttocks at L-5-S1. This area of the back is often described as a "secondary erogenous zone" as a pleasurable sensation is felt when the skin there is caressed lightly with the fingers.

In the U.S. as a result of this case, punitive damages, treble damages for bad faith are awarded regularly against insurance companies acting unreasonably and these high damage awards, usually in the multi millions, deter insurance companies from acting unreasonably, exactly what that law is intended to do. Personal injury attorneys evaluate the cost to benefit ratio since they front the money for the litigation and have to pay for the medical experts, which don't come cheap, before they bring the lawsuit.

As I said, I doubt Thai courts would award much, certainly not punitive damages, so insurance companies really have no meaningful deterrent in Thailand from refusing coverage. With the slander laws as they presently are in Thailand, "putting out the word" on an insurance company is a perilous activity.

Personally I fell while ice skating years ago and tore my rotator cuff. Waited six months and then saw the best shoulder orthopedist in Southern California. He said he needed an MRI to properly evaluate whether he could perform surgery on the tear due to the time late in consulting him.

As the doctor and I stood at his reception desk and heard the conversation by his nurse with the insurance company first line claims evaluator, we were told no MRI, go back to the gate keeper GP or PT. I grabbed the phone and demanded a supervisor, at least a RN if not a Medical Doctor. Got the supervisor and once I explained my profession and the qualifications of the doctor, an MRI was agreed to. In the end, no surgery and I live with the condition today. Such refusals to treat or grant benefits is a daily occurance in the health care field with insurance companies. They are in the business of making money on your premiums, after all.

[Phil Conners]

Yeah I guess that's where Warren Buffett earned his billions, wasn't it?

[citizen33]

Yeah I guess that's where Warren Buffett earned his billions, wasn't it?

One interesting concept in private insurance is 'loss ratio' - the percentage of premiums paid out as benefits. I have heard it said that loss ratios in Thai health insurance are low by international standards.

[JSixpack]

I guess that I could fly to the US for major medical surgery and weigh the cost against paying out of pocket in LOS.

Friend of mine did that re: a breast cancer op & therapy and concluded she would pay less and get better care in LOS. So she did, and is doing fine, happy to say.

With Medicare there's the annual contribution and then the co-payment of course. Then you add in the air fare . . . .

[Ricohoc]

I guess that I could fly to the US for major medical surgery and weigh the cost against paying out of pocket in LOS.

Friend of mine did that re: a breast cancer op & therapy and concluded she would pay less and get better care in LOS. So she did, and is doing fine, happy to say.

With Medicare there's the annual contribution and then the co-payment of course. Then you add in the air fare . . . .

Thanks for that tidbit, my friend.

Yes, I've also considered the cost of airfare to add to it; and I have heard that there are some excellent hospitals with excellent care in the LOS.

You have validated previous information, and I appreciate it.