Medical Insurance Claims - Who Pays The Hospital Direct ?

[torrenova]

As I look for some new health / medical insurance for the family I am wondering if the members here could help and post up whether they know of companies who settle direct with the hospital rather than you having to find the cash yourself and then claim it back from the insurance company.

To me, this is a far better system as long as it is not abused by the hospital adding on unnecessary charges and by the insurance companies who prevaricate and hold back authorisation when such is required.

Thai Visa Insurance, you are most welcome to comment but please a little more than just "apply to this office" as I want to see a list of companies who will and will not do this. Thanks.

[jfchandler]

I have a no-deductible Maxi Care policy thru LMG Pacific Healthcare (part of the Liberty Mutual Group) that pays direct for services at a long list of participating hospitals, both in BKK and in the provinces... The list includes all the major farang hospitals around BKK and many others as well..

I've also looked at the Premiere International coverage available thru Lawton Asia, and I believe they also have direct payment to participating hospitals, but only if you have a zero deductible policy. If you have any of their several deductible plans, then I believe you have to submit claims.

[ThaivisaInsurance]

As I look for some new health / medical insurance for the family I am wondering if the members here could help and post up whether they know of companies who settle direct with the hospital rather than you having to find the cash yourself and then claim it back from the insurance company.

To me, this is a far better system as long as it is not abused by the hospital adding on unnecessary charges and by the insurance companies who prevaricate and hold back authorisation when such is required.

Thai Visa Insurance, you are most welcome to comment but please a little more than just "apply to this office" as I want to see a list of companies who will and will not do this. Thanks.

This is an interesting question but easily answered – all Insurance companies will deal direct with their approved hospitals. Whoever you sign up with has a list of hospitals they will deal with direct – these are the larger hospitals all over Thailand so you will not have problems anywhere you live.

Going on from that, if you do live a long way from a town and have a ‘favorite’ hospital not on the list Thai Visa Insurance can arrange to have the insurance company deal direct with that hospital just for you.

[henryalleman]

DKV (Deutsche Kranken Versicherung)does it and you have a free choice of hospital, and you insured worldwide.

2,2 million baht cover include 1 month pre-op and 3 months aftercare and 10% of the total cover for medicines, and no franchise about 80 000 Baht;

In my home country they give you a personal Medicard and you don't see any bill. Abroad they ask you to contact them beforehand and they will contact the hospital.

[wca01]

My wife just had a road accident some days ago. She is insured by BUPA for an annual fee of Baht 8,500. The hospital did all the paperwork and BUPA paid directly. Satisfied with their service.

WCA

[ThaivisaInsurance]

DKV (Deutsche Kranken Versicherung)does it and you have a free choice of hospital, and you insured worldwide.

2,2 million baht cover include 1 month pre-op and 3 months aftercare and 10% of the total cover for medicines, and no franchise about 80 000 Baht;

In my home country they give you a personal Medicard and you don't see any bill. Abroad they ask you to contact them beforehand and they will contact the hospital.

This is the problem with foreign insurances – in an emergency not good as can take too long for contacting the insurance company and obtaining their clearance.

Note, this also applies to people who say they can always use their credit cards – those too need clearance !

[torrenova]

As I look for some new health / medical insurance for the family I am wondering if the members here could help and post up whether they know of companies who settle direct with the hospital rather than you having to find the cash yourself and then claim it back from the insurance company.

To me, this is a far better system as long as it is not abused by the hospital adding on unnecessary charges and by the insurance companies who prevaricate and hold back authorisation when such is required.

Thai Visa Insurance, you are most welcome to comment but please a little more than just "apply to this office" as I want to see a list of companies who will and will not do this. Thanks.

This is an interesting question but easily answered – all Insurance companies will deal direct with their approved hospitals. Whoever you sign up with has a list of hospitals they will deal with direct – these are the larger hospitals all over Thailand so you will not have problems anywhere you live.

Going on from that, if you do live a long way from a town and have a ‘favorite’ hospital not on the list Thai Visa Insurance can arrange to have the insurance company deal direct with that hospital just for you.

A good reply

I move around a lot and the missus and baby more than most I would say so we don't have a "favourite" hospital.

So you've got to go down the process of looking at each companies policies and then see if they cover the main hospitals or exclude ones you would use. Don't they just publish this information ?

[publicadjuster01]

Hai

In my family all having Medical Insurance this most impront to where life.public adjuster istell me family insurance is very impront........

[samran]

DKV (Deutsche Kranken Versicherung)does it and you have a free choice of hospital, and you insured worldwide.

2,2 million baht cover include 1 month pre-op and 3 months aftercare and 10% of the total cover for medicines, and no franchise about 80 000 Baht;

In my home country they give you a personal Medicard and you don't see any bill. Abroad they ask you to contact them beforehand and they will contact the hospital.

This is the problem with foreign insurances – in an emergency not good as can take too long for contacting the insurance company and obtaining their clearance.

Note, this also applies to people who say they can always use their credit cards – those too need clearance !

Sorry, a bit confused on your comment.

Just that a foreign insurer offers a 24 hour per day hotline for emergencies, no different from a local one. How does this make things faster/slower than a local insurer giving approval? Additionally, and I've read my fine print, my insurer will allow (and presumably pay for) immediate treatment in the case where it is unreasonable to contact them given that your emergency prevents you from contacting them?

Even for non-emergencies (for instance my wifes maternity expenses, pre and post natal) they have no problems paying out each and every time. All we did was simply notify them that she was pregnant and they've not needed to hear from us since...

Edited January 11, 2009 by samran

[ThaivisaInsurance]

You are quite correct that all insurance companies offer a 24hr phone number but that is not the problem.

The problem (and especially in an emergency) is for the insurance company to convince the hospital they will pay.

The Thai based insurance companies have already set up contracts with all the major hospitals in Thailand which smoothes this problem out.

You say in your fine print your insurer will allow ‘immediate treatment in the case where it is unreasonable to contact them’ – that is excellent, now all you have to do is get the hospital to agree to that in an emergency …………………….

As for your wife’s maternity expense that is straight forward as you have notified them in advance and have given time for the insurer and hospital to agree.

[Alex8]

You are quite correct that all insurance companies offer a 24hr phone number but that is not the problem.

The problem (and especially in an emergency) is for the insurance company to convince the hospital they will pay.

The Thai based insurance companies have already set up contracts with all the major hospitals in Thailand which smoothes this problem out.

You say in your fine print your insurer will allow ‘immediate treatment in the case where it is unreasonable to contact them’ – that is excellent, now all you have to do is get the hospital to agree to that in an emergency …………………….

As for your wife’s maternity expense that is straight forward as you have notified them in advance and have given time for the insurer and hospital to agree.

I wish to expand this discusion by adding further considerations that afflict many of us in the outside world. Some readers, indeed insurers too, may find some of my content bathed in cynicism. Please feel free to send me as much flack as you like.

I am a Brit ex-pat and have been covered previously by three major health insurance providers in the UK. I parted company with them due to outrageous annual escalation of fees and their reluctance to provide an honest and transparent policy. Skirmishing to avoid payment when sickness occurred was another feature that persuaded me to avoid their smart marketing practices.

You may call me unwise for having returned to the British state funded National Health Service, in spite of all its shortcomings but I did at least know where I stood.

I am currently covering my health risks from my own resources, here in Thailand, but I reman in the market for a policy that I have not uyet found....This is my requirement.

I want a worldwide 24/365 comprehensive policy that permits me to access any hospital when I am disabled either from natural causes or a victim of an accident. That includes transfers to a better/bigger hospital where the nearest proves inadequate for my needs. If I am in a coma and am unaccompanied by friend or relative, I still need that access. The ambulance or paramedic services are the first link in the chain. It can be achieved if the medical and insurance industries get their acts together.

Nominating just one or a small selection of hospitals from a list is simply not good enough. When you are unconscious and cannot speak or negotiate for yourself, you instantly fall victim to more than your disabilityi/illness. You are immediately in the hands of a mixed kettle of 'handlers', some honest and capable, the rest a partial criminal mix of vultures.

I may be asking for too much. I may be naive but might I constructively suggest that a scheme could be introduced whereby a member could be issued with a card or toggle to be worn about his/her neck or about his/her person that would carry proof that he has paid for his policy, that cash will be forthcoming from his/her insurance company and that he/she should be treated immediately with best available medical care. Outstanding issues, if any, can be argued later. The card or toggle could also carry full name and address, facial photograph, scars, medical history, current medication requirements, blood group, allergies, next of kin details, solicitor, lodgement of will & testament, embassy phone no. and address etc...in a hologram or chipset.

If you have a better idea, I would like to hear about it because I have money in my pocket ready to subscribe.

Thank you for listening/reading

Signed: Alex8

[tvaddict]

As I look for some new health / medical insurance for the family I am wondering if the members here could help and post up whether they know of companies who settle direct with the hospital rather than you having to find the cash yourself and then claim it back from the insurance company.

To me, this is a far better system as long as it is not abused by the hospital adding on unnecessary charges and by the insurance companies who prevaricate and hold back authorisation when such is required.

Thai Visa Insurance, you are most welcome to comment but please a little more than just "apply to this office" as I want to see a list of companies who will and will not do this. Thanks.

------------------------------------------------------------------

BUPA in thailand have a list of all the hospitals they deal directly with ( they'll settle the bill with the cashier) without the need for you to use your own cash, make a claim and seek payback later ( up to your benefit limits)

simple to find-- just type BUPA Thailand and then click on the Hospital list and download the English version PDF file

or alternatively click on the link:

http://www.bupathailand.com/HospitalList.asp#

I'm a bit surprised that the original poster hasn't just looked first before opening up the question on a forum

I have no reason to doubt that other insurers will do something similar on their sites and that bupa will too on versions for other countries

PS

to the poster recommending a chip containing info-- i don't think you've considered security as an issue yet -

so much personal data in one spot -- -- ever heard of identity theft?

if you want these details available then carry some cards in your wallet and furthermore if you travel a lot -

do what i've done which is make copies of all important stuff , eg. passport page, visa page, credit card scan showing number, flight details, insurance info, etc and then e-mail the attachment to yourself so in the event of a theft/ loss/ emergency abroad/ away from home you can / friend can access your email account from anywhere, print a copy to show to police/ embassy, etc to help you out of a difficult spot!!!

[Alex8]

As I look for some new health / medical insurance for the family I am wondering if the members here could help and post up whether they know of companies who settle direct with the hospital rather than you having to find the cash yourself and then claim it back from the insurance company.

To me, this is a far better system as long as it is not abused by the hospital adding on unnecessary charges and by the insurance companies who prevaricate and hold back authorisation when such is required.

Thai Visa Insurance, you are most welcome to comment but please a little more than just "apply to this office" as I want to see a list of companies who will and will not do this. Thanks.

------------------------------------------------------------------

BUPA in thailand have a list of all the hospitals they deal directly with ( they'll settle the bill with the cashier) without the need for you to use your own cash, make a claim and seek payback later ( up to your benefit limits)

simple to find-- just type BUPA Thailand and then click on the Hospital list and download the English version PDF file

or alternatively click on the link:

http://www.bupathailand.com/HospitalList.asp#

I'm a bit surprised that the original poster hasn't just looked first before opening up the question on a forum

I have no reason to doubt that other insurers will do something similar on their sites and that bupa will too on versions for other countries

PS

to the poster recommending a chip containing info-- i don't think you've considered security as an issue yet -

so much personal data in one spot -- -- ever heard of identity theft?

if you want these details available then carry some cards in your wallet and furthermore if you travel a lot -

do what i've done which is make copies of all important stuff , eg. passport page, visa page, credit card scan showing number, flight details, insurance info, etc and then e-mail the attachment to yourself so in the event of a theft/ loss/ emergency abroad/ away from home you can / friend can access your email account from anywhere, print a copy to show to police/ embassy, etc to help you out of a difficult spot!!!

TVaddict,

Thanks for your response. I am in agreement with your thinking and the logic that you portray but I have addressed the issue from 'worst scenario' situation. Cards in the wallet can be stolen by rescuers/thieves as can a toggle around your neck.

I have already taken the precautions that you mention. Being in reasonably good health for my age I am neither morbid nor am I an introverted health freak. Having access to my complete life's profile, my trusted friends and kin can rush to my aid but only if they know I am in difficulty.

If I am involved in an accident and rendered unconscious, be it of my own making or not, when I am travelling alone, how am I able to let them know? I then, (and you too, for that matter) would find myself in the hands of helpers/bystanders. At that point, my life under threat, I wouldn't give a fiddler's fig about identity theft. My life is of paramount importance. Should I survive the traumatic experience, I shall live another day to deal with identity theft.

I would also not much care should anybody in the chain, whilst getting me to competent medical care, strip me of my passport, cash, credit cards and mobile phone. I would find myself, as I previously suggested, in the hands of fellow human beings, many of whom are decent people who would quickly deliver me to the best possible and nearest medical facility. Others would be predators who would seek to profit from my injuries.

Life is like that. You takes your chances but that doesn't prevent you from hunting for a good insurance policy. Most policies I have read fall far short of my (and my family's ) needs.

Afterthought. TVaddict and other posters... I believe some of you have never been involved in a critical or life threatening event.

Your first duty is to survive. If you don't, how can you later help yourself or others. The aftermath of a critical injury can and often does carry years of fighting legal processes, far beyond your previous experience and competence. If the original trauma didn't conquor you, the ensuing legal treadmill might.

As, in my old industry, we used to hear the expression, offering the choice...'Do you want a Military Court's Martial or a Military Funeral?'

Signing of again: Alex8