Hospital Bills - Should Pay Or Not?

[Seekingasylum]

My wife's 17 year old son borrowed a motorcycle from a friend with his permission to drive to the next village. On his way back he collided with another motorcycle. Witnesses etc have testified that he was not at fault but the fact remained that he was driving without insurance and a licence.

He was injured and taken to the local hospital where he was admitted for 7 days and treated for an injury to his foot.

The bill came to approx. 12,000 bt which the doctor claimed the family had to pay because the lad was not insured and did not have a licence.

My understanding of the universal care system was that this treatment should have been free with the hospital claiming back the treatment costs from central government under their schedule of fees.

The doctor has nevertheless maintained the family should pay and were bullied into payment.

Does anyone know the regulations on this? Personally, I am quite sceptical of the notion that culpability within the law pertaining to road traffic legislation should determine whether or not someone, particularly a juvenile, may receive medical treatment under health legislation. I am quite certain the doctor is simply seizing the opportunity to make money from both the family and the state.

Anyone assist - I have tried to research as much as I can but the only information I can find leads me to conclude the UCS covers treatment including that arising out of accidents

Edited November 24, 2010 by Seekingasylum

[GuestHouse]

Give the bill to the lad and tell him to sort his own sh1t.

[lovelomsak]

Make the kid pay it back and tell him to get a drivers license.

[Seekingasylum]

Aside from lessons to be learned my hope was to receive some guidance on the UCS and its regulations. Responsibility is one thing but extortion under the guise of glib deceit is another.

[harrry]

I think you will find that when they introduced the compulsory 3rd class insurance they removed care from the Universal scheme. The thought was thas that accidents would be covered by the insurance but it didn't work out that way as top becovered an insured vehicle must be involved.

A similar thing applie in Australia. I would normaly be fully covered for health and hospital by our medicaree scheme. Motor vehicle accidents are excluded. They are covered by insurance but only to the percentage that you were not adjudged to blame. In my case I got a 25% payout of an amount which was jusdged sufficient to cover for life medical and ancilliary expenses stemming from the accident.

In practice in Australia if this was not enough the hospital would still treat yoiu but they are cheating in doing so.

[gregb]

It is highly unlikely this is corruption by the doctor. Most likely, the hospital administration has made it clear to the doctor that he should attempt to collect cash. Why? Because the state won't give the hospital anything close to the 12,000 baht they can get from you as a cash patient.

My advice is to tell them to go pound sand. That they must put the charges under the gold card scheme, and that you will call the NHSO office in Bangkok and file formal complaints if they refuse (http://www.nhso.go.th/eng/index_main.jsp). In any case, make it clear to the hospital administrator (not the doctor, he has no authority. Speak directly to the administration.) in no uncertain terms that you will not be paying a single baht unless you receive a statement in writing from the head office in Bangkok clearly stating the policy.

Don't accept anything less than a statement from the NHSO. You may have to initiate the inquiry yourself to get this. Many of these provincial hospitals think they can make up their own rules. I wouldn't believe a word they told me.

To be honest, I don't know what the rules are here. It is possible the hospital is correct, but unless you hear it straight from the NHSO, I wouldn't accept it.

[JurgenG]

You go to the hospital, you have to pay the bill. It's a no-brainer.

Now you have an insurance, check with them if they cover the accident, and if so, ask them to pay you back

Someone else is responsible for the accident ? Sue them !

I never heard of anyone being treated free of charge in an hospital but I could be wrong. I'm also interested to know what is the experience of other posters.

[Indo-Siam]

There are public hospitals (not for profit) that must treat all patients, and do so at low rates, with government reimbursements. And there are private hospitals, which run for profit - and they charge whatever their fee rates are. The private hospitals tend to give much better care than the public hospitals (a good example is to look at a scar from a cesarean childbirth at a public hospital, compared to the scar from a similar birth at a private hospital).

If your stepson was treated at a private hospital, then you need to pay the bill they charge. It is possible that some family member wanting to get superior care for the young man sent him to a private hospital, figuring that you - the "rich farang" - could pay for it.

'Not actually sure what happens if you stiff them. At minimum, I would expect that hospital would not accept nor treat your family members again.

Indo-Siam

[Xircal]

If the driver doesn't have a licence, then the vehicle is not insured. The driver subsequently becomes personally liable for any injuries or damage caused to third parties. As regards his own injuries, he won't be covered by his own health insurance for the same reasons.

Driving without insurance is also a criminal offence and he'll be lucky if he can avoid a jail term if the police become involved which might happen if you don't pay the hospital bill.

[afarang]

If the driver doesn't have a licence, then the vehicle is not insured. The driver subsequently becomes personally liable for any injuries or damage caused to third parties. As regards his own injuries, he won't be covered by his own health insurance for the same reasons.

Driving without insurance is also a criminal offence and he'll be lucky if he can avoid a jail term if the police become involved which might happen if you don't pay the hospital bill.

Quite correct. This is such a common occurence, in Thailand. Your 3rd. party insurance ,only covers licensed drivers, or riders.

[harrry]

If the driver doesn't have a licence, then the vehicle is not insured. The driver subsequently becomes personally liable for any injuries or damage caused to third parties. As regards his own injuries, he won't be covered by his own health insurance for the same reasons.

Driving without insurance is also a criminal offence and he'll be lucky if he can avoid a jail term if the police become involved which might happen if you don't pay the hospital bill.

This is not the case in Thailand. The fine for driving without a licence would be maximum 500 baht if the police decide to charge him. Insurance under the 3rd class is not related to the licence however there is a limit of 14500 baht without proving blame. It is possible the boy did not put an insurance claim in. He still can.

Edited November 24, 2010 by harrry

[citizen33]

This is a tricky one because I suspect the formal position isn’t the same as informal practice in most hospitals. My understanding is that the UC Scheme introduced in 2001-02, left in place the 1992 Motor Vehicle Accident Victim Protection Act, which provides compensation for traffic accident victims and their relatives, funded from a levy on motor vehicle insurance policies. I’m not sure if there is a provision of the National Health Insurance Act 2002, hidden away somewhere that specifies what happens when a patient is not covered by a motor insurance policy. Of course, that is the hub of your question and I don’t know the answer.

What I do know is that in practice the treatment of road traffic accident victims is funded under a number of schemes. For example Riewpaiboon (2008) found in a research study that the pattern of payment for RTAs in one hospital was:

UC 44%

MVAVP 13.5%

SSS 12%

CSMBS 1.5%

Private insurance 2.5%

Out of pocket 26.5%

The majority of the RTAs studied were motor cycle accidents.

imsear.hellis.org/bitstream/123456789/36245/3/se1139.pdf

My guess is that this means that in practice there is a lot of negotiation about which scheme or which person pays.

You could see if you can find anything on this site.

http://www.nhso.go.th/eng/index_main.jsp

I have mislaid my English translation of the 2002 Act, so cannot look.

Edited November 24, 2010 by citizen33

[elliss]

when you went to visit the lad ,

the doctor seen farang ,

and smelled ,, monee :jap:

[remiss]

You go to the hospital, you have to pay the bill. It's a no-brainer.

..

I never heard of anyone being treated free of charge in an hospital but I could be wrong. I'm also interested to know what is the experience of other posters.

In Norway it's free if you spend at least one night..

And btw, when I went to a thai hospital I paid like 120 baht for consultation, x-ray and medicines.. (which they had to get paid by the government for somehow)

Edited November 24, 2010 by remiss

[H2oDunc]

You go to the hospital, you have to pay the bill. It's a no-brainer.

Not so The missus came off her bike the other month. no serious damage but lots of missing skin etc. Took her straight to the local hospital that patched her up, she saw a doctor who checked her over, had some X rays and got some tablets. When I stepped up to pay I was told it was all free.

[sarahsbloke]

You go to the hospital, you have to pay the bill. It's a no-brainer.

Now you have an insurance, check with them if they cover the accident, and if so, ask them to pay you back

As far as I know the compulsory insurance on the motorcycle, paid each year when you tax the m/c, covers any rider for up to 15kbht of hospital fees.

[harrry]

You go to the hospital, you have to pay the bill. It's a no-brainer.

Now you have an insurance, check with them if they cover the accident, and if so, ask them to pay you back

As far as I know the compulsory insurance on the motorcycle, paid each year when you tax the m/c, covers any rider for up to 15kbht of hospital fees.

I understand it is 14500 for no fault and about 100000if you take a claim to court. You need a police report the licence doesn't come into it unless the police charge you and then it will be a max of 500 baht fine. They generally will not. The problem comes if the vehicle involved was uninsured.

[travelmann]

No Insurance no licence sounds like no brain either so I suggest you tell him the easy way to pay for his care rather than sponge of anyone is to sell one of his kidneys.

[kokesaat]

Same problem happened to a Thai neighbor last year. No falang involvement. He was unlicensed, uninsured, and borrowed a friend's motorcycle. The family had to pay the bill at the government hospital.

[haveaniceday]

If the driver doesn't have a licence, then the vehicle is not insured. The driver subsequently becomes personally liable for any injuries or damage caused to third parties. As regards his own injuries, he won't be covered by his own health insurance for the same reasons.

Driving without insurance is also a criminal offence and he'll be lucky if he can avoid a jail term if the police become involved which might happen if you don't pay the hospital bill.

Quite correct. This is such a common occurence, in Thailand. Your 3rd. party insurance ,only covers licensed drivers, or riders.

Just clearing up, as it is 99% the round eyes fault, If a Farlang was driving and considered at fault, or was simply at fault, and had Class 1 insurance, and the other bike or car had an unlicensed driver and was uninsured, my insurance company would still cover their bills, correct? So the other party wont come and say I at fault and demand cash as my insurance company walk away as they were unlicensed. ??

[Kwasaki]

Same problem happened to a Thai neighbor last year. No falang involvement. He was unlicensed, uninsured, and borrowed a friend's motorcycle. The family had to pay the bill at the government hospital.

That's correct happen to one of my Thai family members, if l were you pay the bill and hope nothing else comes of it, unless your not bother about what happens to you Thai family and make him pay it back somehow.

[sarahsbloke]

Same problem happened to a Thai neighbor last year. No falang involvement. He was unlicensed, uninsured, and borrowed a friend's motorcycle. The family had to pay the bill at the government hospital.

Slight terminology problem here, hinting that you don't quite understand (along with many others) Thai insurance.

If you were to state

He was unlicensed .... not relevant to the compulsory insurance, it covers any rider up to 15kbht for hospital bills

The motorcycle was uninsured and untaxed ... for the m/c to be taxed, you have to buy insurance. The guy riding it doesn't need insurance, that is provided by the m/c.

So to rewrite your sentence to have meaning you would need to put.

Same problem happened to a Thai neighbor last year. No falang involvement. The friends motorcycle was untaxed and uninsured. The family had to pay the bill at the government hospital.

Edited November 25, 2010 by sarahsbloke

[F1fanatic]

Same problem happened to a Thai neighbor last year. No falang involvement. He was unlicensed, uninsured, and borrowed a friend's motorcycle. The family had to pay the bill at the government hospital.

Slight terminology problem here, hinting that you don't quite understand (along with many others) Thai insurance.

If you were to state

He was unlicensed .... not relevant to the compulsory insurance, it covers any rider up to 15kbht for hospital bills

The motorcycle was uninsured and untaxed ... for the m/c to be taxed, you have to buy insurance. The guy riding it doesn't need insurance, that is provided by the m/c.

So to rewrite your sentence to have meaning you would need to put.

Same problem happened to a Thai neighbor last year. No falang involvement. The friends motorcycle was untaxed and uninsured. The family had to pay the bill at the government hospital.

Yes, when I insured my car and enquired about 'other drivers' I was told it was THE CAR that was insured, not me (if you see what I mean!). So I didn't need to worry about who was driving the car.

[jazzbo]

With many hospitals in Thailand whether public or private the patient will not be allowed to leave the premises until the bill is paid in full or other arrangements made to the satisfaction of the hospital billing office ... with Thai and non-Thai patients alike,

[citizen33]

Here's another bit in the jigsaw towards the answer. The next stage would be to read the 2002 Act alongside any amendments and regulations (which I have not done). My guess though is that the sections below are still in force except for the co-payment (the 30 baht). I'd say that the best course for the OP is to contact the NHSO and say that he is concerned that the right to service is being denied on inappropriate grounds.

National Health Insurance Act 2002

Section 5 The Thai population shall be entitled to a Health service with such standards and efficiency as prescribed in this Act. The Board shall have beneficiaries jointly pay cost sharing as prescribed by the Board to the Health care unit per visit, except such persons as prescribed by the Board who shall be entitled to Health service without joint payment. Types and limits of Health service for beneficiaries shall be as prescribed by the Board.

[section 5 sets out the general entitlement to service. It makes reference to the now defunct co-payment]

[section 6 specifies the conditions for enrollment]

Section 7 Enrolled persons shall receive Health service at their personal Health care unit, primary care unit within the relevant network of Health care units, or other Health care unit, to which he is referred by his personal Health care unit or network of Health care units. Except, in case of reasonableness, accident, or emergency illness, an enrolled person shall receive Health service at such other health facility as prescribed by the Board, having mainly regard to their convenience and necessity. A health facility providing such service shall be entitled to the reimbursement from the Fund pursuant to such rules, procedures, and conditions as prescribed by the Board.

[This section says that beneficiaries should normally receive treatment at their local health unit. It makes provision for them to receive treatment outside the local network of health care organisations in case of reasonableness, accident or emergency].

[section 9 limits the right to service under the Act of beneficiaries covered by the CSMBS. S. 10 limits the right to service of those covered by the Social Security Scheme, Section 11 makes provision for reimbursement of costs of treatment for (eligible) patients covered by the Workman’s Compensation Fund.]

Section 12 In the case where a victim, caused by a motor vehicle under the Protection for Motor Vehicle Accident Victims Law, whenever, enjoys the right of Health service from a Health care unit pursuant to this Act, the said Health care unit shall notify such event to the Office. The office shall be entitled to the reimbursement from the Victim Compensation Fund, not exceeding such amount as prescribed in the Protection for Motor Vehicle Accident Victims Law, and shall submit such amount of reimbursement to the Fund in order to be transferred to the said Health care unit.

In the case where an insurance company or the Road Victims Protection Company is liable to pay the compensation to a motor vehicle accident victim who has enjoyed the right of Health service in accordance with paragraph one, the Office shall have powers to issue an order requesting the said company to pay such Health service expenses, not exceeding the amount in accordance with the conditions of the insurance policy.

Payment of Health service under this Section shall be deemed payment of the medical care compensation pursuant to the Protection for Vehicle Accident Victims Law.

[My reading is that s. 12 does not include a restriction of right to service such as that included in ss. 9 and 10 relating to members of the CSMB and SS schemes. It states in essence that where a patient has a right of service under the earlier provisions of the Act, which s/he then exercises, the treating health care unit can under certain circumstances gain reimbursement from the Victim Compensation Fund or an insurance company. The section does not appear to give authority to refuse treatment to a patient entitled to treatment, for example by virtue of prior enrollment in the UC scheme, who is not excluded from eligibility under another heading.]

Open to correction if anybody can support an argument with evidence.

Edited November 25, 2010 by citizen33

[Seekingasylum]

Thanks to all who provided helpful and informative replies, particularly Citizen 33.

I shall contact the NHSO when next in Bangkok.

I have already defrayed the expenses but am pursuing matters on grounds of general principle. The cultural response by Isaanites to those in authority drives me to almost beyond reason but I am determined to show that fighting one's corner can be done and is worthwhile........unless of course the NHSO confirm the Surin Hospital is correct , in which case I shall simply step on the lad's sore foot from time to time to reinforce the lessons experience is currently teaching him.

[PingManDan]

Give the bill to the lad and tell him to sort his own sh1t.

Yes I agree let him deal with it, they just expect the farang to pay

[Seekingasylum]

If I hadn't paid then the family would have had to borrow the money. This would have simply added more pressure to finances and made them more vulnerable to adverse circumstances in the future.

Is Thailand the only place in the world where the young and foolish act irresponsibly? Reading some of the more fatuous comments to my OP one could be forgiven for thinking it so.

[travelmann]

If I hadn't paid then the family would have had to borrow the money. This would have simply added more pressure to finances and made them more vulnerable to adverse circumstances in the future.

Is Thailand the only place in the world where the young and foolish act irresponsibly? Reading some of the more fatuous comments to my OP one could be forgiven for thinking it so.

Has he sold his kidney then or what?

[haveaniceday]

afarang, on 2010-11-24 22:27, said:

Xircal, on 2010-11-24 22:18, said:

If the driver doesn't have a licence, then the vehicle is not insured. The driver subsequently becomes personally liable for any injuries or damage caused to third parties. As regards his own injuries, he won't be covered by his own health insurance for the same reasons.

Driving without insurance is also a criminal offence and he'll be lucky if he can avoid a jail term if the police become involved which might happen if you don't pay the hospital bill.

Quite correct. This is such a common occurence, in Thailand. Your 3rd. party insurance ,only covers licensed drivers, or riders.

Just clearing up, If I was driving and considered at fault, and had Class 1 insurance, and the other bike or car had an unlicensed driver then would my Thai my insurance company would still cover their bills, correct? So the other party wont come and say I am at fault and demand cash as my insurance company walk away as they were unlicensed and illegal. ??