Getting Health Insurance For A Thai Girl?

[Zend99]

Hello everyone. I was wondering if you might help an American guy like myself .... help a thai friend who lives in Thailand .... apply for and get set up with a substantial health insurance policy.

I will be paying for it. However I don't have the slightest idea where to start, and given that I dont speak Thai, im not sure how to get it applied for and get her officially "Covered".

Can someone assist?

She is HIV Positive.

Thank you.

[Pormax]

There are many companies here that do a substantial health/life insurance but I would be very surprised if they would take on someone who is HIV positive as there are far too many associated health problems with this ailment. I would also suggest that not only will the pemiums be very high indeed but there would be endless exclusion causes added.

But the first thing one requires to know are you here in Thailand with this friend. Or are you just being asked for the money to do this? If it is the later I would suggest that you wait until you come here to pay the money direct to the Company you choose and then arrange the yearly payments to them from your bank.

My own feelings is that you save the money and help (if you can) to pay medical bills when neccessary. You could well end up paying less in the long run.

[citizen33]

I'll reply to this as a serious inquiry, though the scenario does raise one's eyebrows. Individual health insurance is intended to cover the risk of some future eventuality that might arise, rather than to meet the costs of something that has already happened - you would not find many companies rushing to enter a contract to meet the costs of a road traffic accident that happened last week. This inquiry is really about how a benefactor can meet the costs of treating a long-term chronic condition in the most cost-effective way. It seems to me really to be about how one can get the best deal from a health care provider (or series of providers) rather than find the most attractive insurance policy. In other words the OP isn't likely to offload any responsibility to a third-party payer, and as the purchaser must do some research to find out which providers give best value.

Having said that, the Thai public health insurance schemes do not operate on an individual risk basis and do provide some cover for HIV/AIDS. If, for example, the woman in question is or has been covered through employment by the social security scheme that would entitle her to basic treatment. Indeed even the universal coverage scheme (the old 30 baht scheme) does cover basic treatments. Recently, the government announced that HIV/AIDS is one of three areas (along with emergency services and renal replacement therapy) where it will harmonise provision across the public schemes (i.e. channel the money through the NHSO and allow all patients to have the same treatment). So my suggestion to the OP is that he sees what is available through public services and then contributes some money to top up if necessary.

Here is a link to a recent report on services in Thailand.

http://www.unaids.or...e_Report[1].pdf

It isn't so recent that it mentions the harmonisation proposal, but it does show that a lot is going on. Many people on the forum will question the value of the public schemes, but getting the best out of them is partly about knowing what should be available and requesting citizen entitlements.

Edited October 31, 2012 by citizen33

[samran]

As others have said, private health insurance won't cover preexisting conditions.

The best help your friend can get will be through the government system. The best way into that system for a disease like HIV will be via some of the larger excellent public hospitals such as Chulalongkorn in Bangkok.

There are others in Bangkok and the larger cities. I am sure others will be along shortly to recommend these.

[samran]

Mods why not move this to the health forum? It will probably be more useful to the OP there..

[Zend99]

Thanks guys. Im afraid I have no idea what I just read though. LOL .... i am in the USA. I never just send cash. It would always be paid directly to whatever company. But I dont understand the options given above, even though I greatly appreciate the time and effort you put into writing them out. I guess its the issue of reading "about" them ... versus knowing what to actually do to get them activated and in place for her. I think I would need someone locally who handles things like this - financial and paperwork matters for guys like me who are overseas .... to handle everything from documentaitons to insurance to whatever may come up.

Are there such services ?

[lopburi3]

Thailand offers basic health care service free or with marginal payment and this is all most people will ever have - although with employment additional access to commercial facilities is often available (although not always better). With a major pre-existing condition most insurance, even if extended for other ills, would do there best to not pay claims by using the excuse the pre-existing condition cased the new illness. I suspect in most cases of having HIV self insurance is the best option and taking full advantage of government facilities for cost savings.

I am sure you can find someone to take your money - either an insurance firm or perhaps another foreigner. But I could not recommend any and would not advise anyone without street smarts in Thailand to do so. Buyer beware is doubly true here.

[samran]

Thanks guys. Im afraid I have no idea what I just read though. LOL .... i am in the USA. I never just send cash. It would always be paid directly to whatever company. But I dont understand the options given above, even though I greatly appreciate the time and effort you put into writing them out. I guess its the issue of reading "about" them ... versus knowing what to actually do to get them activated and in place for her. I think I would need someone locally who handles things like this - financial and paperwork matters for guys like me who are overseas .... to handle everything from documentaitons to insurance to whatever may come up.

Are there such services ?

In simple language: As everyone has told you no insurance company will touch your friend with a barge poll. If they do, any condition which they can even vaugely link HIV/AIDS will not be covered. So don't bother even trying to get insurance for he.

Again in simple terms: Thailand has some very decent public hospitals which are free or very cheap to Thai citizens - so she can access that. Your friend turns up and she gets treated.

As Lop also said - if your friend also has a legit full time job, she will automatically be covered (again via the government) from payments deducted from her salary.

Either or, she has access to treatment. She just needs to seek it out. There is little I would think you could do from the US.

Edited November 1, 2012 by samran

[Sheryl]

Thailand has a system of universal coverage for its citizens. It consists of 3 systems, one for civil servants, one for people employed in the formal sector, and one for everyone else, which is the largets and probably where she fits in. People sometimes refer to this as the "30 baht scheme" or the "gold card".

It is very unlikely that she is nto already enrolled under this scheme but if for soem reason she is not, all she has to do is take her "tabian baan" (house registration) to a nearby government hopsital. Any problems, call the National Health Security Offiuce hotline 1330.

Care is free or nominal cost including HIV care.

Private insurance is uncommon here since Thais do not need it. Its only advantage is that ti would allow access to private hospitals whereas the abiove system limits one to government hospitals, but the quality of care in these (including HIV care) is quite good. And, no company will insure someone who is already HIV+.

[Zend99]

Thanks everyone. I suppose a little more information would be helpful.

First off, regarding the generalized coverage that *does* include HIV care. I think i would need to find out what qualifies as HIV care. She is newly diagnosed, and I am learning that HIV is anything but "basic". Her first order of business (as per talking with a specialist here in the USA) was to get numerous vaccinations. These will protect her from possible infections in the future which she would not be able to fight off. Would those be covered? Secondly, to properly manage this disease (something I am told very few Thai residents do), she needs CD4 and Viral Load testing done every 3 months, to track her trends and anticipate when medications should begin. I wonder if those tests are covered.

More significantly is the very expensive but necessary (for proper care) Drug Resistance Test. This test costs upwards of a Thousand $ US, but is of utmost importance. It deterimes whether her particular virus strain is immune to any medications currently available, and if so, which ones. Having this information on hand can help direct which treatment regimen she is put on, and thereby prolong her life significantly. Would this be covered?

Thus far, I have paid for all of these things up front - by wiring money directly to the hospital. So she is done with the preliminary stuff. But these up front costs will be nothing in comparison to the care needed when her health begins to fail. That is what i am mostly concerned about, as it pertains to insurance.

For now, its just going to be : CD4 and Viral load repeat testing, and eventually medication. I would expect that this would be her only major needs for the next 5, 10, 15, 20 years. If she is managed properly, at least. But needless to say, when things start going down hill, we are talking full treatment for major diseases - sometimes multiple diseases - possibly cancer treatments, then maybe lymphoma treatments then maybe chronic Pneumonia or Bronchitis... etc. Those are the days that concern me.

Any idea what this Gold Card care includes as it pertains to HIV?

[Sheryl]

The Gold Card covers ALLL OF THIS.

For reasons of economy, drug resistance tests are limited to patients who fail to rerspoond to first line drugs (bear in mind, the Thai public health authorities keep close tabs on trends in drug resistance so they know which drug combinations are most effective currently, and they continuously revise protocals accordingly.).

The frequency of VL testing will be less than might be the case in the West due to cost consciousness but this will not adversely affect care. Bear in mind that if one is treated in a private hospital where doctors are paid more if they do more, there is always a bias towards maximum number of tests in procedures, in a publicly funded health system this is absent and tests are kept to the minimum absolutley necessary. Treatment is based on CD4 counts. VLs are useful is cetrtain situations but are arguably overused in the West.

There are thousands of Thais being treated for HIV under the public health system and doing very well as long as they adhere to medical advise.

Money for treatment is not the problem. Nor is lack of doctors with expertise in the field, there are many excellent ones.

What is a problem is that there is a striong stigma towards HIV in Thai society and a lot of ignorance. HIV+ people sometimes fail to seek treatment or stop going due to an out-of-date sense of fatalism. Bity there are plenty who know better, including many who run support groups for other Thai HIV+ people.

[jrtmedic]

Sorry but seems that a very blunt response is required here.

Your friend will not secure health insurance from any reputable company which will provide cover for HIV, any sequelae which may arise, monitoring (blood Tests) or treatment. If by any chance you do discover a company who will offer a policy it will be expensive and exclude any cover for a pre- existing condition.

If you wish to check this just make a few enquiries of major American providers of health care insurance making sure you inform them of the HIV status.

Your friends best course of action is to take advantage of the Thai Governments health care facilities. Thai doctors have much experience in treating HIV and any sequelae. If she is uncertain about this advise can be obtained from her local Provincial Administrative Organisation or "Or-Bor-Tor"

A major problem doctors experience is securing ongoing patient compliance especially if the patient is symptom free.

If you are not convinced the government hospitals are "good" enough you may care to investigate the private sector to determine if a Doctor/Hospital would agree to care for your friend on a long term on-going basis with bills being sent directly to yourself (A substantial deposit may be required)

I would council against directly providing money intended for health care to your friend,

Clearly you are worried and concerned about your friend, However, if the advise, contained in this and earlier posts, is followed your friend will be well cared for.

Best wishes

Edited November 4, 2012 by jrtmedic

[Zend99]

Thanks again. So what is the process of getting the Gold Card? If this was already stated I apologize.

[Zend99]

Nevermind, I see it now: "It is very unlikely that she is nto already enrolled under this scheme but if for soem reason she is not, all she has to do is take her "tabian baan" (house registration) to a nearby government hopsital. Any problems, call the National Health Security Offiuce hotline 1330."