Reasonable Charges For Stitches? (Caution Scary Picture)

[agksmehx]

My poor Thai friend was hit by a car and got stitches all over her lips and a small knee scrape.

Is 22,800 baht a reasonable charge for the service in Ramkhamhaeng, Bangkok? It seemed a bit high I am attaching pictures: of the lips after stitches (sorry this is scary), and the knee wound.

I am surprised that she was able to pay it in the first place. She said she borrowed money from somebody to pay it. But she doesn't have any collateral. Is it the case that hospitals have tie-ins with some loan agents?

If there is a link between loan/collection agent and hospital, is there room to negotiate it? I realize during the emergency nobody can negotiate and that probably explains the 22,800 bill. (I am sorry if I am just not aware of reasonable charges, and if these are reasonable then I will just encourage her to pay it somehow.)

Also what is the name of the hospital - I can't read Thai and it is an image.

Any advice is appreciated!

[Sheryl]

If she was hit by a car the driver (or his insurance) should cover this, was it a hit and run?

And was this care at Ramkhamheng Hosputal (a private hospital) or at a government hospital in the Ramkamheng area?

Never heard of an ytie in between hospitals and loan agents.

From the pictures, this would have needed a plastic surgeon and been very time consuming to do in order to avoid scarring. Even so, assuming she was not admitted to the hospital, 22,000 sounds too high for a government hospital. For a private hospital certainly possible but why on earth would she have gone to a private hospital?

[TommoPhysicist]

From the look at the 'lips' photo, the work seems top quality.

22k for having your lips back on properly by a skilled plastic surgeon seems a bargain to me.

Edited November 11, 2012 by TommoPhysicist

[lopburi3]

You did not include any image to read hospital name from (that I could find). As said plastic surgeon at a private hospital could well be this price or much more in my experience - for two small excisions of skin cancer paid 25k and that would have been less work than this I would suspect.

[agksmehx]

Thank you very much all of you: lopburi3, TommoPhysicist, Sheryl, for your good advice, especially on the quality of the work on the lips.

I am pretty sure it is a private hospital. I am attaching a picture of the bill which has the name. (I cannot read it but I am sure it is private.)

I do not know whether the car that hit her covered it via liability insurance or not. I do not have all the facts yet because she cannot speak. She is an ex-girlfriend and she (rather she at the behest of her family and friends) has extracted a lot of money from me for other, non-medical reasons. This was the unfortunate last straw but of course a genuine emergency. So I paid up -- I did not want it to be a story of "crying wolf" where she is forced to pay a physical price for past acts.

With that contexts, the possibilities are: hit and run, car did not have insurance, she got paid by the car insurance and also decided to get some money from me, or may be it wasn't an automibile accident but somebody beat her up for whatever reason (there are no scrapes on the chin or cheek so there is the possibility that it was a punch to the mouth rather than a fall from a car hit).

Anyways, it really really helped to know that it probably involved a plastic surgeon and that the quality of work on the lips is good. Medical care under emergency has no price pressure and hence typically overpriced. So all in all, I am happy to pay up for this and for the amount I think I got off easy. Naturally now I would never feel guilty about not giving her another dime for rent or food or anything else other than a medical expense. And, I will promptly buy medical insurance for her so that even if she gets hit by a truck it doesn't cost me any significant money again.

Sorry to morph this into a relationship thread, but I thought the context would help somebody else reading it.

Again, I am grateful for your replies. Any further information / opinion is welcome. :-)

[AyG]

The invoice doesn't mention the hospital concerned. It does, however, mention the name of the plastic surgeon, ปิติ รุจนเวชช์, who happens to work at Samitivej Sri Nakarin which is in the Ramkhamhaeng area so is possibly the hospital at which the patient was treated. This is one of the more expensive private hospitals in Thailand, which would explain the relatively high charge. You can see his details at http://www.samitivejhospitals.com/RSSR/Reader.aspx?type=dr&id=11950655-1-1

Incidentally, the invoice contains the name of the patient, so it might be a good idea to get the image removed to protect the privacy of the patient concerned.

[agksmehx]

Thank you very much for the information. How can I get the image removed?

[AyG]

I haven't actually tried this, but I think you go to My control panel → Settings → Manage Attachments and select/delete the image there.

[Kalbo]

Thank you very much all of you: lopburi3, TommoPhysicist, Sheryl, for your good advice, especially on the quality of the work on the lips.

I am pretty sure it is a private hospital. I am attaching a picture of the bill which has the name. (I cannot read it but I am sure it is private.)

I do not know whether the car that hit her covered it via liability insurance or not. I do not have all the facts yet because she cannot speak. She is an ex-girlfriend and she (rather she at the behest of her family and friends) has extracted a lot of money from me for other, non-medical reasons. This was the unfortunate last straw but of course a genuine emergency. So I paid up -- I did not want it to be a story of "crying wolf" where she is forced to pay a physical price for past acts.

With that contexts, the possibilities are: hit and run, car did not have insurance, she got paid by the car insurance and also decided to get some money from me, or may be it wasn't an automibile accident but somebody beat her up for whatever reason (there are no scrapes on the chin or cheek so there is the possibility that it was a punch to the mouth rather than a fall from a car hit).

Anyways, it really really helped to know that it probably involved a plastic surgeon and that the quality of work on the lips is good. Medical care under emergency has no price pressure and hence typically overpriced. So all in all, I am happy to pay up for this and for the amount I think I got off easy. Naturally now I would never feel guilty about not giving her another dime for rent or food or anything else other than a medical expense. And, I will promptly buy medical insurance for her so that even if she gets hit by a truck it doesn't cost me any significant money again.

Sorry to morph this into a relationship thread, but I thought the context would help somebody else reading it.

Again, I am grateful for your replies. Any further information / opinion is welcome. :-)

With all due respect, those stitches in the lips really do not look consistent with a motorcycle accident. From the information given, I'm almost certain she's had plastic surgery and lied about the accident to rinse you of a bit more money.

[Sheryl]

The above is indeed possible, or else she may have been punched in the lip.

Eelective cosmetic surgery would explain the choice of a private hospital since it is not a service she could get under the universal health scheme.

Possible that embarassment about being beaten/in a fight might also make her opt against going to the government facility at which she is registered -- and she is regustered at one and able to get free care at it. You do NOT need to get her medical insurance. Thais already have coverage through the government system, so 9 times out of 10 when a farang is asked for money for basic medical costs it is, to be frank, a scam.

[agksmehx]

Thanks re opinions on whether it was an accident involving an automoble (story is she got hit by car and fell and struck her face on the curb / sidewalk); or if it was inflicted violence by another person (punch on the mouth).

Thanks also regarding information on most Thais having medical insurance coverage. I was not sure whether that was a permanent perk initiated by a former prime minister, or if it was a temporary one that has been revoked or diluted in recent years.

As far as rinsing me of money, it could only be opportunistic behavior after she got injured. Something on the lines of "well, now that I have medical expenses, let me try to reimburse them from multiple people". I have never heard of somebody purposely hurting another person or themselves so significantly in the hope of getting multiple reimbursements that are not guaranteed.

Any further opinions on the probability / chances that it was an act of violence versus an accident, would be greatly appreciated. I definitely think it is at least 60-40 odds that it was not an accident. But I am not sure whether the odds are 90-10, or 99-1. The information would be helpful in allowing me to dig deeper into what's going on; because as much as I have personally broken up with her, I am definitely concerned as one human being to another.

[agksmehx]

Eelective cosmetic surgery would explain the choice of a private hospital since it is not a service she could get under the universal health scheme.

Possible that embarassment about being beaten/in a fight might also make her opt against going to the government facility at which she is registered -- and she is regustered at one and able to get free care at it. ...

I doubt if it is cosmetic surgery. She always had full lips; which I thought is something you'd want to retain rather than diminish (but who knows and time will tell for sure because I will know if her look changes).

Regarding going to a government facility -- she is currently in Bangkok but family is in Khon Kaen. If she is registered in Khon Kaen, would that explain going to a private facility in Bangkok? Or, can she still go to a government facility in a different city?

Thanks!

[Sheryl]

For emergency care, she could have gone to a private hospital even if registered at a hospital elsewhere.

Nobody is going to be able to tell you if this was an accident vs being beaten, but it would take a very odd sequence of events for being hiot by a car to have produced that. Still, not impossible. To my mind the strongest reason for thinkimng maybe beaten was the decision to go to a private hospital.

Not only did she go to a private hopsital but to an unusually expensive one, that caters mainly to farang and upper class Thais. This would definitely not be the usual choice for a Thai from the provinces with limited financial resources, and there are an abundance of less expensive private hospitals around if the issue was privacy. Frankly the way a girl from Isaan with little money would most likely end up being treated there is by having been taken there by a farang. So indeed you may have reimbursed something already paid for, possibly by a new boyriend (who may or may not have also been the one responsible for the injury). But I dio not see, if this girl does not choose to tell you, how you can ever know.

[Payboy]

Looks very close to stitches after lip enhancement surgery. Google for images.

[agksmehx]

Not only did she go to a private hopsital but to an unusually expensive one, that caters mainly to farang and upper class Thais. This would definitely not be the usual choice for a Thai from the provinces with limited financial resources, and there are an abundance of less expensive private hospitals around if the issue was privacy. Frankly the way a girl from Isaan with little money would most likely end up being treated there is by having been taken there by a farang. So indeed you may have reimbursed something already paid for, possibly by a new boyriend (who may or may not have also been the one responsible for the injury). But I dio not see, if this girl does not choose to tell you, how you can ever know.

Thanks Sheryl and Payboy -- that's excellent information and analysis. I'm the ex-boyfriend, btw, so the only remaining connection is humanitarian. The amount of money, 22,800 baht, is not that large given my resources, so no sweat on this one incident. As long as there is some reasonable chance that she is genuinely in trouble, it is no big deal to help. However, I am definitely not rich enough to pay for several such items, and as you can see from my attempt to get to the bottom of this incident -- I am not one to perpetually throw away good money at a bad cause.

My specific goal is to arrive at a strategic long-term decision for subsequent requests. (I wish I could find a Thai translation of the "crying wolf" story and send it to her. She is heading towards that outcome, and losing out in the long-term.)

A fine Holmes-worthy incident this is.

There is indeed good chance it is cosmetic surgery given the perfectly symmetrical cut around the middle and entire length of both lips. The choice of a top plastic surgeon at a private hospital suggests a non-emergency situation. However, the knee wound is entirely inconsistent. I'm guessing it would only have to be lip reduction in that case since she had particularly full lips that many girls would envy, but perhaps in Thailand they prefer more moderate lips. Either way, it will shortly be clear once she heals. Perhaps I will find myself sending her even more money after being charmed by her enhanced appearance -- haha ;-) Seriously, that would be enough to cut her off in all ways including medical emergencies with a perfectly clear conscience.

The other possibility that a farang boyfriend beat her up and then got her fixed. Well, I'm not at all bothered by that possibility. How do you spell "sumnamna"? :-) That too would help me cut her off completely with a clear conscience.

The possibility that did bother me significantly was the chance that somebody who is Thai beating her up and controlling her, for whatever reason. I'd naturally cut her off financially since that would only feed the control. But I would want to see what could be done to fix that situation. Happily though, I doubt if that's the situation. She would not be able to go to a top-notch private plastic surgeon in an emergency. I think the odds are sufficiently low that I can eliminate that possibility. (thank you all for helping me arrive at that).

The odds of an automobile accident too are low given the nature of the cut, and given that she found time to go to a plastic surgeon at a private hospital in an emergency. This is also consistent with her anger when I stalled a little bit on her demand, suggesting whether I could talk to the loan agent to negotiate a 15-day delay when I would personally be in Thailand, or other possibilities.

All in all, I am happy it is likely not a Thai beating her up as a way to get her to do something. And that it isn't an automobile accident that may disfigure her. And that I'm on my way to being free of a disingenous dependent with a perfectly clear conscience.

Thank you all -- I have one last thing to add. There is one more picture that shows a blueness on the right cheek suggesting of blunt force. That is inconsistent with cosmetic surgery though (in addition to the knee). I'll post that picture later today.

[agksmehx]

Here's the other picture showing the blueness on the cheek that I mentioned right above.

[Payboy]

Here's the other picture showing the blueness on the cheek that I mentioned right above.

The blueness is consistent with post-surgery trauma around the op site.

[agksmehx]

The blueness is consistent with post-surgery trauma around the op site.

Thank you immensely. That settles it; it will be an interesting story to tell my grandkids or whoever: cue the Beatles: "I once had a girl; or should I say; she once had me" :-)

The only thing I feel mildly offended with her is that she sent me the pictures with full confidence that I wouldn't figure out it was cosmetic surgery. I mean I didn't but that I wouldn't find other people who would; and she also sent the bill with the doctor's name. Li'l brat! :-)

Thanks everybody, and amen to lessons learnt. I will post once after a few weeks to let you all know how the surgery turned out. "Oh, I just happen to look (arguably) more beautiful after being hit by a car."

[Payboy]

Looking closely at those stitches, it seems she's opted for the bow shape look so popular these days.

[agksmehx]

Thanks matey; good to know exactly what I should look out for in a few weeks! <--- my lips will be bow-shaped too. btw, any thoughts on the knee bandage?

[TheWalkingMan]

You should have had her send you pictures of her hands. There should have been scarring.

[Payboy]

any thoughts on the knee bandage?

Creativity with ketchup is not unknown in tourist parts hereabouts.

[Satcommlee]

I'm not sure,

I googled "Lip Enhancement surgery" and some of the images of the stitches are almost identical to the image you posted.

If she did have an accident on the motorbike, then I would have thought she'd have also presented you with a Dentist bill, in my opinion.

Can;t help to think you have just paid for her to have cosmetic surgery.

[agksmehx]

(nine pictures attached)

Great thoughts regarding lack of dentistry and no pictures of scrapes on hand. I talked to her on video on Skype -- she was typing fine with her hands and other than lips and knee there was not an iota of scrape anywhere else. There should be significant chance of teeth damage with an impact that cuts the lips so bad.

I must say there is just one significant flaw in the cosmetic surgery hypothesis though. She has always had a particularly full natural lips. The LAST thing she could want to do is augment them further. So, I am assuming that there is something called a lip reduction surgery, or, as somebody pointed out lip reshaping. The images are not consistent with lip reduction unless there is temporary swelling that makes them slightly larger than what they were before surgery.

In fact, I dug up a whole bunch of her pictures and am attaching nine of them. Any thoughts on what specific cosmetic procedure might be recommended for such natural lips?

Edited November 18, 2012 by agksmehx

[rics21]

(nine pictures attached)

Great thoughts regarding lack of dentistry and no pictures of scrapes on hand. I talked to her on video on Skype -- she was typing fine with her hands and other than lips and knee there was not an iota of scrape anywhere else. There should be significant chance of teeth damage with an impact that cuts the lips so bad.

I must say there is just one significant flaw in the cosmetic surgery hypothesis though. She has always had a particularly full natural lips. The LAST thing she could want to do is augment them further. So, I am assuming that there is something called a lip reduction surgery, or, as somebody pointed out lip reshaping. The images are not consistent with lip reduction unless there is temporary swelling that makes them slightly larger than what they were before surgery.

In fact, I dug up a whole bunch of her pictures and am attaching nine of them. Any thoughts on what specific cosmetic procedure might be recommended for such natural lips?

Don't look that full to me. Seem coyotes with thicker lips.

Sent from my XT910 using Thaivisa Connect App

[Sheryl]

Whether you think she would want a particular cosmetic surgery has nothing to do with whether she would think so.

[TheWalkingMan]

Whether you think she would want a particular cosmetic surgery has nothing to do with whether she would think so.

Beat to the punch on that one. I know this naturally top heavy woman and she wants augment her breasts more. The eye of the beholder...

[lopburi3]

What is most unusual is that receipt you posted (and removed) as it is not what any hospital here would provide - they will always have name/address/phone and normally details to include at least general list of charges (with detailed receipt available if required) as this is needed by many customers for tax/insurance reasons. This had nothing and can not believe could have been issued by major hospital. I have seen billings from half a dozen hospitals in Bangkok including government and none would have been like that. So if this was a real bill suspect it was not from a hospital but from doctor in private clinic practice of some type.

[agksmehx]

Thanks all for that final bit of feedback. I will post again in a few weeks as a follow-up when the picture is clearer.

The summary for now is that it is almost certainly not an accident. It is either cosmetic surgery or a rich boyfriend hit her. In both cases it is a fancy plastic surgeon working privately. The knee wound is likely fake. Between cosmetic surgery and a rich boyfriend hitting her, the odds of cosmetic surgery are way higher; I'd say 90% to 10% because of how perfectly the cut goes all around right in the middle of the lips.

Things will be clearer in a few weeks. I'll visit Thailand for a couple of months starting the 28th of November. I don't intend to chase this down, but information might come my way if I see her or talk to people. If I am bored I might discreetly contact the good doctor.

This is great for me because I was supporting her to the tune of 6,000 baht / month, and this incident gives me the impetus to totally cut her off, permanently, with a clear conscience. Faking a medical emergency is probably the worst way to scam someone who had some concern for her. Any other use of money would be better than helping such a person. The savings of 6,000 baht per month are enough to recover the 18,000 I gave her in 3 short months. But that pales to the mental energy I'll save. I was spending a lot of personal time and energy trying to get her to start working a healthy job. So, don't cry for me Argentina ;-)

For context, I have been involved with her for about 18 months in a non-romantic way (the romantic phase was a couple of months before the start of the 18 months). I've visited her village in Issan and lived there for a couple of weeks a couple of times; know her folks, family friends, village folk and such. The goal was always to get an ex-girlfriend to live a straight life rather than support a romantic girlfriend. This is the natural conclusion; it is the first time she's fallen so low in terms of extracting money.

PS: I do not doubt the receipt because the medical work is genuine and corroborated here as that of very good quality, consistent with the receipt and amount.

[uptheos]

From the look at the 'lips' photo, the work seems top quality.

22k for having your lips back on properly by a skilled plastic surgeon seems a bargain to me.

Indeed, quality plastic surgery does not come cheap and I agree that 22k is a bargain.