Drug reimbursement under social security scheme.

[pistachios]

Do you know if it is possible to get drugs prescribed by a doctor from a private hospital reimbursed by the social security scheme, for a thai national worker in the private sector?

I can't believe that not only are my girlfriend's condition required visits to a specialist and ct scans not covered by the SS scheme, but that she also has to pay for all of her (expensive) prescribed medicines out of her pocket.

[PMNL]

It is covered but at her registered hospital. Nearly all illness and investigation but many times the hospital seem to make a speed bump policy on the investigation to try safe cost.

Paying 750 baht a month would not get anyone into Bangkok hospital or Bumrungrad for free treatment, does not sound right.

Though if it was emergency, stated on medical report by attending dr, she could be partially reimbursed by the SSS.

[pistachios]

She goes indeed to bangkok hospital in order to get a good specialist. I was wondering if she could go to the government hospital's pharmacy to get her prescribed medicine at least partially reimbursed. Otherwise, as she is working in a pharmacy, she can already get the drugs at supplier's price, but it's already almost her monthly salary for the batch she needs to procure...

[TerryLH]

Did she get a referral to the private hospital from her assigned hospital?

Even with a referral, if the hospital she wants to use doesn't do SS, she might be out of luck.

[inbangkok]

The problem is that a government hospital is not going to fill prescriptions written by a Dr. at a private one. Also, SS is not going to reimburse for medicine from an expensive hospital. Especially when some of the private ones only carry brand name medicine with a 300% mark up.

Edited December 11, 2014 by inbangkok

[pistachios]

She didn't, I know that she cannot get the consultation and ct scans reimbursed.

I wanted to know if it was possible to do as in my country : with a prescription we can get our drugs reimbursed by the social security according to their own calculation. We just need to send some forms and copy of the prescription and get some money later.

I know that in Thailand private pharmacies don't do that, but maybe it's possible in the government hospital's pharmacy or by sending the medical file and some bills to the SSO?

[pistachios]

The problem is that a government hospital is not going to fill prescriptions written by a Dr. at a private one. Also, SS is not going to reimburse for medicine from an expensive hospital. Especially when some of the private ones only carry brand name medicine with a 300% mark up.

Why not? Most doctors work in a private hospital on top of the government hospital shifts. You can or cannot get your prescription filled up depending on where that doctor wrote it? Seems crazy.

[Sheryl]

Her meds will be paid for only if dispensed by the hospital where she is registered or a hospital they referred her to (and they should make such a referral if she requires a type of specialist they do not have on staff. Wouldn't refer to Bkk Hosp though).

My suggestions:

1. She should go back to the hospital she is registered at under SS and see a doctor there, show him a report and recommendation for tteatment from the private specialist and ask him to prescribe the medication in question. She'll need to have a medical report in hand showing diagnosis, recommended treatment and name of the private specialist. It is not possible to just take this to the hospital pharmacy as they are only allowed to fill orders from doctors on staff at that hospital; she has to see a doctor and get the meds prescribed.

2. Change hospital of registration under SS to one which has a better specialist of the needed type.

While it is not possible to register at expensive pvt hospitals under SS, there is s choice of hospitals (usually govt and smaller pvt ones) anf at least one of them may be a bettter option to where she is currently registered.

[inbangkok]

The problem is that a government hospital is not going to fill prescriptions written by a Dr. at a private one. Also, SS is not going to reimburse for medicine from an expensive hospital. Especially when some of the private ones only carry brand name medicine with a 300% mark up.

Why not? Most doctors work in a private hospital on top of the government hospital shifts. You can or cannot get your prescription filled up depending on where that doctor wrote it? Seems crazy.

First of all, I highly doubt any of the Dr.s working at Bangkok Hospital work at a government hospital as well. And if they do, why not go see them at the government hospital they work at then?

As for the prescriptions......that is just the way it is and understandably so. My guess is that people (including me) would continue to go see their high priced Dr. at an international hospital and then walk across the street to a government hospital to fill the prescription, thus leaving those pharmacies empty. If you want a prescription filled at a government hospital, you nee a Dr. who works there to write it for you.

Edited December 11, 2014 by inbangkok

[inbangkok]

Her meds will be paid for only if dispensed by the hospital where she is registered or a hospital they referred her to (and they should make such a referral if she requires a type of specialist they do not have on staff. Wouldn't refer to Bkk Hosp though).

My suggestions:

1. She should go back to the hospital she is registered at under SS and see a doctor there, show him a report and recommendation for tteatment from the private specialist and ask him to prescribe the medication in question. She'll need to have a medical report in hand showing diagnosis, recommended treatment and name of the private specialist. It is not possible to just take this to the hospital pharmacy as they are only allowed to fill orders from doctors on staff at that hospital; she has to see a doctor and get the meds prescribed.

2. Change hospital of registration under SS to one which has a better specialist of the needed type.

While it is not possible to register at expensive pvt hospitals under SS, there is s choice of hospitals (usually govt and smaller pvt ones) anf at least one of them may be a bettter option to where she is currently registered.

There are often long wait lists to get to better hospitals on the SS scheme. I know people waiting to transfer hospitals and there is no telling how many months/years they may have to wait.

[Sheryl]

The problem is that a government hospital is not going to fill prescriptions written by a Dr. at a private one. Also, SS is not going to reimburse for medicine from an expensive hospital. Especially when some of the private ones only carry brand name medicine with a 300% mark up.

Why not? Most doctors work in a private hospital on top of the government hospital shifts. You can or cannot get your prescription filled up depending on where that doctor wrote it? Seems crazy.

[Sheryl]

Hospital pharmacies are not public pharmacies. They solely serve to dispense meds in conjunction with in and out patient services at that hospital.

True not only in Thailand but mosy other countries as well.

AFAIK SS has no mechanism to reimburse for meds obtained at a private (non hospital) pharmacy but you can call the SS office to confirm.