Problem with an insurance company and hospital bill

[Muzarella]

Last week I call my agent at my very well known Thai health insurance company asking if I will be covered for some testings, etc. She said yes, and also she volunteers to come with me to this private hospital to take care of everything. She speak a little English, and I do not speak Thai. After she talking with nurses and doctors, she booked a room for the night to do all the testings. I left the hospital the next day without having to pay anything and happy about the service and the agent. Now, she said that I have to pay 4000THB and wants to show me the bills, etc.

I am not happy. What may happen if I do not pay this bill, and I cancel the insurance I am paying monthly?

My Thai wife said that if I do that may become a police matter. If that true?

[Langsuan Man]

Sounds to me, since the amount is only 4,000 THB, that you are having to pay your annual deductible. Don't know Thai health insurance but in the West most health plans have an annual deductible amount

Have your wife read your policy, it should be clearly stated what the deductible is

As far as not paying, I doubt if it would be a police matter but you can be assured that you will never get health insurance from another company so long as you are here, they talk to each other and share information. There are no health privacy laws here so they are free to disclose any information about you

[Muzarella]

Sounds to me, since the amount is only 4,000 THB, that you are having to pay your annual deductible. Don't know Thai health insurance but in the West most health plans have an annual deductible amount

Have your wife read your policy, it should be clearly stated what the deductible is

As far as not paying, I doubt if it would be a police matter but you can be assured that you will never get health insurance from another company so long as you are here, they talk to each other and share information. There are no health privacy laws here so they are free to disclose any information about you

No deductible. This was an error from the agent, because I had the option to do it on a less expensive hospital, and I did even extra exams because she said was covered. The hospital release me because got confirmation from the insurance company that everything will be paid.

About losing insurance rights, I know that. For what I paid every year I can travel to my country and do it all for free. I was ready to cancel this when I decided to test it one more time. If that will be the only problem, I will not paid. Was not my fault.

I just do not want any trouble with police or with my immigration retirement extension.

Edited April 19, 2015 by Muzarella

[JohnC]

So, you are out and about and a drunk driver knocks you down, you are unconscious and they take you to hospital or getting older you have a heart attack or stroke pray tell me how you are going to get home for "free" treatment?

In addition if you are from UK note they are tightening up in treatments from overseas visitors.

I would pay the 4000 baht, put it down to experience and renew my insurance, as you get older you may find taking out health insurance impossible but renewing a current policy is not usually a problem.

[samuibeachcomber]

Amazing post!...........your agent goes with you says everything is covered,but later finds out something is not covered...and its only 4000 baht and you are whingeing like a stuck pig!....after all the good service you have been given!Just pay the money and be thankful.Failing that and i am sure TV members can have a whip round.

[Sheryl]

So, you are out and about and a drunk driver knocks you down, you are unconscious and they take you to hospital or getting older you have a heart attack or stroke pray tell me how you are going to get home for "free" treatment?

In addition if you are from UK note they are tightening up in treatments from overseas visitors.

I would pay the 4000 baht, put it down to experience and renew my insurance, as you get older you may find taking out health insurance impossible but renewing a current policy is not usually a problem.

As above except that I would consider changing insurance companies unless you are able to figure out why there is 4,000 baht due. Start by allowing her to show you the relevant receipts and explain why these costs were not covered (it would also be useful to know the total cost and how much the insurance co. did pay).

There are many possible reasons...the policy may exclude certain specific things, or you may have reached a cap in the coverage. Either way, you need to understand it for future reference.

[Muzarella]

So, you are out and about and a drunk driver knocks you down, you are unconscious and they take you to hospital or getting older you have a heart attack or stroke pray tell me how you are going to get home for "free" treatment?

In addition if you are from UK note they are tightening up in treatments from overseas visitors.

I would pay the 4000 baht, put it down to experience and renew my insurance, as you get older you may find taking out health insurance impossible but renewing a current policy is not usually a problem.

As above except that I would consider changing insurance companies unless you are able to figure out why there is 4,000 baht due. Start by allowing her to show you the relevant receipts and explain why these costs were not covered (it would also be useful to know the total cost and how much the insurance co. did pay).

There are many possible reasons...the policy may exclude certain specific things, or you may have reached a cap in the coverage. Either way, you need to understand it for future reference.

The problem here is not the amount or the hospital service...the problem is the irresponsibility and incompetence of my agent.

She is Thai, she sold the policy, and supposedly she knew very well the coverage...that's why she was with me all the time. Because she said that my policy covers a lot more than I was asking, I was very, but very close, to ask for more related and expensive exams, that even will require more nights on the hospital.

I didn't do it because my policy is the cheapest one, and I was surprised by the agent statement, and the exams were not so important at that time. If not, I will be facing now with a VERY BIG bill.

Anyway, I will go to the hospital tomorrow, and I will ask about any not explained extra charge.

Like I said in another posting about Thailand, here I have to be in defensive mode every time I deal with money because nothing is for sure. Thailand is cheap. If I have the money some people here have, I will pay many things without even looking at the bill...but I may be an exception here. I have a modest income, even in Thai standards. If you wonder about my bank deposit for my retirement extension, or minimum income, I do not have it.

I am Italian, but also I am an American citizen....that some people will call Cheap Charlie.

Edited April 19, 2015 by Muzarella

[Issangeorge]

I don't know what hospital you went to, or what tests, but living in Eastern Isaan, where I mostly use government hospitals and the odd private one, ฿4,000 would cover a lot of tests, not counting what the insurance company covered. I just had a chest x-ray, and EKG for ฿600.

[JoePai]

Could be something lost in translation - next time use a native English speaking broker.

[Soutpeel]

Could be something lost in translation - next time use a native English speaking broker.

Which may prove rather problematic don't you think being insured by a local insurance company even if it is a branch of an international company, hardly worth employing a native speaker considering the main customer base would be Thai speaking

[PMNL]

Get the intermixed receipt and the coverage detail form the hospital then you will know what is that 4K for, simple.

Agent in thailand mostly are incompetent know nothing more than commission, having said that there are a few good competent ones know what they are doing. If you want to know the coverage you might be able to get more information calling the call center, health claim section.

To be fair, You said you requested a few extra tests, you should not moan about paying extra then, as the insurance especially small policy( I would not call it cheap) cover the test related to the illness at the time of admission and requested by attending dr not the patients.

[Muzarella]

Update...The agent just come to my home to explain to me the problem, and brought the bill I didn't saw..because in theory was covered.

II never used the insurance before. First Time. I went to the hospital to check for acid reflux, and the doctor said that will be better to do an endoscopy..but..in Thailand I will have to spend one night at the hospital. In other private hospital, without insurance, an endoscopy price was 6000 THB. The agent asked the price for the endoscopy in this hospital and was told 8000THB plus "extras". The room rate, 2000THB/night was cover by the policy.

The agent said that I will be cover up to 20000THB.....and I was very close to ask for a colonoscopy too. Thanks God I didn't.

Surprise. The bill total is 27000 THB for the room for a day and the endoscopy, that...by the way.. shows not problems. All very clean. No biopsy or pathology need it. Doctor said that was the cleaner picture ever. I do not drink or smoke.

The charge for the room was 2200 THB plus.... Some extras? 850 THB for one hospital meal (not include on the room rate??) . Blood and urine test, 3000 THB, A bunch of antacid pills giving to take home 4000 THB....etc, etc, etc, Insurance paid 23000THB.

Tomorrow..another confrontation in sight....asking for explanations. I am tired already.

[abrahamzvi]

Every policy in Thailand (and for that matter in most countries) has limits per day, per treatment, OPD and hospital stays, etc. I would suggest that you ask the agent why you are charged BHT 4,000 and I am pretty certain that this represents the excess of limit, or limits.

[scorecard]

Are you sure the agent is not playing a cunning game?

From several family experiences I wouldn't trust Thai insurance agents with 5 Baht and the same in many other countries.

Example: just recently my Thai son decided to look for a family health insurance policy, son, wife, 2 kids.

My coincidence an agent (very high profile company) made a cold call about insurances and my son said send me some details about health by e-mail.

Meanwhile he found what he wanted from another company and all paid

First agent has since called my son numerous times, tells my son he's not happy and son is unfair and demands that my son transfer 500Baht to him for compensation. It will never happen.

[inbangkok]

Amazing post!...........your agent goes with you says everything is covered,but later finds out something is not covered...and its only 4000 baht and you are whingeing like a stuck pig!....after all the good service you have been given!Just pay the money and be thankful.Failing that and i am sure TV members can have a whip round.

Nope.....nothing amazing about the original post. Yours is the amazing one. Acting like a total, disrespectful ass. Telling a man to be "thankful" when he is being billed for something that he was told would be free.

99.9% of people are not going to be happy when they are told something is free and then receive a bill for over $120. You must be that 0.1% that does not value his own money.

[Muzarella]

Every policy in Thailand (and for that matter in most countries) has limits per day, per treatment, OPD and hospital stays, etc. I would suggest that you ask the agent why you are charged BHT 4,000 and I am pretty certain that this represents the excess of limit, or limits.

The bill is full of "extras", even the separated price for the room meal do not have sense ( A room for 2000...a simple meal for 850? )

The endoscopy procedure billed 7000 and over the counter medication to take home 4000?

"Surgery room" 7000? What surgery?

Blood and urine test 4000?

To me looks that the hospital wants to make money with the insurance and with myself too...

An endoscopy without biopsies for 27000THB ?.

I am old but in very good health....and with free medical in the US...Next time with a little more than 27000 THB I can go to the US and do anything I want and need. With that kind of pricing if something big happens looks like my insurance here will be not enough at all. Something to think about this week, if even with the agent at my side I cannot get precise price info.

Edited April 19, 2015 by Muzarella

[Muzarella]

I am not bashing Thailand because this It is happening in many countries, specially when an insurance company is involved. The vendors will do everything its can to take advantage. It is then insurance company obligation to protect its interest, because in that way its will protect its clients. Unfortunately do not happen, specially in the car insurance business. I had a small accident with my car years ago, the insurance covers everything, but I was feeling bad about the other party, the guilty party in the accident, a poor guy. Before bringing my car to the dealer for the insurance claim, I went to a good body shop and was quoted 5000 THB for a good job. The other party didn't have money to pay for that, and I brought my car to the Honda Dealer. The Honda Dealer quoted and got 12000 THB from the insurance company.

This practice it is very common in the US, but some insurance will give you the money quoted, and will allow you to take care of the repairs, and the same can be done with medical services quoted in advance. Not surprises..and I really do not like surprises, and I cannot afford it.

But also I do not like legal problems. If I have to pay, I will someway...after fighting hard for my rights. Just that.

If somebody had this kind of problems, let me know how ended. Thanks.

[Suradit69]

She speak a little English, and I do not speak Thai.

Could be something lost in translation - next time use a native English speaking broker.

Yes, that seems likely. Even in English, if someone says that an event is "covered," it doesn't necessarily imply 100% reimbursement.

My foreign based medical insurance "covers" virtually everything ... prescriptions, medical, optical or dental ... but reimbursement percentage rates vary.

[NoshowJones]

Amazing post!...........your agent goes with you says everything is covered,but later finds out something is not covered...and its only 4000 baht and you are whingeing like a stuck pig!....after all the good service you have been given!Just pay the money and be thankful.Failing that and i am sure TV members can have a whip round.

Nope.....nothing amazing about the original post. Yours is the amazing one. Acting like a total, disrespectful ass. Telling a man to be "thankful" when he is being billed for something that he was told would be free.

99.9% of people are not going to be happy when they are told something is free and then receive a bill for over $120. You must be that 0.1% that does not value his own money.

Lawyers, insurance companies, men in suits. I hate the lot of them. thieving, cheating crooks.

All over the world.

[gemguy]

Hmmmm...question is: How much would the medical treatment cost you if you had no insurance and had to pay the hospital bill all by yourself.....as some of the hospitals are far from cheap......and just plain expensive.

If you go and have a sit down talk with your medical insurance company management or the women who assisted you at the hospital , then 99.9 % for sure they will show you somewhere in the contract why you have to pay the 4000 Baht,......as there always is some aspect of the insurance coverage that you did not understand or recognize or simply forgot.

Cheers

[colinneil]

I used to have insurance cover. It clearly stated a 2500 baht excess, payable by policy holder.

Now i have no problems, have been in hospital for a total of 30 weeks in the last 18 months.

Not had to pay 1 baht everything paid for by Thai government (wife is a school director).

In reference to OP check your policy, to see if you have excess mentioned.

[gemguy]

Update...The agent just come to my home to explain to me the problem, and brought the bill I didn't saw..because in theory was covered.

II never used the insurance before. First Time. I went to the hospital to check for acid reflux, and the doctor said that will be better to do an endoscopy..but..in Thailand I will have to spend one night at the hospital. In other private hospital, without insurance, an endoscopy price was 6000 THB. The agent asked the price for the endoscopy in this hospital and was told 8000THB plus "extras". The room rate, 2000THB/night was cover by the policy.

The agent said that I will be cover up to 20000THB.....and I was very close to ask for a colonoscopy too. Thanks God I didn't.

Surprise. The bill total is 27000 THB for the room for a day and the endoscopy, that...by the way.. shows not problems. All very clean. No biopsy or pathology need it. Doctor said that was the cleaner picture ever. I do not drink or smoke.

The charge for the room was 2200 THB plus.... Some extras? 850 THB for one hospital meal (not include on the room rate??) . Blood and urine test, 3000 THB, A bunch of antacid pills giving to take home 4000 THB....etc, etc, etc, Insurance paid 23000THB.

Tomorrow..another confrontation in sight....asking for explanations. I am tired already.

Yes...this is the problem near everyone has with hospitals and or hospital insurance companies.

Hindsight will say that you should have asked for specific prices and costs for everything involved.....but the problem is..... if you do not know what the medical problem is then how can you assess the costs in general before hand.

9 times out of 10 the costs and final bill will be more than you figured and often enough way more and questionable as to where all the charges and additional charges came from and or the validity of the charges.

In my experience, when you ask them specifically how much is the cost of known factors such as a room per day and or meals per day they can answer you but even then they are vague while telling you it could cost say from 1500 baht per day to 3000 baht per day.....for example....but you do not know how many days you will be in there while they do not know how many other room related services they may have to provide you with relative to the room costs...so they tell you from 1500 Baht per day minimum to 3000 Baht per day maximum....or so they say!!

Nearly all the other costs are difficult to say unless they present you with a list of costs for common tests and doctors fees etc etc ...but they do not know yet what they are dealing with exactly and just how many services or tests or doctors have to be involved and or medicines they will have to administer to you....during or after your hospital stay.

You just know it is going to cost you more than you want to have to pay while they are trying to charge you the full amounts when ever they can.

The medicines are where there is a big discrepancy in prices because you can go to a drug store and learn the same medicines the doctors at the hospitals recommended, and you already paid for, are 1/5 to 1/3 the price at near any drug store.

The hospitals have 3 to 5 times or more mark up on medicines and considered one of their more lucrative and profitable aspects of running a hospital.

Really, you can not win especially if you are really sick or hurt badly and need to be taken care of immediately.

They are almost rubbing their hands together thinking of the money they are going to get out of you.

Questions is: Do they charge you more than they charge the Thais for the same or similar medical maladies.

I would surmise yes.

Cheers

Edited April 19, 2015 by gemguy

[Travelman868]

Sounds to me, since the amount is only 4,000 THB, that you are having to pay your annual deductible. Don't know Thai health insurance but in the West most health plans have an annual deductible amount

Have your wife read your policy, it should be clearly stated what the deductible is

As far as not paying, I doubt if it would be a police matter but you can be assured that you will never get health insurance from another company so long as you are here, they talk to each other and share information. There are no health privacy laws here so they are free to disclose any information about you

No deductible. This was an error from the agent, because I had the option to do it on a less expensive hospital, and I did even extra exams because she said was covered. The hospital release me because got confirmation from the insurance company that everything will be paid.

About losing insurance rights, I know that. For what I paid every year I can travel to my country and do it all for free. I was ready to cancel this when I decided to test it one more time. If that will be the only problem, I will not paid. Was not my fault.

I just do not want any trouble with police or with my immigration retirement extension.

It still sounds like a deducible. The bill is less than £90 so I would be inclined to pay then have a friendly chat with the agent to go through ALL the terms of the policy.

I do have to say that Thai people are not very good at customer service. After they have the money the service very often stops.

[Pdavies99]

Sounds to me, since the amount is only 4,000 THB, that you are having to pay your annual deductible. Don't know Thai health insurance but in the West most health plans have an annual deductible amount

Have your wife read your policy, it should be clearly stated what the deductible is

As far as not paying, I doubt if it would be a police matter but you can be assured that you will never get health insurance from another company so long as you are here, they talk to each other and share information. There are no health privacy laws here so they are free to disclose any information about you

No deductible. This was an error from the agent, because I had the option to do it on a less expensive hospital, and I did even extra exams because she said was covered. The hospital release me because got confirmation from the insurance company that everything will be paid.

About losing insurance rights, I know that. For what I paid every year I can travel to my country and do it all for free. I was ready to cancel this when I decided to test it one more time. If that will be the only problem, I will not paid. Was not my fault.

I just do not want any trouble with police or with my immigration retirement extension.

I just dont get it? You have an insurance company covering your bills in Thailand, the agent with no charge comes to the hospital to assist you and you are quibbling about 4000 baht?

Fine but up to you, risk it and see where you end up....no insurance!

[Muzarella]

Thank you for all responses. I had insurance before in many other countries, and every time I did a quote in advance showing the possible extras. This is Thailand. I do not speak Thai, and I am aware about mistakes and misunderstandings. That's why I asked my agent to come with me to the hospitals to ask for quotes. I make very clear to her that I wanted to be sure that the insurance will pay for the services I asked, and I will not have to use my money. I even brought my policy, only in Thai, for her to look if necessary, but she knew about all details. She speak English enough and I was with my wife to translate some if need it, but the agent English is better than of my wife. I repeated my concern to my agent many times during the enquires, and she always repeated that everything will be cover. She even chose the most expensive associated private hospital in town, and not the one I elected first. My insurance do not have deductible, just limits for the services. My agent said that my insurance will cover even more than my requested exam, an endoscopy. I knew that, if the exam will show some material to test and do pathology, I will have to pay more, but the exam shows not problem, nothing to test, and the report I got with the pictures states that. No surgery, no biopsy, all very clear. Even only one meal in the room because I get there in the afternoon and leave in the morning next day.

Comparing with the quotes I got in the cheaper private hospital associated with the insurance company, of about 6000THB including free private room for the night, in this one, also an associated hospital, the estimate was about 10000 THB for the same service.

The agent said that my insurance will cover up to 20000 THB. She even pushed for me to get more services, but I didn't.

The bill I got is for 27000 THB, and show charges that doesn't looks right. The agent said that I have to pay the difference now, no negotiations, etc, etc......The company is the best well known Thai health and life insurance company in Thailand. The policy was the cheapest one, and I knew that...and I was surprised with the service I got....but...now... surprised with my agent "help".... I didn't pushed for VIP service..all the contrary.

She did a mistake.....and I was released from the hospital without any bill or paying for nothing...because by my policy the insurance company pays directly to the associated hospitals. It is not the kind with reimbursements after I paid the bills.

I make a decision not to pay the difference, and fight for a new bill. I do not know what chances I have to be considered...or the consequences if I do not pay....It is OK for me to lose the insurance. Too costly just for this service, cannot imagine for something really serious...and I cannot afford to get better policy.

Edited April 19, 2015 by Muzarella

[Naroge]

The agent speaks "little" English and you no Thai. Obviously there is a risk of something "lost in translation"

You have not yet given the agent the chance to explain the charge of 4,000 Baht, so don't blame the agent or the company yet.

Come back to us when you have the details and we can give our advice, if still needed. Before that we are all just playing a guessing game.

[Nuddy]

OP is kidding isn't he?

Just pay the 4000 thb and forget about it

You cannot do "this is a principle thing"here in Thailand

Just be happy you are still alive and survived being in hospital.

Yeah mate I know it hurts but it stuff all. Move on.

Regards

[inbangkok]

OP is kidding isn't he?

Just pay the 4000 thb and forget about it

You cannot do "this is a principle thing"here in Thailand

Just be happy you are still alive and survived being in hospital.

Yeah mate I know it hurts but it stuff all. Move on.

Regards

Get real! You know how many times I have had to battle BUPA to have things covered or get reimbursed. Off the top of my head, 4 times within a year! I won every single battle as well because legally they had to pay. Once you understand insurance companies, you understand it is not personal. It is there job not to pay out claims. Not paying claims is what makes them money and profitable. They will do everything possible not to pay. You just have to know how to deal with them.

If the OP was being sincere, and he was told he would not have to pay, he can fight it a bit and I am 99% sure the insurance company will back down.

[Minnehaha]

As was pointed out... a likely explanation for the 4000 is probably a deductible or some 'first claim' amount. Or could be an amount exceeding a coverage. For example you may have "room coverage" under your policy but it may be limited at 3,000 Baht. But the only room the hospital has free (or bed) is a single expensive room which is 6,000 Baht. No choice there.

Hospitals billing is f*%*d up. Rates that a hospital charges for a procedure/ hospital room / medicine / etc. may be higher or lower when an insurance company is paying vs. a person out of pocket. Samitivej is almost always higher for the insurance company. But then some insurance companies get a discount at the end. It is a crap shoot. In my experience this is true for all hospitals in the Dusit Medical group - Bumrungrad is the worst, Samitivej is not far behind, and that old one off Convent is 3rd. All others follow.

Keep your insurance.

I know a guy who paid his 35000 a year for about 8 years. Never had a claim. The company was a local one but policy was with Generali (internationally known, top quality company). They left Thailand in 2008 and the guy saw his premium change to 65000 a year. He hesitated, and decided to shop for a new one. While shopping wound up in hospital with big bills. Worst of all, he is now un insurable with pre-existing conditions.

Moral of the story, pay the 4000.

READ YOUR POLICY.

Keep it forever. You will likely use it at some point.

Lastly, if Thailand would ever allow disability insurance, a company could make a lot of money on it. That is the most often needed claim for wealthy people with families. People in places like the USA know they need this. A guy is more likely to find himself disabled during his peak earning years than dead. What to do when you cant make money to feed the family or yourself?

[SOTIRIOS]

...one has to wonder in this 'free-for-all' business environment....

....someone telling to 'verbally cough up 4000 baht' after the fact.....

...self-entitlement.....???