Problem with an insurance company and hospital bill

[realenglish1]

Your wife is very uniformed This is NOT a matter for the police She is very paranoid This is civil not criminal Having said that its ony 4,000 baht Pay the bill

[Muzarella]

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.

Thank you. I will follow your advice.

I just went to the Hospital to ask for a doctor appointment. When the doctor, who speaks English, recommended an endoscopy, but said that I will need to spend the night (that is not common request for that procedure in the US) I called and asked the agent to meet me at the hospital and look at the charges. We were at the less expensive hospital, but she said that the policy will also pay for the better one, and we went there. She spoke with everybody at the hospital, before telling me that I will not have to pay anything. A blood and urine test was done that afternoon. Nothing new comes during the procedure, the next morning. Was nothing more than a camera exam to see that everything was normal. Not extractions, no biopsies.Took less than one hour, and I was ready to go home one hour later, but I had to wait 5 hours to be released.

My policy is with AIA. They pay directly to the associated hospitals. No deductible.

I may be wrong, but I believe that the Hospital will not let me go if the charges were not paid or OK by AIA before that. The news about the balance due I got it days after that, with a bill for 27000thb. The agent said that AIA paid 23000 and she paid the 4000 thb balance already...also something I do not believe. Because the not-sense charges I found on the bill are a lot more than 4000thb, I will ask for a revision and a new billing to AIA.

Am I right?

Edited April 19, 2015 by Muzarella

[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.

Thank you. I will follow your advice.

I just went to the Hospital to ask for a doctor appointment. When the doctor, who speaks English, recommended an endoscopy, but said that I will need to spend the night (that is not common request for that procedure in the US) I called and asked the agent to meet me at the hospital and look at the charges. We were at the less expensive hospital, but she said that the policy will also pay for the better one, and we went there. She spoke with everybody at the hospital, before telling me that I will not have to pay anything. A blood and urine test was done that afternoon. Nothing new comes during the procedure, the next morning. Was nothing more than a camera exam to see that everything was normal. Not extractions, no biopsies.Took less than one hour, and I was ready to go home one hour later, but I had to wait 5 hours to be released.

My policy is with AIA. They pay directly to the associated hospitals. No deductible.

I may be wrong, but I believe that the Hospital will not let me go if the charges were not paid or OK by AIA before that. The news about the balance due I got it days after that, with a bill for 27000thb. The agent said that AIA paid 23000 and she paid the 4000 thb balance already...also something I do not believe. Because the not-sense charges I found on the bill are a lot more than 4000thb, I will ask for a revision and a new billing to AIA.

Am I right?

Yeah, gotta at least look into it. However, I can tell you this. There are certain things like personal medical supplies that are rarely covered by insurance. Things like a knee brace, etc. Birth control is rarely covered as are preventative injections. But if this is the case, AIA should be able to clearly explain to you why you have to pay the 4, 000 baht and explain to you what parts of the bill they are not responsible for. If they can do this, you will probably have to pay. However, If they can't explain it, or start pushing you around, don't back down.

These guys have very good lawyers working for them. However, they know when the patient is right and they know when the insurance companies have no legal grounds to demand payment. That is why you gotta fight it sometimes and they will often back down and give in. It is a hassle, but welcome to the world of private medical insurance.

Even of they can give you a list of what was not covered and why you have to pay the extra 4,000, I would still let them know how unhappy you are that you were told that everything would be covered beforehand.

Edited April 19, 2015 by inbangkok

[Muzarella]

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.

Thank you. I will follow your advice.

I just went to the Hospital to ask for a doctor appointment. When the doctor, who speaks English, recommended an endoscopy, but said that I will need to spend the night (that is not common request for that procedure in the US) I called and asked the agent to meet me at the hospital and look at the charges. We were at the less expensive hospital, but she said that the policy will also pay for the better one, and we went there. She spoke with everybody at the hospital, before telling me that I will not have to pay anything. A blood and urine test was done that afternoon. Nothing new comes during the procedure, the next morning. Was nothing more than a camera exam to see that everything was normal. Not extractions, no biopsies.Took less than one hour, and I was ready to go home one hour later, but I had to wait 5 hours to be released.

My policy is with AIA. They pay directly to the associated hospitals. No deductible.

I may be wrong, but I believe that the Hospital will not let me go if the charges were not paid or OK by AIA before that. The news about the balance due I got it days after that, with a bill for 27000thb. The agent said that AIA paid 23000 and she paid the 4000 thb balance already...also something I do not believe. Because the not-sense charges I found on the bill are a lot more than 4000thb, I will ask for a revision and a new billing to AIA.

Am I right?

Yeah, gotta at least look into it. However, I can tell you this. There are certain things like personal medical supplies that are rarely covered by insurance. Things like a knee brace, etc. Birth control is rarely covered as are preventative injections. But if this is the case, AIA should be able to clearly explain to you why you have to pay the 4, 000 baht and explain to you what parts of the bill they are not responsible for. If they can do this, you will probably have to pay. However, If they can't explain it, or start pushing you around, don't back down.

These guys have very good lawyers working for them. However, they know when the patient is right and they know when the insurance companies have no legal grounds to demand payment. That is why you gotta fight it sometimes and they will often back down and give in. It is a hassle, but welcome to the world of private medical insurance.

Even of they can give you a list of what was not covered and why you have to pay the extra 4,000, I would still let them know how unhappy you are that you were told that everything would be covered beforehand.

Thank you..Probably the hospital, AIA, and its lawyers also will not believe that I do not have the money to pay now...and that was the main reason what I was with the agent at my side and being very clear and pushy with her to find all about charges and coverage.

AIA may have an explanation, but I do not have the money. Will see what happens tomorrow. I will let you know if you are interested. Anyway, I hope passing my experience will be useful to somebody here.

[scorecard]

There's another point:

All hospitals, when they know you have insurance will charge you at a much higher rate.

Case by case, it's sometimes better to pay cash up front (much smaller bill) then take the bills, medical reports, receipts etc., to the insurance company for reimbursement.

One simple example: My son took his 10 year old daughter to a CM hospital and he immediately showed the membership card from the insurance company.

His daughter saw the doctor for less than 5 minutes very basic examination and the doctor talked most of the time on her mobile phone to her friend, Very simple medication prescribed.

Bill was 1,200Baht but health card only covered 1,000Baht, son had to pay the extra 200 in cash. Another customer said quietly to my son 'how much does the bill show for the doctors consultation' - 800Baht. Consultation without insurance card at this hospital is 250Baht.

[MyFriend You]

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.

I almost just 'Liked' your post above, but have to comment - the only part I really 'liked' is the last sentence - says it all about you, not the fact you hold American citizenship, but the fact "You Sir are indeed a Cheap Charlie " - not typical of real Americans.

[PMNL]

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.

I am sorry, this is obviously too late to tell you but certain procedure such as endoscopy( gastro/colonoscopy), some type of biopsy, though most insurance state they do pay only for inpatient, 99% of them consider those procedure as a day case surgery and they do pay even though you not staying over night, so they can save the money on room rate, food, and unnecessary nursing check.

Your agent are clueless and advised wrong strategy.

Home medication normally has a very little coverage in thai policy, say ~1000 THB, I suspect that is the majority of the extra you have to pay for.

[BudRight]

You apologists are cooking up excuses for this bill like a godamn chem lab. It's sickening.

Don't give the bitch a cent.

Also, I find that on this forum whatever follows the words "In the USA..." is usually a lie.

Edited April 19, 2015 by BudRight

[Tony125]

Don't be an idiot, cheap charlie or not if you are living over here or even visiting you need to be covered by insurance that will cover you over here. Doesn't make any difference that you are covered in USA (Medicare?Medicaid) if an emergency happens you won't be able to fly back to be treated there for free. I have been in good shape all my life but suffered a heart attack over a year ago was rushed to local hospital ( Vibhavadi ) in BKK 15 mins away from my Bangkok aprt. They did an angioplasty on me and said I was lucky no damge was done to heart but if I had not gotten there so fast they said I would probably been dead in 15 more mins. The cost for the operation was $8,000 USD of which my insurance paid $7,000 USD. In the USA the same operation would have cost $47,000 USD

Plus you say you could fly back and be treated free in USA? You would rather spend $900---$1,500 RT Bangkok to USA than pay a small decuctable or partial payment here in Thailand? If your really a cheap charlie stop paying Medicare/Medicaid in USA since you can't use it over here and your not subject to Obamacare rules living overseas.

[Jonmarleesco]

You need to ask the agent how the B4,000 came about. A deductible, possibly; or a sub-limit/cap, but that should have been made clear. Besides, it's odd that the hospital didn't demand any payment before you left.

Perhaps a reason not to use Thai health insurance companies.

[NanLaew]

The agent talked the OP into using a more expensive hospital (alarm bells) and because of the language difficulties, the OP can only assume that she was working in his best interests when she claims the hospital had agreed to all charges to be covered under the policy. Indeed, if there had been any question of the hospital being out of pocket even by a few baht, they would have insisted on being paid before releasing the OP.

I think that once the paperwork was all completed, the agent discovered that there was some items that AIA did not cover, probably all to do with the 'room and board' aspect. I am pretty sure in this tiny world where 'face' is paramount, the agent probably paid that herself so that the hospital is happy and they see her as more than just a used-car salesperson. Then she comes after the OP for this 4000 baht as she is out of pocket through her own ignorance of the policy she is supposed to be selling and servicing.

Although it's 'only' 4000 baht, paying it is condoning the agents lack of knowledge on the products she is touting. The OP has been unable to obtain any sort of accounting that explains this arbitrary 'overcharge' so should pursue that until it is crystal clear what it is for. Beyond that, it is up to the OP if he wishes to retain this insurance or take a look for something that has a complete, dual-language policy or at least have the coverages, deductibles and other caps clearly explained in English.

A final comment, these 'room and board' charges are mostly a cash cow for hospitals and in the most part not required for an out-patient style investigation or treatment. I had an endoscopy done at AEK Udon (biggest private hospital) in Udon Thani several years ago and that was a mid-morning ordeal and I was home in time for lunch. It was never suggested that I overnight when the doctor recommended the endoscopy to help with his diagnosis.

Edited April 19, 2015 by NanLaew

[JLCrab]

You need to ask the agent how the B4,000 came about. A deductible, possibly; or a sub-limit/cap, but that should have been made clear. Besides, it's odd that the hospital didn't demand any payment before you left.

Perhaps a reason not to use Thai health insurance companies.

Perhaps a reason not to use an agent as with most of the big Thai health insurance companies you can deal with them directly.

Edited April 19, 2015 by JLCrab

[Si Thea01]

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.

Are you happy with the treatment provided and the accommodation. If you answer yes, then 4000 baht is such a small amount for happiness. Seriously, if it's an agent, then contact the insurance company's Head Office and explain what occurred. Preferably by someone who can speak Thai but most insurers do have English speaking people to assist you. If you do the talking, be polite but firm and advise them had you not been covered as initially informed, then you would have opted for the less expensive hospital and not had the additional tests. You might be presently surprised.

I don't know where you live but I use Khon Kaen University Hospital, despite it being 250 kilometres from where I live. I find the treatment better, am looked after by fully qualified specialists at a seventh of the cost private hospitals. My last operation (eye) saw me hospitalised for 3 days, had a VIP room, which was like a large hotel room, and allowed my wife to stay during my period of hospitalisation. Had great food and service at a cost of 27,000 baht, which was totally covered by my insurer. I had one operation (Nose) at a large private hospital, in for the same period, costs, 160,000 baht. I ended up being out of pocket 50,000, as the hospital charged well above what the insurer allowed. Never again.

I do not know what the repercussions would be if you failed to meet those costs but is 4,000 baht worth any type of drama it may bring should you not pay.

[jacko45k]

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.

No actually, rumour has it that if you have paid sufficient into the NHI, system,you will be able to get free healthcare.

(Future possibility). And if you are of pension age, you can already get it.

OP, have you asked the agent what the charge is for and where in the policy is it mentioned?

You asked the lady a question, she answered it without knowing her facts (perhaps, but common place here), and now you are making her liable.

Edited April 19, 2015 by jacko45k

[geisha]

Muzarella, keep your insurance policy as if you had an accident, even a small one, or an illness that prevented you from flying, you would need it !! You said you were not young ! I'm quite sure if you don't have 4000 B at the moment , the hospital will let you pay it off monthly ! I also think that maybe your agent and that particular hospital are " working together". She is bringing them patients and the bill is blown up a bit too. ( commission) . Next time, go to a normal hospital and take your wife with you. Tell them no extras. Medication can be bought at outside chemists at much cheaper prices. But please, do keep your policy! Good luck.

[godden]

It's one off those sharp intake of breath and bite the bullet times, happens to us all here at some time.

[NancyL]

Before the OP goes off half-cocked and cancels his insurance, he would be well advised to be sure he can get insurance from another company, especially since it sounds like he's not a young man. And to be sure that insurance will cover all his health problems, like whatever it is this procedure was investigating. Most new policies have exclusions for "pre-existing conditions" for several years that he should consider.

Also, he should be aware that many insurance companies will refuse to continue his coverage once he gets to be a certain age. It's a consideration for someone on a retirement visa.

And frankly, as someone who spent a lifetime in with the U.S. "medical system", I wouldn't have batted an eye at having to pay 4000 baht. I'd have figured it was a co-pay, deductible or something similar. All every common with insurance. And as for the micro-inspection of the bill -- meals aren't included in room charges here, not even at the government hospitals.

[Muzarella]

Thank you for the responses. I need to say that the agent is a AIA employee, not a broker or rep. He sells the policy, and works on an AIA office. he was "helping" me because she is a nice young woman. I was ready to recommend her to everybody in my town. I wants to believe that she was naive and incompetent, even that she already paid the balance. I will negotiate and get into an agreement with the hospital to review the bill, that was translated in English, and show many charges that looks not appropriated for the kind of procedure. If I the end I have to pay something, I will do it someway, but not without good explanations.The overnight stay rule is part of the policy. Very strange rule. The insurance paid treatments and exams only if interned in the hospital, if not, only in case of an accident and in the first 24 hours. Do not make sense, but was the reason why I had to get a room. Also, the price of the room was very OK, and the hospital service very good. But all the "extras" charges for a simple endoscopy without any find, and an over the counter medication were too high.

My policy only pays directly to those 2 private hospitals, in any other or a government hospital I decided to use, I will have to pay first. I do not have problems in use public hospitals. I did before getting the insurance, but if I have a big health problem, looks also I will get a very big bill to pay in advance. Not good option for a "Cheap Charlie". I probably will keep this insurance, and make of this a learning experience, to figure out how to deal with this next time.

[gemguy]

Your wife is very uniformed This is NOT a matter for the police She is very paranoid This is civil not criminal Having said that its ony 4,000 baht Pay the bill

You are correct....this not a police matter....but all too many people and or companies freely threaten others with police action while all too often people do use the police to make you see it their way and eventually get their way.

For example: My Thai friend has not submitted his yearly company tax audit for 3 years because business is not nearly as good as it used to be while the income flow is 10 percent of what it used to be.

One day...he gets a visit from the police...and not the police from his district...but police from another district telling him he has to file or he will be arrested.

Are tax audits now a police matter?

No they are not.

But everyone thinks they can use the police to solve the problem, for or against them, while the police seldom say no as they are always eager to get involved if they think there is some money to be made....or they are outright paid up front to go and make a visit.

Point being...if the OP refused to pay the insurance company it would be no surprise at all if the police did come knocking on his door on behalf of the insurance company as that is how things work here in Thailand...all too often.

Cheers

Edited April 20, 2015 by gemguy

[pchansmorn]

If you have free healthcare in your country, why use Thai healthcare, you should had gone to a community hospital, all private hospitals will charge a lot. The other thing you could do is pay cash & then submit that bill to your insurance. No matter what you do, you will be paying more because you are a Expat, get used to it. 120.00 dollars some seem like a lot to pay for all your tests. The US would had charged 1500.00 at least. You must realise that Thai hospital are a business and have to make money when they think they can. I went to a Government hospital to have my ears cleaned cost me .50 baht so I made a donation to the hospital for 30.00 US dollars. Only fare that I pay something if I can, and not take advantage of the system. I would try to learn more about your coverage and what it really pays for. Our Thai Insurance only pays for hospital care, so you need to stay over night for it to cover you. Good Luck to You.

[JimHuaHin]

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.

FYI

I had to have a gastroendoscopy and colonoscopy at Chulalongkorn University Hospital in Bangkok at the beginning of this month.

Although many public and private hospitals in Thailand do endoscopic examinations with the patient wide awake ... I insisted on an anesthetic.

Although the gastroendoscopy revealed no major issues, the colonoscopy revealed 8 polyps which were removed and sent to the lab for analysis.

The costs - Anesthetics Baht 766, Laboratory pathology Baht 1,440, Physician and Anesthetic procedures Baht 14,500, Nursing charges Baht 120, Doctor's fees Baht 5,300 = Baht 22,126 (I hope).

The initial quotation for both procedures was about Baht 16,700 for memory - the additional costs were obviosuly for the lab work and the extra medical time required to remove the 8 polyps.

The 10-12 others who underwent similar procedures at the same session, and myself, were allowed to go home after we awoke.

I have has several gastroendoscopy and endoscopy examinations in Australia, and have been been required to stay over night in hospital.

[asean]

at law you do not have to pay them anything as you never received a quote for this 4,000. so the best thing you can do to make the thing go away is send the hospital a letter with the bill attached asking for a copy of the quote that you signed. They will know what you are up to and just leave it.

I know its only 4,000 baht. But the same rules apply as the 4,000,000 baht hospital bills.

Edited April 20, 2015 by asean

[lopburi3]

Actually from what poster has said this was normally an outpatient procedure; for which he had no coverage, that he and insurance agent tried to get covered as inpatient by having hospital provide a room. Suspect legalities are rather shaky.

Or have I misread the thread?

[samuibeachcomber]

I still find this topic "much ado about nothing"..............so somewhere down the line something was n't covered,big deal 4000 baht,and the OP is giving himself a stressful time over it!

[Naroge]

Thank you for the responses. I need to say that the agent is a AIA employee, not a broker or rep. He sells the policy, and works on an AIA office. he was "helping" me because she is a nice young woman. I was ready to recommend her to everybody in my town. I wants to believe that she was naive and incompetent, even that she already paid the balance. I will negotiate and get into an agreement with the hospital to review the bill, that was translated in English, and show many charges that looks not appropriated for the kind of procedure. If I the end I have to pay something, I will do it someway, but not without good explanations.The overnight stay rule is part of the policy. Very strange rule. The insurance paid treatments and exams only if interned in the hospital, if not, only in case of an accident and in the first 24 hours. Do not make sense, but was the reason why I had to get a room. Also, the price of the room was very OK, and the hospital service very good. But all the "extras" charges for a simple endoscopy without any find, and an over the counter medication were too high.

My policy only pays directly to those 2 private hospitals, in any other or a government hospital I decided to use, I will have to pay first. I do not have problems in use public hospitals. I did before getting the insurance, but if I have a big health problem, looks also I will get a very big bill to pay in advance. Not good option for a "Cheap Charlie". I probably will keep this insurance, and make of this a learning experience, to figure out how to deal with this next time.

I don't understand why you want to negotiate the bill with the hospital. The one asking 4,000 Baht from you is the agent so ask the agent to itemize the 4,000 Baht he/she wants. Only then will you understand with whom you might have to "negotiate". Don't make it more complicated than necessary.

[Muzarella]

Update. End of the history with this hospital.

I had the chance of translating the bill, and was many charges related with surgery and operation room.....and I just did a endoscopy exam with clean results. No surgery, no biopsies or pathology. But they did more testing with my blood and urine that is normal in the US for just and endoscopy....

Asking for explanation, and after a lot of BS, they said that the "surgery" thing...was a mistake from the billing Dept. That "mistake" was already billed and paid by AIA and was more than 10000thb. Also they said that cannot change the bill now. The medication I took home and that was billed 2300thb, I had to pay 800thb because I used some. At the end, they asked for me not to talk about the problem with AIA. Easy to understand why...

Lesson learned:

Next time I will ask for a bill translated to English, or I will translate it to OK it before send to the insurance company, and I will ask for just a prescription to buy medication at pharmacies, not taking from the hospital to be part of the bill.

A good surprise in all this.....My agent, an AIA employee, who help me with translations and quotes, really paid in advance the 4000thb before asking me for the money, and she recognized that she was in fault in not asking for more details.

It is very well know that vendors and associates with insurance companies will do everything to bill the more they can, and it is happens in any country, and I do not care what they do if I will not be also affected by its actions. Was very clear to me that the hospital was trying to get more money from AIA and also some from me. Probably that is happening a lot more often with foreigners here, without help from Thai friends

Edited April 20, 2015 by Muzarella

[Sheryl]

The impression I get is:

1. The policy covered up to a maximum amount which was below the estimated cost hence Agent said all would be covered.

2. Bill submitted by hospital exceeded the estimate and the insurance maximum. Also seems a bit excessive on some items e.g. 850 baht for one hospital meal.

So far, not unusual. Hospitals do sometimes "pad" bills to insurance companies.

Where it gets odd is the behavior of the insurer. Normally they would question the hospital on the costs and also would reimburse no more than the max. In a case like this the hospital would normally settle for what the insurance paid. In fact one of the reasons for the padding is to be sure to get the maximum amount, knowing that some items will likely be disallowed or reimbursed

This Agent behaved oddly, perhaps due to inexperience but perhsps for other reasons. It is unusual for an Agent to have gone in petson with you to the hospital. And more than unususl to have encouraged the use of a more expensive hospital..

This incident aside, OP has a problem in that he has an insurance policy only in Thai and does not clearly know its provisions. It may also be an overly low level of coverage. And, the behavior of the local rep seems dubious.

Personally I would investigate options that provide copy of the policy in English...and rethink level of coverage.

[Tony125]

Find a way to pay the agent back the 4,000 baht she paid out. You realise your policy doesn't cover you for outpatient service so she went along to ask the hospital to admit you so you would be covered for the exams . Was not totally legal but she was doing YOU a favor so you could check if you had any problems.. Basically yoiu would have had to pay out of your own pocket for all the exams done outpatient but she got you admited to the hospital so that most of the costs would be covered by the insurance. Difficult or not give her back the 4,000 baht even if you have to pay monthly.

[DepDavid]

What is the annual premium for this policy? Most importantly what should an annual premium for upgraded policy be for say 53 yo male?

[Sheryl]

Annual premium amounts will vary with the insurance company and, most importantly, with the level and type of coverage, which vary greatly among the policies offered by even the same company and need to be carefully understood.

Policies which are in-patient only will be less than policies that include OPD (in most cases, in Thailand, OPD coverage is not worth it). Policies with deductibles and copays will be less than those without. Policies with a low maximum benefit will obviously be less than those with a higher maximum, but one should not, IMO, take a policy with a maximum of less than 2-5 million baht per episode (higher if the maximum is calaculated per year rather than per event)..