Insurance pays upfront, or I pay upfront and get reimbursed--who knows?

[steelepulse]

I have to have a pretty expensive operation and even my insurance agent doesn't know if AIA will pay upfront and if they will reimburse. Does anyone have any experience in this. I've asked him to talk to his bosses, but from what it seems, it's a coin toss.

[lopburi3]

Believe decision may depend on hospital rather than insurance - believe procedure is for insurance to issue a letter of coverage to hospital for direct payment if they have agreement with them (or can come to an agreement).

[stevenl]

If the hospital has a contract with AIA, which is likely, AIA will pay direct. Check with the hospital upfront, they can also get AIA's permission upfront.

[orchidlady]

Will insurance pay 100% of costs or will you have a copay? If you will have a copay you should check price with and without insurance. If it is a Thai insurance company, most private hospitals charge more (unlike in west where they have negotiated lower rates) and have a lower price for cash. I paid cash and saved about 35,000 baht at one of the 5 star hotel like hospitals.

[steelepulse]

I've contacted both the hospital and AIA, so hoping the for profit BKK hospital gets the ball rolling. My insurance guy is the boss of the southern provinces so he wants me to get the operation done here as it would be easier for him. I want it done in BKK, so this is causing a bit of a problem, but last time I checked, I'm the customer.

[Kabula]

Most Insurance Companies follow the same procedures. Your hospital will submit a Proof of Loss form providing your Insurance Co. with notice of claim. The Insurance Company will then submit an approval or denial. Most of the time they will submit an approval immediately to the hospital even if it is a $50,000 surgery. However in the approval letter in smaller print they reserve the right to deny the claim based on a pre-existing condition or an exclusion in the policy. They need time to exam your history. Hospitals take a financial beating with this system when many claims get denied based on an alleged pre-existing condition after the surgeries have been done. I believe this is why medical costs have doubled in the last few years.

Edited April 25, 2016 by Kabula

[thailand49]

First for future reference.. and good to find out now.. AIA is a well known insurance in Thailand you need to find out instead of thinking you have insurance you need to find out from your boss, what you are actually covered for and how much? The policy AIA should have a list of hospital that you can use and will be covered.

From what you posted you might think about canning your agent, since he doesn't even know if it is covered and he is the boss of what? Southern province.

Here no different than anywhere? Either it is cover or it isn't unless it borders on being a Elective surgery. If they tell you the operation is 200,000 baht total the hospital has a estimate as to the breakdown what everything is going to cost and based on the limitation of your policy it will determine how much out of pocket on your end.

The authorization should be given to you before the operation and the only billing requirement from you would be what is your share of cost if any after billing agreement is made with AIA and the hospital. As to the selection of the hospital the agent might be pushing you towards another due to the cost difference between the hospital in BKK which is general more.

Honestly you need to know more about insurance in Thailand.. it is not the same as the West.. here it is a mine field. What is the actual limitation of your policy or what are you covered for? What is the amount 700,000 / 1,000,000 / 2,000,000 that you are covered for?

[nev]

Be careful with AIA I am or should I say was by them, I had a TURP operation done on my prostate, 1st of all the refused to pay because of one word the doctor wrote on his report, so I had to return to the doctor and get a new report done.

Then after putting in the claim again and chasing them up, they sent a report stating that I have not been in the fund long enough to be covered for a hernia operation, so I contact them and say what has this to do with my claim for a prostate operation they could not answer, maybe they had read the wrong file, well let's just say I have still not got anything back and its 10 months gone by.

The last I heard they are still looking into it, I would not hold out much luck of you getting your money back if you pay up front like I did.

[SOTIRIOS]

........a terrible predicament to be in.....

...doesn't seem anyone is concerned about your peace of mind....or well-being...???

...no alternatives.....a second opinion...???

[Suradit69]

Be careful with AIA I am or should I say was by them, I had a TURP operation done on my prostate, 1st of all the refused to pay because of one word the doctor wrote on his report, so I had to return to the doctor and get a new report done.

Then after putting in the claim again and chasing them up, they sent a report stating that I have not been in the fund long enough to be covered for a hernia operation, so I contact them and say what has this to do with my claim for a prostate operation they could not answer, maybe they had read the wrong file, well let's just say I have still not got anything back and its 10 months gone by.

The last I heard they are still looking into it, I would not hold out much luck of you getting your money back if you pay up front like I did.

A Thai friend had AIA. He received emergency treatment at BPH. Had to be paid for up front and the agent asked him to supply all the relevant paperwork and that they would reimburse him. Despite continued requests for a progress report on when reimbursement would be made, nothing was ever paid and no plausible reason was ever given. It's been about two years.

[Jonmarleesco]

I assume your agent's not knowing whether or not AIA will pay at all is just the way the post reads? The terms should be clearly spelt out in the terms and conditions. Usually, if you advise the company in advance, they will arrange to pay directly - assuming the hospital isn't one on their list. Otherwise, you would pay in advance then reclaim.

[Jonmarleesco]

First for future reference.. and good to find out now.. AIA is a well known insurance in Thailand you need to find out instead of thinking you have insurance you need to find out from your boss, what you are actually covered for and how much? The policy AIA should have a list of hospital that you can use and will be covered.

From what you posted you might think about canning your agent, since he doesn't even know if it is covered and he is the boss of what? Southern province.

Here no different than anywhere? Either it is cover or it isn't unless it borders on being a Elective surgery. If they tell you the operation is 200,000 baht total the hospital has a estimate as to the breakdown what everything is going to cost and based on the limitation of your policy it will determine how much out of pocket on your end.

The authorization should be given to you before the operation and the only billing requirement from you would be what is your share of cost if any after billing agreement is made with AIA and the hospital. As to the selection of the hospital the agent might be pushing you towards another due to the cost difference between the hospital in BKK which is general more.

Honestly you need to know more about insurance in Thailand.. it is not the same as the West.. here it is a mine field. What is the actual limitation of your policy or what are you covered for? What is the amount 700,000 / 1,000,000 / 2,000,000 that you are covered for?

Being a Thai company, that would likely be right. Internationals are more reliable, and not necessarily more expensive. FTR, elective, in health insurance terms, is any treatment that is neither emergency treatment nor for an accident.

[thailand49]

First for future reference.. and good to find out now.. AIA is a well known insurance in Thailand you need to find out instead of thinking you have insurance you need to find out from your boss, what you are actually covered for and how much? The policy AIA should have a list of hospital that you can use and will be covered.

From what you posted you might think about canning your agent, since he doesn't even know if it is covered and he is the boss of what? Southern province.

Here no different than anywhere? Either it is cover or it isn't unless it borders on being a Elective surgery. If they tell you the operation is 200,000 baht total the hospital has a estimate as to the breakdown what everything is going to cost and based on the limitation of your policy it will determine how much out of pocket on your end.

The authorization should be given to you before the operation and the only billing requirement from you would be what is your share of cost if any after billing agreement is made with AIA and the hospital. As to the selection of the hospital the agent might be pushing you towards another due to the cost difference between the hospital in BKK which is general more.

Honestly you need to know more about insurance in Thailand.. it is not the same as the West.. here it is a mine field. What is the actual limitation of your policy or what are you covered for? What is the amount 700,000 / 1,000,000 / 2,000,000 that you are covered for?

Being a Thai company, that would likely be right. Internationals are more reliable, and not necessarily more expensive. FTR, elective, in health insurance terms, is any treatment that is neither emergency treatment nor for an accident.

Personally my post was to let the poster know something doesn't smell right. He has left out a lot of stuff causing speculation. AIA, is a very large company selling out of Thailand, in fact, they have all types of agents running around selling to low income Thais with very low coverage for little money to attract them. AIA used to be owned by AIG, remember them but sold their Asia operation after the meltdown in 2008.

He says he needs a very expensive operation assumption it is not elective, has a lousy agent and does not know exactly what his policy covers and for how much. There are AIA policy that covers inpatients for as low as 300,000 baht, that isn't going to help you much if you go to a place like Bangkok Pattaya or in Bangkok Bumrungrad. He needs to get a reality check and find out what is the max coverage he holds in his policy?. It seems he has no idea or just neglected to give everyone the important details so we can actually help him. I once had Bupa, got into a accident when to BPH, emergency they cover max 10,000 baht, the fee was just under but I needed another operation a few days later to correct a problem, I was to stay overnight one night. They called Bupa and a few days later I got the authorization and once that happen I made the arrangement with the hospital for the operation didn't do a thing except pay 300 baht for my deductible.

When you reference International insurance not necessary. Very few hospital will deal directly with oversea Insurance like Blue Cross. Blue Shield, they want payment up front or a huge deposit and then provide English paperwork so you can submit your claim back home. Even if they have dealing Internationally in your case they want a deposit. One got to remember the language problem and time difference. You actually what a large company like AXA, Bupa, Thai, so all you got to do is present the card and they know exactly who to contact and trust so they do not ask for a deposit before they get you a room and actually help.

Here is a recent experience my friend has had at Bangkok Pattaya, he has insurance back home, and the hospital has all the contacts number of personal with the insurance in the U.S., in the past after days of back and forth the always get their money. But each time he goes in they have placed him in ICU, the most expensive ward, 30,000 plus a day. Although they have all his insurance information every day they badger his wife for a larger deposit each day when she visit in the morning as if they aren't going to get pay. I finally went in to speak to someone in the office and ask them " who in this office walks around with 500,000 baht in their pocket?

Edited April 25, 2016 by thailand49

[steelepulse]

Just to clarify, agent says AIA will pay, coverage good for up to 1 million baht. What isn't clear is whether they will cover the cost and deal directly with the hospital, or I pay first and then have to chase down my reimbursement. I've got an email in with AIA ( they're already responded and asked for details) and I've contacted Bumrungrad about this so they too can contact the insurance company. Operation in question is a knee operation, and not a basic scope.

[malcoml]

I'm pretty sure we had AIA insurance and our son was quickly admitted to hospital.

We paid upfront and then were reimbursed a month or so later.

[lopburi3]

You do not need any insurance to be quickly admitted to a hospital - the idea is to have them directly pay the hospital so you do not have to worry about paying cash to be released. Local insurance really should pay directly and avoid the need to have cash upfront.

[HenryB]

Will insurance pay 100% of costs or will you have a copay? If you will have a copay you should check price with and without insurance. If it is a Thai insurance company, most private hospitals charge more (unlike in west where they have negotiated lower rates) and have a lower price for cash. I paid cash and saved about 35,000 baht at one of the 5 star hotel like hospitals.

Sorry to say you wil never pay as a Farang less than a Insurance Company no mater what the Hospital

Wow a one of the 5 star hotel like hospitals where you can not drop the tap water

Edited April 28, 2016 by HenryB

[stevenl]

Will insurance pay 100% of costs or will you have a copay? If you will have a copay you should check price with and without insurance. If it is a Thai insurance company, most private hospitals charge more (unlike in west where they have negotiated lower rates) and have a lower price for cash. I paid cash and saved about 35,000 baht at one of the 5 star hotel like hospitals.

Sorry to say you wil never pay as a Farang less than a Insurance Company no mater what the Hospital

Wow a one of the 5 star hotel like hospitals where you can not drop the tap water

Nonsense.

[Garry]

First for future reference.. and good to find out now.. AIA is a well known insurance in Thailand you need to find out instead of thinking you have insurance you need to find out from your boss, what you are actually covered for and how much? The policy AIA should have a list of hospital that you can use and will be covered.

From what you posted you might think about canning your agent, since he doesn't even know if it is covered and he is the boss of what? Southern province.

Here no different than anywhere? Either it is cover or it isn't unless it borders on being a Elective surgery. If they tell you the operation is 200,000 baht total the hospital has a estimate as to the breakdown what everything is going to cost and based on the limitation of your policy it will determine how much out of pocket on your end.

The authorization should be given to you before the operation and the only billing requirement from you would be what is your share of cost if any after billing agreement is made with AIA and the hospital. As to the selection of the hospital the agent might be pushing you towards another due to the cost difference between the hospital in BKK which is general more.

Honestly you need to know more about insurance in Thailand.. it is not the same as the West.. here it is a mine field. What is the actual limitation of your policy or what are you covered for? What is the amount 700,000 / 1,000,000 / 2,000,000 that you are covered for?

Being a Thai company, that would likely be right. Internationals are more reliable, and not necessarily more expensive. FTR, elective, in health insurance terms, is any treatment that is neither emergency treatment nor for an accident.

Agreed, though I'm with a company sponsored scheme whom I intend to keep using them when I leave. I've used the international insurance for stays in Thai hospitals with no issues and no paying up front.

[nev]

Be careful with AIA I am or should I say was by them, I had a TURP operation done on my prostate, 1st of all the refused to pay because of one word the doctor wrote on his report, so I had to return to the doctor and get a new report done.

Then after putting in the claim again and chasing them up, they sent a report stating that I have not been in the fund long enough to be covered for a hernia operation, so I contact them and say what has this to do with my claim for a prostate operation they could not answer, maybe they had read the wrong file, well let's just say I have still not got anything back and its 10 months gone by.

The last I heard they are still looking into it, I would not hold out much luck of you getting your money back if you pay up front like I did.

A Thai friend had AIA. He received emergency treatment at BPH. Had to be paid for up front and the agent asked him to supply all the relevant paperwork and that they would reimburse him. Despite continued requests for a progress report on when reimbursement would be made, nothing was ever paid and no plausible reason was ever given. It's been about two years.

I am not holding out much hope, my wife sells insurance for them, and a very good friend is area manager and chases the claim up for me and nope nothing coming back.

He stated all claims go to Bangkok and they make the decision down there, looks like falang name just knock back for any reason.

I have gone back to Sydney for a work stint and I will be getting travel insurance with a very good medical cover, I have lost all confidence in AIA.