How to obtain a pre-authorization for elective surgery

[CALSinCM]

My eye doctors told me I have cataracts, and I would like to have them removed and replaced with simple IOL lens.  I've had health insurance with THI Thailand for 7 years and have never filed a claim.  However, I'd like to have them pay for this.  But I don't trust any insurance companies.  The cataracts are a new thing, so they can't say it was a pre-existing condition.  But I don't trust them to pay for the surgery without attempting to find a way not to pay.  It seems to be standard operating procedure for insurance companies.

So I want the surgery pre-authorized.  I don't know the process.  How do you get your insurance company to pre-authorize surgery?  

[Upnotover]

I had heart surgery here a few years back and the hospital was fully aware that if my insurance company wouldn't pay then nor would I.  The hospital will get the pre-authorisation, you shouldn't have to do anything.

[tonray]

My best guess would be to ask the insurance company what their procedures are ? They usually have a form, at least in the US they did.

 

Website ?

[lopburi3]

First you need the full name of your insurance company and likely card and give that to hospital - they should be able to arrange direct payment if this is real insurance company (Google did not find "THI" as such so probably need full name).

 

This is not normally an inpatient procedure so you will need to check your policy, or ask your insurance company if hospital can not obtain guarantee, if it is a covered procedure. 

[impulse]

1 hour ago, Upnotover said:

The hospital will get the pre-authorisation, you shouldn't have to do anything.

 

Worked that way for me, too.

 

[Upnotover]

35 minutes ago, lopburi3 said:

First you need the full name of your insurance company and likely card and give that to hospital - they should be able to arrange direct payment if this is real insurance company (Google did not find "THI" as such so probably need full name).

FYI;

 

https://www.thailand-health-insurance.com/

[lopburi3]

In other words they are not an insurance provider and are not even located in Thailand?  All the more reason he needs to get real provider card/policy/information.

[Sheryl]

As above - there appears to be no such thing as THI insurance, it is just a web site that links to various policies. You need to find out what company you actually have a policy with, and your policy number.

 

Depending on who the insurer actually is, they may or may not have a direct billing arrangement with hospitals (and this may or may not include the hospital you plan to use). So that is the first thing to figure out.

 

Secondly, most plans -- even in-patient only plans - would cover catarct surgery but you do need to be sure so you need to check the terms of your policy. Some might cover the surgery but not the lens cost.

 

If it turns out your policy covers the procedure and your insurer has a direct payment arrangement with the hospital in question, then the hospital will usually take care of the pre-authorization for you, though you can also initiate it yourself bu calling the number that would be clearly indicated in your member handbook.

 

It would be extremely unusual to have any problem getting a policy to pay for a procedure after having held the policy for 7 years with no claim. Most of the issues arise either because (1) the claim occurs very soon after taking out the policy and is related to a problem that by its nature takes years to develop or (2) the terms of the policy exclude some or all of the claim, and the insured person simply never read their own policy.

 

It is not "standard operating procedure" for insurance companies to try to find a way not to pay, they pay the majority if claims without any issue at all.  However, claims related to chronic conditions that are made soon after taking out a policy will always get extra scrutiny and may be contentious.  Bear in min it  is the claims they deny that end up being posted about, nobody starts a thread to say "I had X procedure done and insurance paid for it, no problem". 

 

And to be frank, an awful lot of expats in Thailand fail to take out health insurance until they develop health problems so they are in fact, from an insurance company point of view, trying to game the system.

 

BTW a cataract needing surgery is not a new thing. It takes years for a cataract to get to the point that removal is necessary. But I think 7 years into a policy, there shouldn't be an issue.

[CALSinCM]

23 hours ago, lopburi3 said:

First you need the full name of your insurance company and likely card and give that to hospital - they should be able to arrange direct payment if this is real insurance company (Google did not find "THI" as such so probably need full name).

 

This is not normally an inpatient procedure so you will need to check your policy, or ask your insurance company if hospital can not obtain guarantee, if it is a covered procedure. 

It is in fact THI which is the abbreviation for Thailand Health Insurance and can be found at the link provided by Upnotover.  

Sheryl and Lopburi3: Thanks much for the additional information.  I do appreciate it!    I'll start the process and see how it goes.  

Edited July 22, 2017 by CALSinCM

[perthperson]

1 minute ago, CALSinCM said:

It is THI which is the abbreviation for Thailand Health Insurance and can be found at the link provided by Upnotover.  

The OP said   "I've had health insurance with THI Thailand for 7 years"

 

If that link is opened it will be found there is no company called  "THI Thailand"  offering health insurance although the website lists <> 27 companies that do.  

 

As others have observed the OP needs to identify the company which provides his insurance cover. 

[CALSinCM]

54 minutes ago, perthperson said:

The OP said   "I've had health insurance with THI Thailand for 7 years"

 

If that link is opened it will be found there is no company called  "THI Thailand"  offering health insurance although the website lists <> 27 companies that do.  

 

As others have observed the OP needs to identify the company which provides his insurance cover. 

Lordy, lordy, how'd we get here?  From a topic about 'pre-authorization' to a discussion about the authenticity of the OPs reference to an insurance company?  Ok, I'll play.  The policy is issued by Thailife via Thai Health Insurance Public Company Limited or... <wait for it>... the abbreviation THI.  The website can be found here:  https://www.thaihealth.co.th/company_eng.php 
"Why didn't you say that in the first place???"
My bad!  
"And you said the link was in Upnotover' post?"
Yep, fooled me too!  

But hey, no problem.  I understand that TITV (This is ThaiVisa)  

 

Now that we have cleared the air on that minor divergence, let's get back to stories about pre-authorization which was the topic of this thread.  <pretty please? thanks!>  And again, thanks to everyone providing info about pre-authorization in general.  I do appreciate it!!!
I'm still open for comments on this specific issue, especially if they deal with pre-authorization though Thailife, Thai Health Insurance Public Company Limited, or THI. 

Edited July 22, 2017 by CALSinCM

[lopburi3]

You have not provided any hospital information so you would have to contact your provider as we have mentioned.  Again that web site is just a mail order agent portal - there was no way for anyone to know what kind of policy you actually had - and even now it is not clear other than issued by Thailife apparently.  There contact page is:

Thai Life Assurance Public Company Limited (Head Office) 
123 Rachadapisek Road, Din Daeng, Bangkok 10400 Thailand 
Tel: 02 247 0247 
Fax: 02 246 9946 
E-mail: [email protected] 

 

[CALSinCM]

10 minutes ago, lopburi3 said:

You have not provided any hospital information so you would have to contact your provider as we have mentioned.  Again that web site is just a mail order agent portal - there was no way for anyone to know what kind of policy you actually had - and even now it is not clear other than issued by Thailife apparently.  There contact page is:

Thai Life Assurance Public Company Limited (Head Office) 
123 Rachadapisek Road, Din Daeng, Bangkok 10400 Thailand 
Tel: 02 247 0247 
Fax: 02 246 9946 
E-mail: [email protected] 

 

Thank you!