Be prepared for the worst - with Thai health insurance options.

I’ve held a Thai health insurance card for around eight years. For seven of those years it remained in some dark and secret compartment of my wallet, only being fished out when I had the sudden urge to check on the expiry date. I often felt that the 8,000 baht annual expense of renewing the card was something I just didn’t need to pay, especially when you consider that the policy didn’t cover me for out-patient visits (which most hospital visits tend to be) and I appeared to be in relatively good health. In fact other than an eye infection, which cleared up within twenty four hours, and a minor operation to remove a tiny growth from the back of my neck (which cost barely a thousand baht), I can’t think of any other time during that seven-year period when I took advantage of Thailand’s medical services. Then I reached my fortieth birthday on the 27^th April 2004 and it all seemed to go horribly wrong.

Just four days after I’d blown out the candles, I went to bed before midnight with a strange pain in my side. It was nothing too alarming but rather like the old ‘stitch’ that you used to get after you’d completed an exhausting cross-country run. Somehow I managed to fall asleep though. Then at about four in the morning I woke up in agony. The pain coming from my lower abdomen was excruciating. I paced around the bedroom for half an hour willing it to go away. I did all the things I foolishly felt might ease the pain – drinking milk, smoking a cigarette, and praying to any God that would listen. I was about as scared as I’ve ever been. I had to get to a hospital and fast. I threw on some clothes, locked the house and then stumbled the quarter kilometer to the main Rama 9 road (pausing several times to throw up on the way). The taxi driver who picked me up fortunately realized the gravity of the situation and got me to Samithivej hospital in Thonglor within minutes (he rode at least two red lights). Upon reaching the hospital doors the pain got worse and I literally sprinted up to the duty receptionist screaming for help and attention. For those who don’t know Samithiwej hospital, it fits easily into the five-star luxury category (in my blind panic it had been the nearest hospital I could think of) and true to form, the night staff rallied round to bring a wheelchair, mop my brow, show genuine sympathy and finally pump me full of painkillers. 

To cut a very long story short, because I don’t want to turn into one of those sad middle-aged men that likes showing off his battle scars, I was admitted to the hospital for three days, underwent an emergency operation to remove a kidney stone and at the end of the ordeal was presented with a bill for 107,000 baht. The health insurance company thankfully coughed up almost 95% of it. If I had been unsure up to that point that health insurance was all a waste of time, then I had just been given one hell of a wake-up call. Health insurance is something you cannot afford to be without! And yet most of the teachers I seem to meet with have no cover whatsoever. No pun intended but without adequate health insurance, you’re an accident waiting to happen.

The first name that springs to mind when employers consider and offer health insurance is undoubtedly BUPA/Blue Cross, located just off Silom Road. Blue Cross is very geared towards dealing with foreigners, but more importantly as far as schools and colleges are concerned, they offer extremely attractive ‘package’ rates if a school or institute has ten or more teachers/staff who want to take advantage of health cover (I’m not sure if the exact number is ten but it’s there or there about) However, it’s important to bear in mind that nine times out of ten, an employer will sign its teachers up for the cheapest package available often just to be able to say ‘we offer free health insurance’ - and many employers do use BUPA Blue Cross.     

BUPA, like most of the other health insurance companies, offers a fairly straightforward choice of package. In BUPA’s case the packages are named after gemstones -  Ruby, Sapphire, Emerald and Diamond. What differentiates one package from another is the amount of cover they give you in the areas of room and board, general expenses, surgical fees, doctor’s visits, OPD, and emergency accident.

Let’s take room and board as an example. If you go for the cheapest cover then your room and board allowance will probably not exceed 1,500 baht a day. The policy I personally hold covers me for 4,000 baht. For better hospitals such as Samithiwej the most basic single room will currently set you back 3,500, so you do the math. The cheapest policy will only reimburse you for half of the cost. And so it goes with all the other aspects of hospitalization as well. 

It’s worth mentioning that it often doesn’t cost that much to ‘upgrade’ your insurance cover. If your school has you on the cheapest package, it IS possible to pay from your own pocket to upgrade and get something better. This is actually what I currently do – I have a package that costs about 12,000 baht a year. My company pays about 7,000 baht and I foot the extra 5,000 baht a year for the premium upgrade.  Your upgrade problem may come if your school administration says it can’t be implemented. That translates as they can’t be bothered to find out or they just don’t want the extra paperwork it involves.

I’ve spouted on about BUPA Blue Cross enough already and it’s probably led you to believe that they are the company I use. Actually, that’s not the case. I held the BUPA card for seven years, never made a claim, and was even awarded a ‘no claims bonus’ at one stage. Then for some strange unfathomable reason they decided to increase the premium by 50%. My company’s insurance broker advised me to switch to a newish set-up called Thai Health, and I must admit I’ve been very impressed with them so far. Interestingly, Thai Health was started by a group of ex-BUPA Blue Cross executives. Perhaps they’ve learned from the mistakes that their previous company made? Their premiums are certainly a good ten per cent cheaper than BUPA’s as well.

Another name that often crops up in health insurance circles, and the company that many Thai people use, is AIA (American Insurance Association) However, this company specializes in health insurance/life assurance/sick pay/saving plans all rolled up into one convenient bundle. As you would expect, the premiums can be a little more costly than your run-of-the-mill health insurance cover. My wife has a package with AIA that costs her about 40,000 baht a year. That’s a fair chunk of change for a teacher earning 25-30,000 baht a month. As part of the package my wife receives about a thousand baht a day for every day she cannot work through illness, and she gets some kind of financial return every three years and a sizeable return after twenty years. Generally the AIA package is not for teachers who are only here for the short-term period, but some teachers are and therefore do sign up for the AIA packages.

There are two miscellaneous points I need to cover before moving on to the topic of why you should choose a more expensive hospital for your treatment. Firstly, a great advantage of the health card is that it works like a credit card. When you check out of a hospital, you simply present your card to the billing department and you leave the hospital to fight the insurance company over the claim. There’s none of that fannying around paying the bill from your own pocket and then having the rigmarole of trying to get your money back. The hospital will/should give you a fully itemized bill that shows you what you have to pay and what the insurance company will pay. It’s also worth mentioning that checking out of a hospital / settling with the insurance company can take up to a couple of hours. You can sometimes find out that if you feel well enough to leave a hospital after five in the evening, and the insurance company office is closed, you may find yourself needing to stay an extra night so the claim can be settled during office hours the following morning.

Hospitals DO WANT TO KNOW that you have the necessary funds or insurance cover before they begin a course of treatment. If I can be allowed to go back to my night of horror at Samithiwej hospital, when I was writhing around in agony on a hospital trolley with three nurses trying to hold me down. One nurse still had the task of gently enquiring if I had a passport (the first step to finding out if I had any money) When I fumbled in my wallet for the health card, the nurse’s face lit up and a potentially tricky situation was avoided. Treatment could commence.

The second important point in our ‘costs section’ is the difference between an insurance policy that covers out-patient treatment and a policy that doesn’t. You will find with all insurance companies that the premium nigh on doubles if you want out-patient cover. And that generally you are covered for something like 20 out-patient visits per year (if you need to go to hospital twenty times or more in a calendar year then you should seriously think about going home anyway – Thailand is obviously not for you)

I’ve always opted for a card that excludes out-patient treatment (simply because it’s half the price) I want to know that if I have a serious ailment or I’m involved in some sort of accident then I’m going to be taken care of. The piddly out-patient visits I can take care of as and when they arise.

*Note* - the definition of being ‘admitted to hospital’ may very from hospital to hospital. Thai Health Insurance (the company I use) considers anything over six hours as ‘patient being admitted’. Contrary to misguided belief, you do not need to stay in hospital overnight to be classed as an in-patient.

There’s a school of thought that out-patient treatment in Thailand is by and large ludicrously cheap, but I’m starting to change my opinion on this - certainly as regards the better hospitals like Samithiwej. I didn’t know this until very recently but doctors in private hospitals are allowed to literally charge patients whatever they like. Talking to admin staff at Samithiwej (where I sometimes conduct customer care training sessions) one of the biggest complaints is the inconsistency of the pricing structure. One week a patient might see Dr Somchai, who charges 300 baht a consultation, whereas next week the patient pays 500 baht to see Dr Banharn. The reasoning behind this is simply that Dr Banharn is older, more experienced, and feels he’s probably worth more. Try explaining that in a second language to a customer banging his fist on the customer service desk. 

Private hospitals also make a small fortune on the prescribed medication – sometimes charging patients a whopping twenty times more than what you could procure the drugs for in a local pharmacy. Couple the unpredictable doctor’s fee together with the ‘rip-off’ costs of the prescription and at a good private hospital you can expect to pay in the region of a thousand baht for a five-minute chat with the doc and a bag of pills.

So what about the hospitals themselves? There are five-star private hospitals where your every whim is taken care of and there are the private hospitals barely one step above a Thai government clinic. Which one should you choose? I’ve had treatment in both kinds of place and I would opt for the five-star every time. Why? The key word is dignity. It’s bad enough at times being a foreigner in a strange land. It can be frightening when you’re a sick foreigner in a strange land. You want to be treated well, to know that you are in good hands, and to feel that you are going to get better. In your time of need who wouldn’t want the private room with the cable TV, the coffee making facilities, the microwave oven, and the pastel-tiled bathroom? Who wouldn’t want the ‘international communication officer’ – the person who is available 24 hours a day to smooth over any language difficulties? And who wouldn’t want the nurses popping into the room every hour to just check your OK and to offer some words of support and encouragement? I want all that.

Cheaper private hospitals are cheap for a reason. They will still make you better but they have fewer staff, less equipment, etc, etc. These shortcomings are often ruthlessly exposed on your path to wellness. At Samithiwej hospital, going for a routine X-ray involves getting changed in a private room, getting attention from your individual radiologist, and receiving analysis from your own doctor. Going for an X-ray in a lower-class establishment could well involve waddling gingerly to the X-ray room in front of dozens of Thai out-patients, all sniggering at your hospital issue slipperettes. If they’re really lucky, perhaps they might get a flash of bare buttock from under your ill-fitting hospital gown. Dignity. That’s what it’s all about.  

A final point worth mentioning is pre-existing conditions. Insurance companies will always ask you to fill in an application form that includes a section to jot down pre-existing or past health problems. Obviously there is always a temptation to be ‘economical’ with the truth, but this is something you should not do. Hospitals and insurance companies sometimes find these things out and when they do, they will terminate your policy in a heartbeat. Generally, it pays to stick with the same hospital for all of your treatment. I was told that in the case of my kidney stone problem, the health insurance company wouldn’t hesitate to pay for further treatment of kidney stones provided that three months had elapsed between the hospitalization.

So to summarize, health insurance is certainly a very wise idea.  You can take out health insurance individually or as part of a group policy. Remember that most schools and colleges will be providing the cheapest health cover, so don’t always get excited if a job description lists ‘free health cover’ as one of its benefits. If you’re on one of the cheap ‘n’ cheerful packages then think seriously about shelling out a bit extra and having something better. If peace of mind is the only thing you are buying, then it has to be well worth it.