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No, it isn't. Disputes and delays do occur at times, but they have nothing to do with whether you are a “farang” or not. They have to do with what I call “Red Flag” (questionable) claims.” These delays are normally caused because the insurer is seeking additional information from outside sources that either supports approving the claim or rejecting it.  Examples: A. One of our travel insurance clients flew into Bangkok, got off the plane and then had a heart attack. The policy had been in force only 3 days and the insured was under medication for Hypertension. (Ding, ding, ding! Red Flag!!) I was involved with assisting our client with this claim every step of the way (with full cooperation from the insurance company). The claim was finally paid in full. But still, it took nearly 5 months to get it paid. That’s because 1) There were many “Red Flags”. 2) The hospital made a mistake in its report to the insurer. 3) His doctor in Canada sent the wrong supporting information. And 4) Even the client, himself, made a number of mistakes in sending us the necessary supporting documents.

B. We currently, have a Thai client who has been waiting an exceptionally long time. The client spent 2 days in the hospital for treatment that is normally done as outpatient (OPD). (Red Flag!!) The insurer is inclined to reject the claim. But, if the hospital can justify the hospital stay, the insurer will pay it. This delay is being caused by the hospital’s slow reply, not the insurer.

C. We have another client who is insured by both SSI and one of our insurers. Part of his treatment is not covered by SSI (100,000 baht) because its nature, so he submitted a claim for that part through us. In order to act on the claim, though, the insurer needs to obtain the client’s records from the government hospital that treated him. The government hospital has been extremely slow in responding.  We are still waiting. 

Most claims are easily settled directly with the member hospitals – but, even then, a “Red Flag” claim can be rejected for direct payment. In that case, the insurer will ask you to pay the hospital yourself and submit the claim to them for payment. This way the insurer can have more time to carefully evaluate it.

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I hate to leave anyone "in a bit of a quandary", so I'll try to help you out a bit:
The Thai government has all insurance companies in Thailand separated into two separate categories for regulation, "Life Insurance" and "General Insurance". Life insurance, of course, falls under "Life Insurance" for regulation, while all other insurance companies authorized to sell in Thailand are regulated as "General Insurance".
There are about 25 legally authorized life insurance companies operating in Thailand. Most of them also offer health insurance, but it must be purchased as a rider (attachment) to a life insurance policy. Also, expats need to have a Work Permit to buy it (an "O" visa might be okay). The best known life insurance company is AIA..
There are about 7 companies in Thailand that sell only health insurance. They come under the "General Insurance" category. Expats can purchase health insurance through them without having to show a Work Permit or having to buy life insurance. The names of these companies are AXA, BUPA, LMG, MSIG, NZI-IAG, PIH and Thai Health Insurance (THI).).  There are also many health insurance companies outside of Thailand that cater to expats around the world. They tend to be more expensive though
 

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I lean towards recommending Bumrungrad Hospital. Bumrungrad is the hospital I see recommended most often when I read about medical-tourism in Thailand. The American TV news program “60 Minutes” even did a segment on the quality of care they provide. Beyond the high quality of their medical care, though, which I’m sure they all provide, I’m also impressed by their reasonably low room rates. They offer the choice of a four bed room (2,530 baht per day), a two bed room (3,330 baht per day) a private room (6,005 baht per day), a bigger room, better view, micro wave oven and VCR (7,510 baht per day). Frankly, I’m not too proud to sleep in a four bed room, if I have to, in order to receive the quality of care Bumrungrad provides. The truth is, though, if I ever do have to go the hospital, I still plan to use my local hospital, Mongkutwattana (1,900 baht per day). But if I see the doctors and nurses whispering a lot around me and avoiding eye contact with me, I'll be quickly in a taxi and on my way to Bumrungrad – if I can just learn to pronounce it.
 

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The room and board rate that you choose determines the premium charge and defines the overall level of your coverage. Each plan has built in limits for each area of coverage, for example, surgery or outpatient accident care. Increasing the daily R & B benefit increases those limits as well.
Tony's Tip
When purchasing health insurance for a Thai who was born and raised in Thailand, there is a good possibility that he or she may require a lower Daily Room and Board benefit than you require. For example, if you require 4,000 baht a day Room and Board, your Thai partner may only require 2,000 baht Room and Board. Hospitals that cater more to Thai patients are usually cheaper because Thais are much easier for them to care for, for obvious reasons. While hospitals catering to Westerners tend to be more expensive, because Westerners tend to be more demanding, require English speaking medical care providers, have to have special food prepared for them, and expect more of the kinds of amenities found in Western hospitals. Chulalongkorn Hospital, one of the top government hospitals in Thailand, mentions on their website that Western style hospital care can be provided as an option for a higher cost.
When buying insurance for a Thai Significant Other, don't just assume they need the same amount of coverage you do. Talk it over together, and then have your T.S.O. check with the hospital she or he would prefer to use. It could save you some money.
 

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"Wealthy Healthy" plans provide basic hospital inpatient coverage topped off with Major Medical coverage. Each plan pays a fixed amount per day for room, board and nursing care, depending upon the plan, for up to 60 days. It also pays 100% for miscellaneous hospital expenses, surgery and hospital doctor visits up to the fixed amounts specified in the plan. When the basic hospital coverage is used up, the major medical coverage kicks in and starts paying 90% of all additional covered hospital, surgery and doctor visit costs up to the major medical maximum. It also kicks in on the 61st day to continue paying the hospital room, board and nursing care
charges. In addition, Wealthy Healthy are the only plans in their price range to include emergency evacuation and repatriation coverage when experiencing a medical emergency while traveling outside of Thailand.

"Simply Healthy" plans are exactly the same as Wealthy Healthy, but without major medical coverage or emergency evacuation and repatriation protection.

“Maxi Healthy” is a set of plans providing major medical protection after payment of a deducible (excess). It also provides for emergency evacuation and repatriation back to Thailand, like Wealthy Healthy. In fact, if you bought Maxi Healthy along with Simply Healthy you would have the exact same coverage as Wealthy Healthy for a little higher cost. Both Wealthy Healthy and Simply Healthy have the same outpatient (OPD) options.

 

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•Do you want to pay for both your life insurance and your medical insurance with one premium payment? (Life insurance)
•Do you want to break the payment into monthly or quarterly premiums? (life insurance)
•Do you want Major Medical coverage to kick-in when the limits of your basic coverage have been exceeded? (general insurance)
•Do you want outpatient (OP) coverage for illness? (general insurance)
•Do you want Daily Hospital Income coverage included? (life insurance)
•Do you want a separate Daily Hospital Income plan? (general insurance)
•Do you want additional Dread Disease coverage? (life insurance)
•Do you want a separate additional Cancer coverage plan? (general insurance)
•Do you want higher top-end coverage? (general insurance)
•Do you want more flexibility in your insurance program? (general insurance)
•You don’t have a work permit? (general insurance)
 

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THI offers a 10% family discount. Yes, there is very definitely a big difference in overall coverage with every increase of the Daily Room and Board Rate chosen. For example, WH2000 provides 500,000 baht of total protection; WH3000 provides 800,000 baht of protection; WH4000 provides 1,000,000 of protection and WH6000 provides 1,500,000 of protection. One of the features I like about the WH plans is that, while they provide basic Inpatient coverage like most hospital insurance plans, they also include Major Medical coverage to give you greater high-end protection. No, your baby's routine vaccinations would not be covered.

The inpatient care and the emergency accident care provided by Sukumvit Hospital should be quite adequate for most of your child's anticipated needs. Check with the hospital to find out how much inpatient hospital care should cost for her.
 

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Yes, I do. NZI-IAG is a Thai based insurance company that is authorized to sell international insurance at (very high) “Thai prices." The international health insurance company they represent is InterGlobal insurance. They have converted the international prices to Thai baht and lowered the premiums for Thailand. But the premiums are still considerably higher than those of other local companies. But then, so is the coverage. For expats willing to pay for it, this type of coverage satisfies a need that can't be satisfied by most other Thai based companies.
 

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If what they are concerned about is having good quality medical coverage while they are living in Thailand, there is no reason for them to purchase travel insurance before coming here. The simplest, most cost-effective way for them to provide the coverage they need is to purchase the insurance in Thailand before they get here. Then, they can have their coverage start on the day they are scheduled to arrive here.

We have assisted many ex-pats in this regard. It is a very simple process that can be handled by e-mail or by airmail. Payment can be made by credit card. Those wanting this coverage should allow about a month for processing, but we can get the coverage for them almost instantly, if necessary, if they e-mail their application. In addition to completing and signing a very simple health insurance application, a photocopy of the I.D. portion of their passport is also required.
 

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Yes, normally they can. But, the condition they are being treated for won't be covered. This is true with any private insurance company anywhere in the world.
A "pre-existing condition" that requires on-going treatment is a "guaranteed expense" to an insurance company. The only way they could afford to cover "guaranteed expenses" is by passing the cost on to the rest of their insureds in the form of higher premiums. When an insurance company is forced to do this, its insurance plans become less competitively priced against those of its competition to such a degree that only "high risk" insureds are willing to pay the premiums.

Insurance plans that do cover pre-existing conditions are normally government sponsored social-medicine schemes. In America, where "socialized-medicine" is a bad word, they have HIPPA and COBRA to provide coverage to people with health problems who can't get coverage elsewhere. Coverage under COBRA, though, is extremely costly. Some large corporations also provide employees with "guaranteed acceptance" group insurance coverage that doesn't exclude pre-existing conditions of any sort. The cost provides a large tax write-off for the company.

What does an insurance company do about pre-existing conditions the insured didn't tell them about, or the insured actually didn't know about, but, the company discovers after the policy gets issued?

a) If the insured lied, and the company learns that the insured lied, the coverage will be canceled and all claims will be refused - including even the legitimate claims.
b) If the insured seeks treatment for a pre-existing condition the insured was most likely unaware of, the condition wont be covered, but the coverage will continue.

That said, the good news is that the insurance companies are faced with a time-limit for finding and excluding pre-existing conditions that they haven't already found and excluded.

Insurance companies have up to 24 months to find and exclude any pre-existing conditions you might have. Any pre-existing conditions that haven’t been found and excluded within the first 24 months the policy has been in force can no longer be excluded from coverage.

One of the biggest fears insurance companies have to face with each insurance application is that the applicant is taking out the insurance policy to cover a major medical expense that the applicant is expecting to incur soon and wants pass the expense on to the insurance company. The time exclusion is intended to make that less likely to happen.
 

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If the person is 60 or younger, BUPA is still an option. They will guarantee to renew the applicant for life (60 may soon be reduced to age 56, though). Applicants who enroll between ages 61 and 64 will be renewed to age 70.
Beyond that, we offer 4 choices, Premier International Healthcare, NZI InterGlobal, LMG Mega Series and LMG Comprehensive. Anyone who is interested can email me with their age and telephone number and I will send them a spreadsheet showing their options and the cost for their age.
 

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Some teachers complain that their employer provided group coverage is quite small and inadequate. Others complain that their employer refuses to provide them with any medical coverage whatsoever. What options do these teachers have, other than going out and purchasing their own personal medical coverage? Is there any way that E-InsureThailand can help them get good group insurance coverage?
 

E-InsureThailand currently represents 5 well respected local insurers who offer group medical insurance coverage. In terms of price, product, flexibility and service, we should be able to compete quite well in satisfying the group insurance needs of any employer.
 

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1. They can ask their employer for permission to invite E-InsureThailand in to bid on the group insurance needs of the company or school. If the employer agrees to meet with me, the employee can then call or e-mail me and fill me in on anything I need to know before contacting the employer.
2. If the employees are not comfortable approaching the employer about group coverage, they can just contact me and give me all of the information I need to know to approach the employer.

If the employer is willing to listen, but unwilling to pay more to upgrade the coverage, which will most likely be the case, we will work out ways to improve the coverage without increasing the employer’s cost.

If the employer refuses to upgrade the group coverage, then employees can supplement that coverage with a low cost Major Medical policy available from E-InsureThailand. This coverage would take over when the basic benefits were used up and would pay 90% of the additional costs up to a maximum of 1,500,000 baht.

What can the employees do if the employer just absolutely refuses to provide any type of group medical insurance coverage? They can provide it themselves, and not get the employer involved. But, there must be at least 5 or more employees willing to participate. And, one of the group members must be willing to assume the role of “Administrator”, with assistance from E-InsureThailand. The only disadvantage to this is that they would have to pay for their coverage themselves, without employer assistance, and their premium would have to be paid annually.

The advantage would be that group coverage would still be cheaper than personal coverage. Since the premium is determined by group size, the bigger the group the lower the cost. Family members can be included in the group to increase the size and lower the cost per group member. And, since the group has no ties with any employer, group members can change jobs and still keep their coverage, as long they keep paying the annual premium.

We can also provide coverage like this for established clubs and associations. Information on this can be found on our website. www.e-insurethailand.com

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A few insurance companies now refuse to issue insurance policies to applicants with Diabetes. I have “inherited” type-2 diabetes, myself, and have coverage through one of the companies that now refuses to issue a policy to diabetics. They explained that this change in policy came about because of too many problems with diabetics who didn't understand what the the diabetes exclusion entailed when they went into the hospital for treatment. I checked with another health insurer and they told me that they had had the same problem also. Frankly, I didn't understand how broad the exclusion was either. I thought that I was covered for strokes and heart disease, at least.

After researching the matter, I now understand why insurance companies are having this problem. Diabetes is a disease of the blood. Everywhere the blood flows is a candidate for exclusion from coverage for treatment.

People with diabetes are at greater risk for problems that involve damage to small blood vessels and nerves due to high levels of glucose in the blood. They are also at a greater risk of developing hardening of large arteries (atherosclerosis) that can result in a heart attack, stroke, and poor blood flow to the legs. Damage to small blood vessels can affect the eyes, kidneys, and nerves. Damage to eyes, specifically the retina, is called diabetic retinopathy and is the leading cause of blindness. Damage to the kidneys can lead to kidney failure and the need for dialysis and is called diabetic nephropathy. Damage to the nerves that supply the legs and arms and gastrointestinal tract is called neuropathy. Some people with diabetes that develop peripheral neuropathy (damage to the nerves in the legs) and have poor blood flow to the legs will eventually need an amputation. Impotence and depression can also result from diabetes. (Now, I am depressed).

The good news for type 2 diabetics is that these problems can be avoided by proper diet and exercise. But, many sufferers lack the proper determination and commitment to do that. And there is no way for insurance companies to know which of us have it and which of us don’t, without regular testing and follow up. To try to distinguish on a regular basis between those that do and those that don’t would require constant monitoring by the insurance company. Which would cost them money for use of time and resources. That cost would then be passed to policy holders in terms of higher premiums.

Instead, insurance companies opt for the easy way out either by accepting the applicant's money and excluding the condition, or, by rejecting the applicant altogether and thus avoiding conflict in the future.
 

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We have at least 3 health insurance companies we can place them with. They should contact me.