Do major Thai insurance companies often stall and dispute payments to foreigners?
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.
If you are our client and are having a problem getting a claim settled, we will assist you in speeding up the process, just as we have done with many of our other clients.
