Walter van der Wal

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A selection of letters from ajarn readers


I have chosen this letter to respond to because it is very well written, and complete, and it gives me a chance to respond to a number issues I get asked about often.

The Letter:
Two years ago I was in a bad motorcycle accident and spent three months in the hospital including three weeks in an induced coma. I am doing ok now, however, I need powerful pain medications to be comfortable enough to get around. I broke over 20 bones (my spine had to be fused together, hence the need for the pain meds.) and lost my spleen. I currently need these medications every month. Morphine Sulfate 15mg, 60 tabs and either, Oxycodone (Roxycodone) 5mg 270 tabs, or Hydrocodone/app 10/325mg 270 tabs for pain. I am also on two anti-depressants/anxiety medications.

I was turned down for COBRA extension (I was on COBRA at the time of the accident) here in the United States so (1) I had to purchase a policy through my state government (Oregon) to get any medical insurance. (Oregon Medical Insurance Pool, OMIP)

I have done a lot of research including posting questions on the arjan newbie board. (2) I am wondering if I will be able to even get insurance in Thailand and IF I can, will it cover the cost of my prescriptions?

I contacted Bumrungrad Hospital to see if the meds are even available in Thailand and is (3) sounds like the are available although very expensive and difficult to get there. I know that on a teachers salary in Thailand the cost of these meds will make it impossible to support myself without insurance to cover the costs of the drugs I need.

First off do you believe that I would even be able to pass the required medical certificate needed to teach there? (4) Also I was wondering if I could apply for insurance there (without paying for it first) and if it would cover prescriptions. Also, is there a way to get prescription coverage there at all? From what I have read it seems that most insurance does not offer Rx coverage.

My Reponses:

(1) The Oregon Medical Insurance Pool (OMIP) is the high-risk health insurance pool for the state. OMIP was established by the Oregon Legislature to cover adults and children who are unable to obtain medical insurance because of health conditions.

In other words, if you were accepted by OMIP, it was because no other health insurer would cover your existing medical problems. That is still a problem you face.

(2) You can probably get medical insurance in Thailand, but it will definitely exclude treatment and testing for your current medical condition and it will certainly exclude coverage for your medications.

If you got a job at a school offering group coverage under the government SSI program you might be able to get coverage for your medical condition. But ...

(3) If your medications are available here, but expensive and hard to get, that tells me that they are not being produced here. This means that the SSI program will not pay for them.

(4) If you get hired with coverage under SSI, the premium would be taken out of your pay every month, but there would be a waiting period for coverage to start. Your medications, though, would not be covered if they have to be imported into Thailand. No private health insurer will cover medication for pre-existing conditions.

This letter writer is very, very fortunate that OMIP exists. It didn't exist when I lived and grew up in the States. Now, apparently, a few other states have somewhat similar support for the uninsurable.

The good news for this letter writer is that the problem should heal over time and expensive medications will no longer be required. My very strong recommendation is to just Jai Yen (remain cool) for now and remain in Oregon until the medications are no longer required (or at least are more affordable).

If any readers disagree with anything I have said here, please write me and let me know. I am always willing to learn - in fact; I continue to do so every day




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