Have a question about health insurance? Check out the questions below; chances are we've got your query covered!

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What factors should an insurance buyer consider when choosing which source to buy through?

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)

Do any of the medical insurance companies in Thailand cover the cost for cosmetic surgery?

Not normally. As I've said before, insurance companies are not kind hearted philanthropists when it comes to paying out money for unnecessary medical care. As a rule, they need doctor certification that there is a serious health threatening need for the surgery.

• THI excludes: "Any cosmetic surgery except re-constructive surgery which is needed for medical reason."
• BUPA goes into much more detail. They exclude: "Any cosmetic or beautification treatment including lasik surgery, the treatment of acne, freckles, dandruff, weight reduction and weight gain, hair loss.

Reconstructive surgery is also excluded unless injury is sustained as a result of an accident and reconstructive surgery is necessary to restore functionality. Reconstruction of breasts and sexual organs is not covered."

Can you explain why OPD charges are relatively high for illness coverage?

Johnny, why do health insurance companies like BUPA and THI, and others, include outpatient (OPD) for accidents in their basic plan and then charge another 50% to 80% more to add very limited OPD coverage for illness?

Frivolous and unnecessary usage of outpatient (OPD) care for illness is much more difficult to control than inpatient (IPD) care and emergency OPD care for accidents are; and providing it can be very costly to insurance companies.

Both BUPA and THI, therefore, charge more to include OPD coverage, limit the number of doctor visits per year, and put a low ceiling on the amount they will pay per visit.

By contrast, getting admitted to the hospital for IPD care requires the signature of a qualified physician on a form stating the need. While qualifying for emergency accident OPD care, of course, requires an accident to happen and some sort of trauma to the body to occur.

Anyone with insurance that has limited or no OPD coverage for illness who visits the doctor often with the same complaint, and receives only temporary relief for that complaint, should request to be admitted to the hospital for more thorough testing and observation. All it takes is a 6 hour stay in the hospital to qualify for payment under the IPD coverage.

What is Major Medical insurance? Who should consider purchasing Major Medical insurance, and why?

Major Medical insurance is coverage that pushes medical protection beyond the limits of basic hospital coverage. It covers the high end medical expenses that we are least likely to incur, but fear the most.

Major Medical coverage kicks in after a pre-determined deductible (excess) has been satisfied and then shares the cost of medical care with the insured. Traditionally the insurance company pays 80% of the costs with no built in limits, up to the plan maximum per occurrence. THI's Major Medical pays 90% of the medical expenses.

Both THI and BUPA offer basic hospital plans with Major Medical built in. The deductible is satisfied by the basic hospital coverage. So, in effect, there is no deductible. Both BUPA and THI also offer stand-alone Major Medical policies. Their deductibles can be satisfied by the basic hospital coverage issued by any insurance company.

Major Medical insurance is good for anyone who doesn't want to spend a lot of money for medical insurance, but would like to be protected against being wiped out financially by a costly medical problem. Also, anyone who has just a basic hospital plan should consider supplementing it with Major Medical insurance.

Why? Because Major Medical insurance provides high end protection for a relatively low cost.

My BUPA only covers 50% of the costs if it's a bike accident.

This year I renewed my BUPA package and about a month later I was forced to take on the social insurance and nominate my two local private hospitals as my nominated hospitals.
Now if I get sick which insurance do I use first my BUPA or my Social. If god forbid I fall off the bike - which insurance do I claim on first for health.

With Social Security insurance you can go to a private hospital only if it is a "registered" participant in the SSO program. You can go to a "non-registered" hospital only if you require emergency care because of an accident or serious illness and you have no other choice. But the amount they will reimburse you is more limited. With BUPA, you can go to a "non-member" hospital and get reimbursed later.

The maximum Daily Room and Board benefit paid by SSI is only 700 baht a day. If you want a more expensive room you have to pay the extra yourself. But they say they will pay 100% of most of your other medical expenses. They will also pay you half your salary while you are hospitalized or otherwise disabled. It's not a bad deal. The major problem they have with the program is that many of the "registered" hospitals end up losing money on the deal and drop out.

So, what should you do? That depends on you. If the subscriber hospital near you is satisfactory for your needs, use it and use BUPA to cover the additional cost of the room. If you are really lucky, the "subscriber" hospital will also be a BUPA "member" hospital and you won't have to pay anything out of your pocket. Your other option is to go to the "non-subscriber" BUPA "member" hospital of your choice and not use SSI at all for inpatient hospitalization. About your accident insurance: Insurance like that usually pays on top of any other coverage you have. It often even allows you to make a profit from your accident. Check with the company you got the policy from.

By the way, BUPA pays 100% for medical treatment of motorbike accidents, not 50%.

Is there any advantage to purchasing a health plan with high room and board coverage?

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.

Johnny'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.

What happens if the Daily Room and Board coverage provided by my health policy isn't enough?

Will you still be admitted without any hassle? Yes, you will! But, of course, you will have to settle with the hospital for the difference at the time of discharge.

Both Bumrungard Hospital and Bangkok General Hospital (BGH) verified this process for us.

This is one of the advantages of purchasing medical insurance through a locally based insurance company that has a large selection of participating hospitals. You just show the hospital your card and you get admitted without any delay.

That is, as long as you have a doctor certified need to be admitted.

I hear some people talking about “5 Star” hospitals here in Thailand, how are they rated?

Although there are a wide variety of ratings and recommendations a hospital can receive from various sources, there is no industry standard for rating hospitals in Thailand. Those hospitals most often considered to be "5 Star" are the ones that meet or exceed international standards and have been the most successful in attracting patients from around the world.

The Samitivej Hospital, Bumrungrad Hospital, Bangkok Nursing Home Hospital (BNH) and Bangkok General Hospital (BGH) are the ones most often considered to be in the "5 Star" category. BGH also has satellite hospitals in the popular tourist areas throughout Thailand. I'm sure that there are a few other hospitals worthy of being in this category also, but these are the ones mentioned the most often.

Do major Thai insurance companies often stall and dispute payments to foreigners?

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.

I don't understand what pre-existing conditions are?

Pre-existing conditions are medical conditions (problems) that exist at the time you apply for medical insurance.

Insurance companies know that within a given population of insureds a certain number of insureds will require medical treatment which the insurance company will be required to pay for. That‘s fine. Insurance companies are comfortable with this and often take pride in quickly settling deserving claims.

What health insurers really dislike, and are really fearful of, though, are claims for treatment by insureds that purchased the insurance to cover an existing medical problem they were aware of at the time of application. If they didn't list this medical problem on the application and then tried to get the insurer to cover treatment for it, they are committing fraud against the insurance company and are helping to add to the cost of insurance for their fellow insureds.

Surgery, while going through the healing process, can be considered a pre-existing condition. The healing process can normally be up to five years. This can also be true for fully removed cancer. But this may not be true for heart surgery; no matter how successful the surgery is, heart surgery can weaken the heart a bit.

A hernia operation 30 years ago was recently declared to be a pre-existing condition by a client's treating physician; apparently, the original surgery never fully healed properly. The insurer, therefore, declined to pay for the new surgery.

Conditions like Diabetes and Hypertension, that can be controlled, but not cured, are always considered "pre-existing conditions" no matter how well they are controlled.

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