When insurance skips a beat
Long before COVID, expats with no health insurance were trapped in nightmare scenarios, some of which have become island legends. Bruce Stanely shares some of these stories of suffering and examines how to fix the problem.
It was one of those familiar calls that make me sad. “Can you help us? We found our friend Jonathan passed out in his room and don’t know what to do.”
“Where are you now?” I ask them.
“We put him in our truck and took him to the government hospital in Vachira. But when he became conscious, he told us he had health insurance and should please take him to an international hospital. “
Then I learned that no one knew where Jonathan had put his health insurance card, ATM card or passport. Fortunately, he was admitted to one of the international hospitals but asked for a B50,000 deposit for his first aid. His friends all donated enough to take him in.
Within a short period of time, a scan showed that he had a liver overgrowth and other complications that required extensive surgery. The hospital contacted its overseas health insurance company to find out that they would not cover a pre-existing condition. Jonathan’s friends were asked to pay his medical bills, which would eventually run into hundreds of thousands of baht. If there is no guarantee of payment, the patient is transferred to a state hospital.
This troubling story is not unusual. There are thousands of expats from around the world who stay on Phuket for both short and long term with inadequate or no health insurance. Most say they pay when they have a problem. This may have been possible 20 or 30 years ago, when health care costs were more affordable, but with hospital costs soaring, only a fraction of Phuket visitors and residents can afford their medical bills.
When I came to Phuket almost 30 years ago to work on the newly developed Prince of Songkla University Phuket campus, I was given the task of working with the Tourism Authority of Thailand to help foreigners from all countries in need. A large part of my job has been the often delicate negotiations between foreigners and the local police in the event of accidents. The other part helped find medical care for an injured visitor. At that time there were no international hospitals on the island. The choice back then was Vachira or Mission hospitals and a couple of much smaller clinics, and none of them had a lot of medical technology. I remember a Swiss man who was run over by a 10-wheel truck on his motorcycle and broke his leg in many places. He was advised to take a bus to a hospital in Bangkok if he wanted to save his limb.
We have come a long way since then and the island can now boast of an international standard of care but with the additional costs expected of the sick and injured and that means having an adequate insurance policy.
“In an international hospital, the patient must have a direct relationship with his insurer. We can help arrange and resolve a claim, but the patient needs to make sure they are adequately insured for their injury, ”a very experienced claims handler tells me.
If the insurance company is based overseas, there may be problems with the insurer who is unfamiliar with the costs and medical procedures of an injury in Thailand. It is for this reason that the Thai government recommends hiring a Thai insurance company as the hospitals can more easily help the injured and the needy to settle their bills.
Eric Dohlon, Managing Director of Bangkok Insurance Brokers (BIB), has been offering health and accident insurance on Phuket for 20 years. He advocates especially for older expats who need an affordable policy that covers their medical care. He informs himself about the condition of his clients in the hospitals and takes part in their social gatherings and funerals. He works in the best interests of his clients who can easily meet him to discuss their health insurance needs.
“The prices of the hospitals are very different. Many are for-profit and regularly raise their prices when they think an insurance company will pay. Those higher fees then mean that insurance premiums are beyond what customers can afford, ”explains Eric.
“I always advise my customers to shop for non-essential medical supplies in Thailand as the savings can be significant. You should also speak with your insurance company to determine exactly what they cover. Otherwise the customer is responsible for any shortfall. It is also advisable to negotiate the final bill after a medical procedure, as the hospital has flexibility, especially for patients without adequate medical care. “
Medical emergencies are common in Phuket like Richard, who was happily living on Patong Beach when he fell ill. Usually, high doses of paracetamol relieved his symptoms. But it inevitably didn’t and he was taken to Vachira Hospital to find out that his kidneys had stopped working. He was put on dialysis and soon had a big bill. When he advised the hospital to get money from his bank, he found that his friend, who lived in the apartment, had emptied his retirement account and disappeared. Without dialysis, he would die. He had no family in his native England, but was able to scrape together enough money for a one-way ticket to London. He returned to Heathrow Airport in a wheelchair and was cared for by the National Health Service (NHS).
“Health insurance is important, but cheap accident insurance also allows you to be admitted to hospital without problems in the event of vehicle, motorcycle or other unexpected injuries.” Erik explains.
I remember an expat musician on the island who fell in his shower, hit his head and lost his memory, and finally had to be taken back to his home country. And the young woman who tragically fell down the stairs in a club in Patong and her brain was badly damaged. Both had accident insurance, but unfortunately no protection against repatriation to their home countries.
Not so lucky was Greg, a semi-professional cyclist who was hit by a fast-moving truck in Rawai and left on the side of the road before being rescued by a passing Thai family. They drove to several hospitals that asked for proof of insurance before admitting him.
Thailand is the second most dangerous country in the world for road fatalities after South Africa. It’s no secret that many locals and expats drive without training or under the influence of an amazing variety of mind-altering substances. Many tourists think that Phuket is the perfect place to learn to ride a motorcycle without a license or to swim in the warm sea without heeding the warning red flags blowing in the wind. It’s all a perfect setting for disaster for those who are not careful.
Jonathan’s condition improved after two weeks in a virtual coma. He was eventually discharged from the international hospital with a B1 million medical bill. He plans to pay it off monthly and hopefully find health insurance to cover any future relapse.
To consult with Eric Dohlon of Bangkok Insurance Brokers (BIB), visit Insurance-in-Thailand.com or call 076-612722 or 089-6493012.