One of the major concerns and topic of interest for us retirees in Thailand is health insurance and the medical cover it provides. There is endless discussion of the benefits of having insurance or not, the costs and exclusions. I am not going to make this post a medical one-stop reference point because my blog only deals with aspects of Thailand I have experienced directly and I am not about to offer specific advice on such a complex subject. However, what I can share with you is a recent stay I had at a private hospital in Udon Thani, in the northeast, for minor surgery and how that experience went for me including the performance of my Pacific Cross Thailand private health insurance. Obviously, every medical treatment process will be different but I will focus on the administrative and hospital process I experienced, which I think will have enough similarities across the board to make this a useful read for those of you interested in this important subject.
I realised that I had a hernia late 2017 (God knows why as I do almost nothing here) but as a total coward with respect to medical matters I postponed seeing a doctor until February this year. In my defence we had visitors dropping in to see us the first couple of months of the new year so I had a semi-excuse. I decided to get on with it (eventually), mainly because we had bought some new land next to our current house, which you can read about HERE and HERE, and were busy establishing a tropical garden. We had got most of the basics done so it was a good time to have the operation, which has a three-month no-heavy lifting recovery period so that I could resume work after the hot season.
I was reasonably relaxed about the financial side of things because since I moved to Thailand I have had medical insurance with a company called Pacific Cross, which would cover me for expenses up to 200,000 baht per incident. I say “reasonable” because I had never made a claim with PC and there’s always a slight concern as to how genuine they are based on a real situation requiring them to part with money. I will go into a little more information about Pacific Cross later but in the meantime, their excellent English website is HERE, if you wanted to have a browse. I have no relationship with Pacific Cross other than as a customer as this is one of the few non-commercial blog sites in Thailand.
There are three main private hospitals in Udon Thani that I know of plus, of course, you can pay to have treatment in the many local or city public hospitals. I selected AEK International but Bangkok Hospital would have been an equality logical choice. AEK have one of the most useless websites in the history of the internet but I will give you the link anyway HERE.
I selected AEK because they are a JCI accredited hospital, which didn’t mean a lot to me but it’s like choosing between two bottles of wine when one displays a gold medal. You may have no idea of the wine competition involved but any award is better than none 🙂 Anyway JCI accreditation might mean something and the organisation’s website (which wasn’t designed by a twelve-year-old) is HERE. I had also been to AEK once before, just to get an x-ray for my step-daughter, and they were very efficient, so the devil you know.
Our first visit to AEK was to get a formal diagnosis and, as I was pretty sure that an operation would be required, to get a date for the procedure. I will touch on the private v’s public hospital debate here. My only experience of the public hospital system in Thailand has been via my step-daughter Peng, who has six-monthly check-ups for a long-term medical problem related to her mobility, and in 2017 had a major operation at the huge Srinagarind hospital in Khon Kaen, a teaching facility attached to Khon Kaen University. You can read about our ten-day stay in that hospital for Peng’s operation HERE. The thing that really strikes me is the incredible variation in patient numbers between private and public. This is a worldwide phenomenon so I am not telling you anything new – money buys convenience and time-saving. We would go the Khon Kaen for Peng’s regular check-up and every time wait at least four hours for what ended up being a 15-minute visit with the doctor. Add a one and a half hour drive each way and it was a big day out. There is no doubt the public system does the job, but the main cost is time and you do need the patience to work through the process.
I have a couple of ideas as to why the public system is so overwhelmed, or the bit of it I have seen anyway. Firstly medical treatment in public facilities is almost free. The maximum people pay is 30 baht or A$1.20 per visit, under an arrangement introduced by a recent prime minister (now a resident of Dubai). Secondly, it is almost impossible to find a doctor to see you during the day! There are clinics everywhere but the doctors only work there maybe for an hour in the early morning and a couple of hours late afternoon. Where are they during the day you might ask? At the hospital 🙂 If you need a medical person to see you between 9:00 am and 5:00 pm then the local hospital is your best chance and maybe the only option, but be prepared to spend the day waiting. My brother-in-law Lud went to the local hospital in Si Bun Ruang for a blood test and x-ray and he was there literally all day.
Compare that to a private hospital such as AEK in Udon or Khon Kaen Ram (I had a full medical check-up there). In both situations, I walked up to the reception counter and was greeted by a sort of hostess, on the customer side who asks what you want and then deals with the forms and the booking people behind the counter. No waiting and very professional. One of these ladies will then walk you to the next stage and hand you over to the staff at that point. You are always taken to each new service desk within the hospital. Don’t be caught out thinking this is service provided out of kindness. There is nothing complementary given away in the Thai private medical system and you will be charged for “nursing services” or the like at the end! EVERY single action and consumable is recorded and charged.
In my case, I was referred directly to the surgeon who would end up being the guy who carried out the operation. No middleman. The initial consultation, an ultrasound and the follow-up discussion and booking for the operation took around an hour. You will find that many doctors have some grasp of English, as it is a requirement of their training, which was the case with the one I saw.
Now interestingly the other person who automatically made an appearance as part of this process was a representative from the hospital’s finance section! They had already noted my intention to claim on Pacific Cross insurance at the reception. This guy told me that I would have to pay a deposit on the day of the operation of 40,000 baht ($1,600). In Australia with my very limited experience of private hospitals, I remember having to give an imprint of my credit card when I booking in, which was to ensure any excess not covered by insurance was paid. I have never had to pay upfront like this so that’s one to keep in mind. It may be a unique situation with Pacific Cross because I have a friend in Udon whose son has spent some time in AEK and they have never paid a deposit up front. Mind you he hasn’t had an operation so who knows. My friend is with another insurance company.
Depending on the device you are reading this post with the back of Pacific Cross’s ID card may not be readable. Point 6 is the interesting one and it says:
Medical Treatment should be bourne first by the cardholder and claimed back from the company unless special arrangements have been made.
This didn’t end up being the situation with me, although I was expecting it and I will cover this later. So be prepared to make a deposit although in your case it may well never happen. I am sure that what WILL happen is that your ability to pay will be well and truly locked in by the hospital so expect a visit from a finance type person no matter which hospital you are in.
Back to medical stuff. I had an intermittent cough at the time that I couldn’t shake so I was then referred to a nose and throat specialist. A hernia operation and cough don’t mix well so the surgeon wanted to fix it before surgery. This doctor ordered a chest x-ray and that process took longer than my initial consultation because he had previous clients waiting. I was then prescribed a bunch of pills and because they wanted the cough cured before the operation they gave it a couple of weeks for the medication to kick in. Otherwise, I could have had the procedure almost straight away. The cost for the two consultations (both with specialists), an ultrasound, an x-ray plus medication and “nursing charges” came to 4,847 baht or around A$200.00. I seem to remember that even a visit with a GP in Australia cost $70.00 in 2014, the last time I was there, so I think this is probably pretty good value (P.S. I see that a General Practitioner consultation of under 20 minutes in Australia now costs a standard $76.00).
Two weeks later, with my cough a lot better, my in-laws kindly drove me and Gaun (my wife) the one and a half hours to Udon Thani to be at the hospital by 8:00 am with a 10:00 am operation time. They didn’t want me driving home so offered to drop me off and pick me up. I offered to pay for the fuel, which they wouldn’t accept. Just the nicest family you could possibly come across.
The hospital had given me an ID card previously and on presentation, I was taken to Emergency, which seemed a bit dramatic for a hernia operation! Thankfully it wasn’t full of motorbike accidents instead being a very peaceful place to be. Maybe they have their moments but it didn’t look to be set up for big dramas (that’s my TV observation talking) and I was the only person there. There were many nurses on duty, but you get used to that. I know that when Peng spent ten days in the Khon Kaen hospital for her operation the public ward had a daytime ratio of around one nurse to four patients, which sounds impressive. However, on the whole, the staff stayed in their air conditioning office except to dispense medications and take blood pressure. The majority of the hands-on caring work was expected to be done by the family. Gaun lived in the hospital and slept next to Peng’s bed. Back to AEK where I changed into a hospital gown (tied at the front, not the back like Australia – no bum hanging out of your robes in Thailand thank goodness!).
Guess who turned up shortly after I was on my trolley? The finance person who relieved me of my 40,000 baht deposit. I am in Thai mode, so brought cash, but they were expecting a credit card so were a bit surprised by that. I prefer not to use a credit card in Thailand and have got so used to paying for everything in cash that I never give it a thought. All being well a refund would be available sometime after the operation in the form of a cheque (check for my American friends!)
The work-up was done professionally by two nurses and I was hooked up to drip lines, never my favourite experience. The surgeon and the anaesthetist made an appearance the latter wanting to know if I wanted a spinal tap (no way) or to be knocked out (yes please). I am a total coward with medical procedures and I don’t want to be in the room when they’re messing around 🙂 On time I was wheeled into a very modern looking theatre and woke up post-op ready to be taken to my room. My brother and sister in law had stayed with Gaun to make sure all was OK after the operation. Family is there when you need them in Thailand (or mine always is). You will never be alone.
Now talking about rooms take note of the choices because this is a tip for new players. At the beginning of the day, I was offered a menu of rooms and chose one priced at 4,200 baht a day, which came within my 5,000 baht room and board insurance allowance. Please note that under room charges the hospital includes the room rate and nursing services and possibly food as the one billable package under the heading “room rate”. So you need to allow for the possibility that if you add these three components together it might exceed your room insurance coverage, which it did with me. Try and get a total room rate price including the extras and if you need to you can adjust your accommodation to suit your budget. In the case of AEK, my Udon friend Daryl was paying almost half for his son’s room, which was exactly the same as mine on the same floor, so there’s a bit of a smoke and mirrors thing happening here.
I didn’t get a photo of the room thinking I could pull one off the hospital’s website (no such luck) but it is like a standard motel room. Big full-length windows opening onto a small balcony, not that I was too interested, a couch, which is where Gaun slept (some bedding provided) and an ensuite. A big (50 inch?) flat screen TV that I checked out to see if it was screwed down. I thought it could be a little souvenir of the visit 🙂 You get a box of supplies in the room with bathroom essentials and some other things. Do bring instant coffee or tea as they supply a flask of hot water but there are no in-room drink making supplies. There is a bar fridge but no beer 🙁 The bed is an electric one so you can adjust it easily (Peng even had one of these in her public hospital). Air conditioned of course while Peng had to rely on overhead and floor fans.
The nurses made their usual regular visits to hand out medication and check blood pressure and temperature. I only had to push the buzzer once and got a response quickly. They leave you alone outside of that basic maintenance, which in my case was fine. You are, even in a private hospital, expected to have a family member present for the whole stay. If you read the small print of what you sign before the operation there’s a “fall indemnity” which is specifically geared for your support “team” and states you must have someone with you the entire stay. However, especially with a farang, I am sure the hospital is geared for a person who can’t bring a friend and I presume the nurses get to do more work in that case.
You have the opportunity to choose meals from a very extensive menu (at least 5 pages) but not surprisingly 95% of it is Thai dishes. Considering this is an international private hospital with a decent number of expats coming through I would have thought I was a bit disappointed they didn’t have even a very small menu for our tastes. I was told that they would collect food you ordered outside the hospital (a Big Mac with extra cheese, fries and a large strawberry shake springs to mind) but I suspect you would be handing over money for that service. The breakfasts had a few western options although their idea of an American breakfast was a pretty poor attempt. The food side of things was all a bit academic as I wasn’t hungry but Gaun and Tik were happy to eat whatever was provided. TV is Thai only, although there may have been one farang channel in there. The wifi works well enough to power internet browsing and emails.
Mine was only an overnight stay and as always there’s nothing better than getting out of hospital and back home. The nurses made an appearance the next morning to remove the drip lines and we then waited a couple of hours for the final invoice to be worked up. This was done along with three ladies from their PR section who handed over a basketful of goodies including a clock. I only raise the clock because Daryl, whose son has been having problems and is a regular visitor overnight, now had five clocks!
Expecting to pay for the outstanding cost over and above the 40,000 baht deposit I was pleasantly surprised to hear that the hospital and the insurance company had been talking and the only additional money required was 700 baht for the excess room charge (discussed previously). A wheelchair with orderly was on hand to take me to the car (Yuan and Lud having arrived by now) and all the on-duty nurses came to the lift to formally say goodbye.
My final invoice is below. Who knows what all of that means but I am sure it is well padded. My brother-in-law Lud had a hernia operation done at the local public hospital and it cost him nothing. Another brother-in-law had one and he paid an “express” fee to the surgeon of 2,000 baht for his. Mine at 76,000 baht is vastly expensive by these local standards. Even as a farang if I had mine done as a paid procedure in a public hospital it would have been significantly less. If I didn’t have insurance this is the route I would have taken. In a rural area where heavy manual work is a norm I am sure that the local doctors are pretty competent with hernia operations, so I wouldn’t have been concerned. However, having insurance cover it was an easy decision to go private.
About ten days later I went back to AEK for a checkup and to have the stitches removed. That cost me 1,200 baht (my insurance is only for in-patient costs so I had to cover this and the initial consultation). The hospital had previously phoned to say that my refund was ready to collect, which I did at this time. It is now five weeks since my operation and it has healed nicely.
So my first real experience of the Thai medical system was a pretty “painless” one. The hospital process all worked as intended and Pacific Cross lived up to expectations. The main oddity is that 40,000 deposit, which I would query if I had to do this again. Think of the money you’d have to put down for a triple bypass or something far more serious than my minor procedure. I have included my Pacific Cross invoice just to give you an idea of the coverage available on a modest plan and the cost involved for a 61-year-old:
Check out Pacific Cross for your health insurance. One of the big benefits over some of the pure Thai alternatives is that their information and policy terms and conditions are in English. Trying to work through a Thai version with a partner who may not be up for the specialised translation required can be risky. This is such a complicated area that the bonus of being able to see what you’re paying for is a useful one. You can download their very clear brochures as follows:
Standard Plan HERE
Premier Plan HERE
Maxima PLan HERE
and Ultima Plan HERE
If you would like to chat with an English speaker in Pacific Cross you can contact:
Jamie Connell, Director of Client Relationship
Office: 02-401-9189 I Fax: 02-401-9187 I Mobile 0924 063962
152 Chartered Square Building, 21st Floor, Room 21-01 North Sathorn Road, Silom, Bangkok Bangkok 10500
The only reason have added these links is not to promote Pacific Cross, although it may look that way, but that these PDF brochures give you an excellent start from which to compare other plans that may not be so well presented. If you know what your base standard is it then makes it easier to ask about what other maybe more Thai orientated insurers are offering. For example, these are the benefits to the plan I have:
If you have anything you can add to this post please leave a comment. As I said before it is a much-discussed topic on Thailand expat forums and any insights, tips or recommendations would be much appreciated, not just by me but the many others who follow my blog.
Thanks for reading.