Reader Submission: Not all medical expenses in Thailand are reimbursed by health insurance
A few days ago, a request was made for experiences with Dutch health insurers in connection with reimbursements from Thai accounts. I was in a critical phase of talks with ZK at the time, but it has now been closed. Here's my experience.
I have been in Thailand from 15/11/2017 to 1/5/2018. Am insured with the Zilveren Kruis. Submitted 16 Thai bills on May 14. ZK says that claims are in principle processed in 3 days, but everything is only processed on June 12th. Communication was slow and difficult.
It concerns bills from hospitals, clinics and pharmacies. A bacteria in my ear, a food poisoning and two problems with a worn knee. Because I had brought medicines for 4 months and I stayed longer in Thailand, I had to buy medicines there.
Everything that I have declared is submitted to ZK by the healthcare provider in the Netherlands and I see nothing of it. Everything is always reimbursed. Now ZK refuses to reimburse around € 850 of the € 400 that I submitted. Reasons: we do not reimburse undated bills (is one of € 20), if you take medicines in the Netherlands that we reimburse, this does not mean that we reimburse the Thai equivalent, and finally, an expensive injection of Hylaruonic acid that I already have in the Netherlands Have had 2x and which may prevent knee surgery not reimbursed.
Submitted by Hans
Am I missing the sequel, or have you acquiesced in their point of view? And were you insured for costs abroad by means of a supplement to the standard policy?
Firstly, not reimbursing an undated invoice seems logical to me in connection with fraud. It is your own responsibility to ensure that you receive the correct invoice. The non-reimbursed injection: yes, if it is not urgent or too expensive and you take it without prior permission, it is always required abroad, then it is fair that Zilveren Kruis does not accept it. Why haven't you taken out travel insurance so that unforeseen medical costs are reimbursed? I think it's my own negligence, so don't complain afterwards.
I submitted this message on June 11. Here's an update.
After emails and a few phone calls, I sent ZK an overview of my Dutch medicines and the equivalents in Thailand. After that, they finally reimbursed all the medicines.
ZK writes that they usually pay out after three days, for me the medicine payments took up to six weeks.
As far as the hyaluronic acid injection is concerned, ZK wrote in their last email that they MAY NOT reimburse it. That seemed odd to me, I thought they didn't WANT to. The consumer association also thought in that direction.
I have sent a complaint to the SKGZ (Health Insurance Complaints and Disputes Foundation) and it is now being processed.
I also found an article at the Zorginstituut Nederland in which they point out that the reimbursement standard of something that may look like it should be adjusted. However, this government agency advises and, to my knowledge, does not prescribe.
Because of these injections in 2011, 2013 and 2018 I have avoided a €10.000 knee surgery for seven years and now ZK wants me to pay the costs. We are waiting to see what SKGZ reports.
I have the same experience with ONVZ. I also have additional insurance there.
Payments are made, but bills must meet several conditions, including:
– bill drawn up in English language (not everyone is probably familiar with Thai language 😉
– reason for consultation, number of consultations
– doctor's conclusion: diagnosis and possible treatment plan
– specification of treatment and medicines performed: type, quantity, price
– doctor's authorization number, doctor's signature
– name, address details and hospital stamp.
Certain hospitals, mostly private hospitals and internationally oriented, have no problem with this. Other hospitals cannot issue an invoice in English language.
Especially when it comes to more expensive interventions, it is better to first consult with the insurer about exactly what is covered and to find out what the invoice must comply with.
Small expenses I usually pay out of my own pocket if expense claims are not worth it.
Clear summary of the requirements that an invoice must meet. Not unreasonable in itself. But as you yourself noticed, not all hospitals are able to issue a bill in English. And it will often be those hospitals that generally charge a lower price for procedures than the internationally oriented hospitals. With regard to the injection in the knee, Hans could have avoided financial problems by contacting his insurer in advance. I don't give him much hope of a positive result for him on his complaint to the SKGZ. The SKGZ checks whether the law has been applied correctly and does not consider whether an injection prevents an expensive operation. Hans's insurer explicitly states that they are not allowed to reimburse the injection and that will most likely be based on legal rules.
In 2010 I contacted my health insurer, VGZ, by e-mail. Reply by email back: “advance there, declare here.
Back in NL: the entire claim REFUSED, because… not sufficiently specified (up to a needle of € 1,25 (45 THB) was still added), invoice not readable (it was bilingual: Thai and English) and finally: ineffective care. Now that was also from a 3rd grade jungle hospital, called: Bumrungrad in Bangkok. also the witch doctor there, Dr Verapan, and he masters his profession in such a way that he gives demos all over the world of new developments in his field, see google.
Oh double laugher: a few months later, with the aid of Thai scans and examinations, I underwent double back surgery in a VGZ contract hospital in Brasschaat (B). Nothing could be found in the Dutch hospital…
Face it: in the KNOWLEDGE economy we have a few doctors (or are they accountants) towering far above the rest of the world, who know everything much better. That is why treatments applied worldwide are declared here "not in accordance with current science and technology", and are therefore NOT eligible for a declaration, including injection with Hyaluronic acid (see Google), see for example the last piece: https://www.orthopeden.org/downloads/85/standpunt-hyaluronzuur-bij-artrose-knie.pdf or 3rd paragraph https://www.zorginzicht.nl/bibliotheek/hyaluronzuur-injecties-bij-artose-van-de-knie-federatie/Paginas/Home.aspx
That people think differently in many places in the world… well think of Heinrich Heine, around 1800: “when the world ends, I will go to Holland, everything will happen there 20 years later”.
If you detect a slight sarcastic undertone in my story… YES !
Now I have the same problem with my knee, the injection with Hylaruonic acid is also not reimbursed with me (CZ)
The reason they say is that it has not been proven that it works medically those syringes.
Have to say I'm not happy to have it put in because it's a very painful experience.
Had three put in and must say it does help previously painful and always water in my knee that also had to be removed.
Sodium Hyalurronate 25 mg. 2.5 ml, so not reimbursed, have to add that they are expensive that spraying received bills of around 6500 baht every time.
Does anyone know if she will be reimbursed in Ned??
Robert
Undated bills are not reimbursed, logical right!
In fact, you write it yourself.
Because I stayed longer in Thailand….
A travel insurance serves this purpose, which means that ZK now has the feeling that they are paying for costs that a travel insurance company should have paid for.
Depending on where the medicines were bought, they could have been more expensive than if you had bought them in the Netherlands.
If they were bought in a private hospital, you will pay top price for medicines.
Is that so? I suspect that if you were to submit those medical expenses to the travel insurance company, they would refer you to your health insurance policy.
It's just the other way around. You must first submit the costs to your health insurer. If these do not reimburse and you meet the conditions of the travel insurance for reimbursement of the extra medical costs, you can claim it there in the second instance. But here too you come back to the same as with the health insurer, such as the necessity of, for example, the injection, billing requirements and most importantly before you enter a hospital you must formally request permission from the travel insurer for the treatment and medicines to be used and more. And if you don't have travel insurance then you have no right to speak.
And the travel insurance declares on to your health insurance. That's why they ask. So I advise you to take out both with the same insurer.
well,
you can buy a simple date stamp at any bookshop, Tesco and Big-C
Or pay by credit card. Is the exchange rate fixed?
I see some correct and some incorrect responses.
Ruud: that is NOT what travel insurance is for. If you have additional health insurance, this takes precedence as far as reimbursement of medical expenses is concerned.
I have a continuous travel insurance for a stay of up to six months. So the question why I don't have it is not justified.
The medicines in Thailand cost less than when I spent those extra 2 months back in the Netherlands
had been. By extending my stay I saved costs for the ZK.
I have told the sequel. That is submitting a complaint to SKGZ, a neutral body.
My supplementary insurance reimburses all foreign costs with the exception of the USA.
That undated bill was a small one, I should have paid more attention. That was €20 of the €400.
As you write, the travel insurance is for additional medical costs. This means costs abroad that are not covered by the Health Insurance Act. No Dutch travel insurer will be the first to reimburse the costs, because then you quickly end up with a premium of more than 100 Euro per month, equal to a normal health insurance.
Our experience with health insurance through ZK was excellent. Part of the costs were not reimbursed because they were included in the deductible. However, these costs were neatly paid by the travel insurance with the view that we would not have had these costs if we had stayed at home. We are therefore satisfied with the handling of both health and travel insurance.
Isn't it true that you must request prior permission from your health insurance provider for almost all non-emergency medical treatments in the countryside? Then they would also have provided clarity about the compensation. No matter how reasonable you think it is and sometimes even cost-saving compared to the Netherlands. Without prior permission, there may be a lot of misery afterwards.