Best Health Insurance for OPD treatment/medications for chronic illness?

[jackspade]

As luck has it, a week before my meeting with a private insurance advisor, I was diagnosed with Psoriasis and Psoriatic Arthritis. I've now been to the hospital twice in the past 2 weeks and my doctor (Dr. Supat, Bangkok Hospital, EXCELLENT doctor, highly recommended) is keen to get me started on an immunosuppressant biologic as soon as I have insurance coverage, because NSAID treatment is not proving to be very effective.

 

I haven't yet obtained insurance yet because my work permit was only processed last week. Now I'm finally free to go get insurance, but I'm unsure of how to do so and ensure that a future biologic will be covered. Biologics are the most like to put the arthritis into remission for the long-term, but the uninsured cost for an initial treatment of either Cosentyx (secukinumab) or Simponi (golimumab), either of which Dr. Sutep recommended after two very thorough appointments, is very high. Any drug ending with a "mab" are virtually the most expensive drugs on the planet. An initial injection of Simponi, for example, was 240,000 THB without insurance.

Obviously this is a dealbreaker for me, so I absolutely have to find an insurance which will cover this. I'm only 32, and otherwise in good health. (????) Does anyone have any recommendations?

[robblok]

Would this not all be pre existing and excluded from any insurance ? It would be lying if you say you have nothing and then quickly start the regimen. They are not stupid at the insurance companies with claims like that. 

 

Just my two cents, I doubt this will covered unless you lie on your application and are not found out.

[simon43]

As Robblok said, it's now a pre-existing condition, and no insurance company will offer you cover.  Furthermore, if you think you could just keep it a secret from the insurance companies, you've just announced your illness (including the doctor's name and hospital) on an open forum!

[jackspade]

Correction: Dr. Suthep should be Dr. Supat.

 

7 minutes ago, robblok said:

Would this not all be pre existing and excluded from any insurance ? It would be lying if you say you have nothing and then quickly start the regimen. They are not stupid at the insurance companies with claims like that. 

 

Just my two cents, I doubt this will covered unless you lie on your application and are not found out.

 

Excellent work Sherlock, that's the entire reason I posted this thread. ????

[robblok]

Just now, jackspade said:

Correction: Dr. Suthep should be Dr. Supat.

 

 

Excellent work Sherlock, that's the entire reason I posted this thread. ????

Sorry i thought something like this would be obvious. I thought it would be common knowledge that previous conditions are exuded. Sorry for relying too much on common knowledge. 

[jackspade]

12 minutes ago, simon43 said:

As Robblok said, it's now a pre-existing condition, and no insurance company will offer you cover.  Furthermore, if you think you could just keep it a secret from the insurance companies, you've just announced your illness (including the doctor's name and hospital) on an open forum!

????

[jackspade]

Just now, robblok said:

Sorry i thought something like this would be obvious. I thought it would be common knowledge that previous conditions are exuded. Sorry for relying too much on common knowledge. 

It is common knowledge. I was looking for uncommon knowledge/alternative solutions of which I might not already be aware.

[robblok]

Just now, jackspade said:

It is common knowledge. I was looking for uncommon knowledge/alternative solutions of which I might not already be aware.

There is none, sorry mate, the basis of insurance is to insure against an event that MIGHT happen. Not something that will happen. Why would they take you knowing you are going to cost them money unless they can charge you more. 

 

They are in the business of making money, you want to save money and let them pay for it.. just wont work. 

 

Sorry to see you go health problems always suck. 

[lopburi3]

Is return to your home country an option for treatment?

[jackspade]

24 minutes ago, lopburi3 said:

Is return to your home country an option for treatment?

Yes, and I've just discovered Janssen CarePoint, which is a program that works in tandem with my home country's health insurance providers to bring a single treatment down to $5 per injection. Unfortunately I don't know if living abroad is going to render me disqualified, gotta read the fine print.

 

Unfortunately, I can't travel back and forth all the time, it's just not financially viable. So it's looking like I'll have to relocate back to my home country.

[Sheryl]

There is no way you can get a private, individual insurance policy that covers a pre existing condition like this.

In addition OPD cover is prohibitively expensive and the added premium often equals or exceeds the maximum benefit.

However, as you are working here you might be covered under the Thai Social Security system. Pretty much all employment except in private schools is covered. With SS pre-existing does not matter and there is full in and outpatient cover, but you have to get care in one specific hospital which you select from among those in your area which participate in the scheme. Bangkok Hospital and similar are not in the scheme. It is mostly government hospitals.

While SS covers all conditions there are some newer high cost medications not included. I can't say re the medication you need. They might cover only the older drugs like methotrexate but you'd have to ask.

If you are employed by a private school sometimes these have their own group insurance plans, and being group plans it is possible that individual conditions aren't excluded, but these plans are usually of very low level cover.

You need to talk to your employer to find out if you are under SS (there would be payroll deductions for it) or not. If not then find out what if any health insurance rhey provide Then take it from there.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[jackspade]

On 2/3/2019 at 12:02 PM, Sheryl said:

However, as you are working here you might be covered under the Thai Social Security system. Pretty much all employment except in private schools is covered. With SS pre-existing does not matter and there is full in and outpatient cover, but you have to get care in one specific hospital which you select from among those in your area which participate in the scheme. Bangkok Hospital and similar are not in the scheme. It is mostly government hospitals.

While SS covers all conditions there are some newer high cost medications not included. I can't say re the medication you need. They might cover only the older drugs like methotrexate but you'd have to ask.
 

Thank you for your always helpful responses, Sheryl.

I have talked to my employer and I am covered. I am getting my SS healthcare card in April. I would certainly not mind having a place such as Chulalongkorn as my hospital of choice.

I'd be shocked but elated if SSO covers biologics. They could take care of 200 people with methotrexate or sulfasalazine for the same price.

I'll email/call the SSO and ask what is covered, unless you happen to have a link... their website is clearly intended for their own citizens.

[Sheryl]

7 minutes ago, jackspade said:

Thank you for your always helpful responses, Sheryl.

I have talked to my employer and I am covered. I am getting my SS healthcare card in April. I would certainly not mind having a place such as Chulalongkorn as my hospital of choice.

I'd be shocked but elated if SSO covers biologics. They could take care of 200 people with methotrexate or sulfasalazine for the same price.

I'll email/call the SSO and ask what is covered, unless you happen to have a link... their website is clearly intended for their own citizens.

Great that you have SS, you are then insured regardless of pre-existing, with both in and outpt cover. However it is very possible biologics are not covered. If they are it may be conditional e.g. only in patients who first took first line DMARDs failed to improve.

 

I am not sure SS office will be able to give you this info readily but you can try. The hospital will certainly know.

 

Chula, Siriraj etc have long been closed to new SS enrollment.  The last list I saw for Bangkok of hospitals open to new SS enrollment included Mission Hospital, which is   non-profit private hospital, small in size but good in quality. There is only 1 rheumatologist there, Dr. Pornthip Inphibul, so you might want to arrange a consultation first to see if you are happy with him/her before listing that hospital.  Mission Hospital also has a good American GP, one of the few licensed in Thailand, Dr. Nick Walters.

 

Otherwise, from what I recall of the list, Lerdsin looked like the  best of the available government hospitals

[jackspade]

8 minutes ago, Sheryl said:

Chula, Siriraj etc have long been closed to new SS enrollment.  The last list I saw for Bangkok of hospitals open to new SS enrollment included Mission Hospital, which is   non-profit private hospital, small in size but good in quality. There is only 1 rheumatologist there, Dr. Pornthip Inphibul, so you might want to arrange a consultation first to see if you are happy with him/her before listing that hospital.  Mission Hospital also has a good American GP, one of the few licensed in Thailand, Dr. Nick Walters.

 

Otherwise, from what I recall of the list, Lerdsin looked like the  best of the available government hospitals

Many thanks for recommendations!

[Sheryl]

Re options for biologics at lower cost see thsi thread https://forum.thaivisa.com/topic/1083310-psoriasis/