Overprized bill at hospital. Is that possible?

[vi2004]

Hi all,

we have a baby of 7 months in my wife's family.

The baby got fever, the family went to Thainakarin Hospital in Bangna.

The baby got admitted to hospital as the fever went up to 40.

Now the baby spend already 2 days in a normal open to visitors single room.

I told the family to ask for a bill. We were presented a bill for until now of over 22.000 baht???!!

I can see on their website that the room costs 2600 + 1700 nursing fee + 500 service fee = 4800 baht for one day.

The baby gets a simple infusion to keep the baby hydrated I guess and maybe with some other medicine.

Still if the room is about 4800 baht for one day ... what about the other 6200 baht a day.

I cannot believe that this is correct.

On the same website they state the daily price for ICU with 4500 + 3500 + 800 = 8800.

I cannot belive that non-ICU should be 11.000 baht a day.

I am going to talk numbers with them.

But I would be happy to get some ideas and experiences from you

[lopburi3]

First ask for a detailed receipt (itemized bill) - that will show the charge for each item and all hospitals can provide if asked (required for insurance). From that you have a basis to bargain if things seem overpriced or not received.

[vi2004]

Thanks for the answer. I will do that. But I have no experiences in these prices.

I just cannot believe that the baby's treatment ist more expensive than ICU.

I have been there while the nurses visit the baby.

They check fever, give some medicine and sometimes wash the baby.

I would think that this is included in the nursing fee.

6200 baht extra for one day just does not make sense.

I can only compare to ICU with common sense. Other than that I have no experiences regardinhg the price

Do you think it is possible to pay first and make some claims later?

Not sure what to do

[vi2004]

oh ... and I don't mean to bargain or haggle if that impression came up.

I (we) just don't want to get ripped off because I cannot believe that 11.000 a day for non ICU and non critical treatment can be correct.

And the Thais I know tend to believe everything they get presented ... in this case the bill

[lopburi3]

The treatment includes doctors and medications and tests - normally this would amount to at least 2x a room total charge per day. Until you have a detailed statement there is no way to know. Get the detailed receipt before paying - you have every right to have that.

Private hospital are designed to make money - if you use them you pay the price. But they can and do make mistakes so you really need to check the receipt - and if you can not do prior to it being paid and find errors later expect hospital will make good on them if pointed out.

[vi2004]

Ok, thank you.

I will do that. They should be able to present a detailed bill in English.

[loppylugs1]

Private hospitals will bump that bill up every which way, changing half filled oxygen bottles for full ones,keeping you there when there is no need (is need according to them) cartloads of unnecessary medicine

Years ago I had experience I got interview with hospital directer before paying the bill,I knew exactly what their game was,got 50% off,others not so lucky,once bill paid,too late

[ezzra]

You an bargain with them, they have the authority to give you at least 10% discount,

I did with a 350,000 baht bill... don't be shy, ask why and winge and complain

and you'll get a discount, and next time ask in advance what the expect as far

as costs and ask for a quote in writing....

[Sheryl]

The cost you mention is actually quite low for a Thai private hospital. Room rates are always the least of the charge. A two day hospital stay will never be less than 20,000 baht and usually much, much more.

There will be charges for the IV solution, the IV tubing, use of an IV pump to regulate the rate, for the equipment and supplies used to insert the IV, for all medications given, and doctor fees. Even the disposable thermometer used to take the baby's temperature, will be charged.

As others have said, request a detailed bill to make sure there are no inappropriate charges but at that price do not be surprised if it all checks out.

If the child is Thai, could have receive free care in a government hospital.

[luke000]

I took my two year Son to a top private hospital and he spent two nights and days there and had two drips and some checks and pills and the bill came to 11 000 Baht .

[Sheryl]

In the Bangkok area?

[luke000]

chiang mai ^

[Sheryl]

There is a very big difference between hospital costs in Bangkok and upcountry. 22,000 is low for 2 days in a private Bangkok hospital.

[vi2004]

The cost you mention is actually quite low for a Thai private hospital. Room rates are always the least of the charge. A two day hospital stay will never be less than 20,000 baht and usually much, much more.

There will be charges for the IV solution, the IV tubing, use of an IV pump to regulate the rate, for the equipment and supplies used to insert the IV, for all medications given, and doctor fees. Even the disposable thermometer used to take the baby's temperature, will be charged.

As others have said, request a detailed bill to make sure there are no inappropriate charges but at that price do not be surprised if it all checks out.

If the child is Thai, could have receive free care in a government hospital.

Actually I did not expect that.

I remember that I went to Phra Ram 9 hospital.

Seeing the doctor was 400 baht, x-ray, medication ... total loss 1100 baht.

In the original case that I started this topic with we are talking about 6.200 baht extra per day. Even if I take away the 400 for the doctor every day, I am still at 5.800 extra per day.

Don't get me wrong, I believe you. From what I have read here on the forum you obviously know a lot about all this stuff.

But I am still surprised about this amount of money for such minor and common things (in my opinion) like IV solution, tubing etc.

For me it looks a little bit like the electricity bills in Bangkok.

If you choose a condo where you directly pay to the MEA you pay about 3.5 baht a unit.

If you choose the "wrong" condo then you are paying double.

Not sure if that comparision works.

Just a feeling ;-)

[Sheryl]

Outpatient charges and inpatient charges are totally different.

The doctor's daily fee will be much more than for a single OPD visit. There may even be more than one doctor charged if for example another doctor was called in for a consult.

As said, get the itemized bill. Even if already paid, can still get it. Mistakes can happen, you may find things on there that shouldn't be (there was a recent report on this board of a patient being tube-fed and unable to eat, whose bill showed charges for food ordered from a restaurant!).

If nothing else it will give you an idea of what inpatient costs are like.

BTW the admission may not have been necessary if the child was active, alert and able to keep down fluids and had no abnormal neurological signs or trouble breathing. While a temp of 40 can scare parents -- especially first-time parents -- children do commonly spike temperatures that high and in itself, other than in a neonate, it is not an indication for hospitalization. Government hospitals will never admit a patient unnecessarily but private hospitals can and will.

[lopburi3]

As has been pointed out you need to read the bill - your land line phone bill is only 107 baht each month - but if there was any activity it will likely be many times that as the final bill. It is listed on the back - just as a hospital bill is listed if you request a detailed receipt.

[bkkmick]

17k for 4 nights in Siriraj being treated for DKA. It was an open ward but the treatment was great.

[Sheryl]

Yes, government hospitals are vastly less expensive. But this was a private hospital.

[vi2004]

Thanks everybody.

Just a quick update for now:

Total on the bill is 25.000 baht.

Many small positions.

The highest being

- the room for two days 5200 baht (which seems to be correct since this price is stated on their website)

- the nursing charges of 3400 baht (ok too, also stated on the website)

- in-patient medication 4800 baht (I would think this is a bit high but how would I know)

- and they did some lab work for 3600 baht

Initial in-patient evaluation management for 1700 baht.

That for me sounds like a money-making fee. I guess that means putting some names, addresses and numbers in the computer.

But again how do I know. ;-)

So lesson learnt for me and the family.

Next steps / questions:

- Get some decent in-patient health insurance soon. Which one for a Thai baby or maybe Thai mother/baby combination?

- To what hospital should they/we go in the meantime (or even after a health insurance is active)?

[Sheryl]

Inpatient evaluation and management is the fee for the doctors.

Thai mother and baby already both have health care coverage at the government hospital for the area where they are listed in a tabian ban, free of cost. Should hospitalization be required, can pay extra to get a private room. I would really suggest doing this rather than using private hospitals.

But if you are set on private hospitals, then in the Bang Na area I would suggest Sikarin. http://www.sikarin.com/en

For anything very unusual/complicated/highly specialized, need to select the doctor rather than the hospital. There are many threads on this forum recommending doctors for various things, can use the search function. But for routine matters Sikarin will be fine.

The most widely used Thai health insurance is BUPA. http://www.bupa.co.th/en/individuals.aspx

They do not AFAIK have any sort of family plan, you would have to separately insure both mother and baby, though you should call to confirm this. Outpatient cover is usually not worth it as it pushes the premiums way up, and outpatient care is pretty affordable (never, however, buy medicines at the hospital pharmacy as there is huge mark-up. Note the names and buy at a pharmacy). . Health insurance is not a very good deal in Thailand since very, very few Thais get private insurance due to the universal coverage they already have.

Normally I advise people to not consider cover below the level of the Platinum 5 Plan (5 million baht, as this is what a single hospitalization in a private hospital can run to if it is a really catastrophic illness or injury). But in the case of Thai nationals where free care is available at a government hospitals as a fall back and the insurance is just to allow for the greater amenities/comforts/conveniences of a private hospital then could get a lower level of cover with lower premiums, understanding that in the case of something really huge you'd have to use the government system and their government health cover ("gold card").

Don't forget to insure yourself while at it. If you are employed you should already be covered under the Social Security scheme. Otherwise it is a must, unlike Thais you cannot get free care at a government hospital.

[lopburi3]

That appears to be normal receipt - a detailed receipt must be requested and will provide full details and as said inpatient will likely cover doctors fees and medical equipment breakdown as well as each blood or other test and charge - as well as the amount and charge for each medication. They have this on there computers so only takes a few seconds to provide (once they understand what you want).

Edit: maybe I am wrong above as you mention many small positions - but what you outlined are normally on the cash receipt which is total in each category rather than complete breakdown. As pointed out Thai have good and free medical care.

[Social Media]

Provided as a comparison, Thai Mother & Baby with fever, admitted to Government hospital 2 day stay, transferred to Private room with A/c etc, total bill on discharge 4800 baht.

[hbullinger]

In our condo we have to pay 9 baht per unit!!

The cost you mention is actually quite low for a Thai private hospital. Room rates are always the least of the charge. A two day hospital stay will never be less than 20,000 baht and usually much, much more.

There will be charges for the IV solution, the IV tubing, use of an IV pump to regulate the rate, for the equipment and supplies used to insert the IV, for all medications given, and doctor fees. Even the disposable thermometer used to take the baby's temperature, will be charged.

As others have said, request a detailed bill to make sure there are no inappropriate charges but at that price do not be surprised if it all checks out.

If the child is Thai, could have receive free care in a government hospital.

Actually I did not expect that.

I remember that I went to Phra Ram 9 hospital.

Seeing the doctor was 400 baht, x-ray, medication ... total loss 1100 baht.

In the original case that I started this topic with we are talking about 6.200 baht extra per day. Even if I take away the 400 for the doctor every day, I am still at 5.800 extra per day.

Don't get me wrong, I believe you. From what I have read here on the forum you obviously know a lot about all this stuff.

But I am still surprised about this amount of money for such minor and common things (in my opinion) like IV solution, tubing etc.

For me it looks a little bit like the electricity bills in Bangkok.

If you choose a condo where you directly pay to the MEA you pay about 3.5 baht a unit.

If you choose the "wrong" condo then you are paying double.

Not sure if that comparision works.

Just a feeling ;-)

[vi2004]

Inpatient evaluation and management is the fee for the doctors.

Thai mother and baby already both have health care coverage at the government hospital for the area where they are listed in a tabian ban, free of cost. Should hospitalization be required, can pay extra to get a private room. I would really suggest doing this rather than using private hospitals.

But if you are set on private hospitals, then in the Bang Na area I would suggest Sikarin. http://www.sikarin.com/en

For anything very unusual/complicated/highly specialized, need to select the doctor rather than the hospital. There are many threads on this forum recommending doctors for various things, can use the search function. But for routine matters Sikarin will be fine.

The most widely used Thai health insurance is BUPA. http://www.bupa.co.th/en/individuals.aspx

They do not AFAIK have any sort of family plan, you would have to separately insure both mother and baby, though you should call to confirm this. Outpatient cover is usually not worth it as it pushes the premiums way up, and outpatient care is pretty affordable (never, however, buy medicines at the hospital pharmacy as there is huge mark-up. Note the names and buy at a pharmacy). . Health insurance is not a very good deal in Thailand since very, very few Thais get private insurance due to the universal coverage they already have.

Normally I advise people to not consider cover below the level of the Platinum 5 Plan (5 million baht, as this is what a single hospitalization in a private hospital can run to if it is a really catastrophic illness or injury). But in the case of Thai nationals where free care is available at a government hospitals as a fall back and the insurance is just to allow for the greater amenities/comforts/conveniences of a private hospital then could get a lower level of cover with lower premiums, understanding that in the case of something really huge you'd have to use the government system and their government health cover ("gold card").

Don't forget to insure yourself while at it. If you are employed you should already be covered under the Social Security scheme. Otherwise it is a must, unlike Thais you cannot get free care at a government hospital.

Thank you very much Sheryl for your time and extensive answer.

I will dig deeper into that.

I heard about the issue with the local health care coverage before and had lengthy discussions about that.

If a Thai person is listed in a tabian ban at e.g. a dictrict in Isaan because that is where their house is but they actually live most of the time in Bangkok then are they entitled to "free" health care coverage at a government hospital in Bangkok?

If not it is not very feasible to travel 700 km in a case of emergency.

Since the place where they live in Bangkok is a rented apartment/condo there might be no Blue Book with their name in that as far as I understand. And even if ... can you be listed in two Blue Books and get government health care in two areas?

That is something I didn't get so far ;-)

By the way ... I have health insurance already

That appears to be normal receipt - a detailed receipt must be requested and will provide full details and as said inpatient will likely cover doctors fees and medical equipment breakdown as well as each blood or other test and charge - as well as the amount and charge for each medication. They have this on there computers so only takes a few seconds to provide (once they understand what you want).

Edit: maybe I am wrong above as you mention many small positions - but what you outlined are normally on the cash receipt which is total in each category rather than complete breakdown. As pointed out Thai have good and free medical care.

Unfortunately I couldn't be at the hospital at the time they requested the bill. But it took the hospital 3 hours to make the bill. I guess although they have a designated international service area they usually don't have to write too many bills in English.

When I saw the bill I was under the impression that this is a detailed bill but now - after what you mentioned - I am not so sure anymore.

Provided as a comparison, Thai Mother & Baby with fever, admitted to Government hospital 2 day stay, transferred to Private room with A/c etc, total bill on discharge 4800 baht.

Wow! I am kind of jealous now. Which government hospital was that?

Any tipps for government hospitals ... preferably in the extended Ratchada area

[Sheryl]

" ... If a Thai person is listed in a tabian ban at e.g. a dictrict in Isaan because that is where their house is but they actually live most of the time in Bangkok then are they entitled to "free" health care coverage at a government hospital in Bangkok?

If not it is not very feasible to travel 700 km in a case of emergency.

Since the place where they live in Bangkok is a rented apartment/condo there might be no Blue Book with their name in that as far as I understand. And even if ... can you be listed in two Blue Books and get government health care in two areas?

That is something I didn't get so far ;-)"

Free care is only at the hospital responsible for the area in which the person is listed in a tabian ban except in emergency, in which case it is available at any government hospital. Sometimes takes a call to the NHSO hotline to make the hospital waive the charge, but this works and they will - provided it was truly an emergency.

It is perfectly possible to be listed in the tabian ban of a rental. The tabian ban will list the landlord as owner but can (and in theory should) then also list all the people who live there. Obviously, people do not always bother with this especially if they do not expect to live there long term.

However she can only be registered at ONE government hospital. Change of hospital registration can be done 4 times a year but has to be in accordance with tabian ban i.e. would have to change the tabian ban first then at the next open period apply to change hospital registration.

Information on all of this can be obtained from the NHSO, call center is 1330.

Thais tend to never adjust their tabian ban status and a large percentage of the population do not live where they are listed (which of course renders the whole system pretty meaningless, but never mind that). Hence massive movements of people on election days, and common for people to go back to another province for medical care. This owes a lot to dislike/fear of dealing with government bureaucracy, but it really is not that hard to effect a change -- a hassle yes, and will take a little time (and perhaps repeated requests to the landlord) but is worth it if expecting to remain at the same place for several years to come.

There is no choice of government hospital under the universal care system - it is determined by the catchment area of the tabian ban. Can ask neighbors which government hospital is responsible for the area where you live.

It is also possible to use government hospitals on a full pay basis, in which case you can use any hospital including police and military ones. While there will be a charge, it will be from 1/3 to 1/5 that of a private hospital, depending in which private hospital is being compared to. So very affordable unless it is a really major hospitalization with major surgery and/or ICU stay etc.

In addition, some government hospitals have a private channel wherein doctors can be seen by appointment after hours. Costs more but still reasonable and well worth it since (1) can choose the doctor, and be assurred of being treated directly by that person (through the public channel, no choice, and most care is from interns/residents in training under the supervision of a senior doc) and (2) much less wait time (through the public channel, waits are very long and it is first come/first serve. A single outpatient visit can take the better part of a day to complete).

Top government hospitals include Chulalongkhorn (Rama IV/Silom area), Siriraj (Thonburi area), Ramathibodi (Victory Monument area), Ratchatewi (ditto), Police Hospital (Ratchadamri area) and Pra Mongkut Klao (Army hospital, ditto). There is also a dedicated peds hospital, the Queen Sirikit National Institute of Child Health, on Ratchatewi.

Chula and Ramatibhodi both have special after hours clinics. Chula is reasonable, Ramatibhodi is quite expensive for foreigners but I think has double pricing so might be OK for Thai, not sure. I don't know about the Peds Hosptal but they well may, it is becoming the norm at government hospitals and medical centers.

For routine child health things like immunization and treatment of common simple illnesses, can also use the government Health Center. These are usually staffed by recent medical graduates and have no inpatient capacity but are fine for immunization and simple outpatient care of child illnesses, and usually much less crowded than the hospitals. There is one on Lard Prao Soi 24.