Medical insurance is a complex business Mr Ambassador

Only the most expensive forms of medical insurance will guarantee stays in the intensive care unit.

On a recent radio interview with Pattaya’s 103 station, British ambassador Mark Gooding pinpointed the lack of medical insurance by Brits as his biggest takeaway from his tour of the city. The point has been hammered home for 20 years by the UK government, yet above half of all international visitors (not just Brits) are uninsured according to surveys. It’s human nature, of course, to think “the worse won’t happen to me” but there are many reasons for the reality that Brits alone ran up unpaid hospital bills of 300 million baht (8 million pounds) annually prior to the pandemic. That’s according to a report in The Nation newspaper which referenced only state hospitals and omitted the private sector which rarely offers treatment anyway without a copper-bottom guarantee.

The first problem is definitional. Mr Gooding advised all visitors to Thailand to buy “travel insurance”, though he is obviously aware that expats or non-tourists likely won’t be covered if they are not based in the home country of departure. Medical Billing Advocates, an international watchdog leader, state that one in seven of all medical insurance claims are denied or rejected. They point out that the confusion between travel insurance, covering some but not all holiday mishaps, and comprehensive medical cover is a common cause of misunderstanding. Several recent cases of sick Brits appealing for crowd-funded donations to get them back to the UK for an emergency operation have been tourists who had not read the small print in policy documentation.

Thai authorities during the pandemic made matters murky by insisting all visitors had medical insurance – it started at US$50,000 but ended up at US$10,000 prior to cancellation – but then stating it could be restricted to Covid only illness. In the ensuing confusion, some international visitors failed to appreciate that a traffic accident was not Covid-related, whilst several companies went bust because of the pressure of coronavirus claims. Whilst there were undoubtedly some good policies out there, the cheapest ones claiming a month’s cover for a few pounds were worthless and designed only to survive the nod-and-a-wink Thailand Pass entry bureaucracy. There were even policies claiming to be comprehensive, but in reality only offering cremation benefit, and even then requiring documentary evidence of being Covid-free on initially entering the country.

Then we come to the expats. Many on one year extensions of stay, retirement or marriage, turn to agents for help because they lack cash in the bank or income to cover 800,000 or 400,000 baht respectively. The cash-strapped are unlikely to have the funds for comprehensive hospitalization and will simply hope for the best. It is known that a main reason for self-repatriation is fear of falling seriously ill in Thailand. But the only visas currently requiring medical insurance are one type of retirement visa and extension of stay (O/A) and the yet-to-start 10 year LTR or Long Term Resident Visa. There many alternative options without any insurance requirement at all, including the O retirement option and the Elite visa. The latter is seen by many observers as the safest bet because it guarantees multiple-entry for between five and 20 years.

Finally, there are the elderly and the super-aged. Insurance companies prefer customers who won’t make a claim so issues like gerontocracy, pre-existing conditions and high cholesterol in a medical report are distancing strategies like no other. So these expats must either sit tight and hope the grim reaper strikes quickly, or pay through the nose, or self-insure. Interestingly, the Thai Cabinet has now authorized self-insurance as a concept, though how it will be implemented by Thai immigration offices, if at all, is not yet crystal clear. Expat residence in Thailand is never much different. Whilst it is platitudinous to go on repeating “get insurance”, it is equally important to recall the legal concept Caveat Emptor. Buyer Beware!