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Health insurance: Your thoughts on deductibles and cost share

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11 minutes ago, simon43 said:

 So for me, having a deductible sounds like a good idea on paper, but isn't really a good idea, in that it encourages me not to seek medical treatment for an illness that might turn out to be rather serious.  With zero deductible, you can just go to the hospital and be admitted for tests.  

 

Note - hospitals are very happy to admit you, rather than provide these tests as an outpatient, because they know that many medical insurance policies will not pay out for OP tests/treatment.

It's a fair point you're making here. Having said that unless you opt for OPC you will always have to foot the bill for a consultation and treatment as an outpatient yourself (regardless of any deductibles etc).

 

I have a friend who is paying a high premium for OPC with his insurance company so that he won't delay going for a consultation just to avoid paying for it. Personally, I think the premiums the companies are claiming for OPC are unattractively high, especially given the fairly cheap cost for a consultation and basic treatment here in TH.

 

If we were talking about a 20-30% increase on top of the general medical insurance coverage then I might seriously consider OPC. But with OPC premiums being almost as high as the "main" insurance I cannot see myself opting for it.

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2 minutes ago, DUS said:

It's a fair point you're making here. Having said that unless you opt for OPC you will always have to foot the bill for a consultation and treatment as an outpatient yourself (regardless of any deductibles etc).

 

I have a friend who is paying a high premium for OPC with his insurance company so that he won't delay going for a consultation just to avoid paying for it. Personally, I think the premiums the companies are claiming for OPC are unattractively high, especially given the fairly cheap cost for a consultation and basic treatment here in TH.

 

If we were talking about a 20-30% increase on top of the general medical insurance coverage then I might seriously consider OPC. But with OPC premiums being almost as high as the "main" insurance I cannot see myself opting for it.

 

And a lot has to do with personal choice and the discipline (and wherewithal) to suck it up and go in even if you have to pay out of pocket.  Different folks have different needs and different idiosyncrasies.  For me, being 100% covered feeds into a little bit of the hypochondriac in me.  But that's just me. 

 

 

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I always thought that the high cost of Outpatient on insurance was due to things such as kidney dialysis, which is often done on outpatient basis. I don't know for sure but seemed logical as something like that is costly and long term.  ??

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42 minutes ago, cmsally said:

I always thought that the high cost of Outpatient on insurance was due to things such as kidney dialysis, which is often done on outpatient basis. I don't know for sure but seemed logical as something like that is costly and long term.  ??

You need to check with the individual insurance company. As for CIGNA chronic diseases/treatments such as kidney dialysis as well as diabetes will be covered without OPC as long as it isn't  a pre-existing condition.

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The thing to do is ask how much your premiums will be in 10/20/30 years when you need it most. See if its still affordable and worth it for you, everyone is different.

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4 minutes ago, scubascuba3 said:

The thing to do is ask how much your premiums will be in 10/20/30 years when you need it most. See if its still affordable and worth it for you, everyone is different.

Hehe.... yes, if your crystal ball gives you the answers to those questions then please let me know. I might want to buy one of the same brand as well then.... ;-)))

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When I went to the hospital with a fever, the doctor wanted to do some out-patient tests, (which would not be covered by my insurance).  I explained this and the doctor immediately said 'We must admit you for these tests...'  :)  The subsequent cost of these tests (and my stay in the hospital) were 100% paid by my insurance company - no need even to prepay and claim back later.

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59 minutes ago, simon43 said:

When I went to the hospital with a fever, the doctor wanted to do some out-patient tests, (which would not be covered by my insurance).  I explained this and the doctor immediately said 'We must admit you for these tests...'  :)  The subsequent cost of these tests (and my stay in the hospital) were 100% paid by my insurance company - no need even to prepay and claim back later.

 

You do know your insurance company monitors your social media posts?

 

Just kidding.  Or am I?

 

 

 

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You do know your insurance company monitors your social media posts?

 

Not a problem.  It was a medical decision to admit me....

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Right now I'm seriously considering going with Cigna Silver with a high deductible ($3,000) and high cost share (30%, OOP $5,000).

 

I'm 50 years old and in very good health. I know that could change in an instant, but up to this point in my life I have had very few health issues that required medical care.  The main reason I'm getting health insurance is that I don't want my savings wiped out if something does go very wrong.  Of course I don't want to pay $8,000, but at this point of my life I think this is a reasonable path to take.  But I'm willing to listen if you think I'm not thinking clearly or being foolish. 

 

Another poster on this thread recommended that people should talk to other people who have experience with the insurance company that they're considering.

 

Does anyone here have direct experience with Cigna and Thai hospitals?

 

Thanks very much.  :smile:

 

 

Edited by up-country_sinclair

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No experience with that insurance but paid 1.1 million baht for about 10 days/op in Thai hospital last year and about 100k in follow up tests.  Paid 380 thousand for one night stay/op a few years ago.  Paid 100k that same year for another 3 day stay/op.  Paid another 70k for IOL/cataract removals.  Another 100k plus for various skin cancer removals.  

 

If you get older you are very likely to have expenses - although you may (with luck) have some years before they start to hit.

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All the reports I have heard from people with Cigna Global have been positive and I switched to it myself a year ago, in my case $750 deductible and 20% copay up to maximum OOP $5000.

 

How much deductible you should accept depends  on how much money you can afford to put aside for health care costs  and  be able to replenish.

 

In thinking that through it is important to note that, while they guarantee lifetime cover, they do not guarantee  to cover you at a lower deductible/co pay than what you originally apply for. In practice, if you later want to reduce your maximum OOP and have had no claims or only claims for clearly one-time things, they will usually agree, but they may very well refuse if you have developed any chronic conditions or had claims of a type likely to recur - or, they may agree but exclude those conditions from the lower OOP.

 

So think not just of what you can afford now but what you will be able to afford 20, 30 years from now.

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I find this thread tough to follow. 

 

My wife has recently become a representative of one of the largest healthcare insurers in LOS. I'd be happy to give a quote to anyone with a couple of choices in plans that are more economical than stated above (I think) . I need your name, age and email address. 

 

I've just bought a policy that covers up to a million baht per incident. I'm 67 and the total cost is 74,000 baht a year and includes an accident and death policy. 

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55 minutes ago, Pinot said:

I find this thread tough to follow. 

 

My wife has recently become a representative of one of the largest healthcare insurers in LOS. I'd be happy to give a quote to anyone with a couple of choices in plans that are more economical than stated above (I think) . I need your name, age and email address. 

 

I've just bought a policy that covers up to a million baht per incident. I'm 67 and the total cost is 74,000 baht a year and includes an accident and death policy. 

 

As I understand it, the issue with Thai based insurance companies is that there is no guaranty they won't drop you like a rock if they figure you're going to need expensive services going forward.  Which leaves you with no insurance and a (now) pre-existing condition that will prevent you from getting anyone else to cover that condition.

 

I'd hate to find myself with cancer that may require years of treatment only to be dropped by my insurer when my annual policy comes up for renewal.  And good luck finding another policy that will cover it.

 

Again, I'm not holding myself out as an insurance guy, but most posts I've read seem to indicate that Euro based insurance companies are subject to higher standards when it comes to continuing to cover people who come up with long term health care issues.  (Edit:  I'd be interested in feedback about N. American based companies, but I don't read too much input about any of them, good or bad)

 

Anyone else have more insight?

 

Edited by impulse
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Not for open membership but have US Blue Shield/Blue Cross insurance which allows direct payment to selected hospitals here and have had good experience with them.  But if paying fully myself (and allowed which do not believe any open to public) cost would be about $750 per month (single) or $1500 (two) for unlimited/unrestricted coverage so it should be good.  Overseas they use AXA as their agent.

Edited by lopburi3

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