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Thailand Health Insurance Claims

Any medical treatment you receive which is eligible for coverage under the terms and conditions of your Thailand health insurance policy is liable for reimbursement and you as the policyholder must submit a claim for reimbursement of these treatment costs.

The claims process is a core component of all health insurance agreements and individual policyholders appreciate working with a medical insurance provider who are determined to provide a swift and effective claims service. Conscious of this, most Thailand health insurance providers operate a dedicated claims administration team to handle all aspects of the claims procedure.

Our support and research staffs continuously keep abreast of the claims policies and procedures provided by Thailand medical insurance providers and we are perfectly positioned to offer comprehensive and detailed advice on all aspects of your claims process.

Types of Health Insurance Claims

Depending on the Thailand health insurance provider and plan you have chosen, there are a number of ways the provider will try to resolve your claims application. We recommend that all policyholders ensure they know exactly what their health insurance company requires in the form of paperwork, receipts and other documentation. Once all your paperwork is in order, your claim can then be processed in a timely and efficient manner. Detailed below are the most common types of claims made against a Thailand medical insurance plan:

General Out-Patient Claims

The standard claims procedure for an individual who is receiving out-patient medical treatment for which they are covered, is for the individual to settle the costs at the time of treatment and then make a subsequent claim for reimbursement of those costs. Most Thailand medical insurance providers will offer a variety of ways in which you can be reimbursed and you can typically choose the payment option which is most convenient to you.

Out-Patient Direct Settlement

One advantage of using certain Thailand medical insurance providers is that they can offer their out-patient policyholders a direct settlement option.

A direct settlement option is available in any hospital, clinic or medical facility with which the insurance provider has an existing agreement to cover their client’s costs at the time of treatment. Policyholders to whom this settlement option is available to are simply required to provide the medical facility with confirmation of their health insurance plan and your health insurance provider will directly settle all treatment costs.

In-Patient Emergency Treatment Claim

In many cases, an individual who experiences an accident or a sudden illness may not be in a position to contact their medical insurance company before they arrive at the hospital.

Where emergency treatment and services are concerned, a significant number of Thailand health insurance companies will reach agreement with the medical facility to cover all treatment costs. Although rare and depending on the circumstances, you may be required to personally cover the treatment costs and then begin a claims process for reimbursement from your health insurance provider.

At Thailand health insurance, we advise all individuals to formulate an emergency response plan in the event that they should suffer an unfortunate illness or accident. Part of this plan should be you, or if you are unable, a family member, friend or colleague contacting your health insurance provider as soon as possible while also ensuring the medical facility providing you with treatment receives a copy of your Thailand medical insurance plan. Putting a plan such as this in place will help you receive a swift resolution of any claims for reimbursement.

In-Patient Health Insurance Claim Treatment Guarantee

In the event you require In-Patient medical treatment at a specific hospital or clinic, whether as a one off or part of ongoing treatment, your health insurance provider may ask you to complete a Treatment Guarantee Form before you commence treatment.

The treatment guarantee form enables your medical insurance company to contact the medical facility with the intention of ensuring you receive the full treatment you have requested and that all costs relating to the treatment will be met by the insurance provider.

Common Issues with Health Insurance Claims

The claims information and advice we offer is designed to help holders of Thailand health insurance plans understand the claims process and what they are required to do to ensure their application for reimbursement is managed as efficiently as possible. Our staff has long-standing experience with the international Thailand medical insurance industry and they can offer unmatched advice which will help you with your claim application.

A claim application that encounters a delay in processing is usually as a result of either a pre-existing medical condition or incomplete paperwork.

Pre-existing medical conditions

Most Thailand health insurance providers will routinely refuse coverage of a pre-existing medical condition. More information can be found by clicking Pre-Existing Medical Condition Insurance.

Should you submit a claim for reimbursement against a pre-existing medical condition which has not been included for coverage with your plan; your health insurance provider will decline the claims application. It is important you fully understand the terms and conditions, benefits and coverage levels of your Thailand health insurance plan before you begin the process of making a claim application.

Incomplete paperwork

The majority of claims applications which experience delays are due to the submission of incomplete or incorrect paperwork and other documentation. Your health insurance provider will typically request any paperwork or documentation directly connected to the medical treatment you are claiming against, such as hospital bills, invoices and doctors’ letters. It is imperative that you submit all such documentation to ensure your application for reimbursement is processed appropriately.

In case you are a little uncertain as to what documentation you should provide to support your claim, our staff can advise you and review your application to ensure it has been assembled correctly.

Keeping copies of all documentation relating to your claim is also strongly recommended as it may be required at a later date. So ensure that you scan or photocopy all of your documents prior to submitting them.

Thailand Health Insurance Claims Information

Detailed and specific information relating to the claims procedures of a Thailand health insurance policy can be requested by directly contacting our support staff today. General assistance and information on Thailand medical insurance can also be requested by completing the short request form at the top of this page.