The Thaiger key takeaways

• Thailand’s hospitals are well-equipped for international patients, but the claim process can vary between insurers and facilities.
• Understanding direct billing, reimbursement, and pre-authorisation helps make sure your claim is processed quickly.
• Working with an experienced local broker like Pacific Prime Thailand can save you time and prevent costly claim mistakes.

Private hospitals in Thailand are advanced. The doctors are world-class, the hospitals look more like hotels, and the service is impressively efficient. But when the time comes to make a health insurance claim, many foreigners find themselves unsure where to start.

That’s understandable. Claiming international health insurance in Thailand can be a little different from what you’re used to in your home country. Every insurer has its own rules, and every hospital has its own process. The good news is that once you understand how things work here, it becomes fairly easy.

To help you out, here’s our step-by-step guide to claiming international health insurance in Thailand, prepared with insights from Pacific Prime Thailand, one of the region’s leading international insurance advisors.

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Click to jump to section Quick summary Step 1: Claims system Learn the difference between direct billing and reimbursement when filing claims in Thailand. Step 2: Network hospitals Check if your chosen hospital is part of your insurer’s network to avoid upfront payments. Step 3: IPD vs OPD Understand how inpatient and outpatient claims are handled, including letters of guarantee. Step 4: Pre-authorisation Always get approval from your insurer before planned treatments to avoid delays or rejections. Step 5: Reimbursement claims Know which documents to submit and how to file claims for treatments paid out-of-pocket. Step 6: Common mistakes Avoid delays by submitting complete documents and disclosing pre-existing conditions. Step 7: Insurance regulations Familiarise yourself with Thailand’s OIC rules and visa health insurance requirements. Step 8: Local brokers Work with a trusted broker like Pacific Prime Thailand to manage claims and liaise with insurers.

Step 1: Know how the claims system works

There are two main ways international health insurance claims are handled in Thailand: direct billing and reimbursement.

Direct billing is what most people prefer. It’s the cashless option, where the hospital or clinic bills your insurer directly. You simply show your insurance card, sign some paperwork, and pay for any non-covered items like deductibles, co-payments, or excluded treatments. This system is usually available for inpatient stays and certain outpatient services at hospitals that are part of your insurer’s network.

Reimbursement applies when direct billing isn’t possible. You pay the bill yourself and then send the receipts to your insurer for repayment. This is common for outpatient treatments such as GP visits or minor procedures, particularly if you visit a clinic outside your insurer’s partner network.

Step 2: Check if your hospital is in the insurer’s network

Before any planned treatment, ask if the hospital works directly with your insurer. Image by ijeab via Freepik

Thailand’s private hospitals like Bumrungrad International and Bangkok Hospital Pattaya regularly deal with patients who hold international insurance policies. Most have dedicated international insurance desks that handle paperwork for you.

Before any planned treatment, ask if the hospital works directly with your insurer. This way, the hospital can bill your provider and save you from having to pay upfront. You can also check your insurer’s website or if you’re working with a broker like Pacific Prime, you can contact them and they’ll confirm whether the hospital is within your plan’s network.

If the hospital is not part of your insurer’s network, you will likely need to pay for treatment yourself and later file for reimbursement.

Step 3: Understand the difference between inpatient and outpatient claims

Your insurance policy divides treatment into two categories: inpatient (IPD) and outpatient (OPD).

Inpatient treatment means you are admitted to the hospital, usually for surgery or an overnight stay. For this type of care, the hospital will contact your insurer to obtain a letter of guarantee (LOG). This is a confirmation that the insurer will cover the costs based on your policy. Once the LOG is approved, the hospital bills the insurer directly.

Outpatient treatment covers medical appointments where you don’t stay overnight. This could include seeing a doctor for a cold, having blood tests, or getting a prescription. For these visits, most insurers require you to pay first and then submit your claim.

If you’re hospitalised, keep in mind that most hospitals will only wait 48 hours for the LOG to arrive. If the insurer hasn’t confirmed payment within that window, you will need to pay a deposit to continue receiving care. After the insurer’s guarantee is received, the hospital will refund any excess payment, though this may take several weeks.

Step 4: Get pre-authorisation before any planned procedure

You usually need pre-authorisation when you are planning surgery, an MRI, or any high-cost treatment. Image by National Cancer Institute via Unsplash

Pre-authorisation, also called prior approval, is the insurer’s way of confirming that the treatment you need is medically necessary and covered under your plan. You usually need this when you are planning surgery, an MRI, or any high-cost treatment.

Some insurers ask for notice at least five working days in advance, so it’s best to arrange this as soon as your doctor schedules your treatment. Your hospital can help by sending medical reports or cost estimates to your insurers.

In emergency cases, hospitals will treat you immediately and request authorisation afterwards. But for planned procedures, missing this step may delay your claim or result in your insurer refusing to pay.

Step 5: Submit a reimbursement claim when needed

If you’ve had to pay out-of-pocket, the next step is to prepare your reimbursement claim. Therefore, make sure you keep every document and receipt.

You’ll need:

• A completed claim form (available from your insurer or broker)
• Original receipts and itemised bill from the hospital
• A medical certificate or report with your diagnosis
• A copy of your passport or ID
• Your bank details for the transfer

Submit the claim through your insurer’s preferred channel. Many now accept claims through online portals or mobile apps, which tend to be faster than sending paperwork by post. Processing usually takes a few weeks.

Keep in mind that reimbursement is paid in the currency stated in your policy. If your plan is in US dollars or euros, exchange rate changes can slightly affect the amount you receive compared to what you paid in Thai baht.

Step 6: Avoid common claim mistakes

Some plans don’t cover elective surgery or long-term rehabilitation, unless specified in your contract. Image by Hiroshi Tsubono via Unsplash

According to Pacific Prime, one of the most common reasons for claim delays (or worse, rejected) is failing to follow the proper claims process. You need to follow the process down to the tee and make sure no document is missing. Even a missing receipt or unsigned form can stall the process, so always keep all of your documents in one folder until your claim has been approved and paid.

Another common issue is non-disclosure of pre-existing conditions. If you had symptoms or an illness before buying your policy and didn’t declare it, your insurer can deny the claim or cancel the policy entirely. Always be transparent during the application stage, even if it increases your premium.

Also, check what your policy excludes. Some plans don’t cover elective surgery or long-term rehabilitation, unless specified in your contract.

Step 7: Be aware of Thailand’s insurance regulations

The insurance industry in Thailand is regulated by the Office of Insurance Commission (OIC). The OIC has been raising its standards in recent years to align with international rules, which means more transparency and greater protection for policyholders.

If you are a foreign resident, your visa may also require proof of health coverage. Holders of the Non-Immigrant O-A visa, for example, must have insurance that covers at least 40,000 baht for outpatient treatment and 400,000 baht for inpatient care.

Step 8: Work with a local broker

Before any planned treatment, ask if the hospital works directly with your insurer. Image by ijeab via Freepik

International health insurance can be complicated, especially when you’re dealing with foreign insurers and Thai hospitals at the same time. That’s why working with a broker like Pacific Prime Thailand can make the process easier.

A good broker acts as your representative. They can help you understand your policy, liaise with insurers, and follow up on claims. They can also guide you through pre-authorisation requests, clarify hospital procedures, and help if your claim is delayed or disputed.

Pacific Prime works with major hospitals and top international insurers, so they understand the local system and can handle the administrative details for you.

If you want peace of mind that your health insurance will work exactly as it should, reach out to Pacific Prime Thailand. Their team can help you set up your policy, guide you through your first claim, and make sure your healthcare experience in Thailand is as flawless as possible.

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