For those out there who currently have health insurance in place, or those who have researched health insurance, the chances are that you will have come across Thailand hospital networks being mentioned by insurers. The following article will firstly look at what a hospital network physically is, and then will look at what these networks mean to the customer of that particular insurer.

A insurers hospital network is a group of hospitals or health providers who the insurer has developed a relationship with. This relationship can mean customers of the insurer can use the said provider and benefit from direct billing. Direct billing is the ability to use a provider and not have to pay for any costs out of your own pocket. The reason this can be done is because the insurer and the provider have created systems and practices between them which enable claims to be settled immediately. This can be achieved by educating the hospital on the insurer’s plans, and teaching them general policy exclusions or how to recognise exclusions placed on individuals. At this point it’s important to note that direct billing policies vary on an insurer to insurer basis. Some may offer direct billing for inpatient claims only, where as some may offer direct billing for inpatient and outpatient claims. Clarify with your intermediary before you choose a plan.

Another point which people should consider when choosing an insurer is the geographical scope of their networks. If you are resident in Thailand, and only need to access providers here, then a strong local Thai network will suffice. If however you are in international traveller, you ideally want a provider who has an international network. This will mean benefiting from health care internationally without paying out of pocket. However, if your provider does not have an international network then it may not be a huge issue. The key consideration should be the procedures in place for dealing with accident and emergency cases. If they offer a letter of payment guarantee to any hospital then the chances of you having to foot the bill for potentially expensive inpatient care is low. Note that there is no guarantee a global provider would always accept a letter of guarantee from any provider. If however they operate on a pay and claim basis, then you have to asses if you can afford to cover inpatient care costs and then be reimbursed later. If it’s just outpatient care you are receiving this is unlikely to be an issue as costs will likely be much lower and within the scope of most people’s credit card limit. The key point here is to check on where you stand should you require medical care outside of Thailand.

So what else can a network mean for customers?

Controlled claims. By having a smooth system in place which allows for providers to recognise what is covered and what is not, errors in claims payments can be avoided. Whilst having legitimate claims paid for is the promise we buy from an insurer, it is also within our interests as customers that claims that should not be paid, are not paid. The reason being is that any losses will be passed on to customers at renewal. Most insurers in Thailand operate on a ‘community underwriting’ basis meaning increases are shared among all customers. This is a good thing as it means you will not be hit with a premium hike if you make a large claim. At the same time it means uncontrolled claims processes would impact your annual premium increases.

Insurer Discounts. Networks can mean that insurers negotiate discounts with the hospital network. This has the effect of keeping costs down for the insurer, and mitigating any increases that are passed on to clients on an annual basis. Lower costs mean lower premiums, leaving everyone better off!

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