Doing valve replacement overseas without insurance

[newarrior]

Dear All
Hello and good day. I am sending this message to all my heart valve related groups so if you are on more than one of my groups please accept my apologies as my intent was not to spam.
My name is David and I am an American living overseas in Bangkok Thailand. I have moderate aortic stenosis, which was diagnosed last year at age 56. Year over year progression was terribly slow. I am keeping myself healthy in the interim. Bangkok has great doctors many who have trained stateside and speak fluent English as do the nurses and staff. Thailand is filled with lots of retirees from the West, drawn by the climate, dating scene, food, temples, islands, low cost, medical care, etc. etc. Thailand is a famous medical tourism destination and our Covid 19 cases are at zero. The quality of life here is amazing and I have no interest or intention of ever moving back to the states.
About me: Single, 57, no kids wife girlfriend pets de; family in USA all dead; no career or job no home in USA no one to stay with in USA. I get by by my investments which are doing well and my simple low cost of living here in Asia. In good health at present but family history of heart disease. I am fanatic about health—vegan bp meds and statins and aspirin, lifelong exerciser, never drink or do caffeine, do constant screenings, meditate, LDL down to 60 weight at 159 low BP etc. etc. Slight LVH. Calcification score and Lpa high. Other #’s outstanding. Low stress low cost easy life with zero commitments.
My question is this: Insurance in Thailand does NOT cover preexisting conditions i.e. valve related issues as well arrythmia issues. I am covered for heart attacks and strokes. My concern is any out of pocket expenses should I have the surgery in Thailand. Depending on any complications and/or cost of the actual surgery my estimates are from $30,000 up to $100,000; most likely closer to 50K USD. I can afford that as I am single and live cheaply. However, that would cut into my ability to buy a home stateside in the future.
1) Scenario #1—I miraculously find an insurance here that covers preexisting. Unlikely and if so costly. I have checked into this before and looks grim.
2) Scenario #2—Do all surgeries here in Bangkok and hope when that day comes cost and complications are low
3) Scenario #3 I can get medi-cal to fund my surgery here. I passed my USA insurance info on to my hospitals here. Thailand has some of the best healthcare in the world at the lowest prices and they are setup to work with all kinds of insurance. This would be my top scenario.
4) Scenario #4 Move back to states—ugh-I would almost rather die.
5) Scenario #5—favorite scenario after #3—get surgery done in California and bounce back to Bangkok when I recover. Tricky part: where to stay? This is where I need support: Skilled nursing facility; short term air bnb either solo or as a roommate? Or other short-term rental options? Again, no family or friends to stay with and I have no housing stateside. Also, I am utterly single and alone so I may need outside assistance post op.
Unknowns
1) Cost and quality of valves when I need surgery
2) Complications
3) Age when I get surgery
4) How technology evolves
5) My health at time of surgery
6) My finances at time of surgery
7) If I will need a 2nd valve surgery in my lifetime
8) If a pacemaker is needed
9) Will I have a partner to help me post op?
I have vetted this plan by my American doctor at UCLA, my American doctor here, and my Thai heart doctor as well as a few trusted friends and they like it. I am trying to vet the plan with Medi-Cal Anthem Blue Cross, 1-2 more heart drs here in Bangkok and a heart doctor I saw in Los Angeles a year ago.
Further thoughts Questions? Thanks!

 

[Carnelian]

Scenario 2 looks best to me. Have it done there, if you trust the doctor and he has a very high success rate, over 95%, as mine did. I found the data online in a survey.

I also am very alone with nobody I can rely on. Single. I went through rehab alone at home with no company, no assistance. You can do this also. You can pay a nurse or maybe an occupational therapist. Spend your money wisely and think about buying a home much later. And you dont worry about COVID?
What is wonderful about Thailand?

 

[newarrior]

Scenario 2 looks best to me. Have it done there, if you trust the doctor and he has a very high success rate, over 95%, as mine did. I found the data online in a survey.

I also am very alone with nobody I can rely on. Single. I went through rehab alone at home with no company, no assistance. You can do this also. You can pay a nurse or maybe an occupational therapist. Spend your money wisely and think about buying a home much later. And you dont worry about COVID?
What is wonderful about Thailand? You've never been here ? Thailand amazing in many ways a hellhole in others)...Makes it scary because overseas and insurance here does not cover pre existing..Covid gone here thank god....

"Scenario 2 looks best to me. Have it done there, if you trust the doctor and he has a very high success rate, over 95%, as mine did." "I found the data online in a survey".--Can you explain ? Issue with doing surgery in Asia is full cash...If money was no issue better to do here as I am already here....Post op care is concerning as well--who what where how ? In USA have zero family friends to help and no housing...

 

[Carnelian]

Do you have the cash to spend on it? No credit is permitted?
For U.S. surgeons, I found a website 3 years ago that provides details on each one's success rate in types of surgeries. My surgeon at a small hospital near Chicago is listed with around 97% success rate. Most heart surgeons have high success rates (U.S.) of over 93% I was told, for bipass and valves, assuming patients have no other diseases. I don't know if there is a website for Thai doctors...would it be in English? . Also there are stats for followups and returns to the hospital.
Occupational therapists are needed for rehab, as it will be difficult just walking and moving the body. You will need a walker for some weeks. On the internet, there ought to be sites to find a freelance OT (as they are called) who have a Masters or Ph.D.
Or get referred to a rehab center or hospital for this. It is costly. I had medicare. At home, you will may not need them. But you will need to get warfarin (coumadin) and maybe an OT or nursing aide for a few days. Store up plenty of food and supplies because you will not be able to drive. This info is already on this forum, stated by others.

 

[newarrior]

QUOTE="Carnelian, post: 900174, member: 16784"]
Do you have the cash to spend on it? No credit is permitted?
For U.S. surgeons, I found a website 3 years ago that provides details on each one's success rate in types of surgeries. My surgeon at a small hospital near Chicago is listed with around 97% success rate. Most heart surgeons have high success rates (U.S.) of over 93% I was told, for bipass and valves, assuming patients have no other diseases. I don't know if there is a website for Thai doctors...would it be in English? . Also there are stats for followups and returns to the hospital.
Occupational therapists are needed for rehab, as it will be difficult just walking and moving the body. You will need a walker for some weeks. On the internet, there ought to be sites to find a freelance OT (as they are called) who have a Masters or Ph.D.
Or get referred to a rehab center or hospital for this. It is costly. I had medicare. At home, you will may not need them. But you will need to get warfarin (coumadin) and maybe an OT or nursing aide for a few days. Store up plenty of food and supplies because you will not be able to drive. This info is already on this forum, stated by others.
[/QUOTE]
Wow overwhelming...I live overseas; utterly alone both stateside and in Asia, insurance here does not cover pre existing conditions, don't have a job, don't have a home or friends and family that can assist me either stateside or the USA, etc etc... Good question on the cash---I have credit cards but they have limits ..

 

[rich01]

Will you qualify for Medicare at age 65?

Some insurance policies have a 5 year clause for pre-existing conditions (at least they did in the past). If you could find a policy like that, it might be worth buying.

 

[newarrior]

Will you qualify for Medicare at age 65?

Some insurance policies have a 5 year clause for pre-existing conditions (at least they did in the past). If you could find a policy like that, it might be worth buying.

I am 57 medicare a ways off.. I assume I would qualify why not ? Right now on Medi-cal in California

 

[newarrior]

Scenario 2 looks best to me. Have it done there, if you trust the doctor and he has a very high success rate, over 95%, as mine did. I found the data online in a survey.

I also am very alone with nobody I can rely on. Single. I went through rehab alone at home with no company, no assistance. You can do this also. You can pay a nurse or maybe an occupational therapist. Spend your money wisely and think about buying a home much later. And you dont worry about COVID?
What is wonderful about Thailand?

Thailand is good and bad..Do the research about the country and let me know..As an older man it's a great place....I do worry about not owning a home...Paying for help is cheap here..Sorry you are single and alone--it's tough...

 

[rich01]

I am 57 medicare a ways off.. I assume I would qualify why not ? Right now on Medi-cal in California

I would check to see if you qualify for medicare at 65. There are Medicare supplemental plans that provide most of what you are looking for. You would have to have procedure done in US, but costs would be minimal with the right plan.

So maybe you need a plan for if the valve needs to be replaced before age 65 and a different plan if after 65.

 

[newarrior]

I would check to see if you qualify for medicare at 65. There are Medicare supplemental plans that provide most of what you are looking for. You would have to have procedure done in US, but costs would be minimal with the right plan.

So maybe you need a plan for if the valve needs to be replaced before age 65 and a different plan if after 65.

That's probably true beyond that I'm just getting together any kind of plan whether the surgery is 1 or 20 years away.. my insurance in Thailand does not cover valve surgery it does cover Strokes or heart attacks but it doesn't cover any of the screenings or any of the medications I take for cardiac related stuff nor does it cover any arrhythmia type things that may come up. Anyhow my plan is to talk to a doctor that I met in America last year in Los Angeles a cardiologist for going to talk over zoom in about 2 weeks I'm going to run my entire scenario by him and see if he can vet my plan my plan would be to go back to the States when things get more severe pick up an Airbnb for a couple months get treated but really I don't know what I'm doing I've never walked through this process before as I'm sure none of us have until we actually go through it. So I'm trying to understand what are the risks posed during the operation afterwards what kind of help am I going to need of course this is Complicated by living overseas not owning property in America not having a wife girlfriend kids are really any friends or family that I would want to lean on or count on I've got a brother had a cousin that I wouldn't want to lean or count on I wouldn't count on any of my friends here in Thailand or back in California so I assume I'm on 100% responsible for everything pre op op and post-op. Which is sad and depressing but that's my reality. After I talk to this doctor I'll have a better idea of what I can expect during and after the surgery. I can make it a more informed decision as to whether it makes sense for me to continue to stay here in Thailand. Perhaps it's time for me to go back to America something I'd read for personal reasons. A lot to think about. Because I'm overseas. So it's really three options stay here do it here and find my own surgery the second option is to go back to the States when things get worse go get my internet setup get an Airbnb go see a primary care physician quickly get referred to a Cardiologist then get the operation approved and then figure out how and where I'm going to do the post off rehab type stuff and then once I'm good to go go back to Thailand. Or operation number 3 which is just go back to the States which has a 57 year old single man is not exactly something I'm thrilled about not that I have a partner here either .. Plus in the present moment which I don't need surgery but in the present moment the coronavirus is pretty much largely eradicated here and we have no social distancing or anything going on all we have to do is wear a mask our life is not disrupted as people are in America so it's a pretty easy life here in America I'd have a much higher chance of getting the coronavirus as a single person I'd be much more isolated socially as a 57 year old single man with no family or job or anything that I'm overwhelmed by the idea of starting over in the states again from zero. In the meantime I follow dr. Esselstyn low-fat vegan diet I take high-dose statins I meditate I work on my depression and insomnia I take vitamin K2 to remove calcium out of my hardened into my bones and muscles I do all these things that would hopefully slow down heart disease that may slow down aortic stenosis I get screened regularly I take aspirin to do this I do that take a lot of coenzyme Q10 and pray for the best

 

[Chuck C]

Dear All
Hello and good day. I am sending this message to all my heart valve related groups so if you are on more than one of my groups please accept my apologies as my intent was not to spam.
My name is David and I am an American living overseas in Bangkok Thailand. I have moderate aortic stenosis, which was diagnosed last year at age 56. Year over year progression was terribly slow. I am keeping myself healthy in the interim. Bangkok has great doctors many who have trained stateside and speak fluent English as do the nurses and staff. Thailand is filled with lots of retirees from the West, drawn by the climate, dating scene, food, temples, islands, low cost, medical care, etc. etc. Thailand is a famous medical tourism destination and our Covid 19 cases are at zero. The quality of life here is amazing and I have no interest or intention of ever moving back to the states.
About me: Single, 57, no kids wife girlfriend pets de; family in USA all dead; no career or job no home in USA no one to stay with in USA. I get by by my investments which are doing well and my simple low cost of living here in Asia. In good health at present but family history of heart disease. I am fanatic about health—vegan bp meds and statins and aspirin, lifelong exerciser, never drink or do caffeine, do constant screenings, meditate, LDL down to 60 weight at 159 low BP etc. etc. Slight LVH. Calcification score and Lpa high. Other #’s outstanding. Low stress low cost easy life with zero commitments.
My question is this: Insurance in Thailand does NOT cover preexisting conditions i.e. valve related issues as well arrythmia issues. I am covered for heart attacks and strokes. My concern is any out of pocket expenses should I have the surgery in Thailand. Depending on any complications and/or cost of the actual surgery my estimates are from $30,000 up to $100,000; most likely closer to 50K USD. I can afford that as I am single and live cheaply. However, that would cut into my ability to buy a home stateside in the future.
1) Scenario #1—I miraculously find an insurance here that covers preexisting. Unlikely and if so costly. I have checked into this before and looks grim.
2) Scenario #2—Do all surgeries here in Bangkok and hope when that day comes cost and complications are low
3) Scenario #3 I can get medi-cal to fund my surgery here. I passed my USA insurance info on to my hospitals here. Thailand has some of the best healthcare in the world at the lowest prices and they are setup to work with all kinds of insurance. This would be my top scenario.
4) Scenario #4 Move back to states—ugh-I would almost rather die.
5) Scenario #5—favorite scenario after #3—get surgery done in California and bounce back to Bangkok when I recover. Tricky part: where to stay? This is where I need support: Skilled nursing facility; short term air bnb either solo or as a roommate? Or other short-term rental options? Again, no family or friends to stay with and I have no housing stateside. Also, I am utterly single and alone so I may need outside assistance post op.
Unknowns
1) Cost and quality of valves when I need surgery
2) Complications
3) Age when I get surgery
4) How technology evolves
5) My health at time of surgery
6) My finances at time of surgery
7) If I will need a 2nd valve surgery in my lifetime
8) If a pacemaker is needed
9) Will I have a partner to help me post op?
I have vetted this plan by my American doctor at UCLA, my American doctor here, and my Thai heart doctor as well as a few trusted friends and they like it. I am trying to vet the plan with Medi-Cal Anthem Blue Cross, 1-2 more heart drs here in Bangkok and a heart doctor I saw in Los Angeles a year ago.
Further thoughts Questions? Thanks!

Hi newarrior,
You mentioned that you have high Lp(a). You should consider taking your high Lp(a) into consideration in your valve choice. Lp(a) has been proven to accelerate valve calcification in our native valves, but apparently in replacement bio valves as well. I know people who have high Lp(a) and their new bio valves only lasted 6-8 years, almost certainly due to their Lp(a) calcifying their bio valve. A mechanical valve might be a good choice for your, given your age and given your elevated Lp(a). You should consult with a cardiologist who is Lp(a) literate and who understands the role that Lp(a) plays in accelerating valve calcification. You don't want to get a new valve every 6-8 years. If you are set on a bio valve, you might discuss with your cardiologist the Edwards Resilia, which is designed to resist calcification, although there is only about 6 years of human data so far and it is not known long term if it will really achieve the goal of reducing calcification.
You said previously that your AS was moderate. Are you needing surgery soon for some reason. Perhaps you have a few years yet to watch and see what new developments there are and to see more data on the Resilia.
BTW, high Lp(a) runs in my family and I have it myself, as does my brother and one of my daughters. We have had some male family members die very young from heart disease, age 42, 52 and 54. It is suspected that it was the high Lp(a). High Lp(a) is something to be taken very seriously.
Best of luck.

Chuck

 

[Chuck C]

Hi newarrior,
You mentioned that you have high Lp(a). You should consider taking your high Lp(a) into consideration in your valve choice. Lp(a) has been proven to accelerate valve calcification in our native valves, but apparently in replacement bio valves as well. I know people who have high Lp(a) and their new bio valves only lasted 6-8 years, almost certainly due to their Lp(a) calcifying their bio valve. A mechanical valve might be a good choice for your, given your age and given your elevated Lp(a). You should consult with a cardiologist who is Lp(a) literate and who understands the role that Lp(a) plays in accelerating valve calcification. You don't want to get a new valve every 6-8 years. If you are set on a bio valve, you might discuss with your cardiologist the Edwards Resilia, which is designed to resist calcification, although there is only about 6 years of human data so far and it is not known long term if it will really achieve the goal of reducing calcification.
You said previously that your AS was moderate. Are you needing surgery soon for some reason. Perhaps you have a few years yet to watch and see what new developments there are and to see more data on the Resilia.
BTW, high Lp(a) runs in my family and I have it myself, as does my brother and one of my daughters. We have had some male family members die very young from heart disease, age 42, 52 and 54. It is suspected that it was the high Lp(a). High Lp(a) is something to be taken very seriously.
Best of luck.

Chuck

I need to amend this post. Lp(a) has been shown to accelerate the calcification of the native tissue valve. It has not yet been shown to accelerate the calcification of bioprosthetic valves. I was given some incorrect information by a leading Lp(a) researcher in this regard. He pointed me to another researcher with a great deal of literature on Lp(a) and on valves. But, when I communicated with the researched who supposedly had published on this, he clarified that no correlation had yet been shown for the acceleration of SVD for biological valves for Lp(a), only native tissue valves. He did point out that his study did find a correlation between Lp-PLA2 and accelerated SVD, and many people get Lp(a) and Lp(a) confused, even doctors and researchers.

 

[newarrior]

Thailand is good and bad..Do the research about the country and let me know..As an older man it's a great place....I do worry about not owning a home...Paying for help is cheap here..Sorry you are single and alone--it's tough...

Single and alone major depression

 

[newarrior]

I would check to see if you qualify for medicare at 65. There are Medicare supplemental plans that provide most of what you are looking for. You would have to have procedure done in US, but costs would be minimal with the right plan.

So maybe you need a plan for if the valve needs to be replaced before age 65 and a different plan if after 65.

I have medical--in CA--wil need new valve before 65

 

[newarrior]

I

Will you qualify for Medicare at age 65?

Some insurance policies have a 5 year clause for pre-existing conditions (at least they did in the past). If you could find a policy like that, it might be worth buying.

I should qualify for medicare at 65--I thought all pre existing was covered

 

[newarrior]

Scenario 2 looks best to me. Have it done there, if you trust the doctor and he has a very high success rate, over 95%, as mine did. I found the data online in a survey.

I also am very alone with nobody I can rely on. Single. I went through rehab alone at home with no company, no assistance. You can do this also. You can pay a nurse or maybe an occupational therapist. Spend your money wisely and think about buying a home much later. And you dont worry about COVID?
What is wonderful about Thailand?

Thailand is way over rated but it's home

 

[rich01]

I
I should qualify for medicare at 65--I thought all pre existing was covered

Basic medicare does, but if you get a supplemental plan to go with it, it probably has a pre-existing clause. That might leave you with some major expenses not covered by medicare as medicare does not cover 100%.

 

[newarrior]

I am barely 58--too far off to think about...How do people get supplemental insurance to cover what's not covered by medicare ? In California we have Medi-cal if you have no income like myself. I also plan to restart a case for social security disability when I am stateside again. I didn't know insurers in the USA could discriminate for pre existing conditions. I thought the Affordable Care act did away with insurance companies discriminating or using pre existing conditions

 

[newarrior]

Chuck I may need a valve in a few years--early 60's--so may go mechanical---