Hospital bills can seem mysterious, especially if you are travelling for treatment in Southeast Asia. Even people who live locally often find it hard to get clear prices before they commit. This guide explains why prices are high, why hospitals don’t publish them online, what happens when you ask for a quote, and how to manage the process so you don’t get caught out.

Why hospital prices seem inflated

Hospitals don’t set one fair number for each service. They use a complex schedule of “list prices” that are far above what most patients actually pay. These inflated numbers have a name: the chargemaster. The chargemaster is an internal catalogue of services, procedures, and supplies, each with a sticker price that may be several times higher than the cost of delivering the service.

In practice, almost no one pays chargemaster rates. Insurance companies negotiate steep discounts. Big employers and government plans do the same. Self-pay patients can often bargain down their bill too, but only after they’ve been quoted a high starting figure. The chargemaster gives the hospital room to discount while protecting its revenue if someone does pay in full.

Why hospitals don’t publish prices online

Hospitals often resist putting full price lists on their websites for several reasons:

• Negotiation leverage: If insurers or corporate buyers could see exact prices, they would push for deeper discounts.
• Variation by patient: A knee replacement isn’t a single number. The price depends on the implant used, length of stay, anaesthetic time, complications, and aftercare.
• Competitive secrecy: Clinics don’t want rivals to see their internal rates.

Instead of transparent fees, many hospitals promote “health packages” for common procedures. These packages bundle surgery, anaesthesia, a set number of nights in a standard room, and routine tests. They work well for straightforward cases but often exclude extras like extra nights, special implants, or treatment for unexpected issues.

The problem with getting a simple quote

Many patients arrive hoping to ask, “How much is a hip replacement?” or “What does an MRI cost?” Staff may tell you they need you to see a doctor first. That appointment is rarely about setting prices. The doctor may not know what the finance department charges. Often, the doctor will assess your case, then an administrator will look up the price.

This leads to a frustrating loop:

1. Reception says a doctor must see you to give a price.
2. You pay for a consultation.
3. The doctor refers you back to the front desk or a sales officer, who finally produces a figure.

From the hospital’s view, this protects them. They don’t want to commit to a price without confirming what you need, and they prefer to capture your business once you’ve invested in a visit. Often it’s just a pure rip off though. For example, if you see one doctor, you pay extra for prep i.e. being weighed and blood pressure. If that doctor sends you to another doctor, you’ll be billed again for weight and bp, even though it was 30 minutes between each one, and it’s around fifteen US. In the past when I’ve complained about this it’s ‘hospital policy’, i.e. straight up theft. Other scams are insisting on consultation fee for simple or insiting on testing for a disease before vacination tests (Lim Tiang) and insisting on a test before a vaccine, and the test is more than the vaccine!

Why hospitals ask for scans and records

If you email for a quote, hospitals may insist on seeing test results, X-rays, or an MRI. Partly they want to make sure they’re quoting for the right procedure. Another reason is that once the quote is linked to your personal data, it becomes a tailored estimate, not a generic price. That keeps them safe from insurers who might use open quotes to push down rates.

You don’t always have to share your full medical file. If you already have imaging, you can often remove personal identifiers before sending it. Most MRI scans are stored in DICOM format, which contains a “header” with your name, date of birth, and hospital number. Many image viewers let you save an anonymous copy with those fields cleared. You can also crop screenshots of the scan itself—just make sure your details aren’t visible in the margins.

Sending an anonymised image lets you show the problem while keeping control over your data, and it avoids hospitals archiving your records before you’ve chosen where to be treated.

Why prices are higher for medical tourists

In Southeast Asia, locals with national health coverage often pay less. Hospitals make up the difference by charging foreign patients more. This is partly because:

• Tourists often choose private hospitals that cater to foreigners, with newer facilities and English-speaking staff.
• Foreigners usually lack access to local insurance or government subsidies.
• Hospitals expect international patients to compare them with Western prices, so they price below Western levels but above local ones.

It’s still usually cheaper than having treatment in Europe or the US, but the gap between local and tourist rates can be wide.

Package pricing versus itemised billing

Most private hospitals offer package deals for popular surgeries: cataract removal, knee replacement, hip replacement, childbirth, etc. A package is a fixed fee covering the surgeon, anaesthetist, routine supplies, and a basic room.

The upside: you know the baseline cost. The downside: the quote may exclude anything unusual—special equipment, extra nights, blood transfusions, or follow-up visits. If complications arise, you drop out of the package and start paying à la carte, often at high list prices.

Always ask what is covered, what isn’t, and how overages are billed.

How to approach hospitals about price

If you want a clear figure before treatment, here are some steps that work in most countries:

• Contact the hospital’s international or self-pay desk instead of general reception. They often have staff trained to handle quotations.
• Be precise about what you need. Don’t just ask for “surgery.” Say “total hip replacement with a standard implant” or “MRI of the lumbar spine, no contrast.”
• If they ask for records, send only what they need, and remove personal identifiers first.
• Ask for the package price and also the unbundled price list if available.
• Request a written estimate. A paper or email quotation is better than a verbal answer.
• Clarify add-ons. Ask how much for extra nights, special implants, or post-op physio.

If the hospital insists you must see a doctor, try to confirm the consultation cost first. Make sure they understand you want a quote and don’t need a full diagnostic work-up yet. Be very sure what you expect, you want the doctor to look at this scan, examine this part of your body, give an opinion on if you might have that condition etc. and send this in advance. Often a consultation is a three minute conversation, all the doctor will say is ‘I don’t know’ and they’re mostly typing on the computer rather than even looking at you.

Another thing to be aware of is that you might not be alone with a doctor. Sometimes there is a nurse standing to attention next to them or even some students. In my 30 year experience of living here, good doctors see their patients alone and call someone in if help is needed. Be wary of a doctor crowding their consultation room or unwilling to even do a basic thing like draw blood.

Bargaining and payment

In private systems, prices are rarely final until you pay. If you get a bill that feels high, you can often negotiate—politely and with evidence:

• Show written quotes from other hospitals.
• Mention that you are paying cash, upfront, with no insurance claims.
• Ask for a “self-pay discount.”

Many hospitals prefer prompt payment and will cut 10–30% rather than chase invoices later.

Watch out for extras

Even with a package, some costs are rarely included:

• Extra lab tests or imaging
• Take-home drugs
• Specialist consults outside the main procedure
• Upgrading to a private or VIP room
• Complication management

Budget a cushion for surprises, especially if you’re travelling.

Local versus regional chains

In big cities like Bangkok, Kuala Lumpur, or Ho Chi Minh City, international-style hospitals may belong to large chains. Their prices tend to be higher than smaller local clinics but still lower than Western rates. Smaller hospitals may be cheaper but less predictable in quality or aftercare.

Medical tourists often pick mid-range private hospitals: good doctors, modern equipment, and fees far below Western bills. If you’re considering a local clinic, visit first and see how transparent they are about price.

Dealing with the “chargemaster” quote

If you push a hospital to give a generic price without seeing you, they may fall back on the chargemaster rate. This is the sticker price for an unnamed patient. It’s often double or triple what insured or package patients pay. Don’t take that figure as final. It’s the opening bid.

You can say, “That seems high—do you have a package or self-pay rate?” Or get a written estimate from another hospital and ask them to match it.

Summary tips for patients

• Research hospitals before you travel and email their international desks for sample prices.
• Ask for written package deals, not just verbal quotes.
• When sending scans, anonymise them so the quote stays generic.
• Check what the package excludes.
• Expect to pay more than locals but less than Western bills.
• Don’t panic if the first quote is sky-high—it may be the chargemaster number.

Final thoughts

Hospital pricing is complicated everywhere, but in Southeast Asia you can often get excellent treatment at a reasonable price if you plan ahead. The key is to understand why hospitals protect their numbers, how to approach them for an estimate, and how to spot when you’ve been quoted an inflated sticker price.