I plan on travelling by backpack throughout Southeast Asia for an indefinite period of time starting January 2013 in Bangkok. I have never had any problems. I wonder if it is just best to rely on paying directly for any medical services rather than paying the $900 that I was quoted for a U.S. citizen medical policy. Has anyone gone that route?

What does the $900 policy cover? Medical expenses - do they pay the provider directly immediately or do you have to pay and collect money from the insurance company? Does it cover medical evacuation? does it cover any other "travel insurance" things like insurance for possessions that might get stolen or whatever?

I never buy travel medical insurance, but my own medical insurance covers urgent care anywhere in the world. I pay upfront, then submit the bill to my insurance company when I get home. I do carry medical evacuation insurance.

What are the major dangers for you? Routine medical problems like gastro-intestinal complaints can usually be treated quickly and easily by local doctors. And prices for medical care in this part of the world are pretty reasonable. But the bigger things - the leading cause of death for tourists in these countries is motor bike accidents, or what if you get bitten by a monkey or a dog and need to get rabies post-exposure vaccine as soon as possible? Think about what your risks are and what options you have.

You don't say who is quoting this either. Most travelers in the region I know, if they have insurance, have it through World Nomads. I've never dealt with them myself, but people I trust say good things about them.

As a diver, I have to have dive accident insurance anyway, and so I just pay an extra $50 or so to DAN to top that up to full medical.

I'm not a diver, but by joining DAN, I get Med Evac insurance. I think it's $44 a year for the two of us.

i have DAN too at $55 for the 2 of us.. evac only..

i can tell you that generally medical costs are a fraction of what we might pay for services in the usa..

are you from a country with socialized medicine, if so and they would reimburse you, the premium might be wise

The best hospitals in Thailand are the private ones so make sure you are covered for all the private hospitals. Evacuations policies are fine but IMO you would want immediate treatment before even considering evacuation.

Here's what I know of the medical cost for what I considered as emergencies.

Appendicitis operation with hospital stay: Thai Baht 150 - 200,000 at private hospitals.
Simple broken legs or arms: 100 - 200,000.
Emergency Stents: 4 - 500,000.

* These are the costs at the top private hospitals in Thailand.

Also, I would look for insurance that pay the hospital directly vs you having to pay first and get reimbursement from the insurer later.

I live in the UK where comprehensive travel insurance insurance is the norm and it is very cheap and I would not dream of travelling without it. I have never understood why the same does not exist in the US. An annual policy covering trips of up to 30 days comes as a free add on to my home insurance and also with my bank accounts. For longer trips such as your a separate policy is needed and I am just researching the cost for a 6 month trip to South America which is costing around £300 - 450 used. I am look at policies from STA travel and Trailfinders which are travel agencies but I believe they also operate in the US so may be worth a look.

Bear in mind that in most countries, if you do not have insurance or proof of sufficient funds, then the hospital is unlikely to provide treatment which could obviously prove problematic. Most insurers worth their salt will, as Hanuman suggests, pay the hospital direct (essential in my view) and will usually arrange everything else for you. Hopefully you won't need to claim and it will be a complete waste of time apart form the peace of mind. but that is what insurance is all about.