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Everything posted by Sheryl
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They contacted him and asked for more info and he sent him all his prior lab results etc. That is how they know it existed at the time of application. (On the other hand the fact that he readily sent them those reports can be used to support the argument that the omission on the application form was inadvertant and not an act if bad faith).
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I very much doubt the compan reads this website or runs searches of fi=orums. Hardy worth their time and tey are very busy. As OP has already stated, BPH was mentioned on the form submitted by the hospital in the first place. The insurer then contacted OP asking for more information and OP sent them copies of lab tests dating back to before he got his policy.
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Yes, Bangkokdrugstore, Medisafe etc are all "brick and mortar" pharmacies which provide online sales, and completely reputable. I have used them and also Medtide for years and never a problem. OP - all these drugs are readily availablr in Thailand without prescription.
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Never buy medications at a hospital except in the rare case where it is something not available over the counter. Mark up is considerable plus they tend to use the most expensive brands to start with. Get at a pharmacy, and also do not get Lyrica brand. Among imports, Sandoz brand is much less. A box of 56 tabs will be under 2,000 baht. Maxgalin (locally made) is under 500 baht for 30 tabs
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Not "alleged". He has the condition and had it at the time of application. In any insurance policy, if it is found your application contained falsehoods or omissions, it invalidates the entire policy. Sometimes insurers will not invoke that, but they always can. And yes, the knowledge that he may have cancer may have influenced the decision to invoke their right to nullify the policy.
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Yesa, it diminshes the insurer's opinion of risk. Any insurer. BPH is indeed a disease, one that usually requires medication and often eventually surgery or other invasive treatments. It can lead to urinary retention which in turn can infection, even sepsis. Certainly any insurer knowing an applicant has BPH will either exclude prostate conditions or apply a premium load as there is greater chance of hospitalization than in someone without this condition. Being age-related does not make something not a disease; many diseases (arthritis etc) are a natural result of the aging process. The reason most would exclude all prostate related problems and not just BPH is that, even though BPH does not increase the risk of prostate cancer, the odds of needing MRIs and biopsy to rule out cancer are higher if someone has BPH as it can be difficult to distinguish between the two. I had a somewhat analogous situation as I had mild (and well controlled) hypothyroidism at time of my insurance application. Detected on a routine physical check up and beyond that never saw a doctor for it, managed it myself with meds since they are over the counter here. I declared it on the insurance application and I was given the option of either a slightly higher premium or an exclusion of all thyroid conditions, I took the latter. At the time it seemed a bit silly to me since my application was for hospitalization only cover and management of hypothyroidism is usually a simple outpatient matter, and the condition does nto increase the risk of thyroid cancer. However while hypothyroidism seldom required hospitalization and does not increase the risk of thyroid cancer, it does increase the risk of benign thyroid nodules which may have to be biopsied to rule out malignancy...and indeed a few years later that is exactly what happened (I paid for the biopsy out of pocket. Not big money and result benign, fortunately). I think Simon could make a plausible case that he did not act in bad faith (if he words it right) and thereby get part of his premium refunded. That's the best that can be hoped for from an appeal but since the appeals process is pretty simple no reason not to do it unless the amount he'd get back is really small, which depends on how much time was left under the premium payment. If Simon had declared the BPH on his application, unless they offered and he accepted a premium load rather than exclusion, he'd still not have cover for the care he needs now- but his policy would still be in effect covering him for other things and he'd have known from the start that he wasn't covered for prostate which would likely have altered his choice in where to seek care.
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He does not need a lawyer. As stated in the policy, he can appeal directly to the Insurance Mediator which is a completely independent body, and the process is clearly explained online and can be done online "If the disagreement persists and no amicable solution can be found, You may, without prejudice to the other legal remedies available to You and in any event within two months of the sending of Your first complaint, appeal to the Insurance Mediator by post or by email to the following addresses - "La Médiation de l'Assurance" - TSA 50110 - 75441 Paris Cedex 09 - FRANCE. www.mediation-assurance.org" - April Insurance General Conditions The complaint can be done online here https://www.mediation-assurance.org/constituer-mon-dossier/ (it is in French but translates well in Chrome browser). However as it seems clear he failed to declare a health condition on his initial application, the most he is likely to be able to achieve is refund of premium for the period going forward (which may or may not be worth it depending on whether he pays annually or monthly and date he pays). From the French Insurance Code: Article L113-8 the insurance contract is null in the event of reluctance or intentional misrepresentation on the part of the insured, when this reluctance or this misrepresentation changes the subject of the risk or diminishes the insurer's opinion of it, even though the risk omitted or misrepresented by the insured had no influence on the claim. The premiums paid then remain with the insurer, who is entitled to the payment of all premiums due as damages. and Article L113-9 The omission or inaccurate declaration on the part of the insured whose bad faith is not established does not entail the nullity of the insurance. If it is noted before any claim, the insurer has the right either to maintain the contract, subject to a premium increase accepted by the insured, or to terminate the contract ten days after notification sent to the insured by registered letter, in returning the portion of the premium paid for the time when the insurance no longer runs. https://www-legifrance-gouv-fr.translate.goog/codes/section_lc/LEGITEXT000006073984/LEGISCTA000006157200/?_x_tr_sl=fr&_x_tr_tl=en&_x_tr_hl=en&_x_tr_pto=sc#LEGISCTA000006157200 In other words the insurer can drop him over his failure to declare his BPH, and keep the premium paid up to that point regardless. Whether or not they can keep unused premium (payment for the period thereafter) depends on whether or not he acted in bad faith in not declaring it. If he can make a convincing case that he did not, they can still cancel the policy but he can get a partial refund of premium. These regulations are in no way limited to EU countries. Penalties for failing to disclose a health condition at the time of insurance application are severe everywhere and (though not applicable in this instance) can include having to repay any insurance claim the company paid out on.
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I just checked my copy (which is 2017 so yours could differ.) Question 7 "are you currently suffering from any illness or disorder" is where you should have declared your BPH. There is also a question about whether you planned on having any lab tests done in next 12 months which if you have been getting annual PSAs should have been answered accordingly. (and if the records they now have showed annual PSA done since before policy is issued, they will now that).
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Infusions like this are done at some of the anti-aging clinics.
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If you were not on any treatment for the BPH then it is possible you did not misrepresent anything on the application form (I don't remember all the questions on the form). If so then your case for appeal is stronger and you should try. Did you keep a copy of fhe application form? If they do proceed to cancel your policy you may be able to get refund on at least the last premium. As posted previously I suggest you get the biopsy at a government hospital then once you have results can consider what best to do.
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Looking for expert suggestion for Spine Surgeon
Sheryl replied to Monir087's topic in Health and Medicine
Prof. Wicharn at BNH Spine center -
A post with inaccurate information and link to a vidro from an unreliable source, and replies to it , have been removed. Abnormal PSA results do not automatically require biopsy.
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I don't think OP is talking about a permanent move. Just going back for treatment. He'd have to declare an intention to resettle permanently but there is no way to enforce that ...and if he's wise he'd maintain an address and GP registration even after back in Thailand thus ensuring quick future access to care. As to not worrying about things -- some types of prostate cancer are quite aggressive and death from prostate cancer is particularly unpleasant (it metastatizes to bone).
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There is an appeals process and it is outlined in your policy document. It sounds like the denial is because you failed to declare your BPH on your application form. Had you done so they would likely have applied an exclusion for all prostate problems. No harm in appealing anyhow but of you truly did fail to disclose your BPH your odds of success are low. Your choices now are return to UK and get treated under NHS or get treated at a government hospital here. For this condition best options are Ramathibodhi or Siriraj. You might also opt for a combination of the 2 i.e. get biopsy at government hospital here then, if positive, go to UK for further treatment. 2 advantages to this approach: (1) in case biopsy proves negative you'll have avoided unnecessary trip back to UK. (2) If biopsy is positive, with that result in hand you'll get treated under NHS much more quickly than you will without it.
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Recommendations for best Diabetes Specialist/Hospital in Bangkok
Sheryl replied to coachron's topic in Health and Medicine
Please do not make multiple threads on same topuc. . This one closed. @coachron you can post in that other thread. doesn't matter who started it. -
Blood is available. No issue there. They would not be doung a whole blood transusion if problem was WBCs.
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What the family needs to find are replacement donors so that they do not have to pay for the transfusion. Not the immediate source of the blood the patient will receive. As previously posted the Thai Red Cross manages blood donation and screening. No matter what hospital or province the transfusion tajes place in, the blood will have been screened and provided by the TRC.
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How were you contacted and asked for more information if not by the hospital? And was there any confirmation that ghry received the additionsl info you sent?
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His policy is with April France and they are the actual insurer/underwriter.
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1. Complaint procedure is outlined in your policy documents. Make sure you have the exact dates that hospital submitted the initial paperwork and that you subsequently submitted the requested additional information. 2. By your own acccount not the case that they failed to respond within 30 days. It has been more like 16 days since you hsubmitted rhe requested info ( which is still unusualky lonf). You erred in not initially having the hospital submit requuest for pre-aurhorization. 3. Normally the hospital 3rd party payment office will follow-up, have you spoken to them? Often the problem is the insurer awaiting more details on cost estimate from the hospital. 4. How did you email, directly or message through the online Customer Zone?
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Correct on both points. If family can arrange a replacement donation it is done at Red Cross.
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Please see this thread (last few posts), people have been able to get it in Thailand recently: It can also be purchased online from https://bangkokdrugstore.com/?s=lisinopril and https://medtide.com (have to create an acocunt and log in first) and probably also from https://medisafepharma.com/ (have to use the Messenger function to ask them) Where in Thailand are you?
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Blood donation in Thailand is centralized and managed by the Thai Red Cross. In government hospitals, to get free transfusion the patient's family (or people on their behalf) must donate the same quantity of blood. I don't think it has to be of the same blood type or that the prospective donor needs to know their blood type in advance as this donation is not what the patient will receive anyhow. It is just a system to avoid depletion of blood stocks. Over 90% of blood donations in Thailand are made on this basis i.e. the blood banks are dependent on it. Usually it is friends or family who donate, it is nto usual to go around villages asking strangers. If there is no one who can give, the patient can still be transfused but may have to pay a fee as opposed to free.
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Most people who require injected insulin are type 1 diabetics and they will require it for life. Type 2 diabetics can usually be managed without insulin though they may require oral medication. Someone whose type 2 diabetics is so severe as to require insulin will often need it long term, but if there were underlying factors like obesity that are later corrected it is possible they might be able to taper off it. Stopping oral diabetic medications just because you reached desired blood sugar target will simply lead to the blood sugar again going up as these medications do not have a permanent effect. However it can often (not always -- but often) be possible to get to a point where medication is no longer needed through lifestyle changes (exercise, diet, weight loss). People vary greatly in their willingness and ability to make such changes.