Jump to content

rolfefox

Member
  • Posts

    34
  • Joined

  • Last visited

Posts posted by rolfefox

  1. Ask your Broker to sort it out with the Insurance company as they will have all the phone numbers

    I had an expensive operation at BKK Pattaya Hospital. I was told by BUPA that they found a 2 year old blood test that made my

    case a pre-existing condition and would not pay...I appealed and presented information that this test was not relevant. It took time while they reviewed my case but they changed to my favor and paid. So my exprience is that they are fair when concidering pre-existing conditions.

  2. If the payment was denied solely on the basis of a prior cholesterol level, with no other evidence of pre-existing coronary artery disease, this is absurd and you should most definitiely appeal.

    The challenge, of course, will be in figuring out how to do this. You need to speak with the "Financial Ombudsman Office" or Thia equivalent. Be very firm, stating that you wish to appeal a denied claim and insisting on being put through to the appropriate person.

    Start by reading your policy and handbook, fine print included, to see if the process for appeal is described or contact information for an ombudsman provided.

    If no luck in getting hold of an appropriate person -- or if they refuse to provide inf0 on how to appeal the claims denial -- you might try contacting the parent company in the UK:

    The Customer Relations Department:

    Phone: 0845 606 6726 Lines open 8:30am to 5:30pm Mondays to Fridays.

    Fax: 01784 893175

    Financial Ombudsman Service:

    South Quay Plaza

    183 Marsh Wall

    London

    E14 9SR

    Tel: 0845 080 1800

    Please let us know how this turns out, many of us (myself included!) have BUPA coverage and reports of this type are disturbing.

    Assuming there are no details omitted from this story, your case is so solid that I would try to pursue it on your own first before resorting to a lawyer. If you do have to hire a lawyer, make sure it is one with experience in insurance claims.

    I very much apreciate your information and support..They did just say they would review the case,,,this was quite a surprise since it took over 2 month to deny. I will let you know the outcome...

  3. I was recently denied payment by BUPA for a heart stent operation. They claimed a three-year-old cholesterol test which was 11 points over 200 proved a pre-existing condition. This does not even meet their own definition of pre-existing condition.

    Has anybody else been denied payment for a similar situation or required a lawyer for payment?

  4. If you have a pre-existing condition that you are aware of then declare it on the application. It is possible that they won't exclude it or they may impose a co-insurance rather than a full exclusion, i.e. you will be liable to pay a percentage of any treatment costs.

    If it is a pre-existing condition that you are unaware of, they will have difficulty denying the claim.

    As a previous poster stated, a full health check prior to taking out the insurance can be a good idea, provided you are not found to have any health problems. If, however, you are diagnosed with something of which you were previously unaware, it could subsequently be excluded under a health policy. So, it's a difficult call.

    Finally, check the policies and coverage for a number of companies if you can. Remember, you get what you pay for with insurance.

    I have been recently been denied payment for a heart stent by BUPA because they say a 3 year old cholesterol test

    that I forgot about was 211. This does not fall in BUPAs definition of a pre-existing condition however they chose not to pay.

    Has anybody else had a similar experience?

  5. I need health insurance. I have done quite a bit of research on the Internet attempting to determine which company to select. I even went so far as go to Bangkok Pattaya hospital to ask their international department what health insurance they considered best. They were not able to answer the question and sent me to the insurance department. The girl there did speak English, just not the best and never could really grasp the question. But she did indicate they have quite a bit of experience with BUPA.

    I was first turned off by BUPA since they did not directly settle with the hospital. But that has now change and they will pay the hospital directly and you do not have to pay the hospital and later be reimbursed.

    I emailed BUPA the following questions. Below is there response. It seems to me, unless I am mistaken, with the exception of some kind of accident they could deny any claim they deem fit for the first five years of your policy under the “pre-existing clause.”

    I would be interested in comments on this post, and your experience with BUPA.

    Does anybody know if this is standard in the industry? What are other company’s policies on pre-existing conditions?

    The following was email to BUPA.

    To Whom It May Concern:

    I am considering your product. I have been reading quite a bit on the Internet and attempting to determine which health insurance company offers the best product. There are quite a few posts regarding your company and declining benefits due to a clause in your contract against pre-existing conditions. Some of these posts state they have been with your firm for years and paid their premiums all that time and as soon as they need you, your firm declines benefits saying it was “a pre-existing condition.”

    Before I sign up with your firm, could you please answer the following questions?

    A) How do you determine what is a pre-existing condition?

    :) How long do you have to be a client before this clause is waved all together?

    C) If your firm declines benefits due to this clause do you refund the paid premiums?

    D) Unless I am mistaken, with the exception of an accident could your firm not just deny all claims using this as a reason?

    You prompt response will be greatly appreciated.

    BUPA’s Response:

    Dear Khun William,

    Thank you for a good question. I'd like to clarify you question by

    question

    A) Pre-existing conditions. This means any disease, illness or injury

    Or symptoms and complications thereof for which the covered person was

    Treated or knew about (or a prudent person should have been aware existed), Within 5 years before joining BUPA or it is medically proven that the member has such sickness or conditions prior to joining the BUPA health scheme.

    :D Exclusion for pre-existing conditions may be waived if the covered

    person has declared such conditions on the joining application form and

    the company has agreed to cover them.

    C) The Insured can terminate this policy by giving notice to the company in writing. In this event, the company will refund the premium as per the short-rated schedule The Company has the right not to refund the premium of the benefits, which have been claimed form. In the event of cancellation the whole policy will be terminated. It is

    Not possible to cancel some or part of the benefits.

    D) Some of accident Bupa not covered such as

    - dangerous sports or activities including hunting for animals, racing

    of all kinds including car, boat and horse racing, water and snow ski-ing, skating and skateboarding, boxing, parachuting, boarding or traveling in a hot air balloon, gliding, bungy jumping, mountain climbing with equipment, diving with oxygen tank and breathing equipment under water. - While the covered person is boarding or traveling in an aircraft which has no license for caring passengers or does not operate as a commercial aircraft, or whilst piloting or working on board as an employee of an airline.

    -While the covered person serves as a soldier, police, or a volunteer

    and participates in war or crime suppression.

    There are some more that you can find at the major exclusions, where

    contain in the page 3-4 of benefit section.

    If you need further information or have some more questions to be clear

    please do not hesitate to contact me

    I have been denied payment by BUPA because of a 3 year old cholesterol test BUPA claiming the result was a prexisting condition...has anyone had to secure a laywer to to get fair payment from them..?

  6. Make a 'public will' at the Amphur for the GF. I'm almost sure it's free to make. I believe a 'public will', in Thailand, is the only will that's uncontestable, no lawyer required.

    please describe what Amphor is and is there one located in Pattaya your help is appreciated regards Rolfe

  7. Remember there is a third Pattaya Hospital located near 3rd road and Pattaya Klang...named Memorial

    It was recomended as the one to go to for treatment if you are in an accident.... since they have the most experience..

    regards rf

  8. If you need a good hospital then I highly recommend this hospital. My story. Went to Bangkok Pattaya Hospital to get my GF a check up as she had lower abdominal pains. Saw a gynecologist, had an ultra sound and then a consultation with the specialist. Outcome 7000 baht (3500 consultation/3500 ulta sound) and she needs an operation (a woman thing cost about 150,000). Rule of thumb, always get a second opinion so we went to Samitivej Hospital in Siracha as I was at an Expat meeting at the Grand Sole and met the International Ofifcer of the hospital there after she gave a very good presentation (she spoke perfect English). Went to see a specialist at Samitivej, consutation was 400 baht (had the ulta sound pictures with us from Bangkok Hospital) and the quote on the operation was 80,000 baht. Then I asked for a tour of the rooms available. She said do you want the Thai rooms or Foreigner rooms. I said what is the difference and she said all the rooms are the same (dimensions and price) but on the foreigner floor everyone speaks a second language where on the Thai floor they only speak Thai. We looked at both floors (5 & 8) and they are both alike. The cost of a basic room is 4500 baht which includes the room,food and nurses. Well the basic room is like a 4 star hotel room with frig, hot water heater for drinks, 42" flat screen, desk with ADSL hook up and a coutch the folds down to a second bed so a second person can stay overnight. All the rooms have a balcony with an ocean view as the hospital is accross the street from the water. There are more expensive rooms, a one bedroom suite costs 11,000 baht (about the cost of a basic room at Bangkok Pattaya). The food is on a menu and there are 4 choices for each of the 3 daily meals and all 7 days have a different choices (example, dinner one night was baked chicken in red wine sauce with baked potatoe, salad and dessert (not a typical hospital menu). For the additional person there is a room service menu which is the best room service menu I have seen in a long time. The cost of the most expensive item was 180 baht for a steak dinner with baked potatoe and vegtables. Needless to say my GF had great pains on Saturday morning and called the doctor at Samitivej. It was his day off (holiday weekend) but said he would come in and see here at 11am. She needed an emergency operation as the cyst had grown and she was operated on at 1pm Saturday. She was out of surgery at 3pm and she stayed in the hospital till Tuesday noon. The doctor came in every day and checked on her. They asked for my credit card at check out and I thought..80,000 for the operation, 4500/day room, meds, etc,etc.....at least 100,000 baht. The bill was exactly 80,000 baht no add ons. I almost fell over, an honest hospital....what next.

    If you would like a tour of the hospital you can call Jane Tonsombun, the International Officer, at 0-3832-0300 ext. 3118. PM me if you have any questions.

    Rdrokit

    Thank you for the information....and I have an aopointment there tomorrow..

    regards rolfe

  9. If you need a good hospital then I highly recommend this hospital. My story. Went to Bangkok Pattaya Hospital to get my GF a check up as she had lower abdominal pains. Saw a gynecologist, had an ultra sound and then a consultation with the specialist. Outcome 7000 baht (3500 consultation/3500 ulta sound) and she needs an operation (a woman thing cost about 150,000). Rule of thumb, always get a second opinion so we went to Samitivej Hospital in Siracha as I was at an Expat meeting at the Grand Sole and met the International Ofifcer of the hospital there after she gave a very good presentation (she spoke perfect English). Went to see a specialist at Samitivej, consutation was 400 baht (had the ulta sound pictures with us from Bangkok Hospital) and the quote on the operation was 80,000 baht. Then I asked for a tour of the rooms available. She said do you want the Thai rooms or Foreigner rooms. I said what is the difference and she said all the rooms are the same (dimensions and price) but on the foreigner floor everyone speaks a second language where on the Thai floor they only speak Thai. We looked at both floors (5 & 8) and they are both alike. The cost of a basic room is 4500 baht which includes the room,food and nurses. Well the basic room is like a 4 star hotel room with frig, hot water heater for drinks, 42" flat screen, desk with ADSL hook up and a coutch the folds down to a second bed so a second person can stay overnight. All the rooms have a balcony with an ocean view as the hospital is accross the street from the water. There are more expensive rooms, a one bedroom suite costs 11,000 baht (about the cost of a basic room at Bangkok Pattaya). The food is on a menu and there are 4 choices for each of the 3 daily meals and all 7 days have a different choices (example, dinner one night was baked chicken in red wine sauce with baked potatoe, salad and dessert (not a typical hospital menu). For the additional person there is a room service menu which is the best room service menu I have seen in a long time. The cost of the most expensive item was 180 baht for a steak dinner with baked potatoe and vegtables. Needless to say my GF had great pains on Saturday morning and called the doctor at Samitivej. It was his day off (holiday weekend) but said he would come in and see here at 11am. She needed an emergency operation as the cyst had grown and she was operated on at 1pm Saturday. She was out of surgery at 3pm and she stayed in the hospital till Tuesday noon. The doctor came in every day and checked on her. They asked for my credit card at check out and I thought..80,000 for the operation, 4500/day room, meds, etc,etc.....at least 100,000 baht. The bill was exactly 80,000 baht no add ons. I almost fell over, an honest hospital....what next.

    If you would like a tour of the hospital you can call Jane Tonsombun, the International Officer, at 0-3832-0300 ext. 3118. PM me if you have any questions.

    Rdrokit

  10. I have a meniscal (cartilage) tear that needs surgery. I'm looking for a hospital in central Bangkok that is less than the Bumrungrad price range. Also, any idea on costs and the price of MRI scans?

    May you take a look at my Post HERE!

    The Paolo in Samut Prakarn is very good and a lot more cheap than Bumrungrad for example.

    Did you get a MRI to determine it was a cartilidge tear..if so what was the price please..?

    thanks rolfe

  11. Thanks for the tip but how much is the "fair price"?

    They actually start at 400 Baht for the cleaning...all dentist have a range with 500 to 800 baht often being the starting price..Also, remember you are getting a cleaning from a dentist not an assistant...

  12. If you are looking for a great teeth cleaning at a fair price..go to Dental Care Center...

    it is on Pattaya Klang about 100 meters from 3rd Road intersection towards the ocean on left side..(below Carrefour)

    ask for Dr Monthira Jaroenying

  13. I can not believe that as of two p.m. monday afternoon, it looks like the BCS American College Football national tile game (Ohio St./Florida) is NOT scheduled to be aired on ESPN Hong Kong? I do not understand this. The last 2 years the game has been on. It is not listed in UBCTV.com's up to date program listing!!! This is especially frustrating seeing they have carried some college bowl games, such as a meaningless one this morning which featured Southern Miss vs. Ohio which absolutely nobody cares about!!!!!

    I have written a complaint to UBC stating that I was going to subscribe to UBC, if this game would be on. I have since changed my mind. However, I believe it may be more of a problem with ESPN not scheduling it? I need to get a hold of them and complain!!!!

    Is there a place somewhere in the Bangkok/Chon Buri area that may have sattelite? This may be the only way to somehow see this game. Any number that can be given to contact ESPN would be appreciated too. Hope to hear from someone.

    American sports fan lost in Thailand!

×
×
  • Create New...