Thaivisa exclusive: Hua Hin shark attack victim said insurance gave him the green light to go to expensive hospital

[Just Weird]

54 minutes ago, monkfish said:

Same thing thing happened to my mother whilst on 2 week vacation the Insurance refused to pay for treatment at the hospital.
At first a hospital representative dealt with the insurance company on her behalf.
Reason given by the insurance company is this hospital is over priced.

"Reason given by the insurance company is this hospital is over priced".

 

I very much doubt that any insurer would use those words but would love to be proved wrong if you've got the evidence.  Much more likely was that the policy only covered costs from the less expensive hospitals, as is normal if the policy holder wants to keep the premium down.

[cat handler]

Something smells bad here, he claims his Insurance Company told him he would be covered at that hospital yet his policy had expired, you would have thought the Insurance Company would have check the validity of his policy before authorising treatment. I wonder how much he has made from all of this. Also 300,000 baht for 4 days in hospital seems extremely high for what was a minor wound that required only cleaning and 19 stitches, did he also take the happy ending option?

 

[redwhiteandblue]

Nobody really knows what kind of insurance cover he had, or what it actually covers.  And for how long.  Or what was even said on the telephone conversation.

 

Most of the time holiday/travel insurance is sold by a  third party travel agent or bought on-line.  People generally don't ask for exact details of what is covered, and just make assumptions. The travel agency will also usually not go into detail about what is covered etc. 

 

But it is worth noting this:  Travel insurance cannot be extended once you are on your trip,  It doesn't cover you for dangerous activities such as riding a motorbike or jet skiing and also for natural disasters or terrorist attacks.

 

One last thing worth remembering.  Insurance companies don't want to pay out - so they will look for any loophole they can to avoid paying out.

 

And that's why travel insurance is so cheap.

 

 

[Just Weird]

38 minutes ago, Thaidream said:

I had a similar situation when I was a claims adjustor in California- The insurance company gave the authorization for a repair to a damaged auto- then after the repair had already started decided the policy had lapsed.  the customer sued- and the company was found liable.

 

A verbal authorization is as good as a written authorization made by a competent company oficial and  eve though later  it was found the policy was not in force- since the authorization waas given- the company must make their customer whole- meaning the company pays.

 

I see this situation as the same- the customer called the insurance carrier- it's representative gave the authorization to proceed- they are liable for the bill. It is not the customer's fault that the  insurance company did not check their own policy and immediately tell the customer the policy was not covering the incident. I would sue the insurance company and demand payment as well as damages/i

Norway isn't California.

[jkcjag]

For all inpatient treatment that I have ever had in Thailand the hospital have always ensured in advance that the costs will be covered, either by contacting the insurance company directly to verify that the insurance is valid, and to establish exactly what portion would be covered, or by verifying that the patient will pay by whatever means, e.g. cash or credit card. Either way the hospital have written or electronic verification in advance that the bill will be covered. If the patient is paying, then before admission they have charged an estimate of the total cost, and advised that there may be additional charges to cover the final total. However, for emergency treatment situations this procedure may be impacted depending on the ability of the patient to advise on the payment alternatives in advance, and I'm not sure how they would proceed if after emergency surgery they discover that there may be a problem with payment, howsoever caused. 

[scubascuba3]

WHAT?....do you not see the quote sayig

...."an offer that was later rescinded after it was discovered that the policy had run out."? "Run out" means the policy was not in effect. It is crystal clear.

So what exactly does "run out" mean? And no it isn't crystal clear at all, run out could mean several things

[mogandave]

He maybe just asked if the hospital was concidered in the “network”, not wherther his  policy was actually valid.

 

THB 300,000 does not seem like that much to someone that seems to have plenty of time and money to visit Thailand seaveral times a year. 

[scubascuba3]

Maybe we should give Mace the benefit of the doubt and he can see things we (using tapatalk) can't. Still not enough useful info though

No what are you talking about no where in the article does it say that which you have quoted.

[monkfish]

16 minutes ago, Mace648 said:

I copied and pasted those quotes directly out of the article attached to these comments.

The article below

 

Werner Danielsen pictured in Bangkok Hospital Hua Hin earlier this month

 

Thaivisa have contacted the Norwegian man who was attacked by a bull shark off Sai Noi Beach, Hua Hin last month.

 

Werner Danielsen, 54, told how he was assured by his insurance company that they would pay only for them to change their minds four days later after he racked up a 300,000 baht bill. 

 

That was for just four days at Hua Hin Bangkok Hospital.

 

But he had nothing but praise for the Thai people who helped him, the doctors and the reaction of the authorities.

 

Werner was speaking Thursday evening from Khon Kaen where he is still recovering from his ordeal after the bite on his left leg on April 15th. 

 

He left hospital in Khon Kaen three days ago but still needs to have the wound cleaned every few days to safeguard against the possibility of infection.

 

He said that he was with some children at the beach and went out to some rocks. He then jumped in and was swimming about 100 meters offshore when he felt something go for his leg three times.

 

He didn't see what attacked him in the murky water but he managed to get to the shore where Thai people rushed him to hospital.

 

He said that he was mindful that an expensive hospital in Hua Hin would cost him a lot of money and was prepared to go to a cheaper hospital if necessary.

 

But after his insurance company assured him over the phone that everything was okay he decided to go to Hua Hin Bangkok Hospital.

 

He described the treatment and the doctors and nurses as excellent but four days later his insurance company made contact and said they could not cover the bill. 

 

It was reported in the Thai media that he had been away too long and the policy had expired.

 

"I wouldn't have gone to that hospital if I had known," he said resignedly.

 

Now he hopes that representations made on his behalf by the deputy governor of Prajuab Khirikhan might give him some financial assistance.

 

Kindhearted Werner, who runs a home for runaway and problem children back in Norway, is not bitter about his experience and is ambivalent about getting financial help. 

 

If he does that is good, if not never mind.

 

He praised the Thai people who helped him at the beach and the Thai authorities for their actions adding:

 

"I am not the kind of person that bashes Thailand".

 

He said that his girlfriend Amonrat Phaengnga, 43, had been a tower of strength and has sorted out everything for him.

 

The couple are not actually married as has been reported in the media but Werner said that he considers himself married in his heart.

 

Amonrat lives in Khon Kaen, where she looks after family members, preferring not to live with Werner in Norway. But he makes visits to Thailand as regularly as he can.

 

He said that his visa has been extended and he is due to leave before the 16th of June giving him plenty of time to recover from his ordeal that has been top of the news in Thailand for several weeks.  

 

Signs have now been erected at Sai Noi Beach as the authorities mull what further action should be taken.

[mogandave]

2 minutes ago, scubascuba3 said:

22 minutes ago, Mace648 said:

WHAT?....do you not see the quote sayig

...."an offer that was later rescinded after it was discovered that the policy had run out."? "Run out" means the policy was not in effect. It is crystal clear.

So what exactly does "run out" mean? And no it isn't crystal clear at all, run out could mean several things

 

While it “could” mean anything, it seems clear to me. The policy expired prior to the accident. 

 

 

[stevenl]

3 minutes ago, mogandave said:

 

While it “could” mean anything, it seems clear to me. The policy expired prior to the accident. 

 

 

Don't think so. I think the policy was still valid, but he did not meet the policy conditions: he exceeded the time away from Norway on one trip, which is nearly always limited (quite often 30, 45 or 90 days).

[Just Weird]

24 minutes ago, redwhiteandblue said:

Nobody really knows what kind of insurance cover he had, or what it actually covers.  And for how long.  Or what was even said on the telephone conversation.

 

Insurance companies don't want to pay out - so they will look for any loophole they can to avoid paying out.

That is nonsense, insures have an obligation to their policy holders to pay out for all legitimate claims and there are industry regulators that ensure that this happens. Insurers do want to pay legitimate claims as the entire industry would collapse if they didn't and paid claims represent a minute proportion of their income, that's why they're in the business!  For massive claims that could have an effect on their bottom line, insurance companies themselves take out policies to insure against that risk.

 

Insurance companies do not look for "loopholes", they ensure that claims meet the requirements of the policy that the insured paid for and then pay out with no issue.  If a claim is made for something that is not covered, or the policy holder has voided the policy by his own actions, it is their right to decline to pay the claim.

Edited May 4, 2018 by Just Weird

[scubascuba3]

 
While it “could” mean anything, it seems clear to me. The policy expired prior to the accident. 
 
 

Ignorance is bliss for some people

[roath]

15 hours ago, GuiseppeD said:

Seems like a nice guy and very positive.  Though would appear that his insurance was invalid on this occasion, hence the insurance company not paying out.  It is what it is.

Legally, the insurance company can still be liable under the doctrine of estoppel and representation at least for the additional costs of the more expensive hospital over a cheaper one so they are not in my opinion off the hook unless the insured was dishonest with the insurance company

[Bangel72]

300k for four days in hospital for some bites, <deleted>, did they have to sew the foot back on?.


 

[leither69]

13 hours ago, darksidedog said:

Again I reiterate that when an insurance company gives you the green light, as it is alleged they did, you should consider yourself approved to get good treatment. If you make a mistake, you should suffer a consequence when that causes another a financial loss. If the Insurance company originally said you are covered and to go get the treatment, it should not be able to pull out from the financial commitment it has made,especially after a nasty bill has already accrued. Regardless of if they made a mistake with the policy's expiry date, or later found a sub clause exclusion about being away from your home country more than X days. I question again though, why the hospital didn't get it confirmed before allowing such a bill?

I would not go ahead on the strength of a phone call.  Fax or written confirmation only

[monkfish]

1 hour ago, Just Weird said:

"Reason given by the insurance company is this hospital is over priced".

 

I very much doubt that any insurer would use those words but would love to be proved wrong if you've got the evidence.  Much more likely was that the policy only covered costs from the less expensive hospitals, as is normal if the policy holder wants to keep the premium down.

Sorry I am not going to post that Email here you either believe me or you don't up to you.
One thing you are right about is the insurance company wanted her to change to a less expensive hospital in the area but as she was already attached to a drip and in a great deal of pain we decided not to change hospitals and paid for treatment cash. She later when she returned home she was reimbursed for about 60% of the cost of treatment. The policy was purchased together with a direct Flight from London to BKK with BA and purchased from the a well know high street Travel Agency in the UK she chose the most expensive travel insurance policy offered.

I just want to warn other travelers they might not be covered for treatment at the most expensive hospitals that all.
We all assume we can go to every hospital but it's not true.

 

Edited May 4, 2018 by monkfish

[jenny2017]

 

The couple are not actually married as has been reported in the media but Werner said that he considers himself married in his heart.

 

   Perhaps he told the insurance that he was in Mallorca and an insurance clerk then Googled Shark attacks in Spain and that was the end of it.

 

  Kindhearted Werner would never lie. That can happen when  you think that you are a Superstar, but you aren't.  

 

   I can't wait to read his book and of course the movie when he fought for his life and finally killed the shark with his bare hands. 

[PEE TEE]

The only comment i can make is . the first thing is to get to hospital. They ask if you have insurance if so they take  the info and contact the insurance company to find out if your covered for treatment . normally they also want your passport ,they keep it until the payment has been made . That was my case after an accident i had . If you were to be unconscious then i  have no idea of the procedure.   

[natway09]

Why does the insurance Co not make a statement of fact to clear the air. If not, why not?

If the policy has lapsed tough titties for him

[stevenl]

6 minutes ago, natway09 said:

Why does the insurance Co not make a statement of fact to clear the air. If not, why not?

If the policy has lapsed tough titties for him

They can not make public statements about individual cases, privacy laws.

[mihalis]

16 hours ago, GuiseppeD said:

Seems like a nice guy and very positive.  Though would appear that his insurance was invalid on this occasion, hence the insurance company not paying out.  It is what it is.

Invalid, yet they gave him the go ahead.. has he named company ? Would be one to avoid ! 

[stevenl]

Just now, mihalis said:

Invalid, yet they gave him the go ahead.. has he named company ? Would be one to avoid ! 

First of all, did they give him the go ahead?

Second of all, if they did, did he inform the company he violated the policy conditions?

[Thaidream]

1 hour ago, Just Weird said:

at is nonsense, insures have an obligation to their policy holders to pay out for all legitimate claims an

Insurance companies have a legal obligation as well as a moral one to pay all legitimate claims and are normally monitored by a regulating agency of the  government.  

 

In this case, if the insurance company failed to notice that the policy had lapsed or what was being claimed was not part of the policy but went ahead and authorized the payment but then later declined- this is probably in most countries not per the law which governs insurance.   Most people have no idea how intricate insurance coverage can be and sometimes it is very difficult to understand how the policy is written. 

 

In the past most insurance was purchased through an agent who specialized in that particular policy and gave their clients a full explanation of coverage and exclusions. Today, with internet and other methods of electronic purchase- the buyer has to beware.

 

Most  initial claims  for insurance are taken by claims processors in a call center atmosphere and then forwarded to a claims adjustor who contacts the customer within 24 hours and makes the decision if coverage exists or tells the person making the claim further investigation is needed.  I can assure most claims processors taking initial claims are not qualified to make decisions on whether you are covered or not unless that company has  specifically trained their call center staff and  licensed them to make those decisions.

 

However, once a claims agent-even at the lowest level- commits the insurance company verbally to payment by uttering the  words 'your are covered'-   they cannot later come back and say I made a mistake and you are not covered.  The insurance companies will try to rescind the coverage but if the customer complains; files a formal complaint with the insurance commission or gets a lawyer and sues- the insurance company will lose.

 

While Norway is not California where I worked for 15 years as an adjuster- Norway is a first World country with similar laws.

 

Most  reputable insurance companies do provide ethical and lawful coverage- but they also are fully aware of their bottom line.  I can guarantee  you that a first year policyholder may not be treated the same way a 20 year policy holder is as far as speed of handling or other intangibles. In addition, if the charges a hospital wants to make are beyond what the norm is for  the area of  coverage- the insurance company may decline coverage for that  hospital  but will normally go to the hospital and negotiate a lower charge. Insurance companies constantly push the limits of legality to save money and that's why they are constantly sued.

 

If what the  injured person states is correct- that he was informed he was covered is correct- he has a legal case against the insurance company unless Norwegian law specifically states that an Insurance company can rescind coverage after verbally committing to it or if  Norwegian law does not recognize verbal commitment.

 

Just an aside- most call centers for insurance tape all conversations so there should be taped proof of what was said and what was not said.

Edited May 4, 2018 by Thaidream

[stevenl]

Quote

If what the  injured person states is correct- that he was informed he was covered is correct- he has a legal case against the insurance company unless Norwegian law specifically states that an Insurance company can rescind coverage after verbally committing to it or if  Norwegian law does not recognize verbal commitment.

Don't forget the policy holder also has the obligation to disclose any information relevant to the claim. And being abroad for 90+ days when the coverage is only valid for 30, 45 or 90 days would be information relevant to the claim. Just as riding a bike can be covered, and if covered the claims department will assure the policy holder it will pay, but when a few days later evidence comes that he was riding over the legal alcohol limit and was not wearing a compulsory helmet the claim can be rejected.

[monkfish]

20 minutes ago, Thaidream said:

Insurance companies have a legal obligation as well as a moral one to pay all legitimate claims and are normally monitored by a regulating agency of the  government.  

 

In this case, if the insurance company failed to notice that the policy had lapsed or what was being claimed was not part of the policy but went ahead and authorized the payment but then later declined- this is probably in most countries not per the law which governs insurance.   Most people have no idea how intricate insurance coverage can be and sometimes it is very difficult to understand how the policy is written. 

 

In the past most insurance was purchased through an agent who specialized in that particular policy and gave their clients a full explanation of coverage and exclusions. Today, with internet and other methods of electronic purchase- the buyer has to beware.

 

Most  initial claims  for insurance are taken by claims processors in a call center atmosphere and then forwarded to a claims adjustor who contacts the customer within 24 hours and makes the decision if coverage exists or tells the person making the claim further investigation is needed.  I can assure most claims processors taking initial claims are not qualified to make decisions on whether you are covered or not unless that company has  specifically trained their call center staff and  licensed them to make those decisions.

 

However, once a claims agent-even at the lowest level- commits the insurance company verbally to payment by uttering the  words 'your are covered'-   they cannot later come back and say I made a mistake and you are not covered.  The insurance companies will try to rescind the coverage but if the customer complains; files a formal complaint with the insurance commission or gets a lawyer and sues- the insurance company will lose.

 

While Norway is not California where I worked for 15 years as an adjuster- Norway is a first World country with similar laws.

 

Most  reputable insurance companies do provide ethical and lawful coverage- but they also are fully aware of their bottom line.  I can guarantee  you that a first year policyholder may not be treated the same way a 20 year policy holder is as far as speed of handling or other intangibles. In addition, if the charges a hospital wants to make are beyond what the norm is for  the area of  coverage- the insurance company may decline coverage for that  hospital  but will normally go to the hospital and negotiate a lower charge. Insurance companies constantly push the limits of legality to save money and that's why they are constantly sued.

 

If what the  injured person states is correct- that he was informed he was covered is correct- he has a legal case against the insurance company unless Norwegian law specifically states that an Insurance company can rescind coverage after verbally committing to it or if  Norwegian law does not recognize verbal commitment.

Well this is maybe the point as local hospitals are half the price of private in Thailand.
Also to note if Thais offer to pay for the treatment cash and he gets a receipt he could still make a claim with the insurance and possibly recover a percentage of the cost.
mmm

Edited May 4, 2018 by monkfish

[Thaidream]

The burden is on the Insurance claims agent to ask all the questions necessary to determine coverage or delay a decision on coverage until an investigation determines whether there is coverage.   If  there is any doubt- the claims agent does not say you are covered- they say coverage is pending.

[mogandave]

The burden is on the Insurance claims agent to ask all the questions necessary to determine coverage or delay a decision on coverage until an investigation determines whether there is coverage.   If  there is any doubt- the claims agent does not say you are covered- they say coverage is pending.

We have no way of knowing that the insurance company approved the treatment.

We have no idea what the guy even asked the insurance company.

Again, he may have only asked if the hospital was on the preferred provider list.

I know that with my insurance, Bangkok and Bumrungrad are both on the preferred provider list. Anyone could call and get that information, even if they had no policy.

[ttrd]

16 hours ago, hellstens said:

How come the insurance company gives the green light for him to go to Bangkok hospital then?

I smell something rotten here.lol

So, here we goes again with negative speculations...

 

We should take into consideration that he is an older guy who almost got his foot bitten off  which must have been a quite traumatic experience - I would assume the first thing coming to his mind would be to get the best and quickest treatment for his foot rather than counting days to check if the Insurance is valid.

As from what we know he comes and goes on a reguraly  basis on a tourist visa which means 1 month + maximum 1 or 2 extensions gives 45- 90 days which is a timeframe within the norm of a simple short time travel Insurance. The most of us who make short travels take it for granted that the insurance cover the whole travel period and forget to check this up when extensions are involved.

 

As he said, he is prepared to take the bill and I am sure he learned his lesson so no need for further (rotten) speculations....

[mogandave]

The burden is on the Insurance claims agent to ask all the questions necessary to determine coverage or delay a decision on coverage until an investigation determines whether there is coverage.   If  there is any doubt- the claims agent does not say you are covered- they say coverage is pending.

So how do we have any idea what the insurance company actually said?