What exactly constitutes a pre-existing condition?

[KSwr7UDHyn]

A few years ago, back in the US, I began to experience a feeling like my heart was thumping out of beat.  I looked up a bunch of stuff online and most of it said that this was quite common and, to a degree, normal.  Saw a cardiologist and he ran me through the paces, stress testing on a treadmill, ECG, sonicgram of the heat, etc.  Said everything appeared to be normal.  He called it a pre-arteirial contraction and said it was nothing to be concerned about.  Asked if I wanted to try some meds that might make the thumping less annoying by decreasing blood pressure, but mostly, cut caffeine, get more exercise, etc.  I took the meds for a couple of months and then quit taking them (doctor said I could quit if I wanted).  The thumping went away on it’s own and it’s been a year or so now since I last took the meds.  

 

When I applied for a health insurance policy, that was the only other thing I mentioned on my application and it was turned down.  No reason given.  

 

First, is a condition that was temporary and the doctor did not deem serious, a pre-existing condition?

 

Second, I know I could be denied coverage if the insurance company were to find out, but would an insurance company be able to get my US medical records?  Is that common?  

 

Mind you, I’m not trying to cross the line.  I just want to know where the line is.  Too many folks like to say, “report everything” but sometimes we see a doctor because it’s better safe than sorry, especially with something heart related.  If even seeing a doctor to rule out a serious condition could disqualify you from ever receiving health coverage, that seems pretty crazy.  

[OneMoreFarang]

You had a heart problem. How serious that was or is and how serious and expensive that might become is up to the insurance to decide.

And different insurances might see this differently. Other insurances might exclude any payment for this or maybe you are lucky and they don't care. Try!

If any of them thinks this is a sign that likely or possibly an expensive operation might happen then obviously they will be careful.

 

What you did in the USA is on record. When you sign your insurance contract then you allow them to check with anybody about your health record. Likely they won't do this when you sign up. But if you present them with a big invoice then they will likely check if you had any previous diagnosis with anything similar. There is a good chance that they will find out. So in case you want that covered you should tell the insurance.

If you only care about having a health insurance on paper, i.e. to show some Thai official that you have an insurance, then you can obviously forget that little visit at that doctor. But don't count on your insurance to pay when you need them.

 

Additional things you could do: Ask that doctor to send your record with the details to you. And then visit here a doctor and ask him how he interprets this and maybe check you up now to check if that condition still exists and/or if he thinks you are at risk. And depending how the doctor answers you might want to use this with your insurance. But keep in mind that any such visit will also be on record - except you don't tell the doctor your name.

 

My "knowledge" is based on selling private health insurance many years ago. I am pretty sure they still work in similar ways.

[ThaiBunny]

The basic premise of any insurance company is "Don't pay out - deny the claim". They'll find some way not to pay

[MeePeeMai]

27 minutes ago, ThaiBunny said:

The basic premise of any insurance company is "Don't pay out - deny the claim". They'll find some way not to pay

I have never had a claim denied by any of my Health Insurance providers in 58 years but I have never yet had a Thai policy though.  I suspect that policies here are not the same as policies in the USA.

[Puchaiyank]

Worked with insurance company for years...they are in the business to increase profits every year...denying your claims is money in their pockets...they are willing and able to go to court to deny your legitimate claim if needed to...

 

[legend49]

17 hours ago, ThaiBunny said:

The basic premise of any insurance company is "Don't pay out - deny the claim". They'll find some way not to pay

As a purchaser to insurance, tell them nothing. Maybe they insist on a health check at a hospital, how will they detect all pre existing conditions?

[Langsuan Man]

In the real world you have some right of appeal, barring that there is always a law suit

 

Afraid those remedies are not available here, unless you naively believe in the Office of Consumer Affairs, and is probably the number one reason, after cost, why I will never buy the insurance issued by any Thai Company

 

Not only are they corrupt but are clueless on how to write Health Insurance, the perfect example of Thainess, incompetence backed up by corruption  

[Ajvat37]

I have the same exact condition, tried to get insurance through LUMA, they said they would cover me but not for anything heart related. So a stroke I’m covered but a heart attack I’m not.  You willing never get heart coverage out here with your condition but you can get all else covered.   PAC is a type of arythmia, once you have it you always have it even if it’s dormant for a while.  The health insurance companies here don’t care if it’s a benign PAC, all they care about is your have an arythmia and so they lump you into a high risk group incorrectly.  It’s super frustrating but you will get nowhere trying to explain it to them.

Edited December 6, 2019 by Ajvat37

[KSwr7UDHyn]

18 hours ago, OneMoreFarang said:

You had a heart problem.

 

That’s sort of the point I’m making.  According to the doctor, I didn’t have a heart problem.  In fact, because of all of the testing that he did to confirm that there was no problem, I’m probably a lower risk than someone that has never had the tests done.  The doctor said that the pre-arterial contraction is actually normal but some people are more sensitive to feeling it than others.  In other words, you probably have the same thing happening and you may not even know it.  And the doctor doesn’t consider that a problem as there is no correlation to any sort of other heart condition.  

 

Now, an insurance company can say that because I was cautious, that this is now a pre-existing condition.  

 

Doesn’t this just incentivize people to not check out problems until they get to the point of being serious or life threatening? 

 

That’s why I was asking, what defines a pre-existing condition?  If you notice a lump and get freaked out that you have cancer and the doctor performs some tests and determines it’s just some sort of cyst, because you originally sought treatment for cancer is cancer now a pre-existing condition?    

[OneMoreFarang]

24 minutes ago, KSwr7UDHyn said:

 

That’s sort of the point I’m making.  According to the doctor, I didn’t have a heart problem.  In fact, because of all of the testing that he did to confirm that there was no problem, I’m probably a lower risk than someone that has never had the tests done.  The doctor said that the pre-arterial contraction is actually normal but some people are more sensitive to feeling it than others.  In other words, you probably have the same thing happening and you may not even know it.  And the doctor doesn’t consider that a problem as there is no correlation to any sort of other heart condition.  

 

Now, an insurance company can say that because I was cautious, that this is now a pre-existing condition.  

 

Doesn’t this just incentivize people to not check out problems until they get to the point of being serious or life threatening? 

 

That’s why I was asking, what defines a pre-existing condition?  If you notice a lump and get freaked out that you have cancer and the doctor performs some tests and determines it’s just some sort of cyst, because you originally sought treatment for cancer is cancer now a pre-existing condition?    

And insurance company will look at the facts. If condition A makes it likely that condition B will follow and B is expensive then they will be careful. If A is harmless then you have nothing to worry about.

I guess a big part is what the doctor actually wrote in his (internal) report. If he wrote something like: "Patient feels xzy but I checked it and all is fine." then fine. But if he wrote "condition A, I gave him medication" then maybe it's not so fine.

Like I wrote above: Get the records from your doctor. That is what counts.

[OneMoreFarang]

1 hour ago, legend49 said:

As a purchaser to insurance, tell them nothing. Maybe they insist on a health check at a hospital, how will they detect all pre existing conditions?

You sign that you answered all their questions truthfully. If you don't do that and if they discover it, then they won't pay and maybe they call your behavior fraud. And these days with computers everywhere it will be difficult to hide your records.

[AAArdvark]

I can only speak for what sometimes happens in the US and yes I know the question is about Thailand.

In the past ANY preexisting condition, i.e. a bad left knee, would disqualify someone for any coverage.  I have direct experience with my wife not being able to get insurance because she had osteoporosis.  I had a plan denied because of some minor issue which was not even one of their health questions but was discovered by some kind of medical records check.

It doesn't matter what your doctor says.  It is what their doctor says.  In the example given, having a stroke could easily lead to being an underlying heart issue and cause for a denial.

I would be surprised if they are more lenient in Thailand.

[Sheryl]

From what you describe you did not and do not have heart disease.

 

You had  episodes  benign arrythmia (premature atrial contractions, which occurs to many people if they take too much caffeine).

 

What to put on an insurance form will depend on what exactly is asked.

 

You can truthfully put "no" to heart disease. Also "no" to taking any medications for a heart condition.

 

If asked to give details of any condition for which you saw a doctor (not hospitalized) within the time period that this occurred you should put down that you saw a cardiologist for what at the time felt like palpitations, but tests excluded any abnormal heart condition.  And offer to attach full medical report,  which you might do well to get a copy of.

 

It would be unusual for  a an insurance form to ask about doctor visits more than 2 years ago, but be guided by what exactly is asked.  Answer truthfully but do not volunteer more than is asked for.

 

Was this a Thai or international policy that you had applied for?  Unfortunately most Thai underwriters do not use medically trained people to scrutinize forms and staff tend to work robotically off of simplified charts. I have known many cases where people were given exclusions for pre-existing conditions that they never had. Some of the forms are so constructed that if answered literally, everyone would have to say yes to questions that would then lead them to be branded as having a chronic respiratory disease, for example (e.g. along the lines of "Have you ever had a sore throat or runny nose?").

 

No reasonable insurer would consider what you describe as a pre-existing condition, assuming you gave the full information in your post.  But Thai insurance company staff  in my experience would often miss the key elements and take away only "saw a doctor for  a heart condition".

 

 

 

 

[Sheryl]

16 minutes ago, AAArdvark said:

I can only speak for what sometimes happens in the US and yes I know the question is about Thailand.

In the past ANY preexisting condition, i.e. a bad left knee, would disqualify someone for any coverage.  I have direct experience with my wife not being able to get insurance because she had osteoporosis.  I had a plan denied because of some minor issue which was not even one of their health questions but was discovered by some kind of medical records check.

It doesn't matter what your doctor says.  It is what their doctor says.  In the example given, having a stroke could easily lead to being an underlying heart issue and cause for a denial.

I would be surprised if they are more lenient in Thailand.

 

It is only a pre-existing condition if it (condition or risk factor)  exists at the time of application.

 

Osteoporosis is a chronic condition and does create an very increased risk of fractures and other problems.

 

OP describes having had some occasional PAC's, a very different matter, especially as a battery of tests rules out any underlying  cardiac disease.

[BestB]

2 hours ago, Langsuan Man said:

In the real world you have some right of appeal, barring that there is always a law suit

 

Afraid those remedies are not available here, unless you naively believe in the Office of Consumer Affairs, and is probably the number one reason, after cost, why I will never buy the insurance issued by any Thai Company

 

Not only are they corrupt but are clueless on how to write Health Insurance, the perfect example of Thainess, incompetence backed up by corruption  

All depends if a Thai company or international . If international you can lodge complaints with ombudsman office usually in UK.

 

saying that.  Insurance is not obliged to offer anyone cover and are free to refuse cover during application without a reason 

[Mac98]

Renters insurance. Home insurance against falls and burglaries. How about fire insurance? Flood insurance? Earthquake insurance? High wind damage? Car insurance. Uninsured driver insurance? Life insurance. Workers Comp Insurance. Travel insurance. Life Insurance on family members. Burial Insurance. Social Security Insurance. Motorbike insurance. What did I forget? Go ahead, insure to the hilt. Living in insurance wasteland is good for all of us. But say you need a new heart. 20,000,000b. Your insurance company is first rate and pays the max, 400,000. Whoopie! You only owe 19,600,000b. Give in where you feel you must, scrxx the rest.

[Max69xl]

3 hours ago, legend49 said:

As a purchaser to insurance, tell them nothing. Maybe they insist on a health check at a hospital, how will they detect all pre existing conditions?

I think a health check is needed from 66 years of age. Imo, a pre-existing condition is something you've been treated for at a hospital or clinic. 

[WhatupThailand]

3 hours ago, Langsuan Man said:

In the real world you have some right of appeal, barring that there is always a law suit

 

Afraid those remedies are not available here, unless you naively believe in the Office of Consumer Affairs, and is probably the number one reason, after cost, why I will never buy the insurance issued by any Thai Company

 

Not only are they corrupt but are clueless on how to write Health Insurance, the perfect example of Thainess, incompetence backed up by corruption  

Can anyone say "Lottery", because that is what Insurance is.

You pay the ticket, but will you win when needed ?

Just check how many Lawyers your Insurance company has, and you will get the idea.

[allenberg]

3 minutes ago, WhatupThailand said:

Can anyone say "Lottery", because that is what Insurance is.

You pay the ticket, but will you win when needed ?

Just check how many Lawyers your Insurance company has, and you will get the idea.

The health insurance company is betting you won't get sick. You are betting you will get sick...

[Thaidream]

IMO if Medical Insurance is mandatory- the insurance company cannot rule out pre-existing conditions and cannot deny coverage for any reason and only raise prices due to  actuarial reasons.

 

The Thai Insurance industry fails all the tests- it appears it can do whatever it wants with little push back from the Insurance Commission. It is almost unregulated.  The only real recourse is the court system and going the full route is costly and time consuming/

 

It is completely illogical and probably illegal to create a mandatory requirement and then aplicants for coverage are denied.   The only way around this should be a denial letter to the applicant who then presents it to those who demand compliance (Immigration Bureau  ) and the requirement is waived.

In other words, if there is a legal requirement (Medical Insurance) there has to be a way afforded to the apllicant to meet the reuirement and if there is not, it  can't be applicable.

 

This exists in the Malaysian long  stay program which requires medical insurance but then waives the requirement if  one is denied coverage. If you meet the other requirements- you can still get your Visa/Extension.

 

 

 

[KSwr7UDHyn]

2 hours ago, Sheryl said:

From what you describe you did not and do not have heart disease.

 

You had  episodes  benign arrythmia (premature atrial contractions, which occurs to many people if they take too much caffeine).

 

What to put on an insurance form will depend on what exactly is asked.

 

You can truthfully put "no" to heart disease. Also "no" to taking any medications for a heart condition.

 

If asked to give details of any condition for which you saw a doctor (not hospitalized) within the time period that this occurred you should put down that you saw a cardiologist for what at the time felt like palpitations, but tests excluded any abnormal heart condition.  And offer to attach full medical report,  which you might do well to get a copy of.

 

It would be unusual for  a an insurance form to ask about doctor visits more than 2 years ago, but be guided by what exactly is asked.  Answer truthfully but do not volunteer more than is asked for.

 

Was this a Thai or international policy that you had applied for?  Unfortunately most Thai underwriters do not use medically trained people to scrutinize forms and staff tend to work robotically off of simplified charts. I have known many cases where people were given exclusions for pre-existing conditions that they never had. Some of the forms are so constructed that if answered literally, everyone would have to say yes to questions that would then lead them to be branded as having a chronic respiratory disease, for example (e.g. along the lines of "Have you ever had a sore throat or runny nose?").

 

No reasonable insurer would consider what you describe as a pre-existing condition, assuming you gave the full information in your post.  But Thai insurance company staff  in my experience would often miss the key elements and take away only "saw a doctor for  a heart condition".

 

 

It was with April Global and the question was along the lines of “Have you ever . . .”  All the questions were of that format.  Have you ever seen a doctor for a heart related condition?  

 

So, I did answer that truthfully and given that the only other issue in my records was getting my 50+ colonoscopy which I had to list as a surgery (they put you under for the procedure), I have to assume the heart question was the disqualifier.  

 

That’s why I said, I’m not trying to cheat the system.  I just want some advice on where the line is, because, as you say, some of the questions are presented in a fashion where you have to answer yes.  

 

I haven’t applied with another insurer yet and am a little concerned that this cautionary visit to the doctor to get something checked out is suddenly going to set off red flags with a trigger happy reviewer that is looking for a reason to say “no.”. I guess I’ll have to shop around based on their pre-screen questionnaire.  LOL.  

 

BTW, the doctor said exactly what you did, cut down on the caffeine.  I was drinking 4 or 5 cups a day and after I stopped the PACs stopped.  

[chilly07]

Apart from accidents all conditions are preexisting. This is only tested AFTER they have your premium and are looking for a way out. They never expect to pay back your premium and will fight to keep it. And Tourists and Itinerant Workers who do not apply for OA visas will continue to run up the vast majority of bills and do a runner!

[4MyEgo]

23 hours ago, KSwr7UDHyn said:

Mind you, I’m not trying to cross the line.  I just want to know where the line is.  Too many folks like to say, “report everything” but sometimes we see a doctor because it’s better safe than sorry, especially with something heart related.  If even seeing a doctor to rule out a serious condition could disqualify you from ever receiving health coverage, that seems pretty crazy.

I was knocked back two insurance companies for my pre-existing condition, i.e. we will insure you but not for your pre-existing condition, I kindly gave them the middle finger, twice.

 

A year or so later I asked a broker if he knew of any insurers that might cover my pre-existing condition, i.e. I had a mild heart attack in 2008, i.e. I overexerted myself and had the associated crushing pain and loss of breath, went straight to the hospitals emergency section around the corner and the rest is history, meds ever since, and all good with 2 year check up with the Cardiologist and the 5 year treadmill test, all good.

 

If you don't succeed at first, try and try again as the saying goes, suffice to say the insurer gave me the option to insure without the pre-existing or with the pre-existing condition, of which costs me $60USD more than the policy per month, so it is very worth having myself covered in the event of another stent being required.

 

If you would like the brokers details send me a PM alternatively you could go direct to David Shield, however there is no charge by the broker and they do all the leg work, you fill in the forms all by email and make the payment when approved. If you have paperwork from the Cardiologist, they will want to send that across to their doctors/risk assessors and you'll be in like Flynn as your condition sounds mild compared to mine. 

[Sergeant]

Any insurance is Risk sharing except Health Insurance company. They will work for special price with hospital who will not give you the same consideration for any loyalty being treated at any Hospital. international hospital has infected their activity on Thai people to where No Thais can afford Health care of the finest in the world, unless you wait in line for Pandora 400mg?

I see now Bangkok hospital has increase their prices as with ingrown toe nail for $12,000 Baht of 30 second activity. What needs to put in place is proper policy for being honest with charges before any treatment. Then we can choose what hospital thinks more about treating patients than making money. In my experience Honesty always wins out in the long run.

[Matzzon]

Easy! You should be honest and tell when you sign up.

[Just Weird]

23 hours ago, ThaiBunny said:

The basic premise of any insurance company is "Don't pay out - deny the claim". They'll find some way not to pay

Jesus...

[NoshowJones]

22 hours ago, OneMoreFarang said:

You had a heart problem. How serious that was or is and how serious and expensive that might become is up to the insurance to decide.

And different insurances might see this differently. Other insurances might exclude any payment for this or maybe you are lucky and they don't care. Try!

If any of them thinks this is a sign that likely or possibly an expensive operation might happen then obviously they will be careful.

 

What you did in the USA is on record. When you sign your insurance contract then you allow them to check with anybody about your health record. Likely they won't do this when you sign up. But if you present them with a big invoice then they will likely check if you had any previous diagnosis with anything similar. There is a good chance that they will find out. So in case you want that covered you should tell the insurance.

If you only care about having a health insurance on paper, i.e. to show some Thai official that you have an insurance, then you can obviously forget that little visit at that doctor. But don't count on your insurance to pay when you need them.

 

Additional things you could do: Ask that doctor to send your record with the details to you. And then visit here a doctor and ask him how he interprets this and maybe check you up now to check if that condition still exists and/or if he thinks you are at risk. And depending how the doctor answers you might want to use this with your insurance. But keep in mind that any such visit will also be on record - except you don't tell the doctor your name.

 

My "knowledge" is based on selling private health insurance many years ago. I am pretty sure they still work in similar ways.

That's an excellent answer, I do get the impression, though only by reading Thaivisa over the years that Thai insurance companies are not as bad as the ones in the UK when paying out for claims is concerned.

 

I go back to the UK once a year for a few weeks, and there is a Sunday newspaper which has a legal page which fights for people who are wronged in any way.

Almost every week there are complaints from people whose insurance company refuses to meet their claim. That tells you everything about insurance companies in the UK.

[Just Weird]

19 hours ago, Puchaiyank said:

Worked with insurance company for years...they are in the business to increase profits every year...denying your claims is money in their pockets...they are willing and able to go to court to deny your legitimate claim if needed to...

 

No insurer will go to court over a legitimate claim, it's doubt about the legitimacy that makes them do that, something that they have every right to do.

[Just Weird]

5 hours ago, legend49 said:

As a purchaser to insurance, tell them nothing. Maybe they insist on a health check at a hospital, how will they detect all pre existing conditions?

Not difficult for medical professionals!  

[Just Weird]

4 hours ago, KSwr7UDHyn said:

 

That’s sort of the point I’m making.  According to the doctor, I didn’t have a heart problem.  In fact, because of all of the testing that he did to confirm that there was no problem, I’m probably a lower risk than someone that has never had the tests done.  The doctor said that the pre-arterial contraction is actually normal but some people are more sensitive to feeling it than others.  In other words, you probably have the same thing happening and you may not even know it.  And the doctor doesn’t consider that a problem as there is no correlation to any sort of other heart condition.  

 

Now, an insurance company can say that because I was cautious, that this is now a pre-existing condition.  

 

Doesn’t this just incentivize people to not check out problems until they get to the point of being serious or life threatening? 

 

That’s why I was asking, what defines a pre-existing condition?  If you notice a lump and get freaked out that you have cancer and the doctor performs some tests and determines it’s just some sort of cyst, because you originally sought treatment for cancer is cancer now a pre-existing condition?    

The fact that you have consulted a doctor for the condition is enough for an insurer to deny coverage, you will find that the questionnaire that you complete with the application asks if you have, or have had, any particular condition or if you have ever consulted a doctor about any condition.

Edited December 6, 2019 by Just Weird