What exactly constitutes a pre-existing condition?

[Just Weird]

3 hours ago, Sheryl said:

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".

His potential insurers did not say that they were declining cover because he had a pre-existing condition, they simply chose to refuse his application for cover, as is their right, and that policy of refusing some applications is not restricted to Thai insurers!

[Just Weird]

47 minutes ago, KSwr7UDHyn said:

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

Bear in mind that all insurers ask whether you have ever had a policy declined, obviously that has to answered truthfully also.

[Sheryl]

33 minutes ago, KSwr7UDHyn said:

 

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.  

 

I am surprised as April Global (France) in m,y experience usually comes back asking for more information, copies of test results etc.

 

Also what you describe does not sound like their Health Questionnaire. It does sound very much like the Health  Questionnaire of April Thailand (which is underwritten by LMG, a Thai company and so reads like a typical Thai insurance questionnaire).

 

Can you post a pix (identifying info removed) of this questionnaire?

 

If it was in both Thai and English it is not April Global, it is April Thailand.  Ditto if you were told it meets the Thai Immigration requirement for OA visa extension. April Global does not (other than for initial issuance of the visa).

 

If it really was April France and you went through a broker could ask the broker to pursue it and see if you can submit more information to clarify things. (In case it was the colonoscopy, then that report as well as records of your various negative cardiac tests).

 

If however it was April Thailand then what you are getting is from the Thai underwriter and everything I said re them applies. You could try asking broker to interceded, but with Thai underwriters (who do not usually have a medical person look at the forms, and have limited comprehension of English medical terms) it may be hopeless.

[Sheryl]

38 minutes ago, 4MyEgo said:

r 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. 

 

Agree however he ne4eds to clarify if he is seeking "real" insurance or insurance that meets Thai Immigration requirements. If the latter his choices are very, very limited and none of them would even look at a Cardiologists report.

[Just Weird]

 

 

26 minutes ago, possum1931 said:

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.

That also says just as much about some of those who make claims in the UK!   The majority of insurance claims are settled with no disputes.

Edited December 6, 2019 by Just Weird

[KSwr7UDHyn]

34 minutes ago, Sheryl said:

 

I am surprised as April Global (France) in m,y experience usually comes back asking for more information, copies of test results etc.

 

Also what you describe does not sound like their Health Questionnaire. It does sound very much like the Health  Questionnaire of April Thailand (which is underwritten by LMG, a Thai company and so reads like a typical Thai insurance questionnaire).

 

Can you post a pix (identifying info removed) of this questionnaire?

 

If it was in both Thai and English it is not April Global, it is April Thailand.  Ditto if you were told it meets the Thai Immigration requirement for OA visa extension. April Global does not (other than for initial issuance of the visa).

 

If it really was April France and you went through a broker could ask the broker to pursue it and see if you can submit more information to clarify things. (In case it was the colonoscopy, then that report as well as records of your various negative cardiac tests).

 

If however it was April Thailand then what you are getting is from the Thai underwriter and everything I said re them applies. You could try asking broker to interceded, but with Thai underwriters (who do not usually have a medical person look at the forms, and have limited comprehension of English medical terms) it may be hopeless.

 

I re-read the application and it was for within the last 5 years (not ever - must have missed it or been confused).  But this is the language used is attached.  

 

The cover doc says April International, updated April 2018 

 

 

[Max69xl]

4 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 would be unusual for  a an insurance form to ask about doctor visits more than 2 years ago".

I broke my right ankle early 2004,and it healed as it should,and I did mention it in the form when applying for an insurance with Pacific Cross 2 years ago. 15 years later it's mentioned on my 'Insurance card'. How often doesn't a broken ankle,leg or arm heal in 15 years? ????

 

[Sheryl]

28 minutes ago, KSwr7UDHyn said:

 

I re-read the application and it was for within the last 5 years (not ever - must have missed it or been confused).  But this is the language used is attached.  

 

The cover doc says April International, updated April 2018 

 

 

OK yes that is them (Global).

 

Contact them and explain that you think the information may have been misinterpreted and ask if you can submit detailed medical report, because you did not consult a doctor about an actual cardiovascular disease but rather about symptoms that turned out to be nothing and CV disease was thoroughly excluded. 

 

I don't see anywhere on the form that would have elicited the colonoscopy. Did you clearly say "routine colonoscopy for screening purposes only, negative result". ?

 

And your age is under 66, yes? They do not issue new policies over  age 65.

[OneMoreFarang]

1 hour ago, possum1931 said:

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.

I think that is only half of the truth. Because we can also see in this thread that not everybody would answer all the insurance company questions truthfully. I am sure some of the people who don't tell the insurance the truth will later complain why the insurance does not pay. Obviously there can be many reasons. But one reason that the insurance does not pay is that the client didn't tell the whole truth in the application form and/or in the claim. And then it's obviously easy to blame the insurance companies...

 

I have a health insurance which is based in the UK. Until now, over the last couple of years, they paid everything 100%. And they always paid within about 10 days. And I am no special VIP customer. It seems sometimes insurance companies work just the way they should.

[Sheryl]

5 minutes ago, Max69xl said:

"It would be unusual for  a an insurance form to ask about doctor visits more than 2 years ago".

I broke my right ankle early 2004,and it healed as it should,and I did mention it in the form when applying for an insurance with Pacific Cross 2 years ago. 15 years later it's mentioned on my 'Insurance card'. How often doesn't a broken ankle,leg or arm heal in 15 years? ????

 

 

Are you saying that you have an exclusion related to a fracture that healed 15 years ago?

 

If so you should definitely request to have it reviewed and removed. And be persistant. Exclusions can be and often are removed after a policy is initially issued.

 

While PC is an international insurance management company (with a Thai branch) in Thailand they use a Thai underwriter. Hence the PC staff often cannot explain or predict how the actual policy and premiums will come out. They do their own underwriting internationally so I expect it is an OIC requirement that they use a Thai underwriter here.

[Sheryl]

4 minutes ago, OneMoreFarang said:

I think that is only half of the truth. Because we can also see in this thread that not everybody would answer all the insurance company questions truthfully. I am sure some of the people who don't tell the insurance the truth will later complain why the insurance does not pay. Obviously there can be many reasons. But one reason that the insurance does not pay is that the client didn't tell the whole truth in the application form and/or in the claim. And then it's obviously easy to blame the insurance companies...

 

I have a health insurance which is based in the UK. Until now, over the last couple of years, they paid everything 100%. And they always paid within about 10 days. And I am no special VIP customer. It seems sometimes insurance companies work just the way they should.

 

I would make that "usually" not sometimes.

 

But I have to admit that Thai companies are a breed apart. And has explained in my prior post even where the policy is managed by an international company like Pacific Cross, in Thailand there is still a Thai company as actual underwriter and the management co can do only so much. (All them ore reason to use a broker to get the policy, the after-service is invaluable).

 

That said, I've seen a lot of complaints about Thai insurers over the years on this board and whenever it sounded justified I have advised people to appeal to the OIC and provided the link to do so online. As far as I know, not a single one followed up which makes one doubt whether all the circumstances were as they reported.

 

I would certainly file a complaint if I thought an insurer had made a wrong determination. In fact I have an appeal wending its way through the US Medicare system right now.

 

 

[NoshowJones]

1 minute ago, OneMoreFarang said:

I think that is only half of the truth. Because we can also see in this thread that not everybody would answer all the insurance company questions truthfully. I am sure some of the people who don't tell the insurance the truth will later complain why the insurance does not pay. Obviously there can be many reasons. But one reason that the insurance does not pay is that the client didn't tell the whole truth in the application form and/or in the claim. And then it's obviously easy to blame the insurance companies...

 

I have a health insurance which is based in the UK. Until now, over the last couple of years, they paid everything 100%. And they always paid within about 10 days. And I am no special VIP customer. It seems sometimes insurance companies work just the way they should.

No honest company, hotels, restaurants, insurance companies etc, would have the need to use small print, and surely no one would argue that small print is used hoping that people will not notice it.

In the case of insurance companies, along with the small print, they use lots of legal jargon that it is hard for the average person to understand, and just why do they do that? I think the answer is obvious.

[Max69xl]

19 minutes ago, Sheryl said:

 

Are you saying that you have an exclusion related to a fracture that healed 15 years ago?

 

If so you should definitely request to have it reviewed and removed. And be persistant. Exclusions can be and often are removed after a policy is initially issued.

 

While PC is an international insurance management company (with a Thai branch) in Thailand they use a Thai underwriter. Hence the PC staff often cannot explain or predict how the actual policy and premiums will come out. They do their own underwriting internationally so I expect it is an OIC requirement that they use a Thai underwriter here.

I am not so worried about my ankle and breaking it again at the exact same spot is very unlikely. ????

[Sheryl]

14 minutes ago, Max69xl said:

I am not so worried about my ankle and breaking it again at the exact same spot is very unlikely. ????

 

How exactly is this exclusion worded? I doubt it is such that the break would have to be in the same spot.

 

Might not even be limited to fractures.

 

Get it removed, not hard to do (the exclusion, not your ankle ????)

[Sheryl]

29 minutes ago, possum1931 said:

No honest company, hotels, restaurants, insurance companies etc, would have the need to use small print, and surely no one would argue that small print is used hoping that people will not notice it.

In the case of insurance companies, along with the small print, they use lots of legal jargon that it is hard for the average person to understand, and just why do they do that? I think the answer is obvious.

 

Where have you seen an insurance policy with "small print" ? I haven't, and I have read a lot of policies.

 

The "small print" provisions people refer to are usually in perfectly normal size print.  People simply (and, to me, inexplicably) do not take the time to read their policies.

 

As for the "jargon" every insurance policy I have seen includes at the very beginning, pages of precise definitions, even for things like "illness" and "injury". I don't see a lot of highly legalistic wording in most insurance policies.

 

 

[NoshowJones]

2 minutes ago, Sheryl said:

 

Where have you seen an insurance policy with "small print" ? I haven't, and I have read a lot of policies.

 

The "small print" provisions people refer to are usually in perfectly normal size print.  People simply (and, to me, inexplicably) do not take the time to read their policies.

 

As for the "jargon" every insurance policy I have seen includes at the very beginning, pages of precise definitions, even for things like "illness" and "injury". I don't see a lot of highly legalistic wording in most insurance policies.

 

 

I have not seen any insurance policies in years, so many things may have changed now, but please

note I am referring to policies in the UK.

[KSwr7UDHyn]

1 hour ago, Sheryl said:

OK yes that is them (Global).

 

Contact them and explain that you think the information may have been misinterpreted and ask if you can submit detailed medical report, because you did not consult a doctor about an actual cardiovascular disease but rather about symptoms that turned out to be nothing and CV disease was thoroughly excluded. 

 

I don't see anywhere on the form that would have elicited the colonoscopy. Did you clearly say "routine colonoscopy for screening purposes only, negative result". ?

 

And your age is under 66, yes? They do not issue new policies over  age 65.

 

The colonoscopy was in a section worded similarly under gastro.  And I stated it more in terms of, “Colonoscopy as part of 50+ physical.”  

 

I’ll try your suggestion about explaining to them.  My age is under 60 so that should not be the issue.  

[rumak]

9 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?

Under no circumstances tell them you are or once were a member of this forum.  If they know then any mental health claim will be denied as this alone will be proof you had a pre existing condition.

[Sheryl]

28 minutes ago, KSwr7UDHyn said:

 

The colonoscopy was in a section worded similarly under gastro.  And I stated it more in terms of, “Colonoscopy as part of 50+ physical.”  

 

I’ll try your suggestion about explaining to them.  My age is under 60 so that should not be the issue.  

For future reference (and others reading) as the question asked about seeing a doctor for a GI condition that means illness and no need to mention a  routine screening. (Of course if they asked whether you had any sort of procedure done for any reason then that would be different). 

 

Did you go through a broker? As if so they can handle this for you it's one of several advantages to using a broker.  You'd still have to send all the medical info yourself but they can be good at getting an insurer's attention to your case.

[Sheryl]

1 hour ago, possum1931 said:

I have not seen any insurance policies in years, so many things may have changed now, but please

note I am referring to policies in the UK.

I have had a health insurance policiy issued out of UK.  Perfectly normal sized print. Entire booklet of Policy rules/policy guide in the welcome kit along with cover letter urging members to read it carefully. (Cigna)

 

[Sheryl]

9 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?

They have you answer a set of questions which you then sign as true. Any lie and they can invalidate the entire policy. As to how they will know,  once you have a claim they have access to your medical records.

 

And believe me, when brought in to an Emergency Room in fear for your life with a suspected heart attack or whatever,  you will tell the doctors the full truth about your medical history as your only thought at that time will be to enable them to treat you correctly. As it should be. And if you did not lie on your ibsurance application this will be no problem later. But if you did...

[Puchaiyank]

6 hours ago, Just Weird said:

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.

Yes, of course.  I should have used the word "contested claim"...the court desires its legitimacy...I forget sometimes who the audience is here...????

[stevenl]

On 12/5/2019 at 5:29 PM, 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...

 

I also 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 will only go to court to deny your illegitimate claim if needed to...

[Just Weird]

5 minutes ago, stevenl said:

I also 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 will only go to court to deny your illegitimate claim if needed to...

"...they will only go to court to deny your illegitimate claim if needed to..."

What?  No insurance company will deny legitimate claims!

[unblocktheplanet]

I’ve used Thailand Travel Shield for several years. They’re reasonable but they have a weird requirement that the insured must leave the Kingdom & re-enter…every 60 days! Of course, those of us who live here might not be going abroad every two months! It’s good coverage but not a sensible requirement. I can’t read this any other way than the insurance company wants every possible angle to deny a claim.

 

I’ve never made a claim before but this year my wife noticed a odd swelling on my throat. Insurer advised me to go to Samitivej. Lump on throat? Endocrinology.

 

I have had thyroid disease since 1983. It is a genuine pre-existing condition. However, I didn’t go to Samitivej for my thyroid, I went about a lump.

 

Insurer called numerous times, hospital called many times. In every case, I refused to cough up (about B5,000+). Eventually, neither persisted. But I still have no idea how they got paid. Either the endo or nursing staff who wrote up the notes spelled out thyroid disease.

 

(For all you conspiracy buffs, think the docs & hospitals collude with the insurance companies not to pay?!?)

 

In any case, they won’t take on over 70s, so all us geezers is hooped! It’s actually good insurance for tourists, accidents & so on if you’re the right age & if you can leave & return every 60 days.

 

Like all insurers, though, they’d prefer not to pay!

[Max69xl]

On 12/6/2019 at 3:23 PM, Sheryl said:

 

How exactly is this exclusion worded? I doubt it is such that the break would have to be in the same spot.

 

Might not even be limited to fractures.

 

Get it removed, not hard to do (the exclusion, not your ankle ????)

It will be removed from January 1 2020.