Canadian diagnosed with brain tumour in Thailand has travel insurance declined because he had the flu a month ago

[robblok]

20 minutes ago, SteveK said:

Insurance companies are like fruit machines, most people put in way more than they will ever get out. After all, the machine costs money, someone's got to pay for it. The people who don't play them are the smart ones.

Unless you are the one getting sick or having an accident. As long as you will pay for it yourself I am for it. Though just imagine the horror if for instance car insurance was not here. People would have to claim with others fight in courts to get money. Sounds like a lot of trouble to me. So calling insurance bad is just crazy and manipulative as it has its uses.

 

But your right there is more put in then ever been paid out. Do you worry too that you pay more for your T shirt then production cost ? Or that your internet provider makes a profit on you ?

[SteveK]

3 minutes ago, robblok said:

Yes of course, they are a company and want to make a profit. For that they risk pool and use statistics and hope they make a profit. But the idea that they just refuse claims offhand is stupid. I mean everyone has a car insurance and you don't hear people complain about that. 

Car insurance where I am from is generally reliable, but in the case of a claim they still look for reasons to not pay, and still take many months to resolve the claim.

[kingdong]

1 minute ago, robblok said:

Unless you are the one getting sick or having an accident. As long as you will pay for it yourself I am for it. Though just imagine the horror if for instance car insurance was not here. People would have to claim with others fight in courts to get money. Sounds like a lot of trouble to me. So calling insurance bad is just crazy and manipulative as it has its uses.

 

But your right there is more put in then ever been paid out. Do you worry too that you pay more for your T shirt then production cost ? Or that your internet provider makes a profit on you ?

You obviously work in the game.

[robblok]

1 minute ago, SteveK said:

Car insurance where I am from is generally reliable, but in the case of a claim they still look for reasons to not pay, and still take many months to resolve the claim.

Yes of course would they not do that your premiums would rise a lot and you would be complaining about that. Its all perfectly logical if you look further then just your own benefits.

[Sheryl]

49 minutes ago, BestB said:

It’s little confusing . So he has travel insurance and insurance is refusing to pay for what? 
 

he is on holiday from my understanding for 6 weeks, now that he has been diagnosed.  He can still fly back to Canada ,

 

so insurance is refusing to pay for surgery in Thailand ? Or refusing to pay for what?

 

Refusing to pay for medical evacuation back to Canada.

 

His condition is unstable and he is not fit to fly without medical personnel and equipment.

 

While it is possible the headache he had previously was actually due to the tumor  and not flu it is equally possible it was due just to flu and it cannot be proven otherwise. He was examined by a doctor at the time who diagnosed flu.

 

Obviously a brain cancer --  or any other cancer for that matter --  doesn't just occur all of a sudden and would have existed when he took out the policy,  but there is no evidence that he knew of it or could reasobably have been expected to know. The doctors who examined and treated him for flu didn't detect it,  so how would he have?

 

They should appeal (hopefully already have) and they will win if the company doesn't cave first due to the publicity.  

 

The problem is the resulting delay as he needs treatment quickly. 

 

 The company may end up having to pay for complete treatment in Thailand when they could have just paid for repatriation. 

[robblok]

1 minute ago, kingdong said:

You obviously work in the game.

I am an accountant / tax adviser. So no I don't but I have a pretty good understanding how a business works and find it strange that people seem to want the cheapest insurance and then moan when it does not pay. (as your correct there goes less out then is paid in but if you put even less in even less is paid out)

 

But i just see how all businesses need to make money. 

[kingdong]

1 minute ago, robblok said:

Yes of course would they not do that your premiums would rise a lot and you would be complaining about that. Its all perfectly logical if you look further then just your own benefits.

So why do so many insurance companies not investigate blatant fraud because it isn,t worth their while and easier to up the premium of the punter being conned as they still get their money?

[robblok]

3 minutes ago, Sheryl said:

 

Refusing to pay for medical evacuation back to Canada.

 

His condition is unstable and he is not fit to fly without medical personnel and equipment.

 

While it is possible the headache he had previously was actually due to the tumor  and not flu it is equally possible it was due just to flu and it cannot be proven otherwise. He was examined by a doctor at the time who diagnosed flu.

 

Obviously a brain cancer --  or any other cancer for that matter --  doesn't just occur all of a sudden and would have existed when he took out the policy,  but there is no evidence that he knew of it or could reasobably have been expected to know. The doctors who examined and treated him for flu didn't detect it,  so how would he have?

 

They should appeal (hopefully already have) and they will win if the company doesn't cave first due to the publicity.  

 

The problem is the resulting delay as he needs treatment quickly. 

 

 The company may end up having to pay for complete treatment in Thailand when they could have just paid for repatriation. 

Thing is Sheryl, we are taking the word of one side for it. But sure if it is the way you think it is then this company is fully liable. 

[robblok]

1 minute ago, kingdong said:

So why do so many insurance companies not investigate blatant fraud because it isn,t worth their while and easier to up the premium of the punter being conned as they still get their money?

Maybe if you were a bit more cued in its also in your best interest for them not to investigate all fraud. At times an investigation in fraud has far less benefits (fraud amount is lower as what the investigation would cost). So by not going after every possibly fraudulent claim and only going after the ones that are easier to prove and larger they in fact are keeping your premiums down.

 

But many people with limited financial schooling have no clue about how things work. 

[kingdong]

2 minutes ago, robblok said:

I am an accountant 

 

But i just see how all businesses need to make money. 

Like scammers and confidence tricksters?

[zydeco]

17 minutes ago, robblok said:

Risk pooling and insurance has been known to work nothing wrong with it at all.

Work for whom?  The pool is only deep at one end.

[robblok]

1 minute ago, zydeco said:

Work for whom?  The pool is only deep at one end.

Work for all and of course the people who work at an insurance company. I am not sure but I most people who have worked in their life have worked for a organisation that wanted to make a profit. Why would it be different for an insurance agency. Of course they want to make some money too and have their costs too. 

[kingdong]

2 minutes ago, robblok said:

Maybe if you were a bit more cued in its also in your best interest for them not to investigate all fraud. At times an investigation in fraud has far less benefits (fraud amount is lower as what the investigation would cost). So by not going after every possibly fraudulent claim and only going after the ones that are easier to prove and larger they in fact are keeping your premiums down.

 

But many people with limited financial schooling have no clue about how things work. 

Isn,t paying out for fraudulent claims aidding   and abetting criminal activity?

[robblok]

3 minutes ago, kingdong said:

Like scammers and confidence tricksters?

There is a difference between scamming and a business. I guess you never noticed.

[robblok]

2 minutes ago, kingdong said:

Isn,t paying out for fraudulent claims aidding   and abetting criminal activity?

Obviously its not.. so you failed at accounting business and now law.. what did you study.. moaning one one ?

[cyril sneer]

He should insist on going ahead with the treatment then do a runner when the hospital bill comes, like the Russians and Indians do 

[kingdong]

1 minute ago, robblok said:

Work for all and of course the people who work at an insurance company. I am not sure but I most people who have worked in their life have worked for a organisation that wanted to make a profit. Why would it be different for an insurance agency. Of course they want to make some money too and have their costs too. 

Perhaps with that sense of morality,one would be more financially recompensed working for the mafia?

[kingdong]

3 minutes ago, robblok said:

There is a difference between scamming and a business. I guess you never noticed.

Working in insurance and judging by your viewpoint guess you,ve never noticed either.

[AussieBob18]

I use travel insurance evey time we visit Thailand.  But I know that it is for a serious accident or other illness caused by something in Thailand - not for something that is already going wrong inside and flares up/starts in Thailand. As others have said you should always have extra available funds to either pay for a medical treatment or to be able to get home for full diagnosis and treatment.

 

And my added advice would be to never start treatment in Thailand IF you can get on a plane quickly and get home. Once you start treatment in Thailand your passport etc is flagged and you will probably not be able to leave and the airline will probably not accept your booking.   If possible, say thanks - pay the bill - and say you are going to another hospital for second opinion - get to airport and get home.  In this case maybe some rizatriptan for the pain (or something stronger) would have helped and enabled him to fly home - but maybe not and that is why he is stuck waiting for medical evac.  

[kingdong]

1 minute ago, AussieBob18 said:

I use travel insurance evey time we visit Thailand.  But I know that it is for a serious accident or other illness caused by something in Thailand - not for something that is already going wrong inside and flares up/starts in Thailand. As others have said you should always have extra available funds to either pay for a medical treatment or to be able to get home for full diagnosis and treatment.

 

And my added advice would be to never start treatment in Thailand IF you can get on a plane quickly and get home. Once you start treatment in Thailand your passport etc is flagged and you will probably not be able to leave and the airline will probably not accept your booking.   If possible, say thanks - pay the bill - and say you are going to another hospital for second opinion - get to airport and get home.  In this case maybe some rizatriptan for the pain (or something stronger) would have helped and enabled him to fly home - but maybe not and that is why he is stuck waiting for medical evac.  

Right you are mate,I always get travel insurance but I always take an extra 3 large in cash in top of my spending money so if I need to ( and am able ) get home a bit lively after a medical mishap would be able to.

[spidermike007]

Two of the largest mafia organizations in the world are the insurance companies, and the banks. The insurance companies will do everything in their power to deny coverage. They are crooks. I use them as little as I have to. I despise them. 

[NanLaew]

2 hours ago, ezzra said:

i'm not a big fan of insurance companies ways of doing business but there's some information missing from the OP...With all due sympathy here, not sure whether the insurance company should be liable for what is undoubtedly a pre existing condition, surely this massive tumor hasn't come about when he was traveling right?...

It can't be determined with any precision if any condition was pre-existing until it manifests itself. This guys brain tumor was only discovered a few day ago, not when he signed up for the travel insurance several weeks ago.

 

2 hours ago, sunnyboy2018 said:

The issue revolves around whether a person knows they have a medical condition and does not admit it. Or has a medical condition and does not know it.

It is assumed that the guy had no migraines, malaise or other indicators of a serious illness when he signed up for the insurance. In this instance, I say the latter prevails.

 

To say otherwise, which appears to be the stance of the insurance company, is to suggest that the guy decided to go on holiday in Thailand knowing he had a serious illness. This is frankly quite preposterous.

[BestB]

24 minutes ago, Sheryl said:

 

Refusing to pay for medical evacuation back to Canada.

 

His condition is unstable and he is not fit to fly without medical personnel and equipment.

 

While it is possible the headache he had previously was actually due to the tumor  and not flu it is equally possible it was due just to flu and it cannot be proven otherwise. He was examined by a doctor at the time who diagnosed flu.

 

Obviously a brain cancer --  or any other cancer for that matter --  doesn't just occur all of a sudden and would have existed when he took out the policy,  but there is no evidence that he knew of it or could reasobably have been expected to know. The doctors who examined and treated him for flu didn't detect it,  so how would he have?

 

They should appeal (hopefully already have) and they will win if the company doesn't cave first due to the publicity.  

 

The problem is the resulting delay as he needs treatment quickly. 

 

 The company may end up having to pay for complete treatment in Thailand when they could have just paid for repatriation. 

Oh I see now , thank you. Yes totally agree, he should file case with ombudsman in Canada and I have a feeling all will be paid for, but takes time . 
 

I had similar just not a serious case myself some 18 years ago. Ripped shoulder and needed surgery , first claim denied. I filed with ombudsman and 10 days later , got letter of approval. They paid for surgery in Thailand and paid for physio but refused to pay for flight back in business class or higher and stopped paying the moment I set foot back home 

[zydeco]

33 minutes ago, robblok said:

Do you worry too that you pay more for your T shirt then production cost ? Or that your internet provider makes a profit on you ?

The government doesn't require me to buy a T shirt or use an internet provider.

[Sheryl]

17 minutes ago, AussieBob18 said:

.... In this case maybe some rizatriptan for the pain (or something stronger) would have helped and enabled him to fly home - but maybe not and that is why he is stuck waiting for medical evac.  

 

Apparently his headache was not a migraine but rather due to increased intracranial pressure.

 

Strong pain killers in that instance are neither safe nor effective.

 

The intracranial pressure needs to be reduced and fast.  Steroid drugs and other measures can give some temporary help and sounds like this was done. But what is really needed is surgical intervention to reduce pressure on the brain and it is needed soon.

 

With something like this it is understandable the insurer would dig through the records a bit since the tumor obviously existed when the policy was issued (and probably for a year or more before that).  But if, as the article says,  the only thing they found was a medical visit for what was diagnosed as flu, they are clutching at straws and unlikely to prevail on appeal.

 

 

 

[zydeco]

28 minutes ago, robblok said:

But i just see how all businesses need to make money. 

Insurance companies are a middleman who drive up costs for people who would ordinarily pay for medical care out of their own pocket. You don't just pay for your medical risk with an insurance company, you pay for that company's employees, its infrastructure, offices, equipment, advertising, etc. All entirely superfluous to medical costs.

[zydeco]

18 minutes ago, AussieBob18 said:

But I know that it is for a serious accident or other illness caused by something in Thailand - not for something that is already going wrong inside and flares up/starts in Thailand.

So you get appendicitis and you're out of luck? That ought to make people feel safer.

[chainarong]

2 hours ago, leeneeds said:

Get your self over to Australia and see Dr Charlie Teo , he will cut the tumour  out

good luck

Dr Charlie is a legend, hey.

[NanLaew]

1 hour ago, Ron jeremy said:

He came with a return ticket, is he looking to get treated in Thailand????? Simply jump on the big bird, it may cost a few hundred to change flights, and come home. The guys been working for years, is relocating to Toronto, can afford a 6 week vacation, not like he's broke.

unless he's bedridden and incapacitated" , come home.

and it's obviously a pre existing condition. 

Dont nderstand the situation.

If you read the linked article, you will see that there are risks if he travels via commercial airline due to the limitations of medication in lieu of surgery. The insurer initially accepted the claim and were going to send an air ambulance, a life flight for emergency medical repatriation with doctor and medical staff onboard. These typically take a patient to the nearest center of medical excellence as defined in the policy and not necessarily home.

 

On discovering that he had visited a hospital as an out patient for 'flu symptoms' that included reporting a headache before the trip, the insurers have determined the cancer was a pre-existing condition. They will still provide the medical evacuation but will charge for it.

 

  "They offered to still send an air ambulance service and quoted me $265,000 but that’s obviously not an option."

 

Assuming that he also has medical bills for the CAT scan and other services at the Samui hospital, there are these additional charges that the insurers are probably denying as well.

[NanLaew]

59 minutes ago, robblok said:

Good point though it could also be a smoke screen getting insurance an other way. But its a good point. But Thailand has some good hospitals there could be more to this when meet the eye.

I don't think insurance companies are out to get us and my experience has been reasonable with them. But i can understand them investigating a claim like this one.

 

Anyway it looks like we just see one side.

Here's the view from 'the other side'.

 

On their website, Allianz defines a pre-existing condition as "an injury, illness or medical condition that caused someone to seek treatment, presented symptoms, or required medication."

"This may have taken place anytime within 120 days prior to and including the plan’s purchase date."

"Note that you don’t even need an official medical diagnosis from a physician for something to be considered a pre-existing condition."

 

Now, keeping an open mind and avoiding your predilection to seek ulterior motives such as "a smoke screen getting insurance an other way", do you think it is:

 

A ) Fair and reasonable for a major insurance company to place a 4 month pre-existing condition window on a policy?

 

and,

 

B ) Fair and reasonable to completely disregard a medically qualified diagnosis when they deem it detrimental to their position?

 

Although the latter doesn't apply in this instance, the arbitrary non-medical decision has been made. The guy went to the ER with flu symptoms and coincidentally reported a headache; not unusual for influenza. However, Allianz have said he didn't have the flu, he had brain cancer and we aren't paying.