Broker Helps Client Get Full Hospital Bill Paid

 

 

Recently a Pattaya based insurance broker managed to reverse a decision by an international insurer to obtain for their client full payment of their treatment.

 

Macallan Insurance Brokers (MIB) was dealing with the wife of a client who had a medical insurance policy with no exclusions. They knew that, previously, she had had breast cancer, and later on she did not feel too good, and so went to hospital where she was found to have a heart problem. 

 

However, she was refused cover by the insurance company because she had not declared any problems of high blood pressure or hypertension when she had filled out her application form. 

 

This was serious because the lady did need to be seen by a doctor as quickly as possible. Our staff listened to what had happened. Once we had heard the full story, we asked for a complete medical history.

 

After studying the information, it soon became obvious as to what had happened. Whenever the lady went in for her chemotherapy, she understandably became very nervous and so her blood pressure went up dramatically thus causing hypertension. 

 

When the insurance company received the hospital records, they noted the high blood pressure readings, but did not, whether by accident or design, relate them to the distress caused by the cancer therapy. 

 

Meanwhile Macallan Insurance Brokers made the connection immediately, and went back to the insurer. They asked them to reverse their decision not to cover this case but, in what was possibly a face-saving exercise, they refused coverage again.

 

As luck would have it, a 16-year-old client of MIB had just broken a finger in a sports accident. Due to the pain, she had a very high blood pressure reading. We asked the insurer if she would also not be covered for hypertension in the future because of this incident. When the insurer answered she would be covered for high blood pressure and hypertension for as long as she had her policy, and even if she changed insurer, MIB were able to get the insurer to reverse their decision on the earlier case for the woman with the heart problem, and her treatment was paid in full.

 

The point of this is to show that, at times, you need an accomplished broker to fight your cause and only years and years of experience can give you this. www.macallanbroker.com

 

There are of course choices when it comes to buying insurance. You can get it from an agency, a brokerage or directly from the company itself. There are pros and cons to all of them.

 

If you buy from an agency then they can only offer you one type of insurance as they are only able to offer one provider. If you get insurance from a company directly then they may want to protect their claims ratios and so look for any excuse not to pay out on a claim. 

 

A broker on the other hand can offer many options and you are still protected by the Office of Insurance Commission which comes under the auspices of the Ministry of Finance. It usually turns out that a broker has a lot of experience so knows how to fight your corner better than most.

 

 

I read that an Insurance Company can refuse to pay due to a pre-existing condition whether the client knew about it or not.

If the client didn't know for example that they had high BP, or say prostate problems before they took out the policy, and so had not consulted a doctor about it, how can the Insurance Company find out anything?

Can you buy insurance for if your insurance company refuses to payout and your not insured after all ????

15 minutes ago, stouricks said:

I read that an Insurance Company can refuse to pay due to a pre-existing condition whether the client knew about it or not.

If the client didn't know for example that they had high BP, or say prostate problems before they took out the policy, and so had not consulted a doctor about it, how can the Insurance Company find out anything?

If you are diagnosed with heart condition XYZ and they know it takes 5 years to develop and your insurance is only 3 years old then you can be refused as it is preexisting condition and doesn't matter if you knew about it or not.

 

Same with high blood pressure. You just don't wake up one day with high blood pressure.

when the insurance company decides (and not an MD) whether or not you need a medical procedure, you know the country you live in is ...

 

USA is one of them great countries nr 1, but not in health, nor education

 

thailand comes to mind also

 

insurance is a big scam, you can pay for year and when you need it, they try to find reasons not to pay

 

wait for it, soon, you will might a forced vaccination if you want a visa extension,  who knows...

4 hours ago, AndyAndyAndy said:

If you are diagnosed with heart condition XYZ and they know it takes 5 years to develop and your insurance is only 3 years old then you can be refused as it is preexisting condition and doesn't matter if you knew about it or not.

 

Same with high blood pressure. You just don't wake up one day with high blood pressure.

Hope that doesn't apply to Life Insurance or is getting old and dying not classed as pre-existing condition?    555    PML

1 hour ago, Bender Rodriguez said:

when the insurance company decides (and not an MD) whether or not you need a medical procedure, you know the country you live in is ...

 

USA is one of them great countries nr 1, but not in health, nor education

 

thailand comes to mind also

 

insurance is a big scam, you can pay for year and when you need it, they try to find reasons not to pay

 

wait for it, soon, you will might a forced vaccination if you want a visa extension,  who knows...

True.All people over 50 have some health problems before,so what is the point if they do not want cover this?We should be stupid to pay them insurance !!!For what?

4 hours ago, AndyAndyAndy said:

If you are diagnosed with heart condition XYZ and they know it takes 5 years to develop and your insurance is only 3 years old then you can be refused as it is preexisting condition and doesn't matter if you knew about it or not.

 

Same with high blood pressure. You just don't wake up one day with high blood pressure.

Non this is not true, what you do not know you can not tell.

 

Heart condition and blood pressure you refer too  have to be seen in the context. You can say that the dutch football coach not could be insurered for problems with the heart and bloodvessels due to genetic problems in the family. Still he is insurred dispite that his father was know to have been died with genetic heart disorder problem. And his brother also has heart problems.

 

Blood pressure you have to meassure at least serveral times 24 hrs or more. And after minimal 10 minutes of rest, the position should be on a bed laying.

 

The stress pressure or pain pressure ratings are well know and well documented

 

Al's that people can easy have blood pressure over 400.

 

More important is the 24 hrs or week recording of blood pressure and then the pressure one has during rest.

 

Doctors well educated

know this very well as well pharmacy know this too.

 

As well the streptococcus infection cause the increase post infection  bloodpressure aand when patient is in rest with the 24 hrs on for example ICU the pressure is good and you see an increase when the doctor or nurse is seen or in the area (white dress blood pressure)

 

Also be aware the guidelines change over time for weight, bmi, blood pressure and cholestorol

 

Skinny people are having the same problems and health issues as 'fat' people. And not is seems that bmi of 26-30 is overall providing more health way of living then so current of 20-24 bmi.

 

We have seen this in the past too that an bmi of 26-30 was better

The soldiers as well gladiators where on this bmi 25-30.

Recover faster, lesser cut damage, more endurance, lesser problems when they where sick.

 

The modern thin and leanness is actually providing more problems then is solves. 

5 minutes ago, Autonuaq said:

Non this is not true, what you do not know you can not tell.

 

Heart condition and blood pressure you refer too  have to be seen in the context. You can say that the dutch football coach not could be insurered for problems with the heart and bloodvessels due to genetic problems in the family. Still he is insurred dispite that his father was know to have been died with genetic heart disorder problem. And his brother also has heart problems.

 

Blood pressure you have to meassure at least serveral times 24 hrs or more. And after minimal 10 minutes of rest, the position should be on a bed laying.

 

The stress pressure or pain pressure ratings are well know and well documented

 

Al's that people can easy have blood pressure over 400.

 

More important is the 24 hrs or week recording of blood pressure and then the pressure one has during rest.

 

Doctors well educated

know this very well as well pharmacy know this too.

 

As well the streptococcus infection cause the increase post infection  bloodpressure aand when patient is in rest with the 24 hrs on for example ICU the pressure is good and you see an increase when the doctor or nurse is seen or in the area (white dress blood pressure)

 

Also be aware the guidelines change over time for weight, bmi, blood pressure and cholestorol

 

Skinny people are having the same problems and health issues as 'fat' people. And not is seems that bmi of 26-30 is overall providing more health way of living then so current of 20-24 bmi.

 

We have seen this in the past too that an bmi of 26-30 was better

The soldiers as well gladiators where on this bmi 25-30.

Recover faster, lesser cut damage, more endurance, lesser problems when they where sick.

 

The modern thin and leanness is actually providing more problems then is solves. 

Are you ok?

4 hours ago, AndyAndyAndy said:

If you are diagnosed with heart condition XYZ and they know it takes 5 years to develop and your insurance is only 3 years old then you can be refused as it is preexisting condition and doesn't matter if you knew about it or not.

 

Same with high blood pressure. You just don't wake up one day with high blood pressure.

How do you know ? Are you a doctor ? Some people do have high blood pressure from 1 day to the other , can have something to do with stress or multiple reasons and it would have nothing to do with illness . So AndyAndyAndy i geuss you work for an insurence company and are just as greedy as all of them to pay . Even my own insurance company for my motorbike called me just yesterday to tell me that i had to pay 3000baht because my insurance was ending , even though my imsurance is still valid untill februari next year . Geuss they made an honest mistake ????????????. I get it that there is a lot of insurance fraud but they are the ones to figure out what's fraud and what's not otherwise they should have started another company , they make ???? loads of money every year so they should work for it and pay up . Had an accident with the bike while it was parked someone hit it and the damage was Quoted at 80.000 baht all original parts from honda and Quoted by honda dealer but they still tried to pay out only 60.000 . I didn't agree with that but if i did would mean they saved 20.000 baht of of my problems . Peaces of @#$% . Just pay up and don't try to make money of of other peoples real problems , people that pay full price for their insurance every year over and over . 

1 hour ago, vukovar77 said:

True.All people over 50 have some health problems before,so what is the point if they do not want cover this?We should be stupid to pay them insurance !!!For what?

Health problems before are not the same as pre-existing conditions. Like I had only injuries from accident, and these accidents don't count if everything is healed. 

6 hours ago, sammieuk1 said:

Can you buy insurance for if your insurance company refuses to payout and your not insured after all ????

Maybe the premium you'll have to pay for that will be more high than the usual premium.

But , everything is insurable.

Although I appreciate the health insurance I have from my company, I wonder if it is worth paying for myself as it seems the insurance companies will try to escape paying. 

My mother had paid for Blue Cross for years, but when she got cancer, they refused to pay. 

A close friend in England worked for an insurance company (car insurance). His sole job was finding ways for the company not to pay out. 

In Thailand, hospitals will overcharge foreigners, so paying for insurance is really a toss up if you want to fight the insurance company or the hospital. 

47 minutes ago, Peterphuket said:

Maybe the premium you'll have to pay for that will be more high than the usual premium.

But , everything is insurable.

There are insurances that require a medical check before they insure you, and then exclude only present conditions.   So you don't have to come up with your full medical history. 

8 hours ago, ThaivisaSales said:

The point of this is to show that

tell MIB to stick their policy where the sun don't shine ....

Broker does  job, end of story

15 hours ago, Autonuaq said:

You just don't wake up one day with high blood pressure.

Most people's BP is quite a bit higher in the morning than evening. So, yes, you DO wake up most days with high BP.

3 minutes ago, stouricks said:

Most people's BP is quite a bit higher in the morning than evening. So, yes, you DO wake up most days with high BP.

Good morning. 

So I'm quite lucky that my blood pressure is low in the morning and I need coffee to get up? 

21 hours ago, stouricks said:

I read that an Insurance Company can refuse to pay due to a pre-existing condition whether the client knew about it or not.

If the client didn't know for example that they had high BP, or say prostate problems before they took out the policy, and so had not consulted a doctor about it, how can the Insurance Company find out anything?

Insurance companies only need to thinks things and they will try not to pay out on a claim.

1 hour ago, stouricks said:

Most people's BP is quite a bit higher in the morning than evening. So, yes, you DO wake up most days with high BP.

And in localised areas for some of us!   PML

20 hours ago, Sujo said:

Why is this advertisement for an insurance broker allowed.

Maybe because the insurance broker paid for it?

The topic is clearly identified as an advertorial and posted by ThaivisaSales

so it's must be seen like an advertising, nothing more and nothing less than that

22 hours ago, Sujo said:

Why is this advertisement for an insurance broker allowed.

Agreed.  Possibly useful information for some but not exactly a news item.  Does it qualify as "advertorial"?  I think it is more like simply paid advertising not even disguised as news.  Also I wonder if the company rescinded their other decision of what read to me as their also refusing ongoing/renewing cover for the same client/claimant.

P.S.  Thanks to "kingofthemountain" I looked for and found the advertorial banner "hidden in plain view" right at the top of the page.  But of course we all saw it, didn't we.  555!!

On 7/14/2020 at 7:27 PM, micmichd said:

There are insurances that require a medical check before they insure you, and then exclude only present conditions.   So you don't have to come up with your full medical history. 

It is at the time of claiming that they get serious about looking for a reason to reject a claim. It could be as simple as a check at a hospital that detected high BP, which you failed to report to your insurer. They will find it at claim time.

Must be a really slow day in the new section hear the same article Rinn I think in July oh well TIT

X

 

Do you think the broker continues to sell policies for the same company?