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35 minutes ago, Swiss1960 said:

So many people bitching around trying to convince themselves and others that they ate the wisdom with spoons... Here are REAL LIFE experiences by me, my wife and daughter:

  1. Insurances - Thai or others - have never rejected any claims we had against our policies. Same experience as with my previous Swiss insurance.
  2. Insurances - Thai or others - will always review your claims (some faster than others) and make sure that the claims are legitimate and that they MUST pay. I am actually glad about that, since this would have an influence on my premium as well. There are enough scammers out in the wild that insurance companies must be careful.
  3. Experiences: Myself emergency hospital stay (2 nights) due to intestine cramps. Paid even though I have a declared previous surgery for diverticulitis. Wife: Meniscus left knee. Paid, but it took time to get the approval for the surgery (lot of doctors reports). Daughter: Emergency hospital stay due (7 days) to Dengue fever, approved after two days, no issues.

Here comes the HUGE difference: Thai insurances will pay your claim - as they must - BUT your next premium can go up by 25%, because you are now deemed a high risk patient NOT because of WHAT you had, but because you actually dare to make claims. AND Thai insurances will send you not only an invoice with a 25% risk fee added, BUT also a now policy that will NOW list your issue as pre-existing going forward. Happened to my wife with the meniscus. 

 

Thai insurances will ALSO be VERY generous in declaring all of your body as "pre-existing condition" when non-Thai insurances will not. My personal example: I am taking medicine against high blood pressure. I provided the prescription to both a Thai and a non-Thai company. The non-Thai company (Cigna Global) accepted me without any pre-condition. The Thai company (which I am not allowed to name) sent me a 2-page exclusion letter, ending with the following sentences: "A risk-premium loading of 25% has been applied. A 30% client co-payment applies for ...., up to max 300K Baht per policy year). Another Thai insurance uses the sentence "exclude all disorders, complications or consequences directly or indirectly caused by or associated with...", which means that they already tell you they won't pay a thing. Also, this second company, I revealed a hospital stay for a broken right wrist (accident) and they wrote: "To exclude all disorders, complications or consequences directly or indirectly caused by or associated with declared Right Wrist fracture including but not limited to retained hardware or its sequelae."

 

That is the reason why I recommend to EVERYBODY that they OMIT Thai insurances AT ALL COST and pay more for an international health insurance.

Spot on there, people buy the thai insurance because it's cheaper but it's definitely inferior

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11 hours ago, Swiss1960 said:

So many people bitching around trying to convince themselves and others that they ate the wisdom with spoons... Here are REAL LIFE experiences by me, my wife and daughter:

  1. Insurances - Thai or others - have never rejected any claims we had against our policies. Same experience as with my previous Swiss insurance.
  2. Insurances - Thai or others - will always review your claims (some faster than others) and make sure that the claims are legitimate and that they MUST pay. I am actually glad about that, since this would have an influence on my premium as well. There are enough scammers out in the wild that insurance companies must be careful.
  3. Experiences: Myself emergency hospital stay (2 nights) due to intestine cramps. Paid even though I have a declared previous surgery for diverticulitis. Wife: Meniscus left knee. Paid, but it took time to get the approval for the surgery (lot of doctors reports). Daughter: Emergency hospital stay due (7 days) to Dengue fever, approved after two days, no issues.

Here comes the HUGE difference: Thai insurances will pay your claim - as they must - BUT your next premium can go up by 25%, because you are now deemed a high risk patient NOT because of WHAT you had, but because you actually dare to make claims. AND Thai insurances will send you not only an invoice with a 25% risk fee added, BUT also a now policy that will NOW list your issue as pre-existing going forward. Happened to my wife with the meniscus. 

 

Thai insurances will ALSO be VERY generous in declaring all of your body as "pre-existing condition" when non-Thai insurances will not. My personal example: I am taking medicine against high blood pressure. I provided the prescription to both a Thai and a non-Thai company. The non-Thai company (Cigna Global) accepted me without any pre-condition. The Thai company (which I am not allowed to name) sent me a 2-page exclusion letter, ending with the following sentences: "A risk-premium loading of 25% has been applied. A 30% client co-payment applies for ...., up to max 300K Baht per policy year). Another Thai insurance uses the sentence "exclude all disorders, complications or consequences directly or indirectly caused by or associated with...", which means that they already tell you they won't pay a thing. Also, this second company, I revealed a hospital stay for a broken right wrist (accident) and they wrote: "To exclude all disorders, complications or consequences directly or indirectly caused by or associated with declared Right Wrist fracture including but not limited to retained hardware or its sequelae."

 

That is the reason why I recommend to EVERYBODY that they OMIT Thai insurances AT ALL COST and pay more for an international health insurance.

 Fully agree.

 

In addition the level of cover offered by Thai insurers is often so low as to be of no help in case of a serious illness or accident.  If you compare according to level of coverage, Thai based policies are not significantly cheaper than international ones.  What they do (Thai insurers) is develop products with low cover and other limitations and then market them as "cheap insurance", counting pn the consumer not to look at the actual coverage terms. Many people think if they are insured that means they are fully covered, and never look into the actual coverage details. Then when they need to use the insurance, it comes as a huge shock. Happens so often that many Thais -whose experience is limited to Thai companies - believe health insurance is a "scam". Some resident expats likewise.

 

Many Thai insurers will also cut off cover past a certain  age.

 

All that said, some Thai insurers are better than others and there are a few (very few) who offer policies with reasonable levels of cover.

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On 10/4/2021 at 1:17 PM, Liverpool Lou said:

 

 

"Insurance regulations in Thailand are not the same as farangland"

Are you saying that there are Thai insurance regulations that allow insurers to deny legitimate claims? 

 

 

I think what he meant is things like: being allowed to raise premiums if a person has a large claim (on top of any age related increases),  being allowed to introduce exclusions after the policy was issued based on claims etc etc.

 

The regulatory framework for health insurance in Thailand is definitely weaker than that in western countries.

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I've been with Pacific Cross for years, excellent service.

Hip replacement 8 years ago covered in full.

Last may, broke my wrist, 3 days in Hospital with a titanium implant with 8 screws to hold the pieces together, 250,000 baht bill. All covered upfront, I paid nothing. Including all medication, x-rays, and daily visits to change dressing for 2 weeks

The annual cost had been going down the last several years due to no claim, but it jumped up this year because of my wrist operation

Edited by kwonitoy
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12 minutes ago, kwonitoy said:

I've been with Pacific Cross for years, excellent service.

Hip replacement 8 years ago covered in full.

Last may, broke my wrist, 3 days in Hospital with a titanium implant with 8 screws to hold the pieces together, 250,000 baht bill. All covered upfront, I paid nothing. Including all medication, x-rays, and daily visits to change dressing for 2 weeks

The annual cost had been going down the last several years due to no claim, but it jumped up this year because of my wrist operation

After a claim how much do they bump up premiums? 25%

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13 hours ago, Swiss1960 said:

 The non-Thai company (Cigna Global) accepted me without any pre-condition.

It might be worthwhile to dig a bit deeper to see what Cigna's intent really is. Did the policy originally contain a pre-existing condition exclusion and did Cigna issue an endorsement deleting it? Or does the Cigna policy limit the pre-existing exclusion clause to conditions specifically stated in the declarations section of the policy? If not, and the original pre-existing exclusion remains in the policy, then Cigna could still invoke it and deny a claim if they believed the condition existed prior to the commencement of the policy.

Edited by Etaoin Shrdlu
Typo
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5 hours ago, Sheryl said:

 

I think what he meant is things like: being allowed to raise premiums if a person has a large claim (on top of any age related increases),  being allowed to introduce exclusions after the policy was issued based on claims etc etc.

 

The regulatory framework for health insurance in Thailand is definitely weaker than that in western countries.

That's not what was being discussed when he made his comments so why would you think that was what he meant?

 

"being allowed to introduce exclusions after the policy was issued based on claims etc etc."

You're suggesting that, after a policy has been issued and during its term, exclusions can be added by the insurer that changes the contract between the insurer and the policy holder without advising the policy holder in order to deny claims?  Really?   Do you have something empirical to support that assertion?  

Edited by Liverpool Lou
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13 hours ago, Liverpool Lou said:

That's not what was being discussed when he made his comments so why would you think that was what he meant?

 

"being allowed to introduce exclusions after the policy was issued based on claims etc etc."

You're suggesting that, after a policy has been issued and during its term, exclusions can be added by the insurer that changes the contract between the insurer and the policy holder without advising the policy holder in order to deny claims?  Really?   Do you have something empirical to support that assertion?  

 

I have seen innumerable cases where during the term of a policy, and after making a claim, a Thai insurer decided (often on pretty flimsy grounds/big leaps of logic) that they had uncovered proof that the condition was pre-existing and therefore refused to pay, even though it was nto listed as an exclusion on the policy ad the insured had not concealed anything i their application.

 

Anyone with experience with Thai insurers can tell you this.  They do nto do very good medical underwriting and rather wait until claims are submitted to decide what "pre-existing" conditions the insured has, and all of these  investigations are done by people with no medical background or understanding of medical matters.  A case where an insurer refused to pay for a cardiac hospitalization because they uncovered a record mentioning the patient had gastric reflux in the past comes to mind  - despite the insured having never been diagnosed before with a cardiac problem. There have been many, many more.

 

With a handful of exceptions, Thai insurers do not behave like insurers in other countries and it is a mistake to assume they do.

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10 minutes ago, Sheryl said:

 

I have seen innumerable cases where during the term of a policy, and after making a claim, a Thai insurer decided (often on pretty flimsy grounds/big leaps of logic) that they had uncovered proof that the condition was pre-existing and therefore refused to pay, even though it was nto listed as an exclusion on the policy ad the insured had not concealed anything i their application.

 

Anyone with experience with Thai insurers can tell you this.  They do nto do very good medical underwriting and rather wait until claims are submitted to decide what "pre-existing" conditions the insured has, and all of these  investigations are done by people with no medical background or understanding of medical matters.  A case where an insurer refused to pay for a cardiac hospitalization because they uncovered a record mentioning the patient had gastric reflux in the past comes to mind  - despite the insured having never been diagnosed before with a cardiac problem. There have been many, many more.

 

With a handful of exceptions, Thai insurers do not behave like insurers in other countries and it is a mistake to assume they do.

Sounds right,  lawyer friend of mine is currently in court due to a similar example. Liverpool Lou probably knows all this about thai insurance, says he's very experienced

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17 hours ago, scubascuba3 said:

After a claim how much do they bump up premiums? 25%

They can indeed increase premiums by as much as 25% if you have a large claim (whether it will reach 25% or be less than that will depend on the size of the claim) and they can do this every year  that you have a claim. These are on top of age related increases.

 

So premiums can become quite astronomical, enough to price out most people. Hence the lifetime gurantee (or guarantee up to age X) isn't worth much.

 

Typically this problem (astronomical premiums due to individualized hikes based on having had large claims) occurs when the insured person is old and/or had developed a serious chronic disease. At which point they have virtually no option in terms of changing policies. It creates a very bad situation, the very thing that one wants insurance to protect against. Hence my recommendation to only use internationally based insurers.

 

Insurers based in Western countries cannot do this.

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2 hours ago, Sheryl said:
15 hours ago, Liverpool Lou said:

That's not what was being discussed when he made his comments so why would you think that was what he meant?

 

"being allowed to introduce exclusions after the policy was issued based on claims etc etc."

You're suggesting that, after a policy has been issued and during its term, exclusions can be added by the insurer that changes the contract between the insurer and the policy holder without advising the policy holder in order to deny claims?  Really?   Do you have something empirical to support that assertion?  

Expand  

 

I have seen innumerable cases where during the term of a policy, and after making a claim, a Thai insurer decided (often on pretty flimsy grounds/big leaps of logic) that they had uncovered proof that the condition was pre-existing and therefore refused to pay

Ok, that is not what you claimed in your post that I am commenting on!   Discovering a pre-existing condition (and those are obviously excluded from cover by any insurer) is not "adding an exclusion to a pre-existing policy"!   The pre-existing exclusion would always have been a policy condition, not an add-on to deny a claim!  

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On 10/5/2021 at 9:00 PM, Liverpool Lou said:

That's not what was being discussed when he made his comments so why would you think that was what he meant?

 

"being allowed to introduce exclusions after the policy was issued based on claims etc etc."

You're suggesting that, after a policy has been issued and during its term, exclusions can be added by the insurer that changes the contract between the insurer and the policy holder without advising the policy holder in order to deny claims?  Really?   Do you have something empirical to support that assertion?  

But of course...covid insurance cancelled because too many claims

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20 minutes ago, fredscats said:
On 10/5/2021 at 9:00 PM, Liverpool Lou said:

That's not what was being discussed when he made his comments so why would you think that was what he meant?

 

"being allowed to introduce exclusions after the policy was issued based on claims etc etc."

You're suggesting that, after a policy has been issued and during its term, exclusions can be added by the insurer that changes the contract between the insurer and the policy holder without advising the policy holder in order to deny claims?  Really?   Do you have something empirical to support that assertion?  

Expand  

But of course...covid insurance cancelled because too many claims

Really?   Your policy?   Which company?   We were discussing the false claim that "insurers added exclusions to existing policies after their issuance in order to deny claims" and that did not happen.

 

In the case of what you're referring to, what actually happened was that no claims were denied because they were pulling out of the market and premiums were refunded to those affected by cancelled policies.

Edited by Liverpool Lou
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Commercial health insurance provides a poor solution for real risk transfer when one gets older and starts to have chronic medical conditions associated with aging. Exclusions for pre-existing conditions, no guaranteed renewal at expiry and the ability to increase premiums and add additional exclusions at each renewal all make commercial health insurance problematic. 

 

Foreign insurers in general usually do better than Thai insurers, although there are Thai insurers that do a reasonable job. The only way to remove the possibility of an insurer, including a foreign insurer, invoking the pre-existing condition clause for undetected conditions would be to have the exclusion deleted from the policy by endorsement or to have the exclusion limited to the pre-existing conditions specifically listed in the policy's declarations section. I am not sure whether any insurer would be willing to do this.  Beware of any insurer offering coverage without requiring a physical exam, especially if you are older. These insurers will be underwriting their policy via their claims department, something that is considered unprofessional but common in some markets.

 

From an underwriting perspective it becomes difficult to profitably insure a population that has a great propensity to incur large medical bills and commercial insurers are in business to make money. In the US the insurer of last resort, the taxpayer, takes on the task of providing medical insurance for over-65s in the form of Medicare. Even this program has its limitations and some cost-shifting back to the participant. 

 

There really is no attractive solution for most when it comes to insuring medical expenses when we get older if we cannot participate in government schemes.

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The insurance industry is highly regulated and almost all insurers will pay claims exactly in accordance with the terms and conditions of their policies. There are instances in which an insurance company may act in bad faith, but those situations are quite rare. Regulators take an extremely dim view of anything that looks like bad faith and insurers, believe it or not, are concerned about bad publicity and getting a bad reputation. They also don't want to be dragged into the regulator's office. The Office of the Insurance Commissioner is generally consumer-friendly and anyone with a complaint will get a fair hearing, including foreigners.

 

In my opinion, disappointment with insurance stems most often from the following situations:

 

1) The policyholder does not fully understand what their policy actually says, covers and excludes.  

 

2) The policyholder is unaware of their obligations under their policy, especially their duty to fully disclose all material facts when forming a contract of insurance.

 

3) Difficulty in providing the documentation required by insurers when submitting their claim.

 

4) Genuine and legitimate differences of opinion regarding factual issues surrounding a claim.

 

With respect to the first three items above, a good insurance broker can and should help the policyholder understand their policy and its limitations, the obligations of the insured and the documents needed in order to establish proof of loss at claims time. This is best done early on, and in the case of items 1 and 2, prior to the order to bind coverage.

 

Number 4 is a bit more difficult. A good insurance broker will advocate for his client at claims time. If the broker places a sizable amount of business with the insurer, the broker may have enough influence to get a difficult claim paid that may otherwise get denied or to reverse a denial. If this is not sufficient and the policyholder wishes to escalate the matter, approaching the regulator is the next most appropriate step. Ultimately, if still no favorable resolution is forthcoming, the policyholder can always take the insurer to court. Going to court is expensive, time-consuming and there is no guarantee of a favorable outcome for either party.

 

Insurance is an area in which there is asymmetric information and resources and the consumer is usually the one with the short end of the stick. An insurance broker can help reduce the gap and in many cases provide advice that may limit disappointment later on. Insurers have no obligation to provide a policyholder with advice.

 

To paraphrase a saying from the legal profession, anyone who deals directly with an insurer has a fool for a broker.

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3 minutes ago, Etaoin Shrdlu said:

To paraphrase a saying from the legal profession, anyone who deals directly with an insurer has a fool for a broker.

Couldn't agree more, but for some reason people on this forum are often unwilling to use a broker.

 

And then some use poor quality brokers, of which there seem to be many around, and end up getting no after-service once they purchase a policy.

 

I have to differ with your assessment that it is rare for an insurer not to follow the T&C of health insurance policies. Over my years on this  board I have seen innumerable cases, from simply not paying a claim and giving no reason, to refusing to pay for ridiculous reasons. The lack of medical knowledge and evident unwillingness to refer cases to a medical professional lead to some truly absurd leaps of logic as to whether a claim reflects a pre-existing condition.

 

This sort of thing seems far from uncommon among certain Thai insurers here.

 

Unfortunately in addition to not wanting to use a broker, many people shy away from appealing to the OIC.

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19 minutes ago, Etaoin Shrdlu said:

The insurance industry is highly regulated and almost all insurers will pay claims exactly in accordance with the terms and conditions of their policies.

This is Thailand - not the UK/EU/USA or other such country - and even there people get jerked around trying to obtain payments.  Insurance here is not tightly regulated and is for the 'haves' - indeed most people without special connections would not even consider having as they feel they would never be able to obtain payment (any kind of insurance other than required auto).  

Edited by lopburi3
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10 minutes ago, Sheryl said:

 

I have to differ with your assessment that it is rare for an insurer not to follow the T&C of health insurance policies. Over my years on this  board I have seen innumerable cases, from simply not paying a claim and giving no reason, to refusing to pay for ridiculous reasons. The lack of medical knowledge and evident unwillingness to refer cases to a medical professional lead to some truly absurd leaps of logic as to whether a claim reflects a pre-existing condition.

 

 

I don't question your experience with Thai insurers when it comes to claims. Again, a good broker will advise their clients which insurers have a good track record with respect to claims payments and those that don't. Having a client represented by a good (and large) broker also can bring clarity of mind to insurers when considering whether to pay or deny a claim. When working for an insurer, I frequently heard "who is the broker" when a claim was escalated to management internally.

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1 hour ago, lopburi3 said:

This is Thailand - not the UK/EU/USA or other such country - and even there people get jerked around trying to obtain payments.  Insurance here is not tightly regulated and is for the 'haves' - indeed most people without special connections would not even consider having as they feel they would never be able to obtain payment (any kind of insurance other than required auto).  

I worked for many years in the Thai insurance market. The insurers with which my employer had distribution agreements paid claims according to the terms and conditions of their policies. Perhaps it was because if the did not, they would no longer do business with the firm. That does not mean there were not disputes about claims, but the denials did not go without explanation or reference to the terms and conditions of the policy in question or meaningful discussions as to differences in opinion as to matters of fact.

 

You are correct that the regulatory environment here is less stringent than in many developed countries, but it is accessible and the regulator will deal fairly with complaints. And yes, even in developed countries there are disputes regarding claims.

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While I don't want to hijack the thread, my question is about insurance. 

 

When I get insurance for myself, I want to get the same policy for my wife. Working it in to our rough budget, I just did what I think I will pay x2. Is this a correct assumption? Or, would she pay less as a Thai National?

 

Lastly, I hate paying for things monthly. Can I just pay the insurance annually?

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7 hours ago, HappyGoLuckyLife said:

While I don't want to hijack the thread, my question is about insurance. 

 

When I get insurance for myself, I want to get the same policy for my wife. Working it in to our rough budget, I just did what I think I will pay x2. Is this a correct assumption? Or, would she pay less as a Thai National?

 

Lastly, I hate paying for things monthly. Can I just pay the insurance annually?

Most insurance is self or self with family so it may not come out x2 at all.

As a Thai she does not require insurance unless she wants treatment at private hospitals or where not registered.  As you plan frequent moves perhaps insurance is indicated however.  Payment would not be less as a Thai.  As has been said it is best to obtain from international firms in most cases.  Believe most would accept yearly payment.

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On 10/8/2021 at 1:12 AM, HappyGoLuckyLife said:

While I don't want to hijack the thread, my question is about insurance. 

 

When I get insurance for myself, I want to get the same policy for my wife. Working it in to our rough budget, I just did what I think I will pay x2. Is this a correct assumption? Or, would she pay less as a Thai National?

 

Lastly, I hate paying for things monthly. Can I just pay the insurance annually?

 

No discount for being Thai, but she may not be eligible for some of the policies that you are e.g. expat policies.

 

I assume you know that as a Thai national your wife already has access to free health care through the government systam? Most This do not get private insurance for this reason.

 

You can always pay insurance premiums annually and there is often a savings in doing this vs monthly.

 

Some insurers offer a small premium discount for a second family member, typcially about 10%.

 

Should go through a broker, I reccommed AA. www.aainsure.net

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12 hours ago, Sheryl said:

I assume you know that as a Thai national your wife already has access to free health care through the government systam? Most This do not get private insurance for this reason.

Yes, but I wanted to make sure she has equal or better insurance. If she can get that through the gov system, great. But I would always want her to have options.

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Options: nearly all Thai Citizen Medical Treatment in Thailand is Free at Govt. Hospitals ( well, 30 baht each visit). MRI / Other stuff extra at Govt. Tariff. Some Thais feel they are not well treated under this scheme, long hospital waits, waiting lists for non- emergency operations. 

 

Use of convenient / comfortable Private Hospital would mean buying Private Insurance, for cover already in place, which could however also be valid Worldwide.

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“reference to the (UNFAIR) terms and conditions of the (THAI) policy”

 

less regulation = unfair terms = denial of claim / cover and severely restricted cover following related claim …. well known common pratice in the “thai insurance industry” and reported within this Forum.

 

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