Yes health insurance is a scam in Thailand

[Liverpool Lou]

12 minutes ago, Sheryl said:

"Scam" is an inflammatory term but is OP's interpretation of what happened. He is entitled to his view. He has stated the facts in the thread.

PM sent.

[Ebumbu]

Any recommendations for an above-average health insurer at a reasonable rate vs value? I only need it for emergencies, at least for now.  

[Liverpool Lou]

3 hours ago, Jerno said:

Don't be fooled into thinking Insurance companies are there to help you.  They are there to pay out the fewest claims possible.  Every payout is reduced profit for them.

And every unjustifiable denial of a claim is bad publicity, that is why they are few and far between.   Insurers are not there to ensure that policy holders read the policy and agree to the conditions thereof that they, the policy holders, confirm they  have read!

[Sheryl]

15 minutes ago, Ebumbu said:

Any recommendations for an above-average health insurer at a reasonable rate vs value? I only need it for emergencies, at least for now.  

 

You should go through a good broker. I use AA, they have expat staff, specialize in expat policies, and will help with after care (i.e. any issues with claims) .  www.aainsure.net My broker there is Jenny out of their hua Hin office [email protected]  Can do it all by email, no need to go in person. Jenny and also Matthieu in that office have provided me great service and gone above and behind in  helping ensure all claims paid.

 

Your age will greatly affect the range of choice.  Also need to consider how long you expect to be here for, if planning on living out your old age here then there are a host of concerns not otherwise relevant - including whether lifetime renewal is guaranteed, how much rates go up with age, and (very important!) whether they can raise premiums based on claims history. (The latter -- which all Thai-based insurers are allowed to do --  can result in pricing you out making a guarantee of lifetime renewal not worth much)

 

 

[Liverpool Lou]

40 minutes ago, Chad3000 said:

 

The problem is fraud, cheating and theft.

 

We all know this to be true. Why would you even argue against it?

That is not "the problem" with health insurance and "we all" do not "know it".  You really need to back up your allegation with some specifics

[Sheryl]

An abusive post has been removed.

 

Please keep it civil.

 

If you cannot respond to a post in a polite manner then don't respond at all.

 

 

[scubascuba3]

54 minutes ago, blackprince said:

I have an excellent policy from a Thai Insurer. They paid a massive bill 15 months ago without any delay.

 

This particular Thai insurer issues insurance contracts only in Thai. Not unusual for a Thai insurer in Thailand I'm sure.

What's the secret? a good insurer it seems, who was it? I'm guessing some claims are more straight forward to accept like accidents

[Sheryl]

A baiting post has been removed.

[Pravda]

Sheryl, if not a secret how much do you pay for your policy?

[BritManToo]

4 hours ago, scubascuba3 said:

Most people are happy with thai insurance but then again they haven't tried to claim...

I had personal accident from the green bank.

Broke my jaw, they claimed that was cosmetic and didn't pay.

The claim was only just over 3500bht, I got my money back by not having accident insurance after that.

Edited November 20, 2021 by BritManToo

[Chris.B]

44 minutes ago, BritManToo said:

I had personal accident from the green bank.

Broke my jaw, they claimed that was cosmetic and didn't pay.

The claim was only just over 3500bht, I got my money back by not having accident insurance after that.

I checked out some personal accident policies and noticed disabled people weren't covered. A tad discriminatory I thought.  ☹️

Edited November 20, 2021 by Chris.B

[scubascuba3]

42 minutes ago, BritManToo said:

I had personal accident from the green bank.

Broke my jaw, they claimed that was cosmetic and didn't pay.

The claim was only just over 3500bht, I got my money back by not having accident insurance after that.

the only reason i do it is in an accident, motorbike or cycling, I'll have a Axa PA card on me so i should be treated at hospital, If I don't have a card on me and am incapacitated then hospital could do minimal and off to govt hospital

[BritManToo]

1 minute ago, scubascuba3 said:

the only reason i do it is in an accident, motorbike or cycling, I'll have a Axa PA card on me so i should be treated at hospital, If I don't have a card on me and am incapacitated then hospital could do minimal and off to govt hospital

Yes I did, they phoned the insurance company who said NO.

Having the card doesn't mean they'll pay.

Edited November 20, 2021 by BritManToo

[scubascuba3]

3 minutes ago, BritManToo said:

Yes I did, they phoned the insurance company who said NO.

If recent, appeal it, or go to OCPB, I've just seen a case where an insurance company denied a claim, now settling out of court. You do have to read the policy doc in full though

Edited November 20, 2021 by scubascuba3

[NanLaew]

1 hour ago, Ebumbu said:

Any recommendations for an above-average health insurer at a reasonable rate vs value? I only need it for emergencies, at least for now.  

That's a bit like asking what's the best thin-crust, non-delivery pizza near Thonglor on a Wednesday night.

 

As Sheryl has already opined, there are far too many personal variables including age that make the one-size fits-all insurance provider solution a bit of a no-hoper.

[BritManToo]

4 minutes ago, scubascuba3 said:

If recent, appeal it, or go to OCPB, I've just seen a case where an insurance company denied a claim, now settling out of court. You do have to read the policy doc in full though

Hospital charged 3,500bht ......... not worth the effort.

[BE88]

2 hours ago, Chris.B said:

Auto-insurance?

 Autonomous insurance, insurance for yourself

[Chris.B]

9 minutes ago, BE88 said:

 Autonomous insurance, insurance for yourself

The mind boggles! ????

[Chad3000]

1 hour ago, Liverpool Lou said:

That is not "the problem" with health insurance and "we all" do not "know it".  You really need to back up your allegation with some specifics

My parents in law (situation I am directly familiar with) were scammed out of about 160k covid insurance on bs paperwork technicalities.

 

Both spent weeks in field hospital. Taken there by the government DXD them with covid.

 

I bought the policies. One paid 30% the others nothing.

[bojo]

2 hours ago, blackprince said:

I subscribed to the offer 15 years ago. The application period lasted for 6 months.

 

I'm a bit suprised you don't see fit to answer the OP the same question.

 

If you're scared of the libel laws here, you could PM him/her.

I enjoy this forum as for the most part members like to help one another, at least that has been my experience..............do you have anything to lose by sharing? If that's the case, I get it....... I'm sure many would appreciate it if you could share your experience, at least explain how/why you had a great result since you opened up about it in the thread, otherwise, I'm unsure as to why you would mention it in the first place...?

[Chris.B]

4 minutes ago, bojo said:

I enjoy this forum as for the most part members like to help one another, at least that has been my experience..............do you have anything to lose by sharing? If that's the case, I get it....... I'm sure many would appreciate it if you could share your experience, at least explain how/why you had a great result since you opened up about it in the thread, otherwise, I'm unsure as to why you would mention it in the first place...?

His post was probably BS, the only explanation. 

[bojo]

1 minute ago, Chris.B said:

His post was probably BS, the only explanation. 

Personally, I believe i's true.................

[blackprince]

12 minutes ago, bojo said:

I enjoy this forum as for the most part members like to help one another, at least that has been my experience..............do you have anything to lose by sharing? If that's the case, I get it....... I'm sure many would appreciate it if you could share your experience, at least explain how/why you had a great result since you opened up about it in the thread, otherwise, I'm unsure as to why you would mention it in the first place...?

The reason I posted my experience is that i get <deleted> <deleted> by the <deleted> <deleted> posts from people who assume their bad experiences here are typical of Thailand. Their bad experience here is their experience, certainly not mine.

 

I have already explained why there's no point in talking further about my insurance policy - because the offer closed around 14 years ago.

 

 

[Sheryl]

21 minutes ago, Chad3000 said:

My parents in law (situation I am directly familiar with) were scammed out of about 160k covid insurance on bs paperwork technicalities.

 

Both spent weeks in field hospital. Taken there by the government DXD them with covid.

 

I bought the policies. One paid 30% the others nothing.

 

This issue is currently be adjudicated by the OIC which has just ruled that the companies must pay (the companies are appealing that ruling). See 
https://aseannow.com/topic/1240096-thai-insurance-regulator-urged-to-rescind-order-forbidding-cancellation-of-covid-insurance-policies/?tab=comments#comment-16993455

 

So they may yet get paid.

 

[Pravda]

6 minutes ago, blackprince said:

The reason I posted my experience is that i get <deleted> <deleted> by the <deleted> <deleted> posts from people who assume their bad experiences here are typical of Thailand. Their bad experience here is their experience, certainly not mine.

 

I have already explained why there's no point in talking further about my insurance policy - because the offer closed around 14 years ago.

 

 

And the reason I posted my experience is because I strongly believe Thai insurance is deleted deleted deleted ????

 

The offer closed 14 years ago? Hilarious. As much relevance as my experience of buying a condo in Toronto in 2010 for 225,000 dollars.

[bojo]

4 minutes ago, blackprince said:

The reason I posted my experience is that i get <deleted> <deleted> by the <deleted> <deleted> posts from people who assume their bad experiences here are typical of Thailand. Their bad experience here is their experience, certainly not mine.

 

I have already explained why there's no point in talking further about my insurance policy - because the offer closed around 14 years ago.

 

 

That may be the case for some posters who like to reply, but with you opening up with a positive, you give genuine people (who often just read posts and info and don't post pointless or antagonistic replies) hope and then it's subsequently taken away from them, so I'm unsure why you would make the post in the first place............................

[Sheryl]

1 hour ago, BritManToo said:

I had personal accident from the green bank.

Broke my jaw, they claimed that was cosmetic and didn't pay.

The claim was only just over 3500bht, I got my money back by not having accident insurance after that.

 

The problem may have been with what the hospital put on the relevant forms.

 

Not always the case, but it often is, that the fault is with the hospital not the insurer. Thai hospitals are incredibly bad at dealing with insurance reimbursement. Even the pricey large "international" hospitals -- which have departments exclusively to handle 3rd party reimbursment -- will submit claims that are insufficiently detailed or unclear, or fail to use necessary language etc. And they don't seem to learn by experience, either.

 

Government hospitals and upcountry private hospitals which do not have 3rd party reimbursement departments are going to be even worse. Many send in nothing but the hospital bill, and not always a detailed bill at that. Insurers need specific information (including, in the case of a PA policy, that the care provided was linked to an accident and details of that accident).  Many have their own specifc forms that need to be fully filled out.

 

Not at all unusual for a hospital to submit something totally inadequate to an insurer, get a request for resubmission with more detail, and then rather than following up (a process which will likely require -- horror of horrors! -- asking questions of the medical staff )  just tell the patient that "insurance did not pay". And a surprising number of patients then pay themselves without investigating the issue to find out what was going on. Which of course encourages the hospital staff to keep using this dodge to reduce work load/avoid having to involve their superiors or ask questions of people they are kreng jai of.

 

My advice: whenever faced with this (assuming you have read the policy and the claim should be covered under its terms) is: do not readily pay the hospital...not even for a small amount, it sets a bad precedant. Rather tell them that assuming they have provided all necessary information requested by the insurance company, then the insurance company is in violation and you are going to appeal this to the OIC,  and ask them to provide copies of all the communications with the insurance company to proof this is the case. Often this request will magically "fix" the situation as  the hospital will go back to  the insurer with the needed information.

[brewsterbudgen]

Surely a colonoscopy would be an out-patient procedure and covered on a policy that covers out-patient treatment but not if it only covers in-patient treatment? Or is that too simple?

[bojo]

6 minutes ago, Sheryl said:

 

The problem may have been with what the hospital put on the relevant forms.

 

Not always the case, but it often is, that the fault is with the hospital not the insurer. Thai hospitals are incredibly bad at dealing with insurance reimbursement. Even the pricey large "international" hospitals -- which have departments exclusively to handle 3rd party reimbursment -- will submit claims that are insufficiently detailed or unclear, or fail to use necessary language etc. And they don't seem to learn by experience, either.

 

Government hospitals and upcountry private hospitals which do not have 3rd party reimbursement departments are going to be even worse. Many send in nothing but the hospital bill, and not always a detailed bill at that. Insurers need specific information (including, in the case of a PA policy, that the care provided was linked to an accident and details of that accident).  Many have their own specifc forms that need to be fully filled out.

 

Not at all unusual for a hospital to submit something totally inadequate to an insurer, get a request for resubmission with more detail, and then rather than following up (a process which will likely require -- horror of horrors! -- asking questions of the medical staff )  just tell the patient that "insurance did not pay". And a surprising number of patients then pay themselves without investigating the issue to find out what was going on. Which of course encourages the hospital staff to keep using this dodge to reduce work load/avoid having to involve their superiors or ask questions of people they are kreng jai of.

 

My advice: whenever faced with this (assuming you have read the policy and the claim should be covered under its terms) is: do not readily pay the hospital...not even for a small amount, it sets a bad precedant. Rather tell them that assuming they have provided all necessary information requested by the insurance company, then the insurance company is in violation and you are going to appeal this to the OIC,  and ask them to provide copies of all the communications with the insurance company to proof this is the case. Often this request will magically "fix" the situation as  the hospital will go back to  the insurer with the needed information.

Great advice and very detailed info as to why these situations occur, you've certainly highlighted the truth I'm sure...........................................but in reality, when the hospital is demanding payment and you're understanably in a hurry to go home, having a stand off under pressure, especially on foreign turf, is easier said than done.....................................

[Sheryl]

I would add that I have had 6 claims/requests for guarantees of payment  paid by insurers over my 20 + years in Thailand (maybe more, but this is what I readily recall). In not one case was the information provided by the hospital on the first submission adequate. The insurer always had to ask for clarification or additional information.

 

As I made it clear that I was not paying and it was up to them to resolve with the insurer -- and as I was dealing with large private hospitals that had departments set up specifically to deal with insurers - the additional information and clarifications were provided and it got sorted fairly quickly.

 

But one does have to wonder why they keep doing this. It is as if they always make a first attempt that is bound to fail and only after it does, fill out the necessary paperwork.