Yes health insurance is a scam in Thailand

[Sheryl]

4 minutes ago, bojo said:

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.....................................

I know.

 

I've done it. I can recall once, after being told it would mean a long wait for me, that this was fine as I was hungry and would go have lunch and then come back later.  Also once smiled and held up the book I was carrying to show I was quite ready to wait.

 

Once they see you are nto going to cave, they usually come around and do what they need to. They just like to try it on first. Because apparently it often works.

[Pravda]

16 minutes ago, brewsterbudgen said:

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?

By their own policy as agent explained I was supposed to be covered if there were no issues in the past 5 years. They asked a document from a previous hospital for a procedure I had 6 years ago (endoscopy and unrelated) and they denied me.

Edited November 20, 2021 by Pravda

[Sheryl]

13 minutes ago, brewsterbudgen said:

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?

 

It is not that simple as most inpatient-only policies have a provision for outpatient surgery and sometimes far from clear what that encompasses. Some explicitly include endoscopies, some do not.

 

If the policy is hospitalization only and does not specify that outpatient endoscopies are included, then it may come down to things like: was an OR used? (likely not or may not have shown as such on the bill) and: was a stay in recovery room involved? (usually is not). If as is often the case the whole thing was done in the GI outpatient suite, many (bit nto all insurers) would nto consider that as outpatient surgery.

 

But we really have no details on the OP's policy nor on reasons for the insurance denial. Other than that he says the broker thought it should be covered under the policy.

 

Hospitalization-only policies typically have specific provision for certain OPD costs, like cancer care, dialysis, and sometimes (but nto always) CT and MRI scans.

 

 

[bojo]

3 minutes ago, Sheryl said:

I know.

 

I've done it. I can recall once, after being told it would mean a long wait for me, that this was fine as I was hungry and would go have lunch and then come back later.  Also once smiled and held up the book I was carrying to show I was quite ready to wait.

 

Once they see you are nto going to cave, they usually come around and do what they need to. They just like to try it on first. Because apparently it often works.

Again, great advice to those who might be caving in to the pressure..........................I for one, if ever presented with a similar situation will be applying one or many of your tactics....................nice one..................

[HAPPYNUFF]

Show me a a poor Insurance company, and Ill show you a joke.

[WilliamSmits]

Each time I need to have something repaired I go to the hospital first and they check out how it is insured. (they call the insurance) It always results in all costs paid directly by insurance, This way the hospital admin knows the limits of each part of the bill and prepare documents correctly.

[cjinchiangrai]

$500? That doesn't even cover my deductible.

[Chad3000]

35 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.

But this is ridiculous.

 

The government and private insurers must come to terms with what works or it's all broken.

 

Insurance sold under terms that they willfully will not pay out and do not clearly communicate is fraud

 

I know you are insured well Sheryl. I'm just thinking 3m in the bank rather than 12k a month for a bogus policy is the way to go - even healthy people with precondition higher BP or cholesterol but slim, healthy.

 

I know it can be a fight in States too but at least there's law.

 

As I think you'd stated earlier seems like international insco pay better which is kinda laff. That's because they're not total thieves and have some level of corporate responsibility.

 

Thailand is a joke. What industry doesn't enjoy turning it's back on its customers and consumers? Zero accountability. Third world.

[Gecko123]

Whatever the reason being given for denying the claim, your agent should be able to explain the insurance company's reasoning, AND direct you to the clause in the contract being used to justify the denial of coverage.

 

The agent isn't just there to sell you the policy. He's supposed to serve as an interface between the client and the insurance company when problems like this arise.

Edited November 20, 2021 by Gecko123

[blackprince]

42 minutes ago, Pravda said:

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.

I'm sorry to hear you have had such bad experiences. But generalising from your poor understanding of what you were buying  to  "health insurance in Thailand is a scam" is irrational.

 

Yes the offer closed 14 years ago. But the policy is valid for life.

 

It's actually a health and life assurance policy. They're quite common in my country of origin. But I guess few people here would understand the difference between life insurance and life assurance without going to google, so I chose to use the term "insurance" because most people would probably understand that.

 

Anyway, better luck back home, bye.

 

[tgw]

The one useful information in this thread is really what's missing: a recommendation for a good Thai health insurance company.

 

[Sheryl]

4 minutes ago, tgw said:

The one useful information in this thread is really what's missing: a recommendation for a good Thai health insurance company.

 

Because there is no one-size-fits-all answer to that. Innumerable factors: age? How long planning to be in Thailand? Any pre-exisitng conditions? Need to meet O-A visa extension requirements? etc etc etc

 

Also - why are you specifically wanting a Thai company? Why rule out foreign based expat policies? In fact, except where necessary for O-A visa extension reasons, they are what I would generally recommend. They are specifically designed for the situation of an expat living in a foreign country and many have direct payment arrangements with Thai hospitals. Further, they fall under the regulatory framework of the country where they are based (UK, EU, Australia etc).  Among other things this usually means they cannot raise rates based on claims. Thai insurance regulations allow this.  Taking into account level of cover provided, they do nto cost more than Thai company  policies.

 

It is not at all necessary to have a policy from a Thai company to be insured in Thailand.

 

That said, the best policies/companies I know of in Thailand seem to be Aetna and April Thailand (underwritten by LMG) in more or less that order. Neither will newly enroll after age 65 and AETNA will not guarantee lifetime renewal unless you enroll before age 60. If over 65 and if due to visa you must have a Thai company then that leaves Pacific Cross...or a low value/high deductible LMG policy combines with a "real" foreign policy.

 

Never get policy yourself, always go through a broker and select broker with as much care as you select insurer.

 

 

 

 

[madmitch]

24 minutes ago, Gecko123 said:

Whatever the reason being given for denying the claim, your agent should be able to explain the insurance company's reasoning, AND direct you to the clause in the contract being used to justify the denial of coverage.

 

The agent isn't just there to sell you the policy. He's supposed to serve as an interface between the client and the insurance company when problems like this arise.

You are absolutely right, or at least you would be in certain countries.

 

Unfortunately the majority of so-called insurance agents in Thailand are untrained and unprofessional and know nothing about insurance. All they are interested in is the commission they make from sales. I know people that have been on a three day course with no CPD and they call themselves insurance agents.

 

Of course there are exceptions but I'd in general advise against buying from any friends of friends who are representing a particular insurance company and go instead to a professional insurance broker such as AA or Eric Dohlon in Phuket who will have access to several products and can find the best fit for the client.

[Pravda]

33 minutes ago, blackprince said:

I'm sorry to hear you have had such bad experiences. But generalising from your poor understanding of what you were buying  to  "health insurance in Thailand is a scam" is irrational.

 

Yes the offer closed 14 years ago. But the policy is valid for life.

 

It's actually a health and life assurance policy. They're quite common in my country of origin. But I guess few people here would understand the difference between life insurance and life assurance without going to google, so I chose to use the term "insurance" because most people would probably understand that.

 

Anyway, better luck back home, bye.

 

 

 

My understanding is not poor and I'm not stupid. I am simply sharing my experience about what agent and hospital told me and what actually happened. Your mysterious health insurance policy offered over a decade ago on the other hand doesn't even seem to be Thai.

 

Actually Thailand also has this health and life insurance policy and I am quite familiar with it. Wife is insured this way, plus she also has her comprehensive work insurance and social security, of course. Even with this she has to pay for things out of her pocket, like mammograms, blood tests and many more even she's had it for 20 years. Yes, if she does of cancer they'll pay me 1 million baht. Woohoo 

 

Edit.

 

Or maybe not. I forgot I'm a foreigner.

 

 

 

 

 

Edited November 20, 2021 by Pravda

[Sheryl]

1 minute ago, madmitch said:

You are absolutely right, or at least you would be in certain countries.

 

Unfortunately the majority of so-called insurance agents in Thailand are untrained and unprofessional and know nothing about insurance. All they are interested in is the commission they make from sales. I know people that have been on a three day course with no CPD and they call themselves insurance agents.

 

Of course there are exceptions but I'd in general advise against buying from any friends of friends who are representing a particular insurance company and go instead to a professional insurance broker such as AA or Eric Dohlon in Phuket who will have access to several products and can find the best fit for the client.

Fully agree.

 

Need to be careful of choice of broker. It is almost as important as choice of policy. You want a good broker who will provide good service afterwards and not just a sales agent.

 

Anyone who approaches you trying to sell a policy, can pretty well be ruled out. With a "real" broker you have to contact them and they will nto push one specific policy but rather ask questions about your needs and provide a range of choice.  Typically a chart comparing different policy options.

[Sheryl]

2 minutes ago, Pravda said:

 

 

My understanding is not poor and I'm not stupid. I am simply sharing my experience about what agent and hospital told me and what actually happened. Your mysterious health insurance policy offered over a decade ago on the other hand doesn't even seem to be Thai.

 

Actually Thailand also has this health and life insurance policy and I am quite familiar with it. Wife is insured this way, plus she also has her comprehensive work insurance and social security, of course. Even with this she has to pay for things out of her pocket, like mammograms, blood tests and many more even she's had it for 20 years. Yes, if she does of cancer they'll pay me 1 million baht. Woohoo

 

 

 

You did however use an inflammatory thread title and generalize from your experience with one company to all Thai insurers. This is turn is what has aggravated some posters.

 

I have no idea what you mean by "Thailand also has this health and life insurance policy". Are you taking about:

 

-the universal coverage scheme managed by the gvernment? or,

-the Social Security scheme? or

- a private insurance (of which there are many open to Thai citizens, all different in their terms and from different companies)

[tgw]

10 minutes ago, Sheryl said:

Because there is no one-size-fits-all answer to that. Innumerable factors: age? How long planning to be in Thailand? Any pre-exisitng conditions? Need to meet O-A visa extension requirements? etc etc etc

 

Also - why are you specifically wanting a Thai company? Why rule out foreign based expat policies?

I don't rule out foreign companies.
In fact, I am currently studying the offers of Aetna, Allianz, April, Cigna, MSH, Luma, CFE, etc.

 

I just wanted to explore what's offered on the Thai side.

That's my way of working when faced with making a decision, I try to get the full picture before making a choice.

 

With the other thread that I started a couple of weeks ago and this one, I guess I now have the information I wanted about Thai health insurance: no one recommended a Thai insurance company.

 

Edited November 20, 2021 by tgw

[Pravda]

5 minutes ago, Sheryl said:

You did however use an inflammatory thread title and generalize from your experience with one company to all Thai insurers. This is turn is what has aggravated some posters.

 

I have no idea what you mean by "Thailand also has this health and life insurance policy". Are you taking about:

 

-the universal coverage scheme managed by the gvernment? or,

-the Social Security scheme? or

- a private insurance (of which there are many open to Thai citizens, all different in their terms and from different companies)

No.

 

She has a private life insurance and then medical insurance added on top. Apparently these things work interchangeablely to get the best coverage.

Edited November 20, 2021 by Pravda

[blackprince]

2 minutes ago, Pravda said:

 

My understanding is not poor and I'm not stupid. I am simply sharing my experience about what agent and hospital told me and what actually happened. Your mysterious health insurance policy offered over a decade ago on the other hand doesn't even seem to be Thai.

 

Actually Thailand also has this health and life insurance policy and I am quite familiar with it. Wife is insured this way, plus she also has her comprehensive work insurance and social security, of course. Even with this she has to pay for things out of her pocket, like mammograms, blood tests and many more even she's had it for 20 years. Yes, if she does of cancer they'll pay me 1 million baht. Woohoo

Your experience is your experience, and if that's all you were sharing I wouldn't have replied to this thread in the first place. But the problem comes when you generalise from your own (bad) experience to statements like "health insurance is a scam in Thailand".

 

Also I never said you are stupid, but my guess is that you don't understand these products well or what is available. Surely if you did then you would have made a better decision about what to buy and scrutinised the contract in more detail, assuming it was written in English.

 

I stated quite clearly that my insurer is Thai and that the contract is written in Thai, so I have no idea how you get the idea my personal health and life assurance policy is not issued in Thailand by a Thai company. Not only is it a policy issued by a Thai company, it is valid worldwide too.

 

I also have the standard health insurance that legitimate workers in Thailand enjoy.

 

By the way, in 1990 I was a middle manager in a leading health, insurance, assurance, and pensions company (these products are all related). I know the industry well and I know what I'm buying. It would take too long to explain the differences, so I won't.

 

 

[KhaoYai]

I believe the key with any insurance policy is to read the terms and conditions very carefully and make sure you comply with them - that may not be possible with a Thai policy that is not fully translated into English.

 

I think my UK travel policy is superior to that which is being offered in Thailand to satisfy the Thailand Pass requirements but it does contain some points that I may not have thought of should a claim arise.  For example, I am covered (limited amount) for additional accommodation costs if I am ordered to quarantine by a medical professional or the Thai authorities. I may well have had the presence of thought to get the bill for such accommodation but I doubt I would have asked for the order to quarantine to be put in writing. Note the word 'additional' in such clauses - if you are ordered to quarantine in a hotel, the insurers probably wouldn't pay out unless you can show that you wouldn't have been staying at a hotel in normal circumstances. If you had been staying at a hotel and were ordered to quarantine in a hospital - the insurers would probably only pay the difference between a hotel and a hospital.

 

Without reading all 55 pages of the policy again I also noted that there were other matters which, if I presented them in the right way would form a valid claim.  Before contacting your insurers you need to thoroughly read the relevant section, make sure you collect the correct evidence and go on to present your claim in a way that will result in getting paid.  For example, some matters in my policy would require me to have to be hospitalised - I'm pretty sure that a Thai hospital would happily 'hospitalise' me for a night or two if I suggested it may be better.

 

Other parts of my medical cover state that I should contact a handling company in the UK and seek authority before agreeing to any emergency costs - quite how I would do that if I'd been smashed to bits in a motorbike accident, I don't know - I'm writing to my insurers to ask about that point.

 

On non medical matters such as theft - always get a police report and in Thailand, note that a police report is only available from the area in which the loss occured.  If you have your laptop stolen on Koh Samui, its no use trying to get a police report in Bangkok on your way home.

[NanLaew]

1 hour ago, Sheryl said:

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.

Same as it is in any petty Thai bureaucracy. If they reject the claim and the claimant folds, then they don't have to do any of the 'necessary paperwork' and still pick up their paycheck.

 

It's like the sales person saying, 'No have', or bank teller saying, 'Cannot' but when pressed, they go and get what you are looking for or open your account.

[new2here]

8 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.

 

5 hours ago, Liverpool Lou said:

Completely untrue and how this misleading thread is allowed to continue is unbelievable.

At the end of the day, insurers, like most “for-profits” are principally designed to maximize their profits .. and that does mean paying only those claims that fall, in it’s entirety, within the policy wording.. 

 

While insurers so do push the image of “we’re here for you” i think it’s always smart to remember where everyone’s “base” is at..

 

The consumer wants as much covered as possible, and for the absolute lowest cost — as they should 

 

The insurer wants as little paid as possible, and for the highest cost - as they also should.

 

So, the middle is where both really should meet - to me, that’s the actual policy wording, decorations page, exclusions etc.

 

>>So long as<< the insurer properly followed ALL of the policy language, any exceptions/exclusions. then they haven’t done anything wrong at all… the opposite is also equally true … >>IF the claim meets ALL<< of the language, then it should be paid without issue.

 

These posts are always hard to judge as fair and full disclosure is (obviously) lacking - not due to deliberate concealment - but sometimes due to pure lack of access to all the case facts  .. and with most all forms of insurance, the details, the “little” stuff really matters.

 

The part about the hospital saying/implying it’s a valid claim is (IMHO) of little value as they aren’t a representative of the insurer and (i’ll reasonably guess) don’t have access to the specific policy and wording.. the “agent” i think is a bit different, but here too- an agent may in fact be just an authorized sales agent - and lacks any authority to act on claims. 

Edited November 20, 2021 by new2here

[ThailandRyan]

8 hours ago, scubascuba3 said:

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

Never had an issue, mine have all been covered by my insurance after checking before the procedure and the hospital getting it in writing from the insurance company in the form of a quarantee of payment letter.

[tgw]

9 minutes ago, ThailandRyan said:

Never had an issue, mine have all been covered by my insurance after checking before the procedure and the hospital getting it in writing from the insurance company in the form of a quarantee of payment letter.

so which company do you recommend?

[scubascuba3]

15 minutes ago, ThailandRyan said:

Never had an issue, mine have all been covered by my insurance after checking before the procedure and the hospital getting it in writing from the insurance company in the form of a quarantee of payment letter

Presumably your premiums went up after claiming? seems normal for many thai insurance companies

[ThailandRyan]

13 minutes ago, scubascuba3 said:

Presumably your premiums went up after claiming? seems normal for many thai insurance companies

Minimal increase the next year, but then I also did hit the next age bracket.

[ThailandRyan]

27 minutes ago, tgw said:

so which company do you recommend?

Your mileage will vary with any company obviously.  I just go the extra mile and ensure it will be covered and the doctors I have and the hospital require a guarantee of payment prior to the procedure.  However, the doctor I use for my regular procedures always writes up his citation as to why the procedure is needed on a Medical certificate.  For any of my medical stuff that's not cover because of it being a pre-existing known and listed condition my insurance in the US picks up around 90%. of it ie...my diabetic endocrinology visits and they even pay for my meds, well I pay for them first and they reimburse me about 6 weeks later.  I can only say that I guess I have been lucky.

Edited November 20, 2021 by ThailandRyan

[Sheryl]

22 minutes ago, scubascuba3 said:

Presumably your premiums went up after claiming? seems normal for many thai insurance companies

Thai policies allow this but it is not always done. Depends on the size of the claim and what is was for i.e. if the insurer thinks based on it that you have above average likelihood of more claims.

 

It would be unusual to see a premium hike due to a claim related to an accident or a an appendix removal for example.

 

But a claim related to cancer, kidney disease, heart disease = quite likely.

 

The problem is that once you develop such conditions you are stuck with that insurer as no longer eligible for a new policy with another company. You are also often old and on a fixed income. You wind up with unaffordable premiums exactly when you most need good insurance and at an age where relocation is often mentally/emotionally difficult and there may be  are few connections with people back home due to deaths,, passage of time etc. I have seen this a lot.

 

Which is why I recommend against a Thai based policy if planning to grow old here. If someone is comparatively young,  here for a limited time and ready and able to return to their home country should they develop a chronic condition  then a local policy may be fine.

[Etaoin Shrdlu]

2 hours ago, Pravda said:

By their own policy as agent explained I was supposed to be covered if there were no issues in the past 5 years. They asked a document from a previous hospital for a procedure I had 6 years ago (endoscopy and unrelated) and they denied me.

There isn't enough information from the OP to understand the reason for the insurer's denial of the claim, but the reference to the agent stating that things should be ok if something happened more than five years prior gives a possible hint.

 

Some medical insurance application forms ask the applicant to disclose any surgeries or medical procedures they have undergone during a specific time period, typically five or ten years. The intent of this question is to elicit more information regarding the proposer's medical history than may have otherwise been provided based upon the standard request to disclose pre-existing conditions.

 

Some applicants might believe that this means that their duty to disclose the medical condition for which the surgery or procedure was performed does not apply if the surgery or procedure occurred prior to the time period mentioned. This isn't the case. The applicant's duty to disclose material facts is without time limitation and the time period mentioned in the question regarding surgeries or procedures does not over-ride it.

 

An insurer is also entitled to deny a claim and cancel a policy from inception if the nature of the condition that had not been disclosed would have caused the insurer to reject the application based upon its underwriting guidelines, even if the non-disclosed condition had nothing to do with the immediate claim at hand.

 

It would not surprise me if an insurance agent here also misunderstood this issue and gave bad advice.

 

Edited November 20, 2021 by Etaoin Shrdlu

[scubascuba3]

9 minutes ago, Etaoin Shrdlu said:

 

Some medical insurance application forms ask the applicant to disclose any surgeries or medical procedures they have undergone during a specific time period, typically five or ten years. The intent of this question is to elicit more information regarding the proposer's medical history than may have otherwise been provided based upon the standard request to disclose pre-existing conditions.

 

Some applicants might believe that this means that their duty to disclose the medical condition for which the surgery or procedure was performed does not apply if the surgery or procedure occurred prior to the time period mentioned. This isn't the case. The applicant's duty to disclose material facts is without time limitation and the time period mentioned in the question regarding surgeries or procedures does not over-ride it.

 

An insurer is also entitled to deny a claim and cancel a policy from inception if the nature of the condition that had not been disclosed would have caused the insurer to reject the application based upon its underwriting guidelines, even if the non-disclosed condition had nothing to do with the immediate claim at hand.

 

It would not surprise me if an insurance agent here also misunderstood this issue and gave bad advice.

 

Is this thai insurance? or includes Intl insurance? time period of disclosure seems a lot less for intl.