Yes health insurance is a scam in Thailand

[Sheryl]

1 hour ago, scubascuba3 said:

Yes but people need to factor in future costs, in 70s and 80s will be very high

At current rates my premium will still be under US $4,000 at age 70.

 

By age 80 it will be around $4,500 annually.

 

Depending on my state of health and also my financial situation I may consider increasing my deductible at that point to reduce premiums. You can always further increase a deductible. You cannot however always decrease it.

[scubascuba3]

7 minutes ago, Sheryl said:

At current rates my premium will still be under US $4,000 at age 70.

 

By age 80 it will be around $4,500 annually.

 

Depending on my state of health and also my financial situation I may consider increasing my deductible at that point to reduce premiums. You can always further increase a deductible. You cannot however always decrease it.

Yes fine for you I'm sure, but reason I mentioned it is many don't realise how high the premiums go up so they should check. Is it worth insuring in 60s if you can't afford in 70s, I'm not sure

[BusyB]

1 hour ago, sead said:

I didn't know there existed insurance that covered health checkups

Speaking purely as a consumer I'm pretty sure there's no check up allowance in normal travel health insurance. Unless of course you're exhibiting symptoms.

Routine check-ups? Doubtful. It certainly won't be included in the policy I get for my upcoming trip. 

I was privately insured in Germany for a while and the policy included check-ups.

And standard public health in Germany even PUSH you to get things like colonoscopies etc. They've just reminded me, it having been 10 years since the last one. For that kind of thing there are also stool probe checks which can also be fairly efficient but have a slightly higher failure rate than c-scopes.

Prevention is better and infinitely cheaper than cure with a whole bunch of ailments and conditions.

As an addendum,  and more back to topic, I've never had a medical insurance company, either credit card travel, private travel or private domestic, refuse any bills.

A dental top-up insurance I have refused a part of the charge for a treatment but on totally reasonable contractual grounds.

Edited November 21, 2021 by BusyB

[jerrymahoney]

3 hours ago, Sheryl said:

We do not know and we also do not know if pre-approval was required.

Sure but IF it was required, that would be enough for them to deny the claim regardless of their stated reasons.

[Sheryl]

59 minutes ago, BusyB said:

Speaking purely as a consumer I'm pretty sure there's no check up allowance in normal travel health insurance. Unless of course you're exhibiting symptoms.

Routine check-ups? Doubtful. It certainly won't be included in the policy I get for my upcoming trip. 

 

Travel insurance is a different matter. Covers only emergency/urgent care.

 

In regular health insurance there are usually modules that can be optionally selected that cover preventive services but relative to what these cost in Thailand, almost never worth the added cost in premiums.

[Faranguz]

Happened to me as well with AXA Sawasdee.

 

Bangkok hospital prepared all the docs for the insurance, everything was confirmed.

 

I got attacked by stray dogs and had to do the anti-rabies.

[4MyEgo]

On 11/20/2021 at 8:55 PM, 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.

"By their own policy" this to me sounds like the agent didn't explain the policy to you properly, i.e. you the holder of the policy placed your trust in the agent (who earns a commission) and of course can mislead you and that is when the $hit hits the fan, and the policy holder blames the insurer.

 

Did you read the policy ? (I DOUBT IT). You can always post the part your agent refers to "by their own policy", right here so we can see it word for word.

 

The above said, I use an agent for all of my insurance needs, and I ask questions, I also read ALL of the policies and look at the fine prints/disclosures etc before I pay them so that I know what I can claim and what constitutes a claim, that said, my policy which is inpatient only, emergency and elective surgery states that for me to be able to make a claim, I must be admitted for 24 hours which constitutes an emergency, otherwise it's at my expense, because anything short of 24 hours is defined as an outpatient cost which I am not covered for by the insurer, furthermore, I have read the below extract very clearly, that said if I require a procedure, I have to call them for approval beforehand, e.g. not an emergency:  

Should I get pre-authorization before receiving medical treatment?

Your doctors and medical condition alone should determine the need for medical treatment. You are not required to get pre-authorization from THE INSURER in the event of an emergency before receiving medical care and you have the right to choose any medical service provider, however it is recommended that you contact the call centre before receiving medical treatment in order to understand the coverage for the medical treatment in your plan. Also according to the policy terms, you need to pre-notify the customer service department in case of a planned hospitalization and other conditions as specified in the policy's table of benefits.

 

The above to me is pretty straight forward, NOTIFY THE INSURER BEFORE GOING TO HOSPITAL, I.E. ULESS YOUR UNCONSCIOUS.

 

This all sounds to me as if you put all of your trust in the agent and hospital by not contacting the health insurer to get prior approval (in writing) from the insurer before going in for the procedure, set your self up for failure, after all, they are the ones who are paying and would want to know what is going on, i.e. you were conscious and they would be given the opportunity to approve or decline the cost for the procedure that the hospital would quote for the procedure, otherwise it's on you, in other words, it sounds to me that you jumped the gun.

 

Learn from your mistakes, e.g. "get it in writing", otherwise you have nothing but hearsay and that hearsay sounds like it was from the agent and of course the hospital just nod in a polite way not wanting to get involved in your fight with the insurer, your pompen, not ours, smile, so who really is to blame here, did you do your due diligence and read the policy and its fine prints/disclaimers or is it easier to blame the insurer because that makes it justifiable for you, whatabout the agent, perhaps more focus should have been place on him/her, that said, I have caught one telling porkies when I received a policy which he said covered my pre-existing condition, when it didn't and I cancelled it straight away, what if I didn't read it and I had the pre-existing condition flare up and I was hospitalised, should I blame the insurer, hell no, I did my due diligence, TRUST NO ONE, GET IT IN WRITING, you then stand less chances of being let down, once again in this cruel world.

 

It also sounds to me like you did not mention if you had a pre-existing condition or had any similar procedure carried out in the past to the insurer, regardless if it was within the past 5 years as most applications ask you if have have any pre-existing conditions in the past 5 years or had a procedure that we the insurer should know about in the past.

 

The question is why did you not disclose that you had the same procedure 6 years ago, because you knew they would more than likely not cover you for any future procedure IMO, 5, 6, 10 years, is all relevant and I believe most people would answer yes even if it was over 5 years, because the more open they are with the insurer, the more understanding they will have when they get a reply, we will cover it or we won't.

 

Glad to be proven wrong

 

The proof is usually in the pudding and personally I wouldn't be slagging any insurer if you deliberately withheld information from them as that could throw someone off from getting insurance when it was not the insurers fault, thereby rendering the intending policy holder not insured because of your misinformation.

 

 

[Pravda]

38 minutes ago, 4MyEgo said:

"By their own policy" this to me sounds like the agent didn't explain the policy to you properly, i.e. you the holder of the policy placed your trust in the agent (who earns a commission) and of course can mislead you and that is when the $hit hits the fan, and the policy holder blames the insurer.

 

Did you read the policy ? (I DOUBT IT). You can always post the part your agent refers to "by their own policy", right here so we can see it word for word.

 

The above said, I use an agent for all of my insurance needs, and I ask questions, I also read ALL of the policies and look at the fine prints/disclosures etc before I pay them so that I know what I can claim and what constitutes a claim, that said, my policy which is inpatient only, emergency and elective surgery states that for me to be able to make a claim, I must be admitted for 24 hours which constitutes an emergency, otherwise it's at my expense, because anything short of 24 hours is defined as an outpatient cost which I am not covered for by the insurer, furthermore, I have read the below extract very clearly, that said if I require a procedure, I have to call them for approval beforehand, e.g. not an emergency:  

Should I get pre-authorization before receiving medical treatment?

Your doctors and medical condition alone should determine the need for medical treatment. You are not required to get pre-authorization from THE INSURER in the event of an emergency before receiving medical care and you have the right to choose any medical service provider, however it is recommended that you contact the call centre before receiving medical treatment in order to understand the coverage for the medical treatment in your plan. Also according to the policy terms, you need to pre-notify the customer service department in case of a planned hospitalization and other conditions as specified in the policy's table of benefits.

 

The above to me is pretty straight forward, NOTIFY THE INSURER BEFORE GOING TO HOSPITAL, I.E. ULESS YOUR UNCONSCIOUS.

 

This all sounds to me as if you put all of your trust in the agent and hospital by not contacting the health insurer to get prior approval (in writing) from the insurer before going in for the procedure, set your self up for failure, after all, they are the ones who are paying and would want to know what is going on, i.e. you were conscious and they would be given the opportunity to approve or decline the cost for the procedure that the hospital would quote for the procedure, otherwise it's on you, in other words, it sounds to me that you jumped the gun.

 

Learn from your mistakes, e.g. "get it in writing", otherwise you have nothing but hearsay and that hearsay sounds like it was from the agent and of course the hospital just nod in a polite way not wanting to get involved in your fight with the insurer, your pompen, not ours, smile, so who really is to blame here, did you do your due diligence and read the policy and its fine prints/disclaimers or is it easier to blame the insurer because that makes it justifiable for you, whatabout the agent, perhaps more focus should have been place on him/her, that said, I have caught one telling porkies when I received a policy which he said covered my pre-existing condition, when it didn't and I cancelled it straight away, what if I didn't read it and I had the pre-existing condition flare up and I was hospitalised, should I blame the insurer, hell no, I did my due diligence, TRUST NO ONE, GET IT IN WRITING, you then stand less chances of being let down, once again in this cruel world.

 

It also sounds to me like you did not mention if you had a pre-existing condition or had any similar procedure carried out in the past to the insurer, regardless if it was within the past 5 years as most applications ask you if have have any pre-existing conditions in the past 5 years or had a procedure that we the insurer should know about in the past.

 

The question is why did you not disclose that you had the same procedure 6 years ago, because you knew they would more than likely not cover you for any future procedure IMO, 5, 6, 10 years, is all relevant and I believe most people would answer yes even if it was over 5 years, because the more open they are with the insurer, the more understanding they will have when they get a reply, we will cover it or we won't.

 

Glad to be proven wrong

 

The proof is usually in the pudding and personally I wouldn't be slagging any insurer if you deliberately withheld information from them as that could throw someone off from getting insurance when it was not the insurers fault, thereby rendering the intending policy holder not insured because of your misinformation.

 

 

You put so much effort assuming and explaining, but in short I did in fact disclose everything. 

[4MyEgo]

2 hours ago, Pravda said:

You put so much effort assuming and explaining, but in short I did in fact disclose everything. 

I do find it hard to believe, however if that is the case, then you should report them and appeal as Sheryl mentioned earlier, otherwise you allow them to get away with it for the next person.

[Enzian]

On 11/20/2021 at 10:10 AM, BE88 said:

The latest Thai insurance scandal with Covid policies is a clear example.

How did that turn out? When I returned 12/7 I discovered in my storage one of those 680 baht Covid policies from Dhipaya Insurance Company which is still good for a couple months.

[BE88]

17 hours ago, Enzian said:

How did that turn out? When I returned 12/7 I discovered in my storage one of those 680 baht Covid policies from Dhipaya Insurance Company which is still good for a couple months.

People who had Covid with Covid insurance are always waiting for the money from the insurance companies and the insurance companies are always waiting for the government's decision to cancel the policies because they pretend that if they have to pay they will be bankrupt.

 

[BB1955]

I wont name and shame here but I ve been insured with one company here for a long time . I went to the doctor with a torn meniscus , Had the MRI done he said surgery is the only way to fix it . Set up the surgery sent off to the insurance company , we went back and forth a few times . When I thought it was a done deal to approve it . They email me and ask me to do a more less invasive treatment  out patient that they dont cover . My doctor had already told there doctor that would not fix my problem . I went and had the shots 3 of them one week apart . No relief , I found myself in a hotel room packing my knee with ice and hunting pain killers. I email the insurance company tell them going back to the doctor Monday to arrange surgery and I dont expect any problems out of them . I did just that we set the surgery sent everything to the insurance company . We gave them two weeks notice , finally after calling emailing and keeping after them they approved it . I paid the first 20,000 baht and 20 % after. I paid out 53,000 they paid out 138,000 . I still had 29000 out of pocket to submit. 8000 for the MRI , 12,000 for surgery pre screening and 9000 for the shots . I sent that in They denied the shots even though they requested I get them . They paid 6700 baht on pre screening . They denied the MRI because it was less then 20,000 baht . I was upset to say the least . I was ok with the 9000 because it was out patient . The 6700 on the pre screening I was ok too . But the MRI should have been covered . My policy states 20,000 deductible per disability . I spoke with them sent a copy of my policy showing them . No response now they wont return my calls or answer my emails . Clearly they do not know how to treat there customers and they say they are a world class American Based company . I will think hard when my premiums are due again in 6 months .. Insurance companies are great collecting your payments , but reluctant to pay claims ... 

[scubascuba3]

46 minutes ago, BB1955 said:

I wont name and shame here but I ve been insured with one company here for a long time . I went to the doctor with a torn meniscus , Had the MRI done he said surgery is the only way to fix it . Set up the surgery sent off to the insurance company , we went back and forth a few times . When I thought it was a done deal to approve it . They email me and ask me to do a more less invasive treatment  out patient that they dont cover . My doctor had already told there doctor that would not fix my problem . I went and had the shots 3 of them one week apart . No relief , I found myself in a hotel room packing my knee with ice and hunting pain killers. I email the insurance company tell them going back to the doctor Monday to arrange surgery and I dont expect any problems out of them . I did just that we set the surgery sent everything to the insurance company . We gave them two weeks notice , finally after calling emailing and keeping after them they approved it . I paid the first 20,000 baht and 20 % after. I paid out 53,000 they paid out 138,000 . I still had 29000 out of pocket to submit. 8000 for the MRI , 12,000 for surgery pre screening and 9000 for the shots . I sent that in They denied the shots even though they requested I get them . They paid 6700 baht on pre screening . They denied the MRI because it was less then 20,000 baht . I was upset to say the least . I was ok with the 9000 because it was out patient . The 6700 on the pre screening I was ok too . But the MRI should have been covered . My policy states 20,000 deductible per disability . I spoke with them sent a copy of my policy showing them . No response now they wont return my calls or answer my emails . Clearly they do not know how to treat there customers and they say they are a world class American Based company . I will think hard when my premiums are due again in 6 months .. Insurance companies are great collecting your payments , but reluctant to pay claims ... 

Of course. The good news if you don't pay the 60k-200k premiums a year is that can go towards medical treatment with no denial of claims to contend with

[NoshowJones]

On 11/20/2021 at 12:33 PM, scubascuba3 said:

They could still say something is an undiagnosed pre-existing condition and not cover a claim. Maybe you've seen a doc showing how they decide this?

Change "could" to "would".

[Guest Isaanlife]

On 11/19/2021 at 10:04 PM, scubascuba3 said:

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

How can a person be happy with paying for something until they actually use it and see if it works?

 

[KarenBravo]

Recently, I've had Thai insurance pay out over 100,000 Bt after my deductable. No arguments, or even questions, except to the doctor.

 

If insurance companies here didn't pay out, their reputation would spread as non-payers and they would go out of business.

 

A colonoscopy is elective and it's outpatient. I'm betting that this was not covered in the policy.

 

 

Edited December 28, 2021 by KarenBravo

[Guest Isaanlife]

17 minutes ago, KarenBravo said:

Recently, I've had Thai insurance pay out over 100,000 Bt after my deductable. No arguments, or even questions, except to the doctor.

 

If insurance companies here didn't pay out, their reputation would spread as non-payers and they would go out of business.

 

A colonoscopy is elective and it's outpatient. I'm betting that this was not covered in the policy.

 

 

You bet on something you have never read or no factual knowledge of? Come on.

[Pravda]

34 minutes ago, KarenBravo said:

Recently, I've had Thai insurance pay out over 100,000 Bt after my deductable. No arguments, or even questions, except to the doctor.

 

If insurance companies here didn't pay out, their reputation would spread as non-payers and they would go out of business.

 

A colonoscopy is elective and it's outpatient. I'm betting that this was not covered in the policy.

 

 

Yes it is. Period.

[4MyEgo]

53 minutes ago, KarenBravo said:

Recently, I've had Thai insurance pay out over 100,000 Bt after my deductable. No arguments, or even questions, except to the doctor.

 

If insurance companies here didn't pay out, their reputation would spread as non-payers and they would go out of business.

 

A colonoscopy is elective and it's outpatient. I'm betting that this was not covered in the policy.

 

 

I believe the mistakes people make when taking out insurance policies, in this instance we will talk about health insurance policies, although most insurances are the same, i.e. they are contracts and need to be read thoroughly, they are not want people think they are, health insurance policies that cover everything, they just doesn't exist, but come pretty close.

 

What most fail to understand is that most health insurance policies cover emergencies (inpatient) and not (outpatient) unless they opt to pay the higher costs for the premium. For the emergency cover to work, one must be in hospital for a minimum of 24 hours to be classed as an emergency, or if it's elective surgery which is covered by the policy, the insurance company must be advised beforehand to give clearance for the procedure, e.g. you can't just walk in and say, ah give me a Colonoscopy and then tell the insurer, it doesn't work that way, on the other hand if the patient was admitted under an emergency and the Dr thought giving the patient a Colonoscopy to look for causation as his wife mentioned to the Dr that before he passed out he was complaining that he had stomach issues, then the insurer could be advised later when the patient was awake and cover would be granted under that condition.

 

Insurance isn't just insurance and ignorance isn't an excuse, everyone who takes out insurance MUST read the policy and KNOW what they are covered for and when the policy comes into effect and what may cause the policy to not come into effect, e.g. the insurer not having to pay up, for example, by breaching the terms of the policy, or by not following the procedure of the policy, e.g. advising the insurer at the first available moment of knowing that a procedure was require, excluding when a patient is admitted under an emergency and unconscious.

 

Not having insurance means your going to be up for a huge bill if you go into a private hospital, that is inevitable, i.e. unless you go to a government hospital where the bill can still be big, but not as big as a private hospital. 

 

Avoiding the above is by simply having insurance with a reputable insurance company, knowing the policy/contract in and out and abiding by the policy/contract rules, simple really, do that, and you won't be left out in the cold as some claim, never their fault, always the insurers, which I find hard to believe IMO.  

 

Edited December 28, 2021 by 4MyEgo

[Henk Langeweg]

1 hour ago, Isaanlife said:

How can a person be happy with paying for something until they actually use it and see if it works?

 

It's like an umbrella. If you carry one, no rain. If you don't carry one, it will rain.

[KarenBravo]

49 minutes ago, Pravda said:

Yes it is. Period.

Oh.....you used Period which brooks no argument, so it must be true. 

 

Let me have a go. No it isn't. Period.

Hmmmm.....doesn't feel like a good, convincing argument to me.

Edited December 28, 2021 by KarenBravo

[scubascuba3]

1 hour ago, Isaanlife said:

How can a person be happy with paying for something until they actually use it and see if it works?

 

They think it's saving them money and is good so have a warm fuzzy feeling for a while

[KarenBravo]

2 minutes ago, scubascuba3 said:

They think it's saving them money and is good so have a warm fuzzy feeling for a while

Think? No, I know it's saved me money. Speak for yourself

[scubascuba3]

8 minutes ago, KarenBravo said:

Think? No, I know it's saved me money. Speak for yourself

ah good, tell us the good news story?

[The Hammer2021]

It's always best to get advanced confirmation  of payment  in advance

[KarenBravo]

18 minutes ago, scubascuba3 said:

ah good, tell us the good news story?

Eight posts above yours.

 

If insurance didn't work, it wouldn't exist.

 

 

Edited December 28, 2021 by KarenBravo

[scubascuba3]

1 hour ago, KarenBravo said:

Recently, I've had Thai insurance pay out over 100,000 Bt after my deductable. No arguments, or even questions, except to the doctor.

 

If insurance companies here didn't pay out, their reputation would spread as non-payers and they would go out of business.

 

A colonoscopy is elective and it's outpatient. I'm betting that this was not covered in the policy.

 

 

What was the claim for? some things are harder for them to reject. Has your annual premium increased yet?

[KarenBravo]

2 minutes ago, scubascuba3 said:

What was the claim for? some things are harder for them to reject. Has your annual premium increased yet?

You honestly think I'm going to share my medical info on the internet? I don't think so.....

 

The reason I have insurance is that their is a history of cancer in my family, so I'll probably get it one day, too. The insurance company has already confirmed that they will pay out on any claims for cancer, which can run into the millions for treatment.

[scubascuba3]

11 minutes ago, KarenBravo said:

You honestly think I'm going to share my medical info on the internet? I don't think so.....

 

The reason I have insurance is that their is a history of cancer in my family, so I'll probably get it one day, too. The insurance company has already confirmed that they will pay out on any claims for cancer, which can run into the millions for treatment.

Probably what you claimed for is now preexisting and excluded, that gets reported often with thai companies, not foreign companies

[KarenBravo]

1 minute ago, scubascuba3 said:

Probably what you claimed for is now preexisting and excluded, that gets reported often with thai companies, not foreign companies

No it isn't. I asked before using the insurance. Pre-existing conditions means exactly that. Conditions that existed before insurance was bought and paid for.

Also, the maximum yearly increase in premiums is 25%.

It pays to get info first before using insurance.