How do insurers and hospitals share medical history?

[Thomas299]

Hi everyone,

I am considering switching my health insurance provider.

I am registered with one hospital in Thailand (H1) and although I am in good health, in a past visit they made a blank statement saying there is a condition which 'could' require follow up.

To cut a long story short, my medical history is stained by this statement.
The doctor agrees that no follow up is required (it's just the radiologist covering his back) and nothing will come a definitive conclusion and remove the 'stain' from my history.

I am trying to resolve the issue as follows.

1 - Approach the new insurer and make no mention of this hospital (H1).

2 - Register a new hospital (H2) with the insurer, a hospital which I used years ago, where my record is immaculate.

 

My question is: will my new insurance provider find out about my medical record in the hospital which I will not mention (H1)?

 

I read that in the US any prescription made by the hospital will go in a central database and so it would come up, but this is not the US.

My doctor (the one in Hospital 1) said that they would never find out, but I am asking here if someone is informed differently.

Since it is quite a delicate matter I would appreciate informed or expert opinions rather than hearsay, and please let's not focus on me trying to clear my medical history, as this is a channel I have already explored and it looks like it's not possible, not even with repeated follow up visits.

 

So, again, my question is: will my new insurance provider find out about my medical record in the hospital which I will not mention?

 

Thanks a million

Edited July 14, 2022 by Thomas299

[scubascuba3]

They may dig deeper when you claim rather than when you sign up, they like finding preexisting conditions when claiming

[Etaoin Shrdlu]

When a person applies for medical insurance, he or she will be required to sign a proposal form that states that all material facts relating to the proposer's medical history have been disclosed. The proposer also may be required to sign a release that would allow the insurer to obtain medical information directly from any provider.

 

If a policyholder does not disclose a material fact, the the insurer may, depending on what they would have done had the disclosure been made, void the policy regardless of whether the information that was withheld was related to a claim.

 

This duty of disclosure is actually specifically mentioned in the Thai Civil and Commercial Code. The insurance company is not required to specifically request information, the onus is on the proposer to provide it, so the lack of a specific question or inquiry by the insurer on the proposal form does not relieve the proposer of the duty to disclose.

 

It is unlikely that an insurer would make inquiries to various hospitals at the time of forming the contract of insurance, however in the event of a large claim coupled with suspicion that information had been withheld, it may happen that an insurer would make inquiries and find out about the non-disclosure. 

 

My advice would be to disclose and remove the possibility of the insurance policy being voided just when it is most needed.

 

 

[scubascuba3]

2 minutes ago, Etaoin Shrdlu said:

If a policyholder does not disclose a material fact, the the insurer may, depending on what they would have done had the disclosure been made, void the policy regardless of whether the information that was withheld was related to a claim.

I've also seen them cancel the policy, refund the premiums and request previous unrelated claims to be paid back to insurer along with court action, gotta love them

[Etaoin Shrdlu]

Just now, scubascuba3 said:

I've also seen them cancel the policy, refund the premiums and request previous unrelated claims to be paid back to insurer along with court action, gotta love them

Yes, the insurance company is completely within their rights to do so and it does happen more than it should.

 

That's why it is so very important to make full disclosure when forming a contract of insurance. When the amounts are high enough, the insurance company will play hardball.

[Thomas299]

19 minutes ago, Etaoin Shrdlu said:

When a person applies for medical insurance, he or she will be required to sign a proposal form that states that all material facts relating to the proposer's medical history have been disclosed. The proposer also may be required to sign a release that would allow the insurer to obtain medical information directly from any provider.

 

If a policyholder does not disclose a material fact, the the insurer may, depending on what they would have done had the disclosure been made, void the policy regardless of whether the information that was withheld was related to a claim.

 

This duty of disclosure is actually specifically mentioned in the Thai Civil and Commercial Code. The insurance company is not required to specifically request information, the onus is on the proposer to provide it, so the lack of a specific question or inquiry by the insurer on the proposal form does not relieve the proposer of the duty to disclose.

 

It is unlikely that an insurer would make inquiries to various hospitals at the time of forming the contract of insurance, however in the event of a large claim coupled with suspicion that information had been withheld, it may happen that an insurer would make inquiries and find out about the non-disclosure. 

 

My advice would be to disclose and remove the possibility of the insurance policy being voided just when it is most needed.

 

 

Thank you for the well thought advice, which I will probably follow.
Would you be able to clarify for me if insurers have the right to proactive request information to hospitals which I haven't mentioned to them and if I can prevent hospitals to release it without my consent. 

Thanks!

[Richard 2020]

NO, you can't!

 

You ALWAYS sign a "declaration of release! without this no contract, with no insurance!

[Etaoin Shrdlu]

4 minutes ago, Thomas299 said:

Thank you for the well thought advice, which I will probably follow.
Would you be able to clarify for me if insurers have the right to proactive request information to hospitals which I haven't mentioned to them and if I can prevent hospitals to release it without my consent. 

Thanks!

The release that is part of the proposal form would allow them to seek information directly with any hospital regardless of whether you have mentioned the hospital or not.  An insurer could, therefore, make inquiries at any time and of anyone, including at the time they consider your proposal form or later if you submit a claim.

 

I don't think an insurer would favorably consider your application for insurance if you did not agree to the release. It would be like waving a large red flag saying "non-disclosure".

 

I also find it hard to imagine an insurer issuing a policy or paying a claim if faced with a situation in which one of their inquiries was met with refusal by a hospital to honor the release that the proposer signed.  I think this is getting onto really shaky ground. At some point non-disclosure might be seen as insurance fraud, but I really can't comment on that.

 

 

 

 

[bkk6060]

I have been told they have access to a data base with medical history.  I can confirm a hospital I went to was not affiliated with another,  yet they knew all about my history.

If you lie or try to cheat on the application for insurance, don't be surprised if a claim is denied. 

[Thomas299]

19 minutes ago, Etaoin Shrdlu said:

The release that is part of the proposal form would allow them to seek information directly with any hospital regardless of whether you have mentioned the hospital or not.  An insurer could, therefore, make inquiries at any time and of anyone, including at the time they consider your proposal form or later if you submit a claim.

 

I don't think an insurer would favorably consider your application for insurance if you did not agree to the release. It would be like waving a large red flag saying "non-disclosure".

 

I also find it hard to imagine an insurer issuing a policy or paying a claim if faced with a situation in which one of their inquiries was met with refusal by a hospital to honor the release that the proposer signed.  I think this is getting onto really shaky ground. At some point non-disclosure might be seen as insurance fraud, but I really can't comment on that.

 

 

 

 

Thank you. I am convinced. Will stay with my current insurer.

[Etaoin Shrdlu]

11 minutes ago, Thomas299 said:

Thank you. I am convinced. Will stay with my current insurer.

Do you use an insurance broker?

 

A good insurance broker can give you very good advice and formally answer your questions. They may also be able to suggest an insurer that is more flexible when it comes to issues such as pre-existing conditions. Some insurers will exclude some conditions and others may simply charge a higher premium.

[internationalism]

some insurers, like Thai Health Insurance PCL, ask only for 5 years records, some other for 10 years or even "ever".

I was told by my misterprakan broker, that AXA is stricter in issuing policy and that there should be minimum 6 month from some hospitalisation.

The longer it is from medical event, the less likely it would be played by insurer.

In you case I don't think radiologist opinion is relevant to insurer. That opinion was not taken by doctor. Doctors decision overrules radiologist report.

Do same check up again in some other hospital. Enclose it with application form.

 

If you are healthy, as you say, and further radio scans are clear, maybe you should downgrade you insurance premiums, take large deductible, co-pay.

 

Edited July 14, 2022 by internationalism

[Etaoin Shrdlu]

On 7/14/2022 at 10:04 PM, internationalism said:

some insurers, like Thai Health Insurance PCL, ask only for 5 years records, some other for 10 years or even "ever".

 

 

I urge caution in this area.

 

Under the Thai Civil and Commercial Code, the proposer's obligation is to disclose any material fact without limitation. I don't believe this requirement is over-ridden by an insurer putting a timeframe for disclosure on their proposal form or on how questions may be worded, especially if reference is made anywhere on the proposal form to the Civil and Commercial Code's disclosure requirements as is often the case. 

 

At the end of the day, the document that sets out the terms of cover is the policy and not the proposal form. Unless the policy limits the pre-existing condition exclusion to the scope of disclosure mentioned in the proposal, there may be problems in the event of a claim. In effect, the proposal form is inviting potential non-disclosure but at the same time the insurer has a get-out-of-jail-free card under the policy as well as under the Civil and Commercial Code.

 

At the very least, one should make inquiries of the insurer to fully understand the intent, both in terms of the proposal form and the policy itself and get their answer in writing from someone in authority. But absent this, my advice would be to ignore any time limitation set out in the proposal form and disclose anything that may be material to the underwriter's decision-making.  In my experience, there's a modest down-side in over-disclosure but significant risk in material non-disclosure.

[scubascuba3]

11 minutes ago, Etaoin Shrdlu said:

I urge caution in this area.

 

Under the Thai Civil and Commercial Code, the proposer's obligation is to disclose any material fact without limitation. I don't believe this requirement is over-ridden by an insurer putting a timeframe for disclosure on their proposal form or on how questions may be worded, especially if reference is made anywhere on the proposal form to the Civil and Commercial Code's disclosure requirements as is often the case. 

 

At the end of the day, the document that sets out the terms of cover is the policy and not the proposal form. Unless the policy limits the pre-existing condition exclusion to the scope of disclosure mentioned in the proposal, there may be problems in the event of a claim. In effect, the proposal form is inviting potential non-disclosure but at the same time the insurer has a get-out-of-jail-free card under the policy as well as under the Civil and Commercial Code.

 

At the very least, one should make inquiries of the insurer to fully understand the intent, both in terms of the proposal form and the policy itself and get their answer in writing from someone in authority. But absent this, my advice would be to ignore any time limitation set out in the proposal form and disclose anything that may be material to the underwriter's decision-making.  In my experience, there's a modest down-side in over-disclosure but significant risk in material non-disclosure.

You're referring to thai insurers? not foreign insurers following different regs? such as April International (France)

[Etaoin Shrdlu]

55 minutes ago, scubascuba3 said:

You're referring to thai insurers? not foreign insurers following different regs? such as April International (France)

My comments above are based upon my professional experience with insurers domiciled and licensed in Thailand, both Thai insurers and the Thai operations of multinational insurers.

 

I am not familiar with French insurance regulations or the policies and proposal forms that April France would use. I assume that a French insurer would be bound by French (and EU?) consumer and insurance regulations. I don't know how those regulations would be affected, if at all, when the policyholder is located outside of France or the EU.

 

But the duty of disclosure is not unique to Thailand. It is an essential part of the formation of a contract of insurance and is roughly the same in all countries. I suppose it is possible that in some jurisdictions an insurer's ability to request certain information or deny claims based upon non-disclosure may be partially limited by regulation, but I am not aware of any specific examples of this.

[OneMoreFarang]

On 7/14/2022 at 4:02 PM, Thomas299 said:

My question is: will my new insurance provider find out about my medical record in the hospital which I will not mention (H1)?

If they want to find out then likely they will find out. One reason is that with every insurance contract you sign that you allow they to get all your health records from everyone.

Now the good and the bad news: Mostly they don't ask anybody, because that would create cost for them which they want to avoid. They insure you and they will likely pay all your little bills without problems (if it's according to the conditions of your contract.

But if you ever have i.e. an expensive operation and they think that could be connected to a previous condition, then they start digging. And if they find a little then maybe they dig deeper. And if they then find something what you should have told them but you didn't then they might tell you that they are not willing to pay that big bill because you lied to them.

So better think twice.

[Lucky Bones]

On 7/14/2022 at 5:30 PM, Etaoin Shrdlu said:

The release that is part of the proposal form would allow them to seek information directly with any hospital regardless of whether you have mentioned the hospital or not.  An insurer could, therefore, make inquiries at any time and of anyone, including at the time they consider your proposal form or later if you submit a claim.

 

I don't think an insurer would favorably consider your application for insurance if you did not agree to the release. It would be like waving a large red flag saying "non-disclosure".

 

I also find it hard to imagine an insurer issuing a policy or paying a claim if faced with a situation in which one of their inquiries was met with refusal by a hospital to honor the release that the proposer signed.  I think this is getting onto really shaky ground. At some point non-disclosure might be seen as insurance fraud, but I really can't comment on that.

 

 

 

 

Agreed. Insurance fraud would/could well be on the cards.

Not a good game to get into.

[Etaoin Shrdlu]

On 7/14/2022 at 5:36 PM, bkk6060 said:

I have been told they have access to a data base with medical history.  I can confirm a hospital I went to was not affiliated with another,  yet they knew all about my history.

If you lie or try to cheat on the application for insurance, don't be surprised if a claim is denied. 

I think there was an article in a local paper in the past few days that mentioned a medical records database being set up by the government that could be accessed by medical service providers and others with a legitimate interest in this information.

 

The article did not mention how far along this project is, but it would seem to have the potential to allow insurers to easily access medical info on anyone who has sought treatment at a participating facility.

[Lorry]

1 hour ago, Etaoin Shrdlu said:

I suppose it is possible that in some jurisdictions an insurer's ability to request certain information or deny claims based upon non-disclosure may be partially limited by regulation, but I am not aware of any specific examples of this.

Two jurisdictions where I happen to know this: Austria and Germany. Very different from the Anglo-American system. I hear similar things from Scandinavia, but that's just hearsay. 

[Etaoin Shrdlu]

1 minute ago, Lorry said:

Two jurisdictions where I happen to know this: Austria and Germany. Very different from the Anglo-American system. I hear similar things from Scandinavia, but that's just hearsay. 

Upon further reflection, I think the Affordable Care Act in the US also limits insurers' ability to exclude pre-existing conditions. But I'm not familiar with the details.

[Lorry]

1 hour ago, Etaoin Shrdlu said:

limits insurers' ability to exclude pre-existing conditions.

In the Swiss system, the ability to exclude preexisting conditions is limited.

My post above referred to the limits of disclosure.

[internationalism]

On 7/14/2022 at 5:36 PM, bkk6060 said:

I have been told they have access to a data base with medical history.  I can confirm a hospital I went to was not affiliated with another,  yet they knew all about my history.

If you lie or try to cheat on the application for insurance, don't be surprised if a claim is denied. 

I assume  it was thailand.

That system exists less than a year, the last year had 200 participating hospitals. Possibly many more hundreds by now.

But it was set up for patients requesting moving from one hospital to another, using some online application.

Thats from bankok post article "NT, GBDi join hands to launch national healthcare database".

 

I have registered recently with kanchanapisek hospital, which is affiliated to sirirach hospital.  But having this same address, phone and passport number, and having online registration form, they did connect my accounts. Also they did not have my medical record from the nearby government hospital I have stayed this year for 4 nights and from piyavate private hospital 10 days omicron.

So possibly only private hospitals share data, but not the governmental once and not between private and governmental.

 

No harm to apply to a new insurer, on condition they will only offer exclusion of preexisting and not refuse policy, because it would hinder further applications to the other insurers, who would just exclude or even not exclude some minor and outdated illness.

When I was considering some minor policy from AXA, I have asked misterprakan (don't apply, if hospitalisation below 6 months, because AXA is particularly strict) and the AA (do apply and only likely exclusion, but not refusal). I decided to not apply to avoid any risk of exclusion.

 

There are examples on this forum, when minor preexisting conditions were removed from the policy in 2 years on renewing. No harm to ask for that removal, if not offered automatically, it can be granted.

There are also statements, that insurers would hard scrutinise large claims within the first 2 years. Some might even decline renewing policy within the first 2 years.

 

there is also relevant thread

 

Edited July 17, 2022 by internationalism