How do you cope with skyrocketing premiums from health insurers?

[Sheryl]

2 hours ago, GinBoy2 said:

 

 

I always wondered after that, have a heart attack and a stent, next year do they exclude any heart issues as a pre-existing condition?

If you already have the policy then they can't create new exclusions for conditions that newly developed after the policy was already in effect.

 

 

[Sheryl]

2 hours ago, richard_smith237 said:

The exclusions insurance companies apply for non-symptomatic issues is often ridiculous... 

 

I often wonder if I had a broken leg would they exclude me from cover for further broken legs !!!... 

Obviously not.

 

Exclusions come into play for things that put you at above average risk. Diabetes for example put you at above average risk for a host of diseases.  So do dyslopidemias. Someone who has had heart disease in the past is at above average risk of it i  the future.

 

The setting of insurance premiums is s complex thing requiring detailed computations of risk by age performed by actuaries (people with special training in this). The calculations are for the population as a whole and assume people at average risk at time of enrollment.  The whole calculation goes out the window if the insured person is at above average risk for certain conditions.  If the above average risk is limited to specific conditions, the insurer may solve this by applying an exclusion or offering to cover everything at a higher than normal premiums. It needs sophisticated individualized actuarial calculations to arrive at such personalized premiums so only some insurers are able to do this.

 

All that said, many Thai based insurers come up with bizarre/far fetched exclusions based on  history that make no medical  sense at all. They appear to have non-medical people doing this and no real review by medically qualified people.  International insurers usually have medical staff and their reviews are far more reasonable and nuanced.  Their enrollment forms are also clearer and better worded. 

 

Worse yet, some Thai based insurers apply exclusions retroactively after a claim is made even though  full and accurate history was  provided on application. And even insurers who claim to do full medical underwriting, which ought to prevent that.

[The Hammer2021]

On 7/26/2022 at 6:31 PM, Nickelbeer said:

Skyrocketing premiums from companies that usually fail to pay the coverage they agreed to. Insurance in Thailand is a massive scam.

Can you prove  that? I'll don't believe  you. Al company can not refuse to pay unless it has legal grounds not to.

[Nickelbeer]

12 hours ago, Sheryl said:

Obviously not.

 

Exclusions come into play for things that put you at above average risk. Diabetes for example put you at above average risk for a host of diseases.  So do dyslopidemias. Someone who has had heart disease in the past is at above average risk of it i  the future.

 

The setting of insurance premiums is s complex thing requiring detailed computations of risk by age performed by actuaries (people with special training in this). The calculations are for the population as a whole and assume people at average risk at time of enrollment.  The whole calculation goes out the window if the insured person is at above average risk for certain conditions.  If the above average risk is limited to specific conditions, the insurer may solve this by applying an exclusion or offering to cover everything at a higher than normal premiums. It needs sophisticated individualized actuarial calculations to arrive at such personalized premiums so only some insurers are able to do this.

 

All that said, many Thai based insurers come up with bizarre/far fetched exclusions based on  history that make no medical  sense at all. They appear to have non-medical people doing this and no real review by medically qualified people.  International insurers usually have medical staff and their reviews are far more reasonable and nuanced.  Their enrollment forms are also clearer and better worded. 

 

Worse yet, some Thai based insurers apply exclusions retroactively after a claim is made even though  full and accurate history was  provided on application. And even insurers who claim to do full medical underwriting, which ought to prevent that.

I’m certainly glad that Sheryl checked in on this subject. We have a few sour naysayers on board who want “proof” that Thai insurance companies are just playing games with us. Anyone who has ever dealt with a Thai insurance company tells the same story. Thanks, Sheryl, for setting the record straight.

[Dart12]

On 7/29/2022 at 7:28 PM, rumak said:

As in all things in life  ????  .    As i mentioned,  i broke my hip,  when i was 70 .   Looking at google one finds this tidbit :   "One in three adults aged 50 and over dies within 12 months of suffering a hip fracture. Older adults have a five-to-eight times higher risk of dying within the first three months of a hip fracture compared to those without a hip fracture."     

Let me say,  when i broke my hip the pain was incredible.  Couldn't move.   I had the surgery done at a private mid range hospital in CM .   Total cost 140 K  baht .   I was on crutches within a month... and walking without them within 3 months.  This is why i might repeat in some health threads the advantage of taking care of ones self .  

I understand what you say,  that sometimes in life unexpected things happen.  Car crashes, hit by a drunk driver,   sudden rare illness,  etc .     One person's choices will not fit all .   Health insurance for a major catastrophe such as you mention ( in the millions)  would be great.   On the other hand there are hundreds of thousands of people who have been denied or had horrible experiences trying to get insurance companies to pay.    

Working for a company or govt that gives good insurance is definitely worth it.  Self employed and retired people who pay themselves have a tough decision . (well,  for me not tough) .   Pretty sure you will make right choice for yourself when the time comes .  

How long ago was that?  I broke my ankle and had surgery in Pattaya memorial and it cost me 180k, plus weekly doctor visits for checkups after that for almost 3 months.

They tried to get me to come daily for 'cleanings and rebandaging' . NO WAY

[rumak]

1 hour ago, Dart12 said:

How long ago was that?  I broke my ankle and had surgery in Pattaya memorial and it cost me 180k, plus weekly doctor visits for checkups after that for almost 3 months.

They tried to get me to come daily for 'cleanings and rebandaging' . NO WAY

Chiangmai has a number of private hospitals ,  and my guess is that the cost for medical are generally cheaper than BKK,  Pataya,  or Phuket . 

My surgery was done by a very competent surgeon,  I had a private room for 3 days and nights, and i only needed "follow up" once at 2 weeks ,  then 3 more times at one month intervals.   I would have an xray,  then doctor would consult .   I refused "physical therapy "  as the exercises were very simple.           the follow up visits were about 1200 baht each ( total)

note:  would have been a lot cheaper but i went with the best  titanium rod   

[GinBoy2]

On 8/2/2022 at 6:46 AM, Sheryl said:

Obviously not.

 

Exclusions come into play for things that put you at above average risk. Diabetes for example put you at above average risk for a host of diseases.  So do dyslopidemias. Someone who has had heart disease in the past is at above average risk of it i  the future.

 

The setting of insurance premiums is s complex thing requiring detailed computations of risk by age performed by actuaries (people with special training in this). The calculations are for the population as a whole and assume people at average risk at time of enrollment.  The whole calculation goes out the window if the insured person is at above average risk for certain conditions.  If the above average risk is limited to specific conditions, the insurer may solve this by applying an exclusion or offering to cover everything at a higher than normal premiums. It needs sophisticated individualized actuarial calculations to arrive at such personalized premiums so only some insurers are able to do this.

 

All that said, many Thai based insurers come up with bizarre/far fetched exclusions based on  history that make no medical  sense at all. They appear to have non-medical people doing this and no real review by medically qualified people.  International insurers usually have medical staff and their reviews are far more reasonable and nuanced.  Their enrollment forms are also clearer and better worded. 

 

Worse yet, some Thai based insurers apply exclusions retroactively after a claim is made even though  full and accurate history was  provided on application. And even insurers who claim to do full medical underwriting, which ought to prevent that.

I'm glad you posted this.

 

In my previous post I said that we had enrolled with, then BUPA and they then excluded my wife for any gyno issues due to a previous hospitalization for a ruptured ovarian cyst gone bad

 

At the time I 'thought' we were signing up for an international company, albeit the Thai arm of the company.

 

Maybe the line get blurred here, Sheryl may be able to shed more light.

 

Would a truly international insurance actuary have excluded all gynecological issues, for an event which is not uncommon for many women

[Sheryl]

7 hours ago, GinBoy2 said:

I'm glad you posted this.

 

In my previous post I said that we had enrolled with, then BUPA and they then excluded my wife for any gyno issues due to a previous hospitalization for a ruptured ovarian cyst gone bad

 

At the time I 'thought' we were signing up for an international company, albeit the Thai arm of the company.

 

Maybe the line get blurred here, Sheryl may be able to shed more light.

 

Would a truly international insurance actuary have excluded all gynecological issues, for an event which is not uncommon for many women

BUPA  Thailand was a Thai company with some sort of affiliation with BUPA intetnational. Ditto AETNA, Pacific Cross Thailand etc etc.

 

These are Thai companies and come under Thai insurance regulations. 

 

Impossible to say what another insurer would have done. Possible they would have excluded only ovarian conditions but can't be sure. 

[GinBoy2]

1 hour ago, Sheryl said:

BUPA  Thailand was a Thai company with some sort of affiliation with BUPA intetnational. Ditto AETNA, Pacific Cross Thailand etc etc.

 

These are Thai companies and come under Thai insurance regulations. 

 

Impossible to say what another insurer would have done. Possible they would have excluded only ovarian conditions but can't be sure. 

That should be a cautionary tale for folks.

 

The name maybe familiar, but maybe not the company you think it to be!

[internationalism]

if your wife was just enrolling to BUPA and they made this wide exclusion, she could try many other insurers (also those thai ones). 

Some insurers ask on their intake form for 5 years medical history, some for 10, yet some ask "have you ever had". Still, there is an educated opinion from some experienced forum member who said (on insurance sub-forum) that even if only short medical history is required, all previous also should be submitted.

One of my broker's (misterprakan) warned me that axa would likely refuse my application if done within 6 months from a minor hospitalisation. But the other agent I have asked for advice told me just try and they think that condition might even not be excluded. I decided not to apply.

Recent hospitalisations, with longer stays and operations will be classified higher, than mild short stays, for procedures which can't be done outpatient.

 

 

Edited August 6, 2022 by internationalism

[Dart12]

AFter doing homework and trying to work with the agents and companies...it feels like one huge farce.

Looking to exclude you for anything.  One guy just was denied coverage for something because he had spider veins which they said is a pre existing condition so it wipes out all the other coverage.

I thought Aetna was international.  Now I read above that it is not.

PCH excludes almost all aging diseases coverage.

PCH denies you coverage if you get hurt from exercising (weight lifting).

on and on and on.

April will deny you if you attended any doctor for just going in for a cold in the past 2 years when you sign up.

It's just disgusting imo.

[Sheryl]

7 hours ago, Dart12 said:

AFter doing homework and trying to work with the agents and companies...it feels like one huge farce.

Looking to exclude you for anything.  One guy just was denied coverage for something because he had spider veins which they said is a pre existing condition so it wipes out all the other coverage.

I thought Aetna was international.  Now I read above that it is not.

PCH excludes almost all aging diseases coverage.

PCH denies you coverage if you get hurt from exercising (weight lifting).

on and on and on.

April will deny you if you attended any doctor for just going in for a cold in the past 2 years when you sign up.

It's just disgusting imo.

That must be April Thailand. And I think an exaggeration. They will not exclude anyone gor a simple cold.

 

April International will certainly not do this.

 

Stop looking at Thai issued policies and look at international expat policies. 

[gk10012001]

On 8/1/2022 at 6:54 AM, jerrymahoney said:

The standard Part B premium amount in 2022 is $170.10

 

https://www.medicare.gov/your-medicare-costs/part-b-costs

livin

If you don't take Part B, and are willing to put up with a possible Part B enrollment penalty, or have a waiver for such penalty, you have $2040 per year to put toward health insurance in Thailand.

I won't qualify for any type of waiver.  At the moment, will just cross the fingers and return to USA if something happens.  Medicare site keeps saying some or all emergency treatments can or will be reimbursed if the foreign hospital is closer than a USA hospital, and one maintains living in the USA, or something like that.  The part about living in the USA is kind of mis leading or definitely ambiguous.  I will not be making Thailand my permanent residence, but will be spending a lot of time there.    So if anybody has any experience getting emergency treatment in Thailand and then successfully getting reimbursed by USA Medicare, please post.

 

Thanks

[mania]

3 hours ago, gk10012001 said:

 At the moment, will just cross the fingers and return to USA if something happens.  Medicare site keeps saying some or all emergency treatments can or will be reimbursed if the foreign hospital is closer than a USA hospital, and one maintains living in the USA, or something like that.  The part about living in the USA is kind of mis leading or definitely ambiguous.  I will not be making Thailand my permanent residence, but will be spending a lot of time there.    So if anybody has any experience getting emergency treatment in Thailand and then successfully getting reimbursed by USA Medicare, please post.

 

Thanks

I don't see the Medicare statement as ambiguous...If you live in the USA you file yearly tax returns stating so even if you have no income

Living in the USA is quite clear on those tax returns as it qualifies you for certain deductions etc etc

 

That aside most also have other things/proof that clearly shows they live the majority of the year in what ever place they live

 

As for trying to ride that "reimbursed if the foreign hospital is closer than a USA hospital" good luck finding anyone who has done so.

https://www.medicare.gov/coverage/travel-outside-the-u.s.

 

 

If you really claim to live in the USA & "visit" Thailand it will be on you to purchase travel insurance either thru Medicare/Medigap (A 50k policy) or a private company

 

Private is quite affordable...I usually stay 3 months a year at our Thai home & my 100K USD coverage costs me $201

That is 100K USD with a $500 deductible thru IMG Patriot International

 

Good Luck

Edited August 9, 2022 by mania

[Dart12]

15 hours ago, Sheryl said:

That must be April Thailand. And I think an exaggeration. They will not exclude anyone gor a simple cold.

 

April International will certainly not do this.

 

Stop looking at Thai issued policies and look at international expat policies. 

Yes. an exageration. But not by that far.  They go two years back in their exclusions, and anything seeming related they say they will exclude. 

I'm not happy about what I read either.

I'm only looking at the ones that people recommend here, and in facebook, and also these are the top 3 that a Broker wanted me to pick from.  (Aetna, April, and PCH).

Trying to do my homework on this.  More I learn, the more I am alarmed and disheartened by the industry.

Can you recommend an international one?  

Edited August 9, 2022 by Dart12

[internationalism]

april is also international. Even more expensive, that thai based.

Wait 2 years from the last hospitalisation.

Or try many other insurers in the meantime.

There is inevitable, that at some stage, many will be forced to self-insure

 

[Sheryl]

8 hours ago, Dart12 said:

Yes. an exageration. But not by that far.  They go two years back in their exclusions, and anything seeming related they say they will exclude. 

I'm not happy about what I read either.

I'm only looking at the ones that people recommend here, and in facebook, and also these are the top 3 that a Broker wanted me to pick from.  (Aetna, April, and PCH).

Trying to do my homework on this.  More I learn, the more I am alarmed and disheartened by the industry.

Can you recommend an international one?  

I really doubt any insurer is going to exclude anything related to anything you ever saw a doctor got in past 2 years. Have you actually applied and been told of such an exclusion?  Can you post a picture of the form that is saying this? Are you sure each insurer says this or are you thinking of one which insures on moratorium basis and does not do full medical underwriting? 

 

What they are looking for are chronic conditions or events that put you at above higher risk. 

 

Personally I have April Global (not April Thailand), but there are many others especially if you are under 60. Including:

 

William Russell

Allianz International

Cigna Global

BUPA Global

AxA Global (do not confuse with AXA Thailand)

AETNA Globsl

AiA

IMG

 

I suggedt You go back to your broker and clearly tell them you do not want a policy from a Thai company and ask for a listing of  interntionally issued expat policies. Aldo specify no moratorium period, you want a policy that does  full medical underwriting. 

 

It is most unusual for a broker to provide only 3 options.   Did you specify a low premium range or other factors that might account for this?

[Dart12]

 

 

11 hours ago, Sheryl said:

I really doubt any insurer is going to exclude anything related to anything you ever saw a doctor got in past 2 years. Have you actually applied and been told of such an exclusion?  Can you post a picture of the form that is saying this? Are you sure each insurer says this or are you thinking of one which insures on moratorium basis and does not do full medical underwriting? 

 

What they are looking for are chronic conditions or events that put you at above higher risk. 

 

Personally I have April Global (not April Thailand), but there are many others especially if you are under 60. Including:

 

William Russell

Allianz International

Cigna Global

BUPA Global

AxA Global (do not confuse with AXA Thailand)

AETNA Globsl

AiA

IMG

 

I suggedt You go back to your broker and clearly tell them you do not want a policy from a Thai company and ask for a listing of  interntionally issued expat policies. Aldo specify no moratorium period, you want a policy that does  full medical underwriting. 

 

It is most unusual for a broker to provide only 3 options.   Did you specify a low premium range or other factors that might account for this?

This is straight out of Aprils Exclusions:

2. Any pre-existing or related medical condition which occurred or was treated within a 24-month period prior to your effective date or has one of the following characteristics will be excluded from cover:

 

Was foreseeable

Clearly presented itself

You have had signs/symptoms or you were already aware of the condition

You have received treatment for or sought medical advice on the condition or a related condition (including medical check-ups)

To the best of your knowledge you were aware you had

Requires monitoring according to medical advice or opinion

 

2.1 Any pre-existing medical condition or related medical condition may be covered after you have had 24 months’ continuous cover under the plan and within that time you have not experienced signs or symptoms;

asked for advice (including medical checkups);

or required or received treatment, medication, monitoring, or a special diet.

 

2.2 If within a 24-month period following your effective date, in relation to a pre-existing condition you have experienced signs or symptoms; asked for advice (including medical checkups); or needed or received treatment, medication, monitoring or a special diet; then you will have to wait until you have completed a continuous 24-month period when none of these apply to you. Such pre-existing medical conditions or related medical conditions may then be covered

**As you see, they even say if you asked for advice, lol, you get denied.
***The way its' all worded is so ambiguous in the insurers's favor that it lends to the nature that they say that a past incident could clearly be associated with whatever you go in for now.

 

------

Thank you for sharing the info that these companies have Global and just Thai.  I would have assumed they were one in the same. ie Aetna and Aetna Global.

I also thought Bupa was now Aetna?  And have also seen that Aetna and Allianz have merged.  Not sure if they still doing separate policy offers though.
-----
I did not express any premium range at all.  Only what was a quote for someone my age and nationality for both 100% in and outpatient coverage.

They only sent me brochures after that, for the most part.

A second follow up, I did mention I have an offer in waiting from PCH for that full coverage for 61,000 year...but in waiting for an extra long period for the agent to get that official offer to me (over 10 days) I started talking to people who had hidden limits within limits issued on payouts...

and another who was going to switch to PCH change his mind when Aetna showed him that PCH excluded over 17 additional (kind of common) diseases that Aetna covered.

Again. Thank you on even more wisdom in telling me I can ask for no moritorium with full medical underwriting.

Would you be so kind as to share what the medical check up like that fully entails?

I'm now extremely

glad the agent was not on the ball when I turned in my application.  If he would have had it back to me in 48 hours as promised I would have paid in full already.

Thank you for all the valuable education and wisdom you are imparting here Sheryl.

[Dart12]

Refresh me on this, people.  I know I read reasons awhile back:

Why do we want to avoid the Thai companies for insurance? and only seek out International/western companies for policies?
-What is the big knock(s) on using Thai insurance?  or the big benefit of using western over thai?  if that is a nicer way to put it.
-Or is there any difference at all really? (they are all thieves lol)

[Dart12]

As my question above, I see western insurance companies seem to be the preferred choice long term...so I'm now awaiting more quotes from other western companies too.

I WAS set to go with Pacific Cross Health and agent said it would be 48 hour to OFfer, but after turning in my app, their was a Thai holiday then agent was sick and it was over 10 days.

During that time, I started coming across threads like this.  Now, even if I go with them, I'm going to follow @Sheryl advise and get my full underwriting done instead of their moritorium offer where they don't check you at all before giving you insurance but with a 30 day wait period.

It appears they have the best 100% coverage for BOTH in and outpatient with ZERO  deductible at 61k year for me. 

However...does anyone have positive things to say about them or horror stories so I can make a better judgement.   

[Sheryl]

Outpatient cover is almost never worth having in Thailand and greatly increases premiums. It is probably because you asked for outpatient that the broker provided just these 3 options, all of which offer low level OPD. (Still nto worth it for how much it increases premium).

 

There is a huge difference between Thai and Western insurers due mainly to the much weaker regulatory environment in Thailand. Thai insurers are allowed to raise rates on an individual basis (on top of age related increases) based on claims. Which to my mind essentially subverts the whole point of insurance.

 

What you quote from April (1) I suspect is April Thailand not April Global  (2) appears to be moratorium policy not full medical underwriting. It is also not saying that anything you saw a doctor for would be considered a pre-existing condition. 

[spidermike007]

By self insuring. I left them behind a long time ago. Got sick of 20% annual premium hikes without a single claim. It is a mafia. Have saved millions of baht ever since. 

[jerrymahoney]

On 8/11/2022 at 8:39 AM, spidermike007 said:

By self insuring. I left them behind a long time ago. Got sick of 20% annual premium hikes without a single claim. It is a mafia. Have saved millions of baht ever since

So you are 56 years old now and saved millions (i.e. plural) of baht as a self-insured. Even at 2 million baht saved that's about $US 50-60,000 saved  with premiums starting in your age early 40's.

 

But your arithmetic may differ.

Edited August 12, 2022 by jerrymahoney

[3NUMBAS]

when you reach 70s you can expect your health to go into freefall ,everything goes wrong,,  so plenty insurance is required

[connda]

On 7/26/2022 at 5:50 PM, DUS said:

I am 53 years old and have health coverage with CIGNA International.

Wait until you are over 70.  ????  75?  80? 

[jerrymahoney]

Self-insurance is a good deal. Until it isn't.

[gk10012001]

On 8/8/2022 at 9:59 PM, mania said:

I don't see the Medicare statement as ambiguous...If you live in the USA you file yearly tax returns stating so even if you have no income

Living in the USA is quite clear on those tax returns as it qualifies you for certain deductions etc etc

 

That aside most also have other things/proof that clearly shows they live the majority of the year in what ever place they live

 

As for trying to ride that "reimbursed if the foreign hospital is closer than a USA hospital" good luck finding anyone who has done so.

https://www.medicare.gov/coverage/travel-outside-the-u.s.

 

 

If you really claim to live in the USA & "visit" Thailand it will be on you to purchase travel insurance either thru Medicare/Medigap (A 50k policy) or a private company

 

Private is quite affordable...I usually stay 3 months a year at our Thai home & my 100K USD coverage costs me $201

That is 100K USD with a $500 deductible thru IMG Patriot International

 

Good Luck

actually, it turns out that many if not most advantage plans, you get to supplement medicare and get things like D coverage for drugs and a few other things, they cover emergency treatment overseas.  I have medicare A and B, and then got the AARP advantage plan which covers "D" drugs and adds a few other things.  No additional cost.  I had a nice chat with them on the phone, and also read the plan details.  quite good actually.  They may or may not deal directly with the Thai hospital.  If they don't then you file the reimbursement claim.  These advantage plans end up being the processing agents for most medicare claims and usage of any sort.  All that Medicare does is bill you and you pay medicare, but the advantage plans administer all your medicare stuff.

[KannikaP]

On 7/28/2022 at 9:42 AM, mania said:

Man I'm sorry to hear that DUS !

Especially since your using a international provider too!

Not to mention your actually still quite young & like you say should this continue I can only imagine what

it will be when your 65+

 

You might want to try April MH Int Last I checked with

Wim

 

Cell Phone 0971890190

 

AA Insurance Brokers Co., Ltd.   Their prices were better than what you quote

A broker cannot say what the premiums with a particular company are going to be. They can only discount part of what THEY would get out of a deal.

[Sheryl]

2 hours ago, KannikaP said:

A broker cannot say what the premiums with a particular company are going to be. They can only discount part of what THEY would get out of a deal.

A broker can certainly tell you what the premiums currently are at different ages and also what the inflationary increases have historically been.   

 

Of course in the case of Thai companies they can raise your premium up to an additional 25% per year on top of age related increases and across the board inflationary increases if you had a claim in the prior year. Which means you coild end up with a vastly higher premium than others the same age.  A good reason to avoid them.