Denied by Cigna—anyone have recommendations for alternatives?

[PadPrikKhing]

I'm surprised and frustrated by having just been denied by Cigna for an expat medical policy after being told it was the best company to go with. Is there another company that is perhaps less strict that will also be be trustworthy when/if it comes down to making a claim?

 

It's not that my age is super advanced; I'm 60. I guess it was a previous bout with a form of cancer that did it, even though that was five years ago and was dealt with back then very successfully with no subsequent problems. It was so easy to deal with, in fact, that it was outpatient surgery and I was out the same day, no chemo or anything like that. It appeared they were about to say yes, and then the sales rep said that the underwriters had requested a couple of additional medical records and then when they got those, they denied me.

 

The timing is getting close here, as I already have bought my air ticket for early October and have already shipped all my stuff there. I would appreciate any promising recommendations any of you might have as I'm getting pretty nervous about how near to my relocation date it's getting. Thanks in advance.

Edited September 19, 2022 by PadPrikKhing

[scubascuba3]

April International (France), can get via AA insure, brokers in Pattaya and Hua Hin, just ensure they don't give you the April Thailand policy (thai regs)

Edited September 19, 2022 by scubascuba3

[PadPrikKhing]

4 hours ago, scubascuba3 said:

April International (France), can get via AA insure, brokers in Pattaya and Hua Hin, just ensure they don't give you the April Thailand policy (thai regs)

Thanks! When I look them (April) up on trustpilot.com—for whatever this is worth—they seem to have mostly good reviews.

 

By mentioning the brokers in HH and Pattaya, are you saying that it can be obtained after I'm already in the country as an option to obtaining it before arrival? I've noticed that some insurers say that you can only get their expat insurance before you arrive in the country they'd be insuring you in.

[scubascuba3]

1 hour ago, PadPrikKhing said:

Thanks! When I look them (April) up on trustpilot.com—for whatever this is worth—they seem to have mostly good reviews.

 

By mentioning the brokers in HH and Pattaya, are you saying that it can be obtained after I'm already in the country as an option to obtaining it before arrival? I've noticed that some insurers say that you can only get their expat insurance before you arrive in the country they'd be insuring you in.

Yes can definitely buy when you get here, many people do, in fact many people wait weeks, months, years. You could kick off with travel insurance initially, bought before entry, usually much cheaper than full blown health insurance, obviously cover is different but good for emergencies

[internationalism]

Always go with brokers, not directly with insurer. 
Give them all the details and they will select for you several best plans to chose. 
You can correspond with several different brokers at the same time, even from the same company. All might have different sets of companies their work with and different experience in dealing with claims from them. 
Each company deals different with pre-existing and with timing from when they were treated. 
Some will refuse. Some will exclude or put premium on that conditions. On that case you can take a separate cancer policy from that or some other insurer. 
I would think that taking cancer only policy before applying for health insurance will give you a better deal from health insurance. But ask brokers about it. 
As you dont need any insurance for entry thailand so take your time. 
Another consideration you might take is whether your insurer has direct payment with hospital closest to you or your chosen hospital that you trust.   Dont limit yourself to only private hospital, do also look for a good governmental one

Edited September 20, 2022 by internationalism

[Sheryl]

The cancer was definitely the problem.

 

You can try April (Global), their medical review is quite comprehensive and possible they would offer to insure with a cancer exemption. 

 

I very, very much doubt any insurer will offer yo ua policy with no exclusion. Because having had cancer once, you are at above average risk for future cancers (and not just the kind you had).

 

Yiou can get policy through broker now, no need to await arrival - it can all be done by email.  My broker Is Jenny at AA  <[email protected]>

 

Tell her upfront about the cancer and that Cigna rejected you because of it. Also make clear you want an internationally issued policy not a policy from a Thai company (in any case, no Thai insurer will accept you, they are worse than international insurers in that regard).

[PadPrikKhing]

Thank you Sheryl—that is exactly what I'm doing at the moment. As of yesterday I'm corresponding with Jenny at AA Insure about getting April insurance. I only just now read your post, but those are exactly the things I'm doing (though I didn't happen to tell her about Cigna's denial). I wrote her an email yesterday that candidly detailed any/every medical condition I've ever had, and made it very, very clear that it would be fine if they wanted to write exclusions for the things they're concerned about. I told her that what I want the insurance for is any serious  things that might come out of the blue and have nothing to do with my past history. I'm going for a policy that will cover inpatient things only, no outpatient.

 

She sent me the April application form yesterday and medical questionnaire, but I kind of got stopped right away when I noticed that on the signature page the application form said "We cannot accept applications signed in the United States" which confuses me since she instructed me to fill it out and send it. I'll be asking her by LINE tonight (her morning) about this contradiction.

 

My sense of what pushed Cigna to deny me is not so much the cancer thing alone but the cancer history combined with a few other things that are mentioned on a CT scan report from last year that they asked for. It's a report that I had not even seen myself until I requested it to send to them, and unfortunately it noted a couple of other things that I was totally unaware of until I saw it. One of them was that the doctor who interpreted the image wrote "LIVER: liver steatosis" which was total news to me, and unfortunately I saw it for the first time only after I had responded to the Cigna rep during the medical questionnaire phone interiew that I had no known liver problems or symptoms. That was the truth, as I had not seen that CT scan report at the time of the interview, and have no liver symptoms, but it might have looked to them like I had answered untruthfully initially. I fully explained, but it was too late. What makes it worse is that I have it on pretty good authority from a doctor friend of mine that a low level of liver steatosis (aka "fatty liver disease") in someone like me who doesn't drink alcohol is not even necessarily a medically significant thing. Another was a finding of diverticulosis, which again I was totally unaware of until I saw this CT scan report. I would bet that millions of people have uneventful diverticulosis that never develops into anything and causes no symptoms, as in my case.

 

So, my hopes rest with Jenny and April International at the moment...

[PadPrikKhing]

22 hours ago, internationalism said:

Always go with brokers, not directly with insurer. [snip]

Thanks for this reply

[jerrymahoney]

On 9/21/2022 at 8:55 AM, PadPrikKhing said:

I only just now read your post, but those are exactly the things I'm doing (though I didn't happen to tell her about Cigna's denial).

From April Int'l (Hong Kong) application form:

3. INSURANCE DETAILS

Have you or any person to be insured ever had a policy or application for life, sickness, accident disability, critical illness or medical insurance refused or cancelled, or had any special terms imposed?

 

https://asia.april-international.com/sites/asia/files/imce/public/product-documents/MyHEALTH-individual-FMU-application-form-hong-kong.pdf

[jerrymahoney]

Just now saw Ms. Sheryl's post saying to definitely tell Jenny at AA of the CIGNA refusal.

[PadPrikKhing]

Jerrymahoney: I just triple-checked it, and that question absolutely does not appear on the April application form that Jenny provided to me. So the question of whether I should say anything about it is a delicate one because usually in legal and insurance matters, if one is smart one only reveals the things that they are legally bound to reveal. I'd feel pretty stupid if I revealed it despite that the application and company itself didn't ask the question, and then got denied because of that info. If Jenny put the question directly to me, I'd have to answer it, but volunteering that when no one asked me seems like a bad idea.

Edited September 24, 2022 by PadPrikKhing

[jerrymahoney]

That is a standard request. Just make sure you have the right form as April Int'l has different forms for different offering countries. If the form you use does not request it, then don't offer it.

 

However, the UK April Int'l form does say:

 

 I/we declare that the information disclosed in this application form, is to the best
of my/our knowledge and belief both accurate and complete.

 

https://uk.april-international.com/sites/united_kingdom/files/2022-04/Long-Term International Health Plan - Moratorium Application Form.pdf

 

Edited September 24, 2022 by jerrymahoney

[KhunLA]

... "that will also be be trustworthy"

 

good luck with that ????

[Sheryl]

7 hours ago, jerrymahoney said:

That is a standard request. Just make sure you have the right form as April Int'l has different forms for different offering countries. If the form you use does not request it, then don't offer it.

 

However, the UK April Int'l form does say:

 

 I/we declare that the information disclosed in this application form, is to the best
of my/our knowledge and belief both accurate and complete.

 

https://uk.april-international.com/sites/united_kingdom/files/2022-04/Long-Term International Health Plan - Moratorium Application Form.pdf

 

On the insurance form, just answer the questions asked, truthfully.

 

Not all insurers ask about prior denials.

 

However I advised you to tell the broker so that she would be alerted to your situation and better able to advise you - possibly she might know of a better insurer to try, or know if there is any chanceApril would  accept someonewho had cancer, etc etc.

 

Broker is not going to separately share any details with the insurer

[PadPrikKhing]

On 9/24/2022 at 3:27 PM, jerrymahoney said:

Just make sure you have the right form as April Int'l has different forms for different offering countries.

Hmm, I would think that being given the correct application form is fully the responsibility of the broker. I should not have to check her work. 

 

Quote

If the form you use does not request it, then don't offer it.

I agree. That's what I'm saying too.

[PadPrikKhing]

17 hours ago, Sheryl said:

or know if there is any chanceApril would  accept someonewho had cancer, etc etc.

Regarding this, I did disclose the prior cancer in a detailed email, so she's well aware of that and the other history.

 

At the moment, things are temporarily held up because when I looked over the application (before filling it out), I saw that on the signature page it said in parentheses "We cannot accept applications signed in the United States." I immediately brought this to Jenny's attention, and she seemed surprised, saying she had never seen that before. She is currently checking with the company and will get back to me about it. I'll be contacting her tonight (today, for her) to see if there's any clarification.

[jerrymahoney]

So based on the above info on US restriction, maybe this is the application form you have?

 

https://fr.april-international.com/sites/france/files/2021-12/MyHealth International_Application form_2022_0.pdf

[SammyJ]

On 9/26/2022 at 6:18 AM, PadPrikKhing said:

Hmm, I would think that being given the correct application form is fully the responsibility of the broker. I should not have to check her work. 

 

I agree. That's what I'm saying too.

Having worked extensively in insurance in the US, and it's not all that different here, one sometimes thinks they are being "clever" by not disclosing something--even if not directly asked, and then later, find that a major claim is rejected because at that time the insurance carrier discovers something, in their view, that wasn't truthfully disclosed--remember, insurance carriers (Im not talking brokers, but the actual carriers) are not your "friends", they are in a for-profit business, and if there is any valid reason to decline payment, they likely will.  So, to think you are covered for something, then to find out in your moment of need that you are not actually covered for that something could be financial disaster.

[nigelforbes]

I'm in the process of changing from CIGNA to AIA, the latter being an insurance company rather than a health insurance company. I think the AIA policies are far superior  and they have been highly professional to work with during the application process. AIA seems to put more effort and scrutiny into the application process and has paid for a health exam before deciding whether to accept me or not. I prefer it that way, it means there are fewer surprises later if you try to claim. It means I have to pay a life insurance premium every year in addition to the health insurance rider, the total cost is still less than the CIGNA premium. The only downside is that there aren't a lot of good English speakers to deal with at AIA, fortunately I found one person who has lived in the US for many years and has been super helpful.

[Sheryl]

6 hours ago, nigelforbes said:

I'm in the process of changing from CIGNA to AIA, the latter being an insurance company rather than a health insurance company. I think the AIA policies are far superior  and they have been highly professional to work with during the application process. AIA seems to put more effort and scrutiny into the application process and has paid for a health exam before deciding whether to accept me or not. I prefer it that way, it means there are fewer surprises later if you try to claim. It means I have to pay a life insurance premium every year in addition to the health insurance rider, the total cost is still less than the CIGNA premium. The only downside is that there aren't a lot of good English speakers to deal with at AIA, fortunately I found one person who has lived in the US for many years and has been super helpful.

Up to what age do they accept new applications? And do they guarantee lifetime renewal?

 

Note that this is a Thai company and thus under Thai insurance regs. So they can make individual upward adjustments to your premiums (on top of age related increases) based on claims.

[nigelforbes]

44 minutes ago, Sheryl said:

Up to what age do they accept new applications? And do they guarantee lifetime renewal?

 

Note that this is a Thai company and thus under Thai insurance regs. So they can make individual upward adjustments to your premiums (on top of age related increases) based on claims.

You're actually buying a life insurance policy with a health insurance rider so it's not conventional health insurance as we typically know it. The life insurance policy runs until age 99 and the premium for that is based on the age of the applicant when the policy was first taken out. The cost of the rider is also age related and set out in a published table that applies to everyone, up to age 99 year so yes, renewal is assured. Also, there is no deductible and no co-pay with AIA, unlike CIGNA where both can be quite onerous, in my case, up to 500k baht per year (360k deductible and 140k co-pay).

Edited September 27, 2022 by nigelforbes

[jerrymahoney]

Muang Thai Life also has a similar plan available as a rider to a life insurance policy -- but first you have to qualify for and get the life insurance policy.

https://www.muangthai.co.th/en/health-insurance/elite-health-plus

Edited September 27, 2022 by jerrymahoney

[SammyJ]

17 hours ago, Sheryl said:

Up to what age do they accept new applications? And do they guarantee lifetime renewal?

 

Note that this is a Thai company and thus under Thai insurance regs. So they can make individual upward adjustments to your premiums (on top of age related increases) based on claims.

Also,  from talking with some fellow expats who have looked into these kinds of plans, and an expat i know who actually has one, please review the plan benefits and limitations.  You indicate the premium is cheaper than CIGNA, but that doesn't mean a lot if the plan benefits are also far less.  The "devil is in the details" as the saying goes, and I have found far too many people here and previously in the US, really have no idea what exactly their plan covers--what are its co-pays, limits, etc--so when time comes that they need to make a claim, they can just recall years later that "Well, the agent told me......" and then to be told that one's claim is rejected.  The details are all written in the policy which you should review carefully.  Similar plans i have seen from friends have pretty low limits on most areas of coverage, leaving you with a fair amount of "out of pocket expense:, and often require the individual to pay first and then seek reimbursement.  Additionally, it is my understanding that such plans, as they are actually just a "rider" as you indicated, not a full blown health insurance policy, will still exclude for pre-existing conditions.

And as was mentioned in Sheryl's post--is automatic renewal guaranteed regardless of what claims you may make against the health insurance rider?  What happens if then, they deny your renewal, or price it such that you cannot afford it, and then, at a more advanced age, and with more pre-existing conditions, you are left with no coverage at all, and unable to purchase any new coverage?

 

As has been written about by others, far too many assume health insurance in Thailand must be easy to obtain and easy to afford--compared to US rates, it is much less expensive, but most, at least those coming from the US having an employer pay for health coverage, or other countries, UK, etc, with a NHS, they find themselves in a whole different health insurance environment here--you must do your hw and make sure you can qualify for insurance or can afford to self insure.

[jerrymahoney]

One thing about these rider-based health insurance plans:

 

Since you must already have qualified for a life insurance policy, which may involve an extensive health underwriting evaluation or even medical exam, the insurer already knows who you are and what is your medical state-of affairs or at least was at the time of life insurance application.

 

Also, it seems there are few if any Thai-based life insurance plans that allow application past the age of 70.

[nigelforbes]

8 minutes ago, jerrymahoney said:

One thing about these rider-based health insurance plans:

 

Since you must already have qualified for a life insurance policy, which may involve an extensive health underwriting evaluation or even medical exam, the insurer already knows who you are and what is your medical state-of affairs or at least was at the time of life insurance application.

 

Also, it seems there are few if any Thai-based life insurance plans that allow application past the age of 70.

I would much rather have the insurer know the true state of my health before I take out the policy than when I go to claim, only for the claim to be denied because I either exaggerated, lied or forgot about things. It's a false economy to do otherwise. And I had forgotten about some things, when you use your local hospital as a family doctor you tend to rack up the visits pretty quickly, their report of visits ran to five pages (20 years) so be careful.

 

I have been through the (insurance company paid) medical and I have declared everything.  I'm expecting to hear in the next few days what the underwriters counter offer will be and will compare that to what I have at present and will post what they have to say. BTW AIA will accept applications from people over age 70 years.

[jerrymahoney]

11 minutes ago, nigelforbes said:

BTW AIA will accept applications from people over age 70 years.

So this?

 

Summary of Insurance Coverage
AIA H&S (new standard) rider 
Issue age 11 - 75 years old (renewable until 84 years old)

https://www.aia.co.th/content/dam/th/th/docs/our-products/english-brochure/AIA_HS_new_standard_EN_06102021.pdf

[nigelforbes]

1 hour ago, jerrymahoney said:

So this?

 

Summary of Insurance Coverage
AIA H&S (new standard) rider 
Issue age 11 - 75 years old (renewable until 84 years old)

https://www.aia.co.th/content/dam/th/th/docs/our-products/english-brochure/AIA_HS_new_standard_EN_06102021.pdf

More or less, I know it as the Health Happy product. It's 5 mill. coverage which doubles in the event of major illness.

[jerrymahoney]

Just to note that I have a MuangThai Life insurance policy but without the 'Elite' health insurance rider but I will presume I can add it if need be.

[nigelforbes]

1 hour ago, jerrymahoney said:

So this?

 

Summary of Insurance Coverage
AIA H&S (new standard) rider 
Issue age 11 - 75 years old (renewable until 84 years old)

https://www.aia.co.th/content/dam/th/th/docs/our-products/english-brochure/AIA_HS_new_standard_EN_06102021.pdf

I'll post a separate link to the brochure

 

 

 

Edited September 28, 2022 by nigelforbes

[KannikaP]

25 minutes ago, jerrymahoney said:

Just to note that I have a MuangThai Life insurance policy but without the 'Elite' health insurance rider but I will presume I can add it if need be.

I thought you were with WRLife. You are not pushing them to the OP.

Edited September 28, 2022 by KannikaP