Denied by Cigna—anyone have recommendations for alternatives?

[4MyEgo]

8 minutes ago, nigelforbes said:

Using the insurance to pay for the big ticket items and self insuring for the lesser items, is the only way left open.

When the policy I was on climbed to ridiculous, I started self insuring, if your in a position to put 10k of your currency away per annum as I do, it will eventually build up, depending on age and financial position, that said, I am in a good position having funds aside for a major event, although would like to avoid it if possible.

 

Insuring what you can of yourself is good, just want to make sure they honour the claims and not try to blame it on causation, i.e. your pre-existing condition contributed to it, therefore we decline your claim.

 

Being insured only means your insured if they honour your claims, that's a 50/50 at best, however it makes one comfortable to know they are covered, so to speak. 

[nigelforbes]

2 minutes ago, 4MyEgo said:

When the policy I was on climbed to ridiculous, I started self insuring, if your in a position to put 10k of your currency away per annum as I do, it will eventually build up, depending on age and financial position, that said, I am in a good position having funds aside for a major event, although would like to avoid it if possible.

 

Insuring what you can of yourself is good, just want to make sure they honour the claims and not try to blame it on causation, i.e. your pre-existing condition contributed to it, therefore we decline your claim.

 

Being insured only means your insured if they honour your claims, that's a 50/50 at best, however it makes one comfortable to know they are covered, so to speak. 

That's sensible, I'm fortunate that I have cash and other assets I can draw on. I like to work on a worst case basis which means taking a 5 million baht hit after a major medical event. I could just about manage that, afterwards I would only have income and real estate assets in Thailand and the UK so I would be massively exposed and my wife's future financial security would be uncertain. I like to think that the health insurance I have will cover at least some of that 5 mill., which is why I'm happy to undergo company medicals and to disclose everything up front.

[scubascuba3]

33 minutes ago, nigelforbes said:

Speaking as someone who has pre-existing conditions, my objectives now are to try to insure as much of my body as possible, at the cheapest price. If that means using a Thai company who will increase my premium after I claim, that's the price I will have to pay. I will just need to make sure that I only claim when the risk reward balance is in my favor because after I claim I may well have to cancel the policy because the premiums are so high.  Using the insurance to pay for the big ticket items and self insuring for the lesser items, is the only way left open.

If you don't claim it can be a pre-existing condition anyway when they find out about it

[jerrymahoney]

19 minutes ago, 4MyEgo said:

Being insured only means your insured if they honour your claims, that's a 50/50 at best,

Insurance company claim decision maker:

[nigelforbes]

2 minutes ago, scubascuba3 said:

If you don't claim it can be a pre-existing condition anyway when they find out about it

Umm, I don't think so, there is a baseline whereby everything before is pre-existing, everything after isn't.

 

One of the problems I now see is that people such as me who have tried to take care of their health are penalized for having tests and checkups. You have a health exam which detects a slightly blocked artery which is then stented....life saved, job done but from that point onwards you are labelled as having CAD and are uninsurable. Ditto the endoscopy/gastroscopy. A ten year check to make sure your colon is cancer free etc and they detect polyps, a typical finding which is dealt with easily at the time. But thereafter you are suspected of being at risk of colon cancer and must wait 5 years before that part of your body can be insured. The list of these things goes on and on. In my next life I'm going to use fake ID and a remote hospital for all my medical checks, seriously. 

[SammyJ]

15 hours ago, jerrymahoney said:

Well that's what Thai-based companies are allowed to do as Ms. Sheryl often notes on these pages.

Totally understand, it is a common practice in insurance companies--so i do not mention it as a surprise to me, i mention as some may think they can 100% rely on what an insurance company says they might charge for future years.

[SammyJ]

15 hours ago, nigelforbes said:

I'm not convinced that is true. It certainly is true of health insurance but life insurance, even if the health policy is a rider it is still a  life insurance policy and not a health insurance policy....unsure.

well, that quote i copied comes right from the AIA brochure--as i stated, the "devil is in the details"--they are protecting themselves so that might raise premiums beyond what originally predicted due to one's utilization (a favorite insurance industry word), or another favorite--sorry, they say, there has been an increase/inflation in overall medical costs--so, they see that they might be paying out more, per type of surgery or room stay, etc than before--they predict, the hospitals will charge them more, so they, in turn, charge their customers more.

[Sheryl]

50 minutes ago, nigelforbes said:

Speaking as someone who has pre-existing conditions, my objectives now are to try to insure as much of my body as possible, at the cheapest price. If that means using a Thai company who will increase my premium after I claim, that's the price I will have to pay. I will just need to make sure that I only claim when the risk reward balance is in my favor because after I claim I may well have to cancel the policy because the premiums are so high.  Using the insurance to pay for the big ticket items and self insuring for the lesser items, is the only way left open.

Thai companies are more ikely to refuse to insure people with pre-existing conditions than international ones (though the latter will likely apply exclusions). If you can get a Thai policy you can get an international one. If under 65 there are many more options than just Cigna.

 

You should work with a good broker.

 

Worst case scenario, if no one will insure you, get the best accident insurance you can and put aside as much cash as you can as self insurance -- and plan on using government hospitals for anything major.

[SammyJ]

15 hours ago, jerrymahoney said:

 

 

When I had a BUPA Pre-Aetna policy years back and had knee surgery, they increased my rate for a few years and then (as I remember) it came back to the published premium level so I don't know that such a claim is necessarily so ominous.

 

Not meant to "ominous", meant to be transparent by the insurance carrier that this is what can happen--and, it is all so individual to person, company, etc--what happened to you, may never happen to another, or the rate might go up and not go down--that's the thing, one needs to be aware that it can--many do not understand that, and when rates are raised, they complain, and then the company points to that type of language, which will certainly be included in any contract signed, and say, "See, it's right there that allows us to do that."

[Sheryl]

51 minutes ago, 4MyEgo said:

When the policy I was on climbed to ridiculous, I started self insuring, if your in a position to put 10k of your currency away per annum as I do, it will eventually build up, depending on age and financial position, that said, I am in a good position having funds aside for a major event, although would like to avoid it if possible.

 

The drawback to this is

 

1) - a major expense could occur in the first year or two , before you have accumulated enough to cover it - or in the first year or two of replenishment (see below)

 

2) - you need a way to replenish funds as they are used. Or else a plan to leave Thailand at that point and ability to do so.

 

I am not saying no one should self-insure. For some, there is no alternative; for others, the alternatives just aren't feasible (e.g. extremely high premiums for policy with far-reaching exclusions). But these 2 limitations need to be understood. Really once should start with a much larger sum than you mention and then add to that - and one still needs to figure out plan for replenishment. Your assets can be rapidly depleted.

[jerrymahoney]

For most people health insurance is not a good deal. Only a very small percent of policy holders will ever have an event where a paid claim or claims will greatly exceed the paid-in premiums.

 

It's just a matter whether you are willing to take the risk that it might be you.

[SammyJ]

3 minutes ago, Sheryl said:

Thai companies are more ikely to refuse to insure people with pre-existing conditions than international ones (though the latter will likely apply exclusions). If you can get a Thai policy you can get an international one. If under 65 there are many more options than just Cigna.

 

You should work with a good broker.

 

Worst case scenario, if no one will insure you, get the best accident insurance you can and put aside as much cash as you can as self insurance -- and plan on using government hospitals for anything major.

Yes, i agree that brokers can be helpful, and i agree, as i do now, and most of my senior expat friends do--self insure, and as you/Sheryl has advised, look for alternative hospitals that are still very proficient--in Chiang Mai  Chiang Mai Ram and Bangkok Chiang Mai, are the two leading hospitals that seem be favored by foreigners/expats, and are, depending upon dr/speciality/procedure, more expensive than most other.  But, Sriphat, McCormick, and others are also fine hospitals, with more reasonable rates, and you can often find the same doctors working there some days of each week.

I have inquired with most, not all, of the larger, reputable insurance carriers here--CIGNA, Aetna (formerly BUPA), Pacific Cross, LUMA, AXA, etc, and all excluded for pre-existing conditions and all drew the line (except CIGNA) at no new coverage age 65 and up.  If you were already with them prior to age 65, then they would still cover you but for ever increasing premiums.  CIGNA wrote that they took applications up to age 70, but several friends of mine applied, and after listing all medical conditions on the application, these conditions were not excluded, my friends were told that CIGNA underwriting had decided NOT to offer coverage at all.

My congrats to any among us more senior expats who get into our 60's or 70's and don't have something that is a "pre-existing condition", but most of us do ---and to me, anyway, if a plan for which you are paying already a very high premium doesn't even cover one's key medical concerns, what good is it--you are better off, setting money aside and self insuring--but, get a choice of some doctors, and a hospital you like, in advance--do NOT wait, until you have a serious medical crisis to make choices--if an ambulance, Thai local here, comes to get you, you can direct them to take you to what hospital you want.

[SammyJ]

18 hours ago, jerrymahoney said:

AS to above, doesn't seem to me that the AIA Happy premiums are that far out of line with those other providers:

 

This is for the health insurance "rider", correct--you still have to qualify and pay for the life insurance premiums each year as well, correct or not??  That increases an overall cost.

[Sheryl]

25 minutes ago, nigelforbes said:

 You have a health exam which detects a slightly blocked artery which is then stented....life saved, job done but from that point onwards you are labelled as having CAD and are uninsurable. Ditto the endoscopy/gastroscopy. A ten year check to make sure your colon is cancer free etc and they detect polyps, a typical finding which is dealt with easily at the time. But thereafter you are suspected of being at risk of colon cancer and must wait 5 years before that part of your body can be insured.

 

to be fair - if you had a blocked artery, you do have CAD. The stent will have unblocked the affected artery (for now) but does not change the underlying disease process that led to the blockage. You have cardiovascular disease and are at above averge risk for future cardiac events.

 

And people who have had polyps are indeed at above average risk of colon cancer.

 

These are facts. And they are why it is best to get a good insurance cover before you get older and keep it for life. Once older, one does indeed start to have these pre-existing conditions.

 

Insurance is based on statistical odds and premiums are calculated based on average risk in the overall population. Allowing people to enter the pool of insured people whose risk profile, at entry, is not average does not work unless the insurer is able to either exclude the relevant condition or apply a higher tailored  premium, and determining the latter requires fairly sophisticated actuarial computing which international insurers are more likely to be able to do than local ones.

[Sheryl]

Just now, SammyJ said:

This is for the health insurance "rider", correct--you still have to qualify and pay for the life insurance premiums each year as well, correct or not??  That increases an overall cost.

Yes, one would have to also qualify the life insurance, and the same health conditions that make it hard to get health insurance will likely be barriers to that.

[Sheryl]

4 minutes ago, SammyJ said:

 

I have inquired with most, not all, of the larger, reputable insurance carriers here--CIGNA, Aetna (formerly BUPA), Pacific Cross, LUMA, AXA, etc, and all excluded for pre-existing conditions and all drew the line (except CIGNA) at no new coverage age 65 and up.  If you were already with them prior to age 65, then they would still cover you but for ever increasing premiums.  CIGNA wrote that they took applications up to age 70, but several friends of mine applied, and after listing all medical conditions on the application, these conditions were not excluded, my friends were told that CIGNA underwriting had decided NOT to offer coverage at all.

You are referring to  Cigna Thailand, a Thai company. Cigna Global will accept applications up to age 99 or 100 (I forget which).  And are more likely to over insurance with exclusions than referuse cover altogether though it will depend on the nature of the health conditions. In addition they come under UK/EU regs nto Thai insurance regs, which is a big plus.

 

[jerrymahoney]

28 minutes ago, Sheryl said:

Yes, one would have to also qualify the life insurance, and the same health conditions that make it hard to get health insurance will likely be barriers to that.

Conversely, if you do qualify for life insurance, it will make it that much easier to get the health insurance rider.

[nigelforbes]

1 hour ago, Sheryl said:

 

to be fair - if you had a blocked artery, you do have CAD. The stent will have unblocked the affected artery (for now) but does not change the underlying disease process that led to the blockage. You have cardiovascular disease and are at above averge risk for future cardiac events.

 

And people who have had polyps are indeed at above average risk of colon cancer.

 

These are facts. And they are why it is best to get a good insurance cover before you get older and keep it for life. Once older, one does indeed start to have these pre-existing conditions.

 

Insurance is based on statistical odds and premiums are calculated based on average risk in the overall population. Allowing people to enter the pool of insured people whose risk profile, at entry, is not average does not work unless the insurer is able to either exclude the relevant condition or apply a higher tailored  premium, and determining the latter requires fairly sophisticated actuarial computing which international insurers are more likely to be able to do than local ones.

It feels like I should recieve some form of plus points for having been proactive and taking care of my body. I run 4 miles every day, my ankle brachia is 8.0, my LDL/Trig. are stellar, my EKG is normal, my A1C is 5.3 and so on. OK so I'm 72 but let's not dwell on minutae. ????

[SammyJ]

1 hour ago, Sheryl said:

You are referring to  Cigna Thailand, a Thai company. Cigna Global will accept applications up to age 99 or 100 (I forget which).  And are more likely to over insurance with exclusions than referuse cover altogether though it will depend on the nature of the health conditions. In addition they come under UK/EU regs nto Thai insurance regs, which is a big plus.

 

Accepting applications and actually offering coverage are two different things.  I also tried with CIGNA global and got the same rejections, based on pre-existing conditions--and, from their end, it seems perfectly reasonable--they are "for profit" businesses--we all know if someone is 60, 70, and certainly 80 or more, the claims are likely to be coming in and be expensive and far more payout than any premiums collected--and then the premiums are also likely to be so expensive that few could realistically afford them.  Better to put the money aside and self insure--as it goes back to paying very premiums to pay for coverage that excludes your primary health care concerns.

Can you tell me what about being under the UK/EU regs is a big plus--from the Thai regs--I see that most private insurance companies operate primarily in the same fashion--i am not familiar with UK/EU regs, but am familiar to US and Thai practices seem to be quite similar--the US companies would love to be more restrictive, but there are limitations, but not many.

There is, of course, no national health--Medicare is overall very good, but not free, as many may think it is--inpatient coverage, if one paid into it, is covered up to 80%, but outpatient care and outpatient prescription coverage must be purchased--as US medical costs are simply outrageous and outpatient dr visits and prescribed medicines are so expensive, one needs that coverage, where in Thailand, outpatient costs are much more reasonable.

[SammyJ]

1 hour ago, Sheryl said:

Yes, one would have to also qualify the life insurance, and the same health conditions that make it hard to get health insurance will likely be barriers to that.

Exactly, and that is why that additional "barrier" or cost, may make such plans not all the bargain that some may think!

[jerrymahoney]

6 minutes ago, SammyJ said:

Exactly, and that is why that additional "barrier" or cost, may make such plans not all the bargain that some may think!

That assumes you are getting the life insurance just to be able to get the health insurance rider. Some may have life insurance plans already without ever thinking about the health rider. 

[Sheryl]

59 minutes ago, SammyJ said:

Accepting applications and actually offering coverage are two different things.  I also tried with CIGNA global and got the same rejections, based on pre-existing conditions--and, from their end, it seems perfectly reasonable--they are "for profit" businesses--we all know if someone is 60, 70, and certainly 80 or more, the claims are likely to be coming in and be expensive and far more payout than any premiums collected--and then the premiums are also likely to be so expensive that few could realistically afford them.  Better to put the money aside and self insure--as it goes back to paying very premiums to pay for coverage that excludes your primary health care concerns.

Can you tell me what about being under the UK/EU regs is a big plus--from the Thai regs--I see that most private insurance companies operate primarily in the same fashion--i am not familiar with UK/EU regs, but am familiar to US and Thai practices seem to be quite similar--the US companies would love to be more restrictive, but there are limitations, but not many.

There is, of course, no national health--Medicare is overall very good, but not free, as many may think it is--inpatient coverage, if one paid into it, is covered up to 80%, but outpatient care and outpatient prescription coverage must be purchased--as US medical costs are simply outrageous and outpatient dr visits and prescribed medicines are so expensive, one needs that coverage, where in Thailand, outpatient costs are much more reasonable.

Thai practices and regs are quite different. It is a whole other experience than being insured by an international company.

 

Insurers are explicitly allowed by the Insurance Commission allowed to raise premiums on an individual basis based on claims history, on top of age and inflation hikes.  This has huge consequences and IMO undermines the whole point of being insured. This is not allowed by Western insurance regulators.

 

Thai insurers often deny claims on grounds that something was pre-existing despite having supposedly done full medical underwriting in which the client's medical history was accurately reported. Often the grounds for saying something was "pre-existing" are shaky or downright irrational, medically speaking; these determinations are made by persons with no medical background. For example, I have seen claims for cardiac problems denied because the person acknowledged on their application that they had ever experienced reflux/heartburn (who hasn't?). Claims for respiratory problems denied because the application form stated the person had "ever": had a common cold (who hasn't?) etc etc. Similar irrational links made from things they find in the medical records.  Application form health histories are poorly designed, and poorly understood/interpreted by the insurer.  There is of course some variation in how bad these sort of practices are by company, and such behavior is more likely with claims occurring in the first year or two of being insured, but there are some companies who seem to do this pretty much all the time throughout the length of the policy. And they all do it at least sometimes.

 

The above sort of thing is why one reads so many posts claiming "health insurance is a scam" or (in effect) "there is no telling if they will actually pay out on a claim."  This is all coming from people's experiences with local companies.

 

By contrast, international insurers tend to have very clear health history intake forms, identify at the time of policy issuance what, if anything, is considered pre-existing, and unless there was something omitted or wrongfully stated on the application, there are not going to be any surprises later. 

 

[In Full Agreement]

On 9/20/2022 at 1:50 AM, 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)

 

Somehow considering the general reluctance of French to speak English,  I think I'd  fear making a claim to the company in English.

 

And AFA your being denied service by Cigna  goes, I'd try my hardest to pursue exactly why I was denied a policy.

 

Knowing the reason for the denial may help you in your efforts to  secure a different  company.

 

[jerrymahoney]

I think part of the problem Ms. Sheryl references is that, in Thailand, most of the Thai citizens who have health insurance are in group policies. I know that was the case years ago with BUPA and most were related to education/school member groups.

 

Then here comes a segment of largely older expats seeking individual policies and these Thai insurers are not really well set-up for that.

[SammyJ]

28 minutes ago, Sheryl said:

Thai practices and regs are quite different. It is a whole other experience than being insured by an international company.

 

Insurers are explicitly allowed by the Insurance Commission allowed to raise premiums on an individual basis based on claims history, on top of age and inflation hikes.  This has huge consequences and IMO undermines the whole point of being insured. This is not allowed by Western insurance regulators.

 

Thai insurers often deny claims on grounds that something was pre-existing despite having supposedly done full medical underwriting in which the client's medical history was accurately reported. Often the grounds for saying something was "pre-existing" are shaky or downright irrational, medically speaking; these determinations are made by persons with no medical background. For example, I have seen claims for cardiac problems denied because the person acknowledged on their application that they had ever experienced reflux/heartburn (who hasn't?). Claims for respiratory problems denied because the application form stated the person had "ever": had a common cold (who hasn't?) etc etc. Similar irrational links made from things they find in the medical records.  Application form health histories are poorly designed, and poorly understood/interpreted by the insurer.  There is of course some variation in how bad these sort of practices are by company, and such behavior is more likely with claims occurring in the first year or two of being insured, but there are some companies who seem to do this pretty much all the time throughout the length of the policy. And they all do it at least sometimes.

 

The above sort of thing is why one reads so many posts claiming "health insurance is a scam" or (in effect) "there is no telling if they will actually pay out on a claim."  This is all coming from people's experiences with local companies.

 

By contrast, international insurers tend to have very clear health history intake forms, identify at the time of policy issuance what, if anything, is considered pre-existing, and unless there was something omitted or wrongfully stated on the application, there are not going to be any surprises later. 

 

Again, i cannot dispute what may happen per UK/EU regs--but what you describe is what happens in the US--especially with individuals seeking insurance.  In the US, is a horrible system--i am from the US and lived the system and worked it for many years on behalf of employees, so i know it well.  There is no national health--Medicare, which is not entirely free--requiring older Americans to by supplements for the 20% of inpatient coverage not provided--and, crazy, but in the US, that 20% cost can be huge to a patient---plus, one must pay additional for outpatient and prescriptions--the good thing is there is no exclusion for pre-existing conditions with Medicare, or Medicaid which is for those that simply cannot afford any private insurance and their employer, if they have one, does not provide coverage.  Employers, can often negotiate, it they have a large pool of employees, better benefits and window enrollment periods where one cannot be denied because of pre-existing conditions--but individuals are often at the mercy of the  insurance carriers.  I have actually found most Thai companies i have dealt with BETTER than the US.  But, again, the US is foolish for how it offers health care--why some politicians wanted a "medicare for all" or offer to expand medicaid, so less fortunate may also be able to have access to decent health care--but, other politicians, and for the life of me i don't understand, an expansion of health care for US citizens.  Ridiculous--it's not politics, it's basic human decency.   

[SammyJ]

1 hour ago, jerrymahoney said:

That assumes you are getting the life insurance just to be able to get the health insurance rider. Some may have life insurance plans already without ever thinking about the health rider. 

Absolutely correct--and i am not familiar with these companies' rules--do they allow adding the health insurance rider at any time, regardless of age? 

[jerrymahoney]

11 minutes ago, SammyJ said:

Absolutely correct--and i am not familiar with these companies' rules--do they allow adding the health insurance rider at any time, regardless of age? 

Elite Health Plus Rider

Long-Term Health Coverage
Insurable age is until the age of 90 with coverage period until the age of 99.

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

 

The life insurance policy I have had a max application age of 70.

Edited September 29, 2022 by jerrymahoney

[SammyJ]

15 minutes ago, jerrymahoney said:

Elite Health Plus Rider

Long-Term Health Coverage
Insurable age is until the age of 90 with coverage period until the age of 99.

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

 

The life insurance policy I have had a max application age of 70.

I would wonder in much older years, that, like CIGNA did, allow applications but then turned

it over to underwriting and they reject it outright or exclude so much that the policy is not worth having--it is just common sense for a profit company--do we really think they are going to accept individuals in their 80's and 90's when the payout risk is so far greater than any premiums paid?

[Sheryl]

1 minute ago, SammyJ said:

I would wonder in much older years, that, like CIGNA did, allow applications but then turned

it over to underwriting and they reject it outright or exclude so much that the policy is not worth having--it is just common sense for a profit company--do we really think they are going to accept individuals in their 80's and 90's when the payout risk is so far greater than any premiums paid?

I know for a fact that they do accept people of those ages, provided no serious pre-exisitng conditions. And they accept some with pre-existing conditions, but with exclusions.

 

The premiums are much higher for people that age, and this takes care of the  likelihood  of claims. Issues arise  when the individual applying is at above average risk for their age because of specific conditions.

 

And the problem of course is that few people reach such ages without having developed underlying health problems. So in practice nto many people that age can find insurance. But the age per se, is not a barrier for Cigna Global.

[Xonax]

People with existing conditions not covered by the insurance companies, should receive a mandatory discount, as they are not fully covered, which means lower risk for the insurance companies.