PSA value of 11, but I have a UTI.

[simon43]

Update: April International have requested full details of my PSA and BPH history going back 11 years!!  I'm not sure what their reasons are, but BPH is nothing to do with prostate cancer.  My PSA stayed stable for all PSA checks that I had in 2014, 2017 and 2018, but had risen when I had a check-up after returning from Laos/Myanmar.

 

I hope that they are not trying to deny coverage for my prostate cancer, on the basis that I have had BPH for several years.

 

I have sent them scans of my health check ups from these years.  At no time was any further investigations or medication advised by the doctors on seeing my PSA value.

 

Worried.....

[IvorBiggun2]

37 minutes ago, simon43 said:

April International have requested full details of my PSA and BPH history going back 11 years!!  I'm not sure what their reasons are, but BPH is nothing to do with prostate cancer.  My PSA stayed stable for all PSA checks that I had in 2014, 2017 and 2018, but had risen when I had a check-up after returning from Laos/Myanmar.

And people buy medical insurance. 

[scubascuba3]

1 hour ago, simon43 said:

Update: April International have requested full details of my PSA and BPH history going back 11 years!!  I'm not sure what their reasons are, but BPH is nothing to do with prostate cancer.  My PSA stayed stable for all PSA checks that I had in 2014, 2017 and 2018, but had risen when I had a check-up after returning from Laos/Myanmar.

 

I hope that they are not trying to deny coverage for my prostate cancer, on the basis that I have had BPH for several years.

 

I have sent them scans of my health check ups from these years.  At no time was any further investigations or medication advised by the doctors on seeing my PSA value.

 

Worried.....

haven't you only been with April a year or so? i kind of expected them to dig deeper, see what happens, must be stressful which is the last thing you want when have a health issue

[simon43]

29 minutes ago, scubascuba3 said:

haven't you only been with April a year or so? i kind of expected them to dig deeper, see what happens, must be stressful which is the last thing you want when have a health issue

I've been with them about 3 years, and then with other insurance companies before that.  Luckily, I have my health check-up documents from 2017 and 2018 which indicate a stable and lowish (for someone with BPH) PSA value, with no comment from the doctor.  I've emailed these details to April.

 

If April were to deny my claim on some baseless and false grounds, (such as BPH causes prostate cancer), then I would be well and truly f**ked....

[Sheryl]

18 hours ago, simon43 said:

 

 

If April were to deny my claim on some baseless and false grounds, (such as BPH causes prostate cancer), then I would be well and truly f**ked....

That is highly improbable.

 

Most likely they want to ascertain the medical indication for a biopsy. Which the hospital's paperwork may not have made clear

[simon43]

3 hours ago, Sheryl said:

That is highly improbable.

 

Most likely they want to ascertain the medical indication for a biopsy. Which the hospital's paperwork may not have made clear

Hmm, the MRI scan report basically says 2 growths found with a level 5 probability (the highest) that they are cancerous and that a fusion biopsy is required to confirm this.

 

Anyway, I will wait to see what April says...

[Sheryl]

1 hour ago, simon43 said:

Hmm, the MRI scan report basically says 2 growths found with a level 5 probability (the highest) that they are cancerous and that a fusion biopsy is required to confirm this.

 

Anyway, I will wait to see what April says...

The MRI report was likely not included in the form the hospital sent them. There is a specific form used for pre-authorization of hospitalizations and it is  brief, and Thai hospital completion of same tend to be very briefer and incomplete. Single word answers and the like.  It may well have said no more than enlarged prostate, rule out cancer. That would be quite typical here.

[simon43]

January 20th and still no reply/decision from April International, (despite sending them a reminder email which went unanswered by them).  AA Insurance has also (at my request) emailed them, since the insurance policy states a 5-working day decision turnaround...

[simon43]

Well, I really do not know what to do or say about April International insurance.  Yet another 5 days have passed, and no communication from this company to my urgent emails, nor to the emails sent direct to them by AA Insurance Brokers.

 

Now I begin to understand that the prompt service provided by the broker is no indication that the actual insurance provider will do likewise.

 

Do I register a formal complaint with the company or approach the insurance ombudsman body in their country of registration?  It is surely not acceptable that an urgent request by the hospital for pre-authorisation for the biopsy surgery to confirm a Pirads level 5 prostate cancer is processed so slowly by the insurance company.  Since providing them on 10th January with my medical health records dating back to 2014, they have not requested any further documents, nor made any further comment.

 

I'm just about speechless........

[Etaoin Shrdlu]

34 minutes ago, simon43 said:

Well, I really do not know what to do or say about April International insurance.  Yet another 5 days have passed, and no communication from this company to my urgent emails, nor to the emails sent direct to them by AA Insurance Brokers.

 

Now I begin to understand that the prompt service provided by the broker is no indication that the actual insurance provider will do likewise.

 

Do I register a formal complaint with the company or approach the insurance ombudsman body in their country of registration?  It is surely not acceptable that an urgent request by the hospital for pre-authorisation for the biopsy surgery to confirm a Pirads level 5 prostate cancer is processed so slowly by the insurance company.  Since providing them on 10th January with my medical health records dating back to 2014, they have not requested any further documents, nor made any further comment.

 

I'm just about speechless........

Both AA and April International are insurance brokers. Part of the delay may well be attributable to having to pass documents and other communications through two brokers before they get to the insurer.

 

You might want to ask AA to get on the phone with April and find out what is causing the delay. Or perhaps call April yourself? Phone calls convey more urgency than emails.

 

Might also be a good idea to find out the name and contact details of the insurance company that actually pays claims under the policy you have and ask AA to call them.

 

 

[Lorry]

2 hours ago, simon43 said:

Well, I really do not know what to do or say about April International insurance.  Yet another 5 days have passed, and no communication from this company to my urgent emails, nor to the emails sent direct to them by AA Insurance Brokers.

 

Now I begin to understand that the prompt service provided by the broker is no indication that the actual insurance provider will do likewise.

 

Do I register a formal complaint with the company or approach the insurance ombudsman body in their country of registration?  It is surely not acceptable that an urgent request by the hospital for pre-authorisation for the biopsy surgery to confirm a Pirads level 5 prostate cancer is processed so slowly by the insurance company.  Since providing them on 10th January with my medical health records dating back to 2014, they have not requested any further documents, nor made any further comment.

 

I'm just about speechless........

Find out the path that your requests follow.

Etaoin seems to imply it goes like this: you contact AA, they contact April Assistance in Thailand,  they ask April in France.

Ask AA whether they really contact April Assistance in Thailand.  If yes, April Assistance  is most probably the bottleneck. Based on experience,  I recommend to call them every 3 hours.

If no, ie if AA contacts April in France directly,  call them in France and speak to a superior of the person(s) in charge. Follow up with an email to this person. 

 

Find a French person knowledgeable about how to handle French insurances. Is it advisable to use a lawyer? Do they have an ombudsman? Is it advisable to pay yourself and claim later? Questions like this differ from country to country. 

 

 

[scubascuba3]

6 hours ago, simon43 said:

Well, I really do not know what to do or say about April International insurance.  Yet another 5 days have passed, and no communication from this company to my urgent emails, nor to the emails sent direct to them by AA Insurance Brokers.

 

Now I begin to understand that the prompt service provided by the broker is no indication that the actual insurance provider will do likewise.

 

Do I register a formal complaint with the company or approach the insurance ombudsman body in their country of registration?  It is surely not acceptable that an urgent request by the hospital for pre-authorisation for the biopsy surgery to confirm a Pirads level 5 prostate cancer is processed so slowly by the insurance company.  Since providing them on 10th January with my medical health records dating back to 2014, they have not requested any further documents, nor made any further comment.

 

I'm just about speechless........

I would do the complaining after.

 

A friend of mine needed a detached retina emergency surgery here in Pattaya, of course his insurance company were dragging their feet, he had to go to their office and kick off to get them to approve the urgent op. In your case follow up phone calls sound best, use Skype it's cheap if phoning abroad

[simon43]

Thanks for the advice.  Just to emphasize that my insurance is with April International and nothing to do with April Thailand.  AA Insurance are the brokers, but they have made it clear that all communication between the hospital and the insurer must go direct to April International in France.  AA has no input at all in the decisions by April - AA just remind me to pay the premium....

 

April International in France tout their medical insurance to provide a fast (5 days) pre-authorisation decision.  Well, they have failed miserably on that and now they have gone 'dark', with only an automated reply to my emails.  Had my biopsy been performed within 30 days of the MRI, my insurance with April would have paid the cost (54,000 baht).  Perhaps not surprisingly, April failed to give the biopsy go-ahead within 30 days, and so I had to pay for the MRI myself, with no reimbursement possible.

 

I cannot (easily) afford to pay for the biopsy (160,000 baht), and what about the actual prostate surgery cost?

 

April has given no indication that there are any problems with my medical history - they simply haven't responded at all, apart from confirming receipt of documents.

 

I think being an EU company they must have a published formal complaints procedure.  I'll try to find that.

[jerrymahoney]

https://fr.april-international.com/en/complaints

[Sheryl]

44 minutes ago, simon43 said:

Thanks for the advice.  Just to emphasize that my insurance is with April International and nothing to do with April Thailand.  AA Insurance are the brokers, but they have made it clear that all communication between the hospital and the insurer must go direct to April International in France.  AA has no input at all in the decisions by April - AA just remind me to pay the premium....

 

April International in France tout their medical insurance to provide a fast (5 days) pre-authorisation decision.  Well, they have failed miserably on that and now they have gone 'dark', with only an automated reply to my emails.  Had my biopsy been performed within 30 days of the MRI, my insurance with April would have paid the cost (54,000 baht).  Perhaps not surprisingly, April failed to give the biopsy go-ahead within 30 days, and so I had to pay for the MRI myself, with no reimbursement possible.

 

I cannot (easily) afford to pay for the biopsy (160,000 baht), and what about the actual prostate surgery cost?

 

April has given no indication that there are any problems with my medical history - they simply haven't responded at all, apart from confirming receipt of documents.

 

I think being an EU company they must have a published formal complaints procedure.  I'll try to find that.

1. Complaint procedure is outlined in your policy documents. Make sure you have the exact dates that hospital submitted the initial paperwork and that you subsequently submitted the requested additional information.

 

2. By your own acccount not  the case that they failed to respond within 30 days. It has been more like  16 days since you hsubmitted rhe requested info ( which is still unusualky lonf). You erred in not initially  having the hospital submit requuest for pre-aurhorization.

 

3. Normally the hospital 3rd party payment office will follow-up, have you spoken to them? Often the problem is the insurer awaiting more details on cost estimate from the hospital. 

 

4. How did you email, directly or  message through the online Customer Zone? 

[Sheryl]

11 hours ago, Etaoin Shrdlu said:

Both AA and April International are insurance brokers. Part of the delay may well be attributable to having to pass documents and other communications through two brokers before they get to the insurer.

 

You might want to ask AA to get on the phone with April and find out what is causing the delay. Or perhaps call April yourself? Phone calls convey more urgency than emails.

 

Might also be a good idea to find out the name and contact details of the insurance company that actually pays claims under the policy you have and ask AA to call them.

 

 

His policy is with April France and they are the actual insurer/underwriter. 

[jerrymahoney]

16 minutes ago, Sheryl said:

His policy is with April France and they are the actual insurer/underwriter. 

Where does it say that?

 

It does say here: From: 

https://fr.april-international.com/sites/france/files/2022-12/MyHealth International_Brochure_2023.pdf

 

A French simplified joint-stock company (S.A.S.) with capital of €200,000 - RCS Paris 309 707 727
Insurance intermediary - Registered with ORIAS under number 07 008 000 (www.orias.fr)

 

Prudential Supervision and Resolution Authority
4 place de Budapest - CS 92459 - 75436 PARIS CEDEX 09 - FRANCE.

 

This product is conceived and managed by APRIL International Care France and insured
by Groupama Gan Vie (for the medical expenses cover) and by Chubb European Group SE  (for the other covers).

[Will B Good]

PSA velocity is important........... if the numbers are low and stay low I would say your are okay (not a doctor).....if they steadily increase....worry.

 

I was, I feel, scammed into ultrasound tests, then MRI, then biopsy......200,000 baht.......... based on a high PSA when I had an E.coli bladder infection.

 

If you are going to an expensive, private hospital be wary.

[simon43]

33 minutes ago, Sheryl said:

1. Complaint procedure is outlined in your policy documents. Make sure you have the exact dates that hospital submitted the initial paperwork and that you subsequently submitted the requested additional information.

 

2. By your own acccount not  the case that they failed to respond within 30 days. It has been more like  16 days since you hsubmitted rhe requested info ( which is still unusualky lonf). You erred in not initially  having the hospital submit requuest for pre-aurhorization.

 

3. Normally the hospital 3rd party payment office will follow-up, have you spoken to them? Often the problem is the insurer awaiting more details on cost estimate from the hospital. 

 

4. How did you email, directly or  message through the online Customer Zone? 

2 - It is indeed strange that Bumrungrad Hospital did not submit the pre-authorisation request in a timely manner. Water under the bridge....

 

3 - The hospital provided details of the biopsy procedure and cost estimate on the form provided by April International, and April hasn't contacted the hospital since that date (10th January).

 

4 - Direct email to April International in France, also emails sent to AA Insurance brokers were forwarded to France.  This afternoon I'll try to call them in France.

[simon43]

3 minutes ago, Will B Good said:

PSA velocity is important........... if the numbers are low and stay low I would say your are okay (not a doctor).....if they steadily increase....worry.

 

I was, I feel, scammed into ultrasound tests, then MRI, then biopsy......200,000 baht.......... based on a high PSA when I had an E.coli bladder infection.

 

If you are going to an expensive, private hospital be wary.

My numbers were steady for many years, then more than doubled last Autumn, which is when I went straight to the hospital for the MRI etc. The MRI analysis gives it a Pirads 5 level (cancer highly likely), but still wholly contained within my prostate. This is why I need to move quickly before the cancer breaches my prostate.

[Will B Good]

Just now, simon43 said:

My numbers were steady for many years, then more than doubled last Autumn, which is when I went straight to the hospital for the MRI etc. The MRI analysis gives it a Pirads 5 level (cancer highly likely), but still wholly contained within my prostate. This is why I need to move quickly before the cancer breaches my prostate.

This sounds very similar to me.....low PSA then 6.8.....then two months later 8.5.....

 

Told I had level 4 from MRI and biopsy was urgent.

 

Doctor said something very odd....(to my mind).........just before the biopsy........'Try not to worry, it might turn out be benign'......and gave me a knowing smile (my imagination?)

 

True enough benign. had tests since all around 1..........????

 

Nice little money earner for the hospital.

[Will B Good]

It could be risky, but I would at least consider getting your blood pressure down and sorting out the UTI before launching into a biopsy.

 

MONUROL.......one single sachet cleared me of a UTI after three months of pain that brought me to tears on a variety of antibiotics which were prescribed with no urine culture being taken??????

[lopburi3]

2 minutes ago, Will B Good said:

Doctor said something very odd....(to my mind).........just before the biopsy........'Try not to worry, it might turn out be benign'......and gave me a knowing smile (my imagination?)

 

True enough benign. had tests since all around 1..........????

The issue is they do not know until a biopsy is actually done and often they will be negative (most of us consider that a good thing).  Today they can often test/find/remove cancers that in the past would not be found until too late for successful actions based on early testing/treatment.  Yes it does mean we have/pay for more tests but in most cases this is a doctors decision based on medical issues rather than a hospital call.

[simon43]

1 hour ago, Will B Good said:

It could be risky, but I would at least consider getting your blood pressure down and sorting out the UTI before launching into a biopsy.

---

Get my blood pressure down?  I just measured it at 111/76.   How low do you want it? ????

 

The UTI was sorted out months ago, thanks.

[BigStar]

2 hours ago, Will B Good said:

Doctor said something very odd....(to my mind).........just before the biopsy........'Try not to worry, it might turn out be benign'......and gave me a knowing smile (my imagination?)

Enough with the paranoia.

[Lorry]

https://www.trustpilot.com/review/april-international.com

You can try and post here

 

[Etaoin Shrdlu]

4 hours ago, Sheryl said:

His policy is with April France and they are the actual insurer/underwriter. 

April's own website describes them as a leading wholesale insurance broker: 

 

https://fr.april-international.com/en/about-april-international-care

 

I was able to find information from AM Best regarding three companies that are probably part of the April group. Searches for "April International" did not retrieve any results, but "April" did. Two of them appear to be holding companies, but April Sante Prevoyance looks like an operating company.

 

Bloomberg's description of the company is: 

 

"APRIL - Sante Prevoyance SA provides insurance services. The Company designs, manages, and sells life, health, hospitalization, and accidental death insurance policies for families, seniors, entrepreneurs and self employed. APRIL - Sante Prevoyance conducts business in France."

 

To me, this is a description of an insurance intermediary more than an insurance company. Perhaps it is a managing general agent that has some underwriting and claims-paying authority, but I don't think this describes an insurance company.

 

There may be another entity within the April Group that is actually an insurance company, but I'm not able to find information about it using AM Best or internet searches.  It would also be a bit unusual within the insurance industry for a major insurance broker to own an insurance company and place its clients' business with it due to potential conflicts of interest.

 

I think April is an insurance intermediary and may act as a managing general agent for an insurance company or companies, but I am not sure at all that it is an insurance company. If there is a bona fide insurance company within the April Group it seems to be hidden quite well.

 

 

[Sheryl]

4 hours ago, simon43 said:

2 - It is indeed strange that Bumrungrad Hospital did not submit the pre-authorisation request in a timely manner. Water under the bridge....

 

3 - The hospital provided details of the biopsy procedure and cost estimate on the form provided by April International, and April hasn't contacted the hospital since that date (10th January).

 

4 - Direct email to April International in France, also emails sent to AA Insurance brokers were forwarded to France.  This afternoon I'll try to call them in France.

How were you contacted and asked for more information if not by the hospital? 

 

And was there any confirmation that ghry received the additionsl info you sent? 

[simon43]

28 minutes ago, Sheryl said:

How were you contacted and asked for more information if not by the hospital? 

 

And was there any confirmation that ghry received the additionsl info you sent? 

April International emailed me directly for more health history after they had received the completed pre-authorisation form directly from Bumrungrad.  They confirmed receipt of my reply email with all the scans of my PSA numbers from 2014, 2017 and 2018 and that was the last I heard from them! (ie - my 2 follow-up emails to the same email address have not been replied to).  That's why AA Insurance has forwarded my emails 2 times now to France (and they haven't replied to those either), and why I have also emailed all of the Cc; email addresses in my correspondence (which resulted in autoreplies but nothing else).  So I also intend to call April later today (timezone difference)

[simon43]

Update:

 

After telephoning April International insurance in France, I finally received an email reply.

 

They have denied my claim!

 

They state that since my PSA was slightly raised over the past years, I was therefore "suffering from the prostate" for more than 5 years.  They make no mention that I was suffering from prostate cancer.  They go on to state that because I intentionally made a false declaration my insurance cover is null and void and cancelled immediately.

 

It seems they are basing their decision on the mild BPH that I have, which results in a slightly raised but stable PSA.  At no time did any doctor recommend any further investigation or treatment for my slightly raised PSA.

 

So where do I go from here?  I have wasted thousands of $ in insurance cover and of course will now be unable to obtain future cover.  It seems to be that they are denying cover based on my BPH, which is ridiculous.

 

Is there any appeals procedure?  Their decision will probably mean that I have to return to the UK and declare myself to have returned permanently, in order to get NHS treatment.  But I imagine all of that will take months to arrange.

 

Not good news ...