PSA value of 11, but I have a UTI.

[simon43]

7 hours ago, Adumbration said:

Thanks for the updates Simon.

 

Do you know what the relevant costs are?  Or have you not even bothered asking because you are insured.

 

And in Bumrungrad a private or government hospital?

 

Also what is the annual premium on your April insurance?

I haven't asked about the costs because apart from my $500 annual excess, I'm 100% covered for all costs.

 

My annual premium for the 'Essentials' policy with April is about $2,600 at age 63 years. That's with no pre-existing conditions or exclusions.

[Sheryl]

6 hours ago, jerrymahoney said:

Our plans are underwritten by either AXA XL Insurance Company UK Limited or AXA XL Underwriting -- page 8

 

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

That is April UK. Not April Global which is a French company and does their own underwriting. 

[dddave]

Post removed by poster.  Irrelevant.

Edited November 23, 2022 by dddave

[jerrymahoney]

APRIL is the leading wholesale broker in France with a network of 15,000 partner brokers.

 

https://www.april.com/en/about/

[jerrymahoney]

On 11/21/2022 at 9:52 PM, simon43 said:

Dr Viroj specifically wrote on his report to April that surgery/inpatient treatment would be needed, and therefore pre-authorisation for all MRI/biopsy work etc should be given by April.  (I hope April agree to this!).

And?

[simon43]

1 hour ago, jerrymahoney said:

And?

And that was just 3 days ago.  I'm waiting for the go-ahead from April.

[jerrymahoney]

32 minutes ago, simon43 said:

And that was just 3 days ago.  I'm waiting for the go-ahead from April.

As you say, 'just'.

[moogradod]

40 minutes ago, simon43 said:

And that was just 3 days ago.  I'm waiting for the go-ahead from April.

Until April it is still quite some time. You may take this as a good sign !! If everything was so bad they would treat you before. However to be up to date on the situation I would not be shy to ask in detail why April is still OK for treatment in your case and not accept the date without further explanation.

[lopburi3]

4 minutes ago, moogradod said:

Until April it is still quite some time. You may take this as a good sign !! If everything was so bad they would treat you before. However to be up to date on the situation I would not be shy to ask in detail why April is still OK for treatment in your case and not accept the date without further explanation.

You are aware he is talking about April Insurance rather than the month of April.  

[moogradod]

38 minutes ago, lopburi3 said:

You are aware he is talking about April Insurance rather than the month of April.  

Uups !! No, I thought this was about the date of the treatment. I apologize. Now the small differences in grammar make suddenly sense ????. Next time I will read the text in context better before I answer.

 

Sorry again and as someone who has undergone the same procedure I wish the OP all the very best.

Edited November 24, 2022 by moogradod

[Sheryl]

My experience with April was that emergency hospitalization authorization came through in a few hours, non-elective authorization took about a week or week and a half.

 

Broker can assist if things seem to be taking longer. They have more direct channels than we do for contacting April.

 

It also depends a lot on whether hospital provided all; necessary details, often there is some internal back and forth bertween hospital and April on estimated charges (for example, they always need room rate broken out between room alone, nursing care, meals )

[simon43]

1 hour ago, Sheryl said:

My experience with April was that emergency hospitalization authorization came through in a few hours, non-elective authorization took about a week or week and a half.

 

Broker can assist if things seem to be taking longer. They have more direct channels than we do for contacting April.

 

It also depends a lot on whether hospital provided all; necessary details, often there is some internal back and forth bertween hospital and April on estimated charges (for example, they always need room rate broken out between room alone, nursing care, meals )

Update: April has got back to me this morning and I can now book an MRI appointment at Bumrungrad ????

[jerrymahoney]

2 hours ago, simon43 said:

Update: April has got back to me this morning and I can now book an MRI appointment at Bumrungrad ????

Good and good luck. As Tom Petty sang:

 

The Waiting is the Hardest Part.

[simon43]

Update:  MRI scan results: 2 lumps wholly within my prostate, both grade 5 (highly likely to be cancerous). No surprise there. The good news is that nothing suspicious was found outside my prostate, seminal vesicles all good, lymph nodes all ok, bones all OK and apparently I have an "unremarkable rectum"!!

 

Next will be a biopsy after Xmas to confirm the cancer and then RP surgery, (my decision and my doctor fully agrees with this decision). Today is a good day!

[Sheryl]

Thanks for the update. We are all wishing you well

 

[xylophone]

8 minutes ago, simon43 said:

Update:  MRI scan results: 2 lumps wholly within my prostate, both grade 5 (highly likely to be cancerous). No surprise there. The good news is that nothing suspicious was found outside my prostate, seminal vesicles all good, lymph nodes all ok, bones all OK and apparently I have an "unremarkable rectum"!!

 

Next will be a biopsy after Xmas to confirm the cancer and then RP surgery, (my decision and my doctor fully agrees with this decision). Today is a good day!

All the very best Simon and please keep your "readers" up to date as regards your progress. Good luck.

[simon43]

Update:  April International has denied my claim to pay for the MRI scan, even though the medical report indicated that the lumps found in my prostate were 'level 5' (not Gleason), but meaning they were highly likely to be cancerous.  April says they won't pay because an MRI is an outpatient treatment! (My policy does cover outpatient treatment for diagnosed illnesses, but since the cancer is not yet diagnosed, then basically tough!!).

 

So that's 60,000 baht that I have paid out from my low salary....

 

Next the hospital has requested (3 weeks ago), to cover the cost of the biopsy.  Well, I am now expecting April to have the same attitude >>> not yet diagnosed, so not yet covered....  So I may have to pay for the biopsy as well.

 

I am rapidly losing confidence with April International.

[Sheryl]

53 minutes ago, simon43 said:

Update:  April International has denied my claim to pay for the MRI scan, even though the medical report indicated that the lumps found in my prostate were 'level 5' (not Gleason), but meaning they were highly likely to be cancerous.  April says they won't pay because an MRI is an outpatient treatment! (My policy does cover outpatient treatment for diagnosed illnesses, but since the cancer is not yet diagnosed, then basically tough!!).

 

So that's 60,000 baht that I have paid out from my low salary....

 

Next the hospital has requested (3 weeks ago), to cover the cost of the biopsy.  Well, I am now expecting April to have the same attitude >>> not yet diagnosed, so not yet covered....  So I may have to pay for the biopsy as well.

 

I am rapidly losing confidence with April International.

 

Your policy will cover the MRI and other outpt costs if related to subsequent  hospitalization (including day surgery) within 30 days. That is an entirely separate coverage category than outpatient cancer care . But can only be claimed after you have been hospitalized. There is no way it can be approved before that since eligibility is tied to  hospitalization. 

 

Assuming the biopsy is considered a day surgery (as I would expect, but if does depend on how the hospital presented it on the forms) then the fact that cancer not yet confirmed is irrelevant.  Confirmed cancer diagnosis needed only for  cover under outpatient cancer care.

 

It normally takes only 7-10 days to get pre-authorization for a  (non emergency) hospitalization.  I suspect there is some issue with the  information provided by the hospital. Ask your broker to run interference. In doing so be dure to emphasis day surgery/ hospitalization.

 

I have had problems in the past with Bumrungrad and insurance (different insurer at that time) and day surgery coverage because the hospital presented it as an outpatient procedure rather than a day surgery. Their 3rd party payment office appeared not to understand the concept and insurance implucations  of day surgery. Ir may be necessary to call and explain this to them. Buf first gind out from broker if this is the the hang up.

[JimmyJ]

1 hour ago, Sheryl said:

 

Your policy will cover the MRI and other outpt costs if related to subsequent  hospitalization (including day surgery) within 30 days. That is an entirely separate coverage category than outpatient cancer care . But can only be claimed after you have been hospitalized. There is no way it can be approved before that since eligibility is tied to  hospitalization. 

 

Assuming the biopsy is considered a day surgery (as I would expect, but if does depend on how the hospital presented it on the forms) then the fact that cancer not yet confirmed is irrelevant.  Confirmed cancer diagnosis needed only for  cover under outpatient cancer care.

 

It normally takes only 7-10 days to get pre-authorization for a  (non emergency) hospitalization.  I suspect there is some issue with the  information provided by the hospital. Ask your broker to run interference. In doing so be dure to emphasis day surgery/ hospitalization.

 

I have had problems in the past with Bumrungrad and insurance (different insurer at that time) and day surgery coverage because the hospital presented it as an outpatient procedure rather than a day surgery. Their 3rd party payment office appeared not to understand the concept and insurance implucations  of day surgery. Ir may be necessary to call and explain this to them. Buf first gind out from broker if this is the the hang up.

Outpatient April policy.

Do you think they would pay as a day surgery for a thyroid FNA if presented as you describe?

[simon43]

Thanks Sheryl.  It seems that while I relaxed over Xmas, safe in the knowledge that the hospital and my insurance broker were sorting out the pre-authorisation, I now find that this is not the case!  I have to move quickly if I am to be able to claim the MRI cost.  I have spoken and emailed the hospital about this and the need to specify 'day surgery' for the biopsy, and they will do their paperwork tomorrow. 

 

Regardless of any feedback from April, I need to have the biopsy before next Thursday to ensure that I can claim the cost of this, (since I can ensure that my RP is within 30 days of the biopsy).

 

I'm not contacting AA Insurance Brokers, because IMHO, they are to blame for failing to emphasise that time is of the essence in order to meet the operation-wthin-30-days rule on my insurance policy. They are not adding anything of value to resolve this problem).

[Mark Nothing]

On 11/18/2022 at 10:30 PM, scubascuba3 said:

Rolf Harris used to rave about drinking his own urine. What benefits did you get? and how do you know it wasn't just a placebo effect?

Thank you for having an open mind and expressing an interest.

 

I was shocked at first too when I read about urine therapy  as it so radically differed from everything I was taught.  It took months to research and take the plunge.  The benefits have been all encompassing positives related to every aspect of my life.

 

My excruciatingly painful arthritus cleared up, bph eliminated, herpes and genital warts dissappeared.  Vision improved.  Grey hair dissipated.  My body balance and athletism returned.  Much better sleep.  Weight returned to ideal.  Energy and vitality increased.  Just an overall positive affect in every aspect of my life.

 

The analysis indicates the cause of BPH is due to the impurities in a modern diet of food, water, and other items put in your mouth.  By ingesting urine it sweeps through the system eliminating the deposits of impurities returning the body back to health and vitality.

 

Being retired with plenty of time, but with limited resources to spend on heathcare I gave it a try, with success.

 

My research indicates the placebo affect is not valid.  It was a gift from devinity to ensure health and vitality.  You just have to learn how to do it to experience the benefits.  Whiz in a glass and drink.

 

 

[Sheryl]

2 hours ago, JimmyJ said:

Outpatient April policy.

Do you think they would pay as a day surgery for a thyroid FNA if presented as you describe?

Do you really mean outpatient, or do you mean inpatient?

 

A thyroid FNA (which I recently had) is a simple office procedure. Only a policy that covers general outpatient care (which few of us have) would cover that. I paid for my FNA completely out of pocket. Wasn't all that costly.

 

A "day surgery" would be something requiring use of an operating room or equivalent and at least a brief period of observation afterwards. Not something done in doctor's office or adjacent treatment room.

 

 

 

 

[xylophone]

1 hour ago, Mark Nothing said:

Thank you for having an open mind and expressing an interest.

 

I was shocked at first too when I read about urine therapy  as it so radically differed from everything I was taught.  It took months to research and take the plunge.  The benefits have been all encompassing positives related to every aspect of my life.

 

My excruciatingly painful arthritus cleared up, bph eliminated, herpes and genital warts dissappeared.  Vision improved.  Grey hair dissipated.  My body balance and athletism returned.  Much better sleep.  Weight returned to ideal.  Energy and vitality increased.  Just an overall positive affect in every aspect of my life.

 

The analysis indicates the cause of BPH is due to the impurities in a modern diet of food, water, and other items put in your mouth.  By ingesting urine it sweeps through the system eliminating the deposits of impurities returning the body back to health and vitality.

 

Being retired with plenty of time, but with limited resources to spend on heathcare I gave it a try, with success.

 

My research indicates the placebo affect is not valid.  It was a gift from devinity to ensure health and vitality.  You just have to learn how to do it to experience the benefits.  Whiz in a glass and drink.

 

 

Experts don't agree with you......................

 

https://www.healthline.com/health/drinking-urine

[JimmyJ]

3 minutes ago, Sheryl said:

Do you really mean outpatient, or do you mean inpatient?

 

A thyroid FNA (which I recently had) is a simple office procedure. Only a policy that covers general outpatient care (which few of us have) would cover that. I paid for my FNA completely out of pocket. Wasn't all that costly.

 

 

 

 

Thank you.

 

Yes, mental typo, I meant Inpatient coverage only.

 

I was quoted 16-17k at Ram.

Was your cost similar?

(I was very surprised that much for what seemed like - as you state,  a simple office procedure).

Includes a blood test prior, they may have mentioned another test prior.

 

 

 

 

[Sheryl]

2 hours ago, simon43 said:

Thanks Sheryl.  It seems that while I relaxed over Xmas, safe in the knowledge that the hospital and my insurance broker were sorting out the pre-authorisation, I now find that this is not the case!  I have to move quickly if I am to be able to claim the MRI cost.  I have spoken and emailed the hospital about this and the need to specify 'day surgery' for the biopsy, and they will do their paperwork tomorrow. 

 

Regardless of any feedback from April, I need to have the biopsy before next Thursday to ensure that I can claim the cost of this, (since I can ensure that my RP is within 30 days of the biopsy).

 

I'm not contacting AA Insurance Brokers, because IMHO, they are to blame for failing to emphasise that time is of the essence in order to meet the operation-wthin-30-days rule on my insurance policy. They are not adding anything of value to resolve this problem).

 

If you have not contacted them, how can they even know about, let alone  help resolve,  the problem?

 

Brokers have means of contacting insurers that we mortals lack. They can find out quickly what it is that is causing the delay. If it is information needed from the hospital, they can find out what, so that you can then follow up with the hospital specifically. (Assume nothing when dealing with the hospital insurance people).

 

The 30 day bit is very clearly spelled out in the deatiled schedule of benefits:

 

"Outpatient consultations, treatments, diagnostic tests and medical procedures related to hospitalisation/outpatient surgery 30 days before and after hospitalisation (hospital certificate required)" - 100% covered 

 

Can't fault a broker for assuming people have read that. There are likely other things on that schedule as well that they did not describe or emphasize, since it is there in easy to read format.

 

I have had 2 day surgeries paid for by April including, in both cases,  consultations and MRIs done prior (within 30 days of course) and outpatient follow up within 30 days after. 

 

To be fair, in both cases I elected to skip getting pre-authorization because the surgery itself cost under US $2,000 (the threshold for needing pre-authorization) and I was in a lot of pain and did not want to wait.  So I did not go through pre-authorization process for day surgeries with  April, though I have twice gone through pre-authorization for inpatient care. Your biopsy may well exceed that amount in which case that is not an option. Also, be forewarned that reimbursement of out of pocket expenses is slow.

 

One advantage of the reimbursement approach is that the detailed receipts and medical certificate make clear what was done and that it involved use of an OR.  Who knows what Bumrungrad put on the forms they submitted.

 

 

[Sheryl]

5 minutes ago, JimmyJ said:

Thank you.

 

Yes, mental typo, I meant Inpatient coverage only.

 

I was quoted 16-17k at Ram.

Was your cost similar?

(I was very surprised that much for what seemed like - as you state,  a simple office procedure).

Includes a blood test prior, they may have mentioned another test prior.

 

 

 

 

 

I can't find the receipt but I think it was something in the vicinity of 5,000 baht for the FNA including pathology.

 

This is not including the ultrasound, that was another almost 4,000 baht (which seemed high to me).  And then consultation fee of doctor, maybe another 1000.

 

No blood test was required but I already had results of a recent thyroid panel.

 

This was at Bangkok Hospital, Bangkok.

 

No way should an FNA alone cost  17K.

 

Have you already had ultrasound?

[simon43]

[quote]

If you have not contacted them, how can they even know about, let alone  help resolve,  the problem?

[/quote]

 

I have communicated with them about 10 times today, after finding out that April International had received no request from the hospital for the biopsy.  Apparently when the broker insisted that I send them all my original invoices (for the MRI), and the original of the medical report from Bumrungrad where the biopsy was stated as the next requirement, and that the broker would then forward all these to April in France, they omitted to tell me that all of this administration was nothing to do with actually getting April in France to give the go ahead for the biopsy!  That required completion of a form by the hospital that I only received yesterday after April France sent it to the broker who then forwarded it to me.

 

Why was I only sent the form 20 days after the MRI, and so with only 10 days left to make a claim AND with only 10 days to actually have the biopsy surgery so that can be claimed from the insurer? It sure stinks to me of bad practice.

 

 

[Sheryl]

26 minutes ago, simon43 said:

[quote]

If you have not contacted them, how can they even know about, let alone  help resolve,  the problem?

[/quote]

 

I have communicated with them about 10 times today, after finding out that April International had received no request from the hospital for the biopsy.  Apparently when the broker insisted that I send them all my original invoices (for the MRI), and the original of the medical report from Bumrungrad where the biopsy was stated as the next requirement, and that the broker would then forward all these to April in France, they omitted to tell me that all of this administration was nothing to do with actually getting April in France to give the go ahead for the biopsy!  That required completion of a form by the hospital that I only received yesterday after April France sent it to the broker who then forwarded it to me.

 

Why was I only sent the form 20 days after the MRI, and so with only 10 days left to make a claim AND with only 10 days to actually have the biopsy surgery so that can be claimed from the insurer? It sure stinks to me of bad practice.

 

 

 

Brokers are  never able to initiate request for pre-authorization of hospitalization. That can only be done by the hospital and there are specific (and pretty detailed) forms and information that the hospital has to submit.  Broker can only help follow up if there is a delay in processing.

 

Broker does often help submit paperwork for after the fact reimbursement and sounds like that is what they were doing ... but should not/cannot be done now. Normally one waits until after the hospitalization then submits the pre and post op invoices etc to broker to claim reimbursement.

 

The claim does not have to be made within 30 days. But the invoice and services need to have been dated not more than 30 days before hospitalization. 

 

Sounds like massive miscommunication. 

 

[simon43]

[quote]

Sounds like massive miscommunication. 

[/quote]

 

Yes indeed.  Luckily, I have never had to make any insurance claim before, so I made the error of assuming that the insurance broker was handling the claim, since they insisted on receiving all the original medical reports and forwarding them to April.

 

As I said, April denied my claim for the MRI, but IMHO they should not have denied it YET, because there is still the 30-day window.  Unfortunately, because of the time wasted over Xmas and NY, it is highly unlikely that April will approve the biopsy day surgery within the 30 day window, and so my MRI cost claim is null and void.... 

 

Bumrungrad can do the biopsy early next week and within the 30 day window, but understandably, they will not proceed without the go ahead from April.  I cannot pay and claim back because the cost is 180,000 baht, which is beyond my immediate financial reach ????

 

Ho hum, live and learn...

[Sheryl]

2 hours ago, simon43 said:

[quote]

Sounds like massive miscommunication. 

[/quote]

 

Yes indeed.  Luckily, I have never had to make any insurance claim before, so I made the error of assuming that the insurance broker was handling the claim, since they insisted on receiving all the original medical reports and forwarding them to April.

 

As I said, April denied my claim for the MRI, but IMHO they should not have denied it YET, because there is still the 30-day window.  Unfortunately, because of the time wasted over Xmas and NY, it is highly unlikely that April will approve the biopsy day surgery within the 30 day window, and so my MRI cost claim is null and void.... 

 

Bumrungrad can do the biopsy early next week and within the 30 day window, but understandably, they will not proceed without the go ahead from April.  I cannot pay and claim back because the cost is 180,000 baht, which is beyond my immediate financial reach ????

 

Ho hum, live and learn...

Has Bumrungrad submitted the necessary forms to the insurer for pre-approval?  If so a one week turn around is possible. Not guarnteed but certainly possible, if the hospital submission was sufficiently detailed.

 

Any insurer would have rejected your MRU  claim given that it was submitted when there had been no hospitalization. They do not put claims aside and wait to see if a hospitalization later materializes. They just check to see if (1) you have the optional outpatient cover (no) and (2) if not, if there has been an approved hospitalization within 30 days.

 

The error was in the claims submission, should not have been submitted until after the hospitalization. At which point should be submitted together with claim for any home medications and post-op follow up.  You can re-submit after hospitalization accordingly, if it occurs within the 30 day window.

 

As explained, brokers can handle claims for reimbursement of out of pocket costs but cannot handle pre0authorization for hospitalization and direct payment agreement. They can help follow up if there is a delay in processing but it is always the hospital that has to make the submission.