PSA value of 11, but I have a UTI.

[nigelforbes]

22 minutes ago, simon43 said:

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 ...

I'm sorry to hear that Simon, it must be a real worry for you at this stage. I think you are right, you don't seem to have another alternative except to return home. If that's what it is, best get a move on, you can be there by Spring which is not an unpleasant time. Onwards and upwards.

[simon43]

29 minutes ago, nigelforbes said:

I'm sorry to hear that Simon, it must be a real worry for you at this stage. I think you are right, you don't seem to have another alternative except to return home. If that's what it is, best get a move on, you can be there by Spring which is not an unpleasant time. Onwards and upwards.

Alternatively, I can stay in my idyllic location in Thailand, ignore the MRI results and perhaps live for many years without any treatment.....

 

Or.. try to find a cheaper hospital in Thailand and save up for treatment (I don't think a GoFundMe for an old expat will attract any interest!).

Edited January 27, 2023 by simon43

[nigelforbes]

27 minutes ago, simon43 said:

Alternatively, I can stay in my idyllic location in Thailand, ignore the MRI results and perhaps live for many years without any treatment.....

 

Or.. try to find a cheaper hospital in Thailand and save up for treatment (I don't think a GoFundMe for an old expat will attract any interest!).

I suppose it depends on your risk appetite versus your age and available assets. I have to say that at age 73, if I was in your position, I might be inclined to enjoy the idyllic location and try not to worry about things. Even though I have a flat in the UK I couldn't imagine ever moving back there to live, for any reason, not after 20+ years here.

[BritManToo]

55 minutes ago, simon43 said:

Alternatively, I can stay in my idyllic location in Thailand, ignore the MRI results and perhaps live for many years without any treatment.....

I'd go with this choice (which I've already done 3x and survived).

The insurance denying you access to these Thai butchers may well have saved you.

Life's a lottery, why worry about the future, a m/c could kill any of us tomorrow.

And now you don't have to pay for insurance, you've got some more money to spend!

 

Note: 

To all future insurance customers .......... April didn't pay out!

Edited January 27, 2023 by BritManToo

[Sheryl]

7 hours ago, simon43 said:

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 ...

There is an appeals process and it is outlined in your policy document.

 

It sounds like the denial is because you failed to declare your BPH on your application form. Had you done so they would likely have applied an exclusion for all prostate problems.

 

No harm in appealing anyhow but of you truly did fail to disclose your BPH your odds of success are low.

 

Your choices now are return to UK and get treated under NHS or get treated at a government hospital here. For this condition best options are Ramathibodhi or Siriraj.

 

You might also opt for a combination of the 2 i.e. get biopsy at government hospital here then, if positive, go to UK for further treatment.  2 advantages to this approach: (1) in case biopsy proves negative you'll have avoided unnecessary trip back to UK.  (2) If biopsy is positive, with that result in hand you'll get treated under NHS much more quickly than you will without it.

 

 

 

 

 

 

 

 

 

 

[Sheryl]

On 1/27/2023 at 7:34 AM, nigelforbes said:

I suppose it depends on your risk appetite versus your age and available assets. I have to say that at age 73, if I was in your position, I might be inclined to enjoy the idyllic location and try not to worry about things. Even though I have a flat in the UK I couldn't imagine ever moving back there to live, for any reason, not after 20+ years here.

I don't think OP is talking about a permanent move. Just going back for treatment. He'd have to declare an intention to resettle permanently but there is no way to enforce that ...and if he's wise he'd maintain an address and GP registration even after  back in Thailand thus ensuring quick future access to care.

 

As to not worrying about things -- some types of prostate cancer are quite aggressive and death from prostate cancer is particularly unpleasant (it metastatizes to bone). 

[Sheryl]

A post with inaccurate information and link to a vidro from an  unreliable source, and replies to it , have been removed.

 

Abnormal PSA results do not automatically require biopsy. 

[JimmyJ]

4 hours ago, simon43 said:

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.

simon43 - Sorry to read this. Thank you for keeping us informed.

 

simon43 - "...I intentionally made a false declaration...".

 

Are they referring to (what they consider) a false declaration when you applied for insurance, or did they have you answer questions/make a statement recently  when you applied for pre-approval?

 

[simon43]

6 minutes ago, JimmyJ said:

simon43 - Sorry to read this. Thank you for keeping us informed.

 

simon43 - "...I intentionally made a false declaration...".

 

Are they referring to (what they consider) a false declaration when you applied for insurance, or did they have you answer questions/make a statement recently  when you applied for pre-approval?

 

They mean that when I applied for cover in early 2020 (I had actually been similarly covered since 2016 with a different insurance company, but changed because their customer service was appalling - I never made any claim with that company) - I failed to disclose that I had mild BPH.  I was never diagnosed in writing with BPH (the Thai doctor did a DRE and verbally told me that I had slight BPH, but nothing to worry about). I was never prescribed any medication or recommended further treatment for this BPH.  My PSA remained stable around 5 - 6 for years.

 

Sheryl, I have a bunion on my foot. Should I have disclosed that also in case I break my foot at a later date?  BPH is not an illness, it is a common condition for older men.  It bears zero relationship to prostate cancer, as you are well aware.  April simply don't want to accept their responsibility to provide cover.

 

After this experience, you can be damn sure that I will go for self-insurance, despite all my encouragement previously that health insurance is a must for expats.  I consider that I did not mislead the insurance company.

 

I will consider my options now.

[BritManToo]

41 minutes ago, simon43 said:

After this experience, you can be damn sure that I will go for self-insurance, despite all my encouragement previously that health insurance is a must for expats.  I consider that I did not mislead the insurance company.

I had exactly the same experience with accident insurance from the 'green' bank.

Fell off my bicycle, broke my jaw, they said it was 'cosmetic' and refused to pay.

Last health insurance I ever buy (think the insurance cost 500bht so no big loss)

I paid the 3,500bht repairs myself.

Edited January 27, 2023 by BritManToo

[scubascuba3]

A similar claim I recently heard about (different medical condition) the insurer cancelled the policy immediately because they said pre-existing condition not declared, but they did refund all premiums paid, you could try that. The person concerned is also taking the insurer to court

Edited January 27, 2023 by scubascuba3

[Sheryl]

2 hours ago, simon43 said:

They mean that when I applied for cover in early 2020 (I had actually been similarly covered since 2016 with a different insurance company, but changed because their customer service was appalling - I never made any claim with that company) - I failed to disclose that I had mild BPH.  I was never diagnosed in writing with BPH (the Thai doctor did a DRE and verbally told me that I had slight BPH, but nothing to worry about). I was never prescribed any medication or recommended further treatment for this BPH.  My PSA remained stable around 5 - 6 for years.

 

Sheryl, I have a bunion on my foot. Should I have disclosed that also in case I break my foot at a later date?  BPH is not an illness, it is a common condition for older men.  It bears zero relationship to prostate cancer, as you are well aware.  April simply don't want to accept their responsibility to provide cover.

 

After this experience, you can be damn sure that I will go for self-insurance, despite all my encouragement previously that health insurance is a must for expats.  I consider that I did not mislead the insurance company.

 

I will consider my options now.

If you were not on any treatment for the BPH then it is possible you did not misrepresent anything on the application form (I don't remember all the questions on the form).  If so then your case for appeal is stronger and you should try. Did you keep a copy of fhe application form? 

 

If they do proceed to cancel your policy you may be able to get refund on at least the last premium.

 

As posted previously I suggest you get the biopsy at a government hospital then once you have results can consider what best to do.

 

 

[simon43]

55 minutes ago, Sheryl said:

If you were not on any treatment for the BPH then it is possible you did not misrepresent anything on the application form (I don't remember all the questions on the form).  If so then your case for appeal is stronger and you should try. Did you keep a copy of fhe application form? 

 

If they do proceed to cancel your policy you may be able to get refund on at least the last premium.

 

As posted previously I suggest you get the biopsy at a government hospital then once you have results can consider what best to do.

 

 

Prior to visiting Bumrungrad, I have never had any written diagnosis for BPH, nor any recommendation for further treatment or investigation, nor any medication prescribed.  I self-medicated from 2021 with Alfuzoline when I was in north Laos, after an online consultation with Dr Google.

 

April have already stated in their letter that the policy is cancelled immediately, and all premiums paid to date are forfeited....  I have a copy of my original application form.

[Sheryl]

22 minutes ago, simon43 said:

Prior to visiting Bumrungrad, I have never had any written diagnosis for BPH, nor any recommendation for further treatment or investigation, nor any medication prescribed.  I self-medicated from 2021 with Alfuzoline when I was in north Laos, after an online consultation with Dr Google.

 

April have already stated in their letter that the policy is cancelled immediately, and all premiums paid to date are forfeited....  I have a copy of my original application form.

I just checked my copy (which is 2017 so yours could differ.)

 

Question 7 "are you currently suffering from any illness or disorder" is where you should have declared your BPH. There is also a question about whether you planned on having any  lab tests done in next 12 months which if you have been getting annual PSAs should have been answered accordingly. (and if the records they now have showed annual PSA done since before policy is issued, they will now that).

[Will B Good]

On 1/26/2023 at 6:27 AM, simon43 said:

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.

PSA value of 11, but I have a UTI.

[lopburi3]

5 minutes ago, Will B Good said:

PSA value of 11, but I have a UTI.

You did notice that was posted 3.5 months ago?

[Will B Good]

On 1/26/2023 at 6:44 AM, BigStar said:

Enough with the paranoia.

Just to put this 'paranoia' into context.......I was treated for two months with antibiotics that were known to be ineffective in the fight against E.Coli, which is known to account for 70% of bladder infections.

 

Only after two months and Ultrasound tests (?) did they culture the urine and announce...OH! It's an E Coli infection......take this antibiotic  (one dose).....hey presto sorted.

[Will B Good]

1 minute ago, lopburi3 said:

You did notice that was posted 3.5 months ago?

NOPE!!!......555

[simon43]

53 minutes ago, Will B Good said:

NOPE!!!......555

No problem!  I did have a typical UTI, sorted that out with antibiotics, had another PSA test which had gone up again, so then went for the MRI scan and then recommended for biopsy, which is where I am now.

 

I am considering my options, (which might include bombing the offices of April International insurance...).  The most realistic option would be to return back to the UK for NHS treatment, because publicised wait times for cancer treatment are not long, typically within 1 month. But of course, I will need to demonstrate that I have permanently returned to the UK, eg re-register with my doctor, rent a house etc.

 

The first thing I will do on Monday is to have another PSA test, to see where my numbers currently are.

[simon43]

[quote]

...

 There is also a question about whether you planned on having any  lab tests done in next 12 months which if you have been getting annual PSAs should have been answered accordingly.

...

[/quote]

 

These lab tests were part of a general wellness/health check-up package, where all parameters (heart, choresterol etc) were checked.  Does one really have to declare that you have annual health check-ups?  It would seem to be a bonus that one is looking after one's health by having regular check-ups.

[BritManToo]

23 minutes ago, simon43 said:

These lab tests were part of a general wellness/health check-up package, where all parameters (heart, choresterol etc) were checked.  Does one really have to declare that you have annual health check-ups?  It would seem to be a bonus that one is looking after one's health by having regular check-ups.

The NHS stopped doing regular yearly health checks.

Apparently too many 'false' negative results (especially for cancer) that led to unnecessary surgery.

(They still offer 5 year health checks)

[lopburi3]

51 minutes ago, BritManToo said:

'false' negative

Suspect you mean positive?

[Lorry]

5 hours ago, simon43 said:

No problem!  I did have a typical UTI, sorted that out with antibiotics, had another PSA test which had gone up again, so then went for the MRI scan and then recommended for biopsy, which is where I am now.

 

I am considering my options, (which might include bombing the offices of April International insurance...).  The most realistic option would be to return back to the UK for NHS treatment, because publicised wait times for cancer treatment are not long, typically within 1 month. But of course, I will need to demonstrate that I have permanently returned to the UK, eg re-register with my doctor, rent a house etc.

 

The first thing I will do on Monday is to have another PSA test, to see where my numbers currently are.

You really need legal advice.

You might get your premiums back, like scuba wrote. 

You might even get coverage,  but it will probably too slow, because it doesn't seem you know lots of French lawyers (I don't even know whether French law applies).

So for treatment proceed like Sheryl said.

 

As for self- insurance: 160,000 seems to be a lot for you.  If so, don't even dream of self- insurance.  Read in various threads what Sheryl says: you need several million readily accessible to be self-insured.

[Sheryl]

13 hours ago, Lorry said:

You really need legal advice.

You might get your premiums back, like scuba wrote. 

You might even get coverage,  but it will probably too slow, because it doesn't seem you know lots of French lawyers (I don't even know whether French law applies).

So for treatment proceed like Sheryl said.

 

As for self- insurance: 160,000 seems to be a lot for you.  If so, don't even dream of self- insurance.  Read in various threads what Sheryl says: you need several million readily accessible to be self-insured.

He does not need a lawyer. As stated in the policy, he can appeal directly to the Insurance Mediator which is a completely independent body, and the process is clearly explained online and can be done online

 

"If the disagreement persists and no amicable solution can be found, You may, without prejudice to the other legal remedies
available to You and in any event within two months of the sending of Your first complaint, appeal to the Insurance Mediator
by post or by email to the following addresses - "La Médiation de l'Assurance" - TSA 50110 - 75441 Paris Cedex 09 - FRANCE.
www.mediation-assurance.org"

- April Insurance General Conditions

 

The complaint can be done online here https://www.mediation-assurance.org/constituer-mon-dossier/

(it is in French but translates well in Chrome browser).

 

However as it seems clear he failed to declare a health condition on his initial application, the most he is likely to be able to achieve is refund of premium for the period going forward (which may or may not be worth it depending on whether he pays annually or monthly and date he pays).

 

 From the French Insurance Code:

Article L113-8

the insurance contract is null in the event of reluctance or intentional misrepresentation on the part of the insured, when this reluctance or this misrepresentation changes the subject of the risk or diminishes the insurer's opinion of it, even though the risk omitted or misrepresented by the insured had no influence on the claim.

The premiums paid then remain with the insurer, who is entitled to the payment of all premiums due as damages.

 

and

 

Article L113-9

The omission or inaccurate declaration on the part of the insured whose bad faith is not established does not entail the nullity of the insurance.

 

If it is noted before any claim, the insurer has the right either to maintain the contract, subject to a premium increase accepted by the insured, or to terminate the contract ten days after notification sent to the insured by registered letter, in returning the portion of the premium paid for the time when the insurance no longer runs.

https://www-legifrance-gouv-fr.translate.goog/codes/section_lc/LEGITEXT000006073984/LEGISCTA000006157200/?_x_tr_sl=fr&_x_tr_tl=en&_x_tr_hl=en&_x_tr_pto=sc#LEGISCTA000006157200

 

In other words the insurer can drop him over his failure to declare his BPH, and keep the premium paid up to that point regardless. Whether or not they can keep unused premium (payment for the period thereafter) depends on whether or not he acted in bad faith in not declaring it.  If he can make a convincing  case that he did not, they can still cancel the policy but he can get a partial refund of premium.

 

These regulations are in no way limited to EU countries. Penalties for failing to disclose a health condition at the time of insurance application are severe  everywhere and (though not applicable in this instance) can include having to repay any insurance claim the company paid out on.

[Lorry]

2 hours ago, Sheryl said:

when this reluctance or this misrepresentation changes the subject of the risk or diminishes the insurer's opinion of it

(from Art L 113-8)

 

Does the fact he didn't mention BPH diminish the insurer's opinion of the risk?

Simon thinks no. He thinks "BPH is not an illness".

I think he is wrong. But I also know of insurance companies that would not follow April's logic.

 

But I know nothing about French insurance law.

2 hours ago, Sheryl said:

Penalties for failing to disclose a health condition at the time of insurance application are severe  everywhere

This is generally true.

But, at least in continental Europe, there are exceptions. They are usually not practical for old people.  It may also be necessary to have residence or nationality in a certain country.

[liddelljohn]

Going back to Uk temporary may not be effective there are now very long waits for cancer diagnosis and treatments  UK has worst outcomes in Europe for cancer treatment  ,you will need a UK address they are now denying some long term expats treatment

[scubascuba3]

1 hour ago, liddelljohn said:

they are now denying some long term expats treatment

you have a link for that? I've not read that anywhere 

[Mark Nothing]

This is your wakeup call. Are you going to answer it?

[simon43]

6 hours ago, liddelljohn said:

Going back to Uk temporary may not be effective there are now very long waits for cancer diagnosis and treatments  UK has worst outcomes in Europe for cancer treatment  ,you will need a UK address they are now denying some long term expats treatment

In fact, there are not long waiting lists for prostate cancer treatment.  I have already spoken with my old GP who says that the hospital are meeting the government targets of diagnosis procedures within 2 weeks of referral and surgery/treatment within 4 weeks.

 

Naturally I will need a UK address.  I will rent an apartment and sign a rental contract.

[simon43]

[quote]

...

oes the fact he didn't mention BPH diminish the insurer's opinion of the risk?

Simon thinks no. He thinks "BPH is not an illness".

I think he is wrong. But I also know of insurance companies that would not follow April's logic.

...

[/quote]

 

My take on this is that the only time that BPH was mentioned to me by a doctor was about 12 years ago when the Thai doctor who did my health check told me verbally that I had slight BPH.  After that, at all the health check-ups that I've had, no doctor has ever diagnosed me with BPH, nor have I ever had medication for BPH until recently.

 

In any case, BPH has nothing to do with prostate cancer at all.  That is a proven fact.  It is like being refused treatment for prostate cancer because you failed to disclose that you have a bunion on your right foot.  It is irrelevant.  Unfortunately, April's T&Cs state that they can deny you cover/cancel the policy if you fail to disclose any health condition, whether or not it is relevant to the condition that you're claiming for.

 

If it hadn't been the BPH, it would have been my bunion......