April International

[pontious]

We had been warned that April would not pay for single room - even though most private hospitals do not have them. I just had 2 nights in BHP they deducted B2650 for using a single room. On a lengthy stay that could add a considerable bill you will have to pay.

[FriendlyFarang]

My April policy says

"Hospital room and board: Standard private room, Fully Covered"

What does yours say?

 

Why didn't you instruct the hospital to check with April that everything they do is covered?

[pontious]

6 minutes ago, FriendlyFarang said:

My April policy says

"Hospital room and board: Standard private room, Fully Covered"

What does yours say?

 

Why didn't you instruct the hospital to check with April that everything they do is covered?

I am on the Essential policy - you? Are you on the Thai or International one?

[still kicking]

So, what is the cut off age for health insurance for foreigners if there is any at all 

[FriendlyFarang]

8 minutes ago, pontious said:

I am on the Essential policy - you? Are you on the Thai or International one?

I have the "Essential H&S-16.375M, Nil Deductible, ASEAN excluding Singapore" policy, April Thailand, the insurance policy is actually from LMG insurance.

[pontious]

Just now, FriendlyFarang said:

I have the "Essential H&S-16.375M, Nil Deductible, ASEAN excluding Singapore" policy, April Thailand, the insurance policy is actually from LMG insurance.

That is a different policy - they will price you out as you get older like all Thai policies. Good luck anyway.

[Henricus]

13 hours ago, FriendlyFarang said:

I have the "Essential H&S-16.375M, Nil Deductible, ASEAN excluding Singapore" policy, April Thailand, the insurance policy is actually from LMG insurance.

I have the same, deductible 1350 Usd never had any problem. 

[topt]

On 11/28/2022 at 9:17 PM, still kicking said:

So, what is the cut off age for health insurance for foreigners if there is any at all 

With April International you need to be signed up by age 71 to carry on as long as you can keep paying.

It will vary by each individual provider however most Thai based insurers will stop insuring you at a certain age and has nothing to do with whether Thai or foreigner.

[topt]

On 11/28/2022 at 9:12 PM, pontious said:

I am on the Essential policy - you? Are you on the Thai or International one?

Pontious in April International Benefits pdf it states this under Essential policy -

standard private
room
up to €/$75 per
day

 

So my guess is the cost was more than that hence the deduction. I am on the Basic insurance so mine would be a bigger problem as not covered at all in a private room........

[richard_smith237]

I had April insurance - the refused a pay out. 

 

Perhaps my fault for failing to disclosed what they called a pre-existing condition within 5 years. 

 

Approx 5 years before taking the insurance (about 4 years and 10 months to be precise) - I’d passed a kidney stone... (Scans showed no more evidence of a stone - the passing of the stone and no evidence of further stones was noted on my record). 

 

Over 5 years later, half way thought that years April Insurance coverage a routine medical checkup identified another stone.

 

I decided to have lithotripsy to have the stone removed (that failed) - the cost was 130,000 baht, with one overnight stay at Bumrungrad. 

 

April pre-authorised treatment and authorised payment on departure from hospital. 

 

Two months later I received the bill from Bumrungrad - April had refused payment because a kidney stone was considered a pre-existing condition. 

That there was proof that I had no stones 5 years earlier, that I had previously had a stone was considered a pre-existing condition and on that technicality they refused payout. 

 

I argued that having a broken leg is not a preexisting condition and they can’t refuse treatment for having another, but they still classify a previous kidney stone as pre-existing. 

 

A further facet of this: IF April had not preauthorised treatment I would have gone to a chapter hospital for treatment - Thus, not only did they refuse to pay, but I ended up paying for more expensive treatment than I would have had I known they were not going to cover payment. 

 

Come renewal, I removed my family and from any cover with April  (April International BTW). 

 

 

 

 

[pontious]

15 hours ago, topt said:

Pontious in April International Benefits pdf it states this under Essential policy -

standard private
room
up to €/$75 per
day

 

So my guess is the cost was more than that hence the deduction. I am on the Basic insurance so mine would be a bigger problem as not covered at all in a private room........

Thank you for the reply -overnight the price dropped to 725B private room. The trouble is BHP lump everything, nurses care food, drips etc in one line. They should separate each component, but do not.  A colleague on TV who is very knowledgeable in these matters says BHP are probably the worst for dealing with insurance - they should not be - but they are. Am glad to update to reassure holders of the INTERNATIONAL policy. Sometimes it is liking to talking to a wall. 3 different Customer Service staff that April will pay for home medication but it must be itemised. -Was it -NO -  HOME MEDICATION XXXX bAHT. You can claim that back within 30 days with a complete description of what the medicine was and how much it cost but if they had complied with my request to 3 different people THEY DID NOT!!!! I would not have extra hassle - that I really cannot be bothered with  -it was only 1100 Baht.

[timoti]

On 12/3/2022 at 4:08 PM, richard_smith237 said:

I had April insurance - the refused a pay out. 

 

Perhaps my fault for failing to disclosed what they called a pre-existing condition within 5 years. 

 

Approx 5 years before taking the insurance (about 4 years and 10 months to be precise) - I’d passed a kidney stone... (Scans showed no more evidence of a stone - the passing of the stone and no evidence of further stones was noted on my record). 

 

Over 5 years later, half way thought that years April Insurance coverage a routine medical checkup identified another stone.

 

I decided to have lithotripsy to have the stone removed (that failed) - the cost was 130,000 baht, with one overnight stay at Bumrungrad. 

 

April pre-authorised treatment and authorised payment on departure from hospital. 

 

Two months later I received the bill from Bumrungrad - April had refused payment because a kidney stone was considered a pre-existing condition. 

That there was proof that I had no stones 5 years earlier, that I had previously had a stone was considered a pre-existing condition and on that technicality they refused payout. 

 

I argued that having a broken leg is not a preexisting condition and they can’t refuse treatment for having another, but they still classify a previous kidney stone as pre-existing. 

 

A further facet of this: IF April had not preauthorised treatment I would have gone to a chapter hospital for treatment - Thus, not only did they refuse to pay, but I ended up paying for more expensive treatment than I would have had I known they were not going to cover payment. 

 

Come renewal, I removed my family and from any cover with April  (April International BTW). 

 

 

 

 

How did they find out about the previous kidney stone? Was it the same hospital or thai hospitals share policies? I bet if you used different passport, they wouldn't know about this since the new operation would be under a new record.

[richard_smith237]

6 hours ago, timoti said:

How did they find out about the previous kidney stone? Was it the same hospital or thai hospitals share policies? I bet if you used different passport, they wouldn't know about this since the new operation would be under a new record.

Same hospital - records from just under 5 years previously stated - kidney stone present in ultra-sound during medical check-up the previous year, no longer present / has passed. That was sufficient for them to classify the kidney stone as a pre-existing condition...

 

Treatment at a different hospital may not have had the same notes (I’m not sure if hospitals can share information). 

 

Using a different passport won’t work - we are still identified by Name & DOB if we have existing hospital records. 

 

 

 

 

[Sheryl]

It is also possible the the doctor in his notes  for the current condition  mentioned the prior stone.  In fact that is the most likely explanation.

 

Having had 1 kidney stone does in fact put you at greater than avetage risk for another. 

[richard_smith237]

46 minutes ago, Sheryl said:

It is also possible the the doctor in his notes  for the current condition  mentioned the prior stone.  In fact that is the most likely explanation.

 

Having had 1 kidney stone does in fact put you at greater than avetage risk for another. 

Correct. Notes from 6 years prior to taking out the insurance stated presence of a stone. 

Also, notes from 4 years 10 months (approx) prior to taking out the insurance that a stone was no longer present and likely passed. 

 

These notes were in my medical file and the insurance company had access to these notes. 

 

The insurance policy had a 5 year moratorium on pre-existing renal conditions and as there was a note within that 5 years (at the time of taking out the insurance) a kidney stone was considered a pre-existing condition (even though the note stated a stone previously observed was no longer present / had passed).

 

Additionally, the ’new' stone was found in the other kidney (if it matters)...  towards the end of that years period of cover.... in effect nearly 7 years after finding the first stone and 5 years 10 months (approx) after the Drs notes stated no stone present. 

 

All a very flimsy argument from the insurer who at first pre-authorised cover, then refused to pay following treatment. 

 

In hindsight I should have gone to a different hospital which did not have my records. 

 

IMO - based on the wording of the policy the Insurance company should have paid. 

April had just enough wiggle-room to work their way out of payment. 

I was threatened with legal action from the hospital - I need to travel frequently for work, it wasn’t worth the hassle or money to fight the issue. 

 

Another point: VUMI may very well have reacted the same way, it's impossible to know. 

 

VUMI have paid out without an issue for some treatment required by my Wife (something similar to an Ectopic pregnancy).

 

As I now have cover though work, I renewed VUMI for only my Wife and Son this year.

VUMI tried to get a little tricky - VUMI wanted to start cover for my Wife and Son from new, and include a ‘pre-existing condition’ for my Wife (based on her previous years treatment) - I had to argue with VUMI that the cover was ‘continuing’, I was just being removed from the Plan and my Wife and Son were not starting new cover, but continuing existing cover. 

 

IMO - All / many insurance companies are deliberately tricky - VUMI did agree in to cover without pre-existing conditions in the end, but still, I had to force the issue. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Edited December 30, 2022 by richard_smith237

[Sheryl]

If the stone was more than 5 years prior and they are basing the exclusion on date of a note stating the stone is gone you have a good case for appeal.

 

Sppeal process is dedcribed in uour poljcy focumrnts. If appeal to April fsils you can go up yo next level.

[timoti]

On 12/30/2022 at 10:33 PM, richard_smith237 said:

Same hospital - records from just under 5 years previously stated - kidney stone present in ultra-sound during medical check-up the previous year, no longer present / has passed. That was sufficient for them to classify the kidney stone as a pre-existing condition...

 

Treatment at a different hospital may not have had the same notes (I’m not sure if hospitals can share information). 

 

Using a different passport won’t work - we are still identified by Name & DOB if we have existing hospital records. 

 

 

 

 

Oh I see, I thought they use passport number also. From what I have been told April or other insurance companies only check the name for bills.

 

So I guess having another passport with slightly different DOB and number is advisable?

 

On 12/30/2022 at 10:42 PM, Sheryl said:

It is also possible the the doctor in his notes  for the current condition  mentioned the prior stone.  In fact that is the most likely explanation.

 

Having had 1 kidney stone does in fact put you at greater than avetage risk for another. 

Do you think April would classify a new kidney stone as preexisting within a year or 2? I ask this because I know some insurance companies say even if you never had this, because it takes time for the stone to form, they classify it as pre-existing. But then how can you know about this in advance if it's forming in 1-2 years?

 

On 12/30/2022 at 11:29 PM, richard_smith237 said:

Correct. Notes from 6 years prior to taking out the insurance stated presence of a stone. 

Also, notes from 4 years 10 months (approx) prior to taking out the insurance that a stone was no longer present and likely passed. 

 

These notes were in my medical file and the insurance company had access to these notes. 

 

The insurance policy had a 5 year moratorium on pre-existing renal conditions and as there was a note within that 5 years (at the time of taking out the insurance) a kidney stone was considered a pre-existing condition (even though the note stated a stone previously observed was no longer present / had passed).

 

Additionally, the ’new' stone was found in the other kidney (if it matters)...  towards the end of that years period of cover.... in effect nearly 7 years after finding the first stone and 5 years 10 months (approx) after the Drs notes stated no stone present. 

 

All a very flimsy argument from the insurer who at first pre-authorised cover, then refused to pay following treatment. 

 

In hindsight I should have gone to a different hospital which did not have my records. 

 

IMO - based on the wording of the policy the Insurance company should have paid. 

April had just enough wiggle-room to work their way out of payment. 

I was threatened with legal action from the hospital - I need to travel frequently for work, it wasn’t worth the hassle or money to fight the issue. 

 

Another point: VUMI may very well have reacted the same way, it's impossible to know. 

 

VUMI have paid out without an issue for some treatment required by my Wife (something similar to an Ectopic pregnancy).

 

As I now have cover though work, I renewed VUMI for only my Wife and Son this year.

VUMI tried to get a little tricky - VUMI wanted to start cover for my Wife and Son from new, and include a ‘pre-existing condition’ for my Wife (based on her previous years treatment) - I had to argue with VUMI that the cover was ‘continuing’, I was just being removed from the Plan and my Wife and Son were not starting new cover, but continuing existing cover. 

 

IMO - All / many insurance companies are deliberately tricky - VUMI did agree in to cover without pre-existing conditions in the end, but still, I had to force the issue. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is Vumi only in Thailand? I think I was mentioned them before.

[timoti]

19 minutes ago, timoti said:

Oh I see, I thought they use passport number also. From what I have been told April or other insurance companies only check the name for bills.

 

So I guess having another passport with slightly different DOB and number is advisable?

 

Do you think April would classify a new kidney stone as preexisting within a year or 2? I ask this because I know some insurance companies say even if you never had this, because it takes time for the stone to form, they classify it as pre-existing. But then how can you know about this in advance if it's forming in 1-2 years?

 

Is Vumi only in Thailand? I think I was mentioned them before.

Edit: also i think record sharing between hospitals depend on the country. I think in Thailand no because when i sent to different hospital the new doctor also wanted to do xray despite me telling him the first doctor did also.

[Sheryl]

1 hour ago, timoti said:

Oh I see, I thought they use passport number also. From what I have been told April or other insurance companies only check the name for bills.

 

So I guess having another passport with slightly different DOB and number is advisable?

 

Do you think April would classify a new kidney stone as preexisting within a year or 2? I ask this because I know some insurance companies say even if you never had this, because it takes time for the stone to form, they classify it as pre-existing. But then how can you know about this in advance if it's forming in 1-2 years?

 

Is Vumi only in Thailand? I think I was mentioned them before.

If you have never previously had a kidney stone and did not, as far as can be reasonably determined, have one at the time policy was issued then it is not a pre-existing condition.

[Sheryl]

1 hour ago, timoti said:

Edit: also i think record sharing between hospitals depend on the country. I think in Thailand no because when i sent to different hospital the new doctor also wanted to do xray despite me telling him the first doctor did also.

It is necessary to yourself get your records from one hospital and bring them to the other. In case of xray or scsn  get it on CD.  

[HampiK]

2 hours ago, timoti said:

Oh I see, I thought they use passport number also. From what I have been told April or other insurance companies only check the name for bills.

 

So I guess having another passport with slightly different DOB and number is advisable?

 

Do you think April would classify a new kidney stone as preexisting within a year or 2? I ask this because I know some insurance companies say even if you never had this, because it takes time for the stone to form, they classify it as pre-existing. But then how can you know about this in advance if it's forming in 1-2 years?

 

Is Vumi only in Thailand? I think I was mentioned them before.

I have asked a few weeks ago about this: VUMI International health insurance

[scubascuba3]

8 hours ago, Sheryl said:

If you have never previously had a kidney stone and did not, as far as can be reasonably determined, have one at the time policy was issued then it is not a pre-existing condition.

Would insurers ever claim cancer is a pre-existing condition? can take 10 years to grow

[jerrymahoney]

3 hours ago, scubascuba3 said:

Would insurers ever claim cancer is a pre-existing condition? can take 10 years to grow

This is a definition from the National Assoc. of (State) Insurance Commissioners in the US:

 

A health benefit plan shall not define a preexisting condition more restrictively than: 

<snip>

i. A condition that would have caused an ordinarily prudent person to seek medical advice, diagnosis, care or treatment during the six (6) months immediately preceding the effective date of coverage; 

 

https://content.naic.org/sites/default/files/inline-files/State Preexisting Definitions Chart.docx

 

[blackshadow]

anybody know about WR LIFE AND HEALTH INSURANCE/....... are they good??

[brewsterbudgen]

19 minutes ago, blackshadow said:

anybody know about WR LIFE AND HEALTH INSURANCE/....... are they good??

 

[scubascuba3]

3 hours ago, jerrymahoney said:

This is a definition from the National Assoc. of (State) Insurance Commissioners in the US:

 

A health benefit plan shall not define a preexisting condition more restrictively than: 

<snip>

i. A condition that would have caused an ordinarily prudent person to seek medical advice, diagnosis, care or treatment during the six (6) months immediately preceding the effective date of coverage; 

 

https://content.naic.org/sites/default/files/inline-files/State Preexisting Definitions Chart.docx

 

and Thailand? remember thai logic?

I'd be amazed if a thai insurer would cover it if you've only been customer a short time. @Sheryl would know

[Sheryl]

6 hours ago, scubascuba3 said:

Would insurers ever claim cancer is a pre-existing condition? can take 10 years to grow

 

 

I have never heard of that happening unless there were  prior indications or known risk factors.

 

You are overthinking this.

 

Many -- indeed most -- conditions develop over time. The point at which a condition or known risk factor for it  manifests symptoms or is documented in test results,  is the point at which, for insurance purp9ses, it first exists.

 

 

[Sheryl]

7 minutes ago, scubascuba3 said:

and Thailand? remember thai logic?

I'd be amazed if a thai insurer would cover it if you've only been customer a short time. @Sheryl would know

A Thai insurer - indeed any insurer -- would look very closely at a cancer or other chronic illness claim made in say the first year of a policy. They'd look for any record of symptoms or undeclared risk factors pre-dating the policy.

 

However if none exist then they would have to  cover it - unless the policy specifies a moratorium period which some do.

 

Difference between Thai insurers and international insurers is that the former use non medically trained people and vaguely worded reference charts to identify "related" symptoms  and sometimes come up with far fetched conclusions as a result. Also, more Thai policies are on a moratorium basis rather than full medical underwriting. And many expats seem to buy such poluvies without understanding yhat this is what they have.

 

[blackshadow]

1 hour ago, brewsterbudgen said:

 

thanks for replies

[pontious]

DELETED

Edited February 28, 2023 by pontious
DELETE