Insurance companies checking your medical records

[omnipresent]

I'd like to know more about how insurance companies can check your medical records, especially when you've made a claim.

 

Which hospitals can they check, and which can't they check? Every hospital in the world? Only big ones? How about non-hospital clinics?

 

e.g. I once visited the Department of Thai Traditional and Alternative Medicine (DTAM) and got prescribed some medicine there by a doctor. Could insurance companies discover such a record?

 

Do hospitals give insurance companies access to their database so that they can check any time, or must insurance companies make a request and wait?

 

[JimTripper]

When I got my policy it said no exclusions, and it says that on my card also. I don’t think they check past records on mine after a claim, I think they already did it when I was approved for the policy.

[treetops]

In my experience the hospital confirmed with me before they released any information to the insurance company so it hadn't been done at approval stage, and the only hospital they checked was the one I was attending AFAIK.

[chalawaan]

Medical records are requested after you make a claim. Both for the claim treatment, and historical from your doctor.

Which is why it pays to be open and upfront on the questionnaire. 

Prior health events are usually grounds for an exclusion of cover related to that. For example, various Cancers. 

 

Your age and self declared history will impact your policy when it is offered. 

 

There's no one size fits all, I'm just reporting my experience with a serious but short illness well into my 50s.

 

And yes, they paid out in full! $17,000. 

Edited June 14, 2023 by chalawaan

[OneMoreFarang]

When you sign an insurance contract then you sign that you allow everyone who ever treated you to release all the information.

And you have to answer all their questions correctly. You might think: that short visit at the doctor a couple of years ago doesn't matter. And maybe it doesn't. But maybe the insurance thinks otherwise.

 

I think the principle is easy to understand. If you visit a doctor now because you have a cold and you want the money for that visit back, then don't worry.

But if you plan an expensive heart operation then you can be sure the insurance will check your past records for anything they can use against you. And if it is important then expect them to dig, and dig deep. 

 

 

 

[scubascuba3]

I reckon there's a central database, probably secret that insurers can access, unlikely they contact all hospitals and clinics in Thailand. With doctors back home in farangland they expect you to provide history when taking out insurance, if you don't they'd probably use lack of information against you

[Sheryl]

There is no central database. But it is quite easy for insurers to access medical records from all the private hospitals in Thailand and  when you sign an insurance claim you authorize the release of your medical information by any and all healrh care providers. 

 

Do not try to withold any information on your insurance application. If it is found that you have,  the entire policy can be voided. 

[omnipresent]

6 hours ago, Sheryl said:

it is quite easy for insurers to access medical records from all the private hospitals in Thailand

How about small clinics?

How about hospitals or clinics in other countries?

Can and do they really check these?

 

[scubascuba3]

6 hours ago, Sheryl said:

it is quite easy for insurers to access medical records from all the private hospitals in Thailand

How would they do that? let's say there's 50 private hospitals, they email each one? would be a mistake to only email local hospitals

[scorecard]

14 hours ago, chalawaan said:

Medical records are requested after you make a claim. Both for the claim treatment, and historical from your doctor.

Which is why it pays to be open and upfront on the questionnaire. 

Prior health events are usually grounds for an exclusion of cover related to that. For example, various Cancers. 

 

Your age and self declared history will impact your policy when it is offered. 

 

There's no one size fits all, I'm just reporting my experience with a serious but short illness well into my 50s.

 

And yes, they paid out in full! $17,000. 

My Thai son's buddy has a female child who has had many, some serious, medical issues since birth. Many stays in hospital 2 days - 10 days. Many tests and scans. 

 

About 1 yr back (girl was 2 yrs old) my son suggested to his buddy to get health insurance for the girl.

 

Progressively he applied to 3 insurance companies (all international companies), they all refused to issue a policy.

 

He asked on each occasion why, with no hesitation all 3 shared they had analysed the girls past medical history. 

Edited June 15, 2023 by scorecard

[Sheryl]

1 hour ago, scubascuba3 said:

How would they do that? let's say there's 50 private hospitals, they email each one? would be a mistake to only email local hospitals

Most of these private hospitals are part of chains. Many of them owned by the same company. I don't know exactly how it works but it seems to take then no time at all to locate records, they probably have some ready means of contacting all the hospitals in a chain.

 

Which is not to say that they might not miss one at an out of the way private hospital not part of a larger chain. But one should certainly not count on it.

 

 

[Sheryl]

1 hour ago, omnipresent said:

How about small clinics?

How about hospitals or clinics in other countries?

Can and do they really check these?

 

They cannot check hospitals in other countries, no. Nor small stand-alone clinics.

 

Remember that when seen by a doctor, much less hospitalized, they ask the relevant medical history and this gets recorded. Say you had a kidney stone back in your home country X years ago. Then admitted for same or related problem in Thailand. Your history of a prior stone -- which you would need to tell the doctor in order for him to properly diagnose/treat you - will then be on your Thai record and that is all it will take, no need for htem to have the original records from your home country.

it is really very simple: do not try to conceal your medical history. You are more than likely to regret it if you do.

[Sheryl]

16 hours ago, JimTripper said:

When I got my policy it said no exclusions, and it says that on my card also. I don’t think they check past records on mine after a claim, I think they already did it when I was approved for the policy.

Depends on the insurer. What you describe is the norm for international insurers -- though even they may dig a bit further if something about a claim rings alarm bells (usually these are claims submitted within a year or less  of newly getting the policy for something that, by its nature, stands a good chance of being pre-exisitng).

 

Many Thai insurers however seem to go back to thew original application again after a claim is made, and/or to dig through medical records again at that point, seeking evidence of a pre-existing condition. Worse, these investigations are done by non-medically trained people and the conclusions they draw are sometimes absurd.

[marin]

1 hour ago, omnipresent said:

How about small clinics?

How about hospitals or clinics in other countries?

Can and do they really check these?

 

Really sounds like you have hidden or are trying to hide something. 

[CartagenaWarlock]

13 hours ago, scubascuba3 said:

if you don't they'd probably use lack of information against you

You're right. My Ex wife, after marriage, never had to visit a doctor for almost 20-years. So she did not have any medical records (not even yearly health check up). When after we got divorced, she applied for Long-term care she was denied acceptance because she did not have any medical record. They even even won't take her after a health check up. 

[jerrymahoney]

On 6/15/2023 at 3:09 AM, OneMoreFarang said:

But if you plan an expensive heart operation then you can be sure the insurance will check your past records for anything they can use against you. And if it is important then expect them to dig, and dig deep. 

If you need an expensive heart operation, an experienced cardiologist may be able examine you and tell just how long this anomaly has existed without ever having to look back for any prior medical records

[OneMoreFarang]

1 hour ago, jerrymahoney said:

If you need an expensive heart operation, an experienced cardiologist may be able examine you and tell just how long this anomaly has existed without ever having to look back for any prior medical records

That's not the point.

Maybe it hurts a little since years, but you never visited a doctor, then it's no problem.

But if you i.e. 5 years ago visited a doctor and told him your heart hurts and you don't mention that on the application form, that can bite you in the here and now.

[jerrymahoney]

9 minutes ago, OneMoreFarang said:

That's not the point.

Maybe it hurts a little since years, but you never visited a doctor, then it's no problem.

That depends whether it 'hurts a little' before or after you took out the insurance.

 

And insurers often define a pre-existing condition as something a prudent person would have consulted with a doctor so the fact that you never consulted a doctor and thus no medical record might not be determinant.

[liddelljohn]

Thai Hospitals and insurers can access foreign medical records eventually if they have a claim ,, and in My experience the UK NHS will allow it   and also the UK insurers like BUPA have ways of accessing international medical records  if they really need to,not just Data bases as there are  international aggrements  and even private medical detective agents employed by the big insurers

 

Edited June 16, 2023 by liddelljohn

[jerrymahoney]

I was once asked to provide a medical record. This is he letter I received from the hospital in Florida (click on jpg to enlarge)

Edited June 16, 2023 by jerrymahoney

[scorecard]

22 hours ago, scubascuba3 said:

How would they do that? let's say there's 50 private hospitals, they email each one? would be a mistake to only email local hospitals

Maybe it's all online with very fast access by using a fast overall search facility, set up for the most efficient fast use by hospitals, insurance companies and anybody interested. 

[scubascuba3]

1 minute ago, scorecard said:

Maybe it's all online with very fast access by using a fast overall search facility, set up for the most efficient fast use by hospitals, insurance companies and anybody interested. 

Yep i reckon it is, good market for medical records

[JoseThailand]

On 6/15/2023 at 1:24 AM, JimTripper said:

I think they already did it when I was approved for the policy.

They don't check anything before selling you a policy. They normally do the checks after you make a claim to find a reason to deny your claim. That's how it works. 

[Sheryl]

2 minutes ago, JoseThailand said:

They don't check anything before selling you a policy. They normally do the checks after you make a claim to find a reason to deny your claim. That's how it works. 

With many Thai insurers, yes

 

International insurers do a quite detailed review of medical history. With panels of doctors to help. It is a much more thorough inital process and, assuming you told the truth and withheld nothing, you know where you stand in terms of coverage after that.

 

 

[jerrymahoney]

So this whole discussion is how can insurers find out about some  medical event about which you decided not to tell them.

[jerrymahoney]

7 minutes ago, Sheryl said:

and, assuming you told the truth and withheld nothing

Well that's the rub, Ms. Sheryl -- this topic is about how not to tell them the truth and withhold some adverse medical history.

Edited June 16, 2023 by jerrymahoney

[OneMoreFarang]

15 minutes ago, Sheryl said:

With many Thai insurers, yes

 

International insurers do a quite detailed review of medical history. With panels of doctors to help. It is a much more thorough inital process and, assuming you told the truth and withheld nothing, you know where you stand in terms of coverage after that.

Long time ago I worked in that business in Europe.

They did some initial checks, depending on the answers of the applicant. And maybe at the time they didn't sign a contract or only with exception or extra charge.

But it is wrong to think that if they checked initially that they will never check again later.

It seems some applicants like to "forget" lots of details. Then there is little to check initially.

But when then suddenly the person needs some expensive treatment or operation then they will most likely search for things which the patient "forgot" to mention. 

[Sheryl]

2 hours ago, jerrymahoney said:

Well that's the rub, Ms. Sheryl -- this topic is about how not to tell them the truth and withhold some adverse medical history.

Seemingly so. And as I have repeatefly said -  do not even considwr doing this. As many on this board have learned the hard wsy these things have a way of coming out and can leave you in a bad situation when they do. 

[Sheryl]

2 hours ago, OneMoreFarang said:

Long time ago I worked in that business in Europe.

They did some initial checks, depending on the answers of the applicant. And maybe at the time they didn't sign a contract or only with exception or extra charge.

But it is wrong to think that if they checked initially that they will never check again later.

It seems some applicants like to "forget" lots of details. Then there is little to check initially.

But when then suddenly the person needs some expensive treatment or operation then they will most likely search for things which the patient "forgot" to mention. 

Usually don't need to search very far. It is often right in the history of thd current claim.

[Ralf001]

Not sure how they know but my initial 3 month hospital stay this year was in a private hospital that should have been covered by my work supplied private cover.

 

That insurer denied payment after 3 days citing pre-existing conditions, I had disclosed nothing to them or my employer so they found out somehow.

I had a minor stroke 8 years ago, covered by insurance at BPH.... different insurance company.

 

Somehow they linked a stroke in 2015 to the severe pneumonia I was suffering in 2023...... and thats why they denied claim.

 

Edited June 16, 2023 by Ralf001