Insurance companies checking your medical records

[OneMoreFarang]

22 minutes ago, Ralf001 said:

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.

 

You write you disclosed nothing to them. Did they ask medical questions? Did they state that preexisting conditions are not covered? Then you shouldn't be surprised that they didn't pay.

[Ralf001]

1 hour ago, OneMoreFarang said:

You write you disclosed nothing to them. Did they ask medical questions? Did they state that preexisting conditions are not covered? Then you shouldn't be surprised that they didn't pay.

I did not speak them in person, on phone or email.

 

HR manager handed me a business card size piece of plastic not long after starting employment, he said "this is your work funded private insurance, show it when you need to".

 

I did not disclose my medical history to HR manager.

[Liverpool Lou]

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

...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.

...if you plan an expensive heart operation then you can be sure the insurance will check your past records for anything they can use to verify your claim.

[OneMoreFarang]

7 minutes ago, Ralf001 said:

I did not speak them in person, on phone or email.

 

HR manager handed me a business card size piece of plastic not long after starting employment, he said "this is your work funded private insurance, show it when you need to".

 

I did not disclose my medical history to HR manager.

Recently I read the fine print of a corporate group health policy. New employees from a specific company get it without answering any (medical) questions and without signing anything. 

In the case which I know the employer tells the people the insurance will cover anything without any medical questions or examination.

That is almost correct, apart from the small print, which probably only few people read, that the insurer doesn't have to pay for preexisting conditions.

Result: the employee never lied and never withheld information, because he was never asked. But the insurance doesn't have to pay because they write in their contract that they don't pay for preexisting conditions.

[Ralf001]

4 minutes ago, OneMoreFarang said:

Recently I read the fine print of a corporate group health policy. New employees from a specific company get it without answering any (medical) questions and without signing anything. 

In the case which I know the employer tells the people the insurance will cover anything without any medical questions or examination.

That is almost correct, apart from the small print, which probably only few people read, that the insurer doesn't have to pay for preexisting conditions.

Result: the employee never lied and never withheld information, because he was never asked. But the insurance doesn't have to pay because they write in their contract that they don't pay for preexisting conditions.

yeah the pre-existing thing is with pretty much all private health policies, common knowledge to all.

 

How did this insurance company know my history ?

 

If I had a inkling of an idea my pneumonia would be denied due to a mild stroke years ago.... I would have gone to a govt hospital.

 

I now know my "private health insurance" is worth less than the plastic card in my wallet.

will take me atleast 12 months to pay back the 500k I had to borrow to pay the bill.

Edited June 16, 2023 by Ralf001

[OneMoreFarang]

2 hours ago, Ralf001 said:

I now know my "private health insurance" is worth less than the plastic card in my wallet.

will take me atleast 12 months to pay back the 500k I had to borrow to pay the bill.

Have you considered asking your employer to pay that money to you?

I have no idea if you could win such a fight. But if you have somewhere in writing from your employer that  you will get an insurance which will pay everything and they nowhere mention any possible exception, then maybe you have a case.

[scubascuba3]

7 hours ago, Ralf001 said:

How did this insurance company know my history ?

Either there's some kind of secret central database or they contact all hospitals

[jerrymahoney]

As long as this topic is now hypothesizing on secret medical record databases, maybe this:

 

The gent says he spent 3 months and 500k baht on his pneumonia stay. That would indicate to me they ran a lot of tests. Was there some indication in those tests that there had been a prior stroke?
 

Edited June 16, 2023 by jerrymahoney

[Ralf001]

5 hours ago, OneMoreFarang said:

Have you considered asking your employer to pay that money to you?

I have no idea if you could win such a fight. But if you have somewhere in writing from your employer that  you will get an insurance which will pay everything and they nowhere mention any possible exception, then maybe you have a case.

Why should my employer cover the bill... not their fault this insurance company denied claim.

 

The bill I might add, my employer paid it, I was in a medically induced coma when moved to another hospital.... bill had to be paid before the hospital would let me go.

Edited June 16, 2023 by Ralf001

[Ralf001]

38 minutes ago, scubascuba3 said:

Either there's some kind of secret central database or they contact all hospitals

As both events happened in Thailand Iam assuming there is some sort of medical record database.

[scubascuba3]

56 minutes ago, Ralf001 said:

As both events happened in Thailand Iam assuming there is some sort of medical record database.

Were the two hospitals local or in different parts of Thailand?

[OneMoreFarang]

2 hours ago, Ralf001 said:

Why should my employer cover the bill... not their fault this insurance company denied claim.

 

The bill I might add, my employer paid it, I was in a medically induced coma when moved to another hospital.... bill had to be paid before the hospital would let me go.

I know an employer who tells their employees that the insurance will cover everything. But in the insurance contract, which the employee doesn't need to sign or acknowledge, is written that the insurance does not have to pay for preexisting conditions. So in that case it seems the employer promised more than the insurance. It is incorrect from the employer to make incorrect promises. I have no idea if that could be reason enough to demand the money from the employer - who made the incorrect promise. 

[scubascuba3]

44 minutes ago, OneMoreFarang said:

I know an employer who tells their employees that the insurance will cover everything. But in the insurance contract, which the employee doesn't need to sign or acknowledge, is written that the insurance does not have to pay for preexisting conditions. So in that case it seems the employer promised more than the insurance. It is incorrect from the employer to make incorrect promises. I have no idea if that could be reason enough to demand the money from the employer - who made the incorrect promise. 

Employers love difficult employees, just not worth the risk of being fired down the line

[Ralf001]

2 hours ago, scubascuba3 said:

Were the two hospitals local or in different parts of Thailand?

Both Chonburi

[Ralf001]

1 hour ago, OneMoreFarang said:

I know an employer who tells their employees that the insurance will cover everything. But in the insurance contract, which the employee doesn't need to sign or acknowledge, is written that the insurance does not have to pay for preexisting conditions. So in that case it seems the employer promised more than the insurance. It is incorrect from the employer to make incorrect promises. I have no idea if that could be reason enough to demand the money from the employer - who made the incorrect promise. 

Demanding an employer cover the costs of a denied claim seems to me to be a quick track way to unemployment !

 

My employer made no promises as to what the insurance covers, luckily my social security did cover the costs at the other private hospital I was moved to..... that bill was very exxy but my only out of pocket expenses was for the private ward room once I left ICU.

 

Amusingly my previous employer's provided insurance did cover the costs I had a stroke at the same hospital (BPH) I was attending for hypertension and claudication.

Edited June 17, 2023 by Ralf001

[NanLaew]

On 6/15/2023 at 9:38 AM, Sheryl said:

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. 

Correct, thanks @Sheryl, and to add that pay attention to what is in your medical history as recorded by the health care provider.

 

When I signed up for a new health insurance policy just after Covid, I ticked the 'No' box against the personal history of hypertension question; it had never been an issue in my life. However, on reviewing my very limited Thai health care provider data that I agreed to release following a claim, they found a one-off instance of evidence of Stage 1 hypertension recorded during an offshore industry medical from about six years previous. That was enough for them to add a weighting (increase) to my 1-year premium, already paid. My medical claim was not related to hypertension in any way.

[scubascuba3]

1 hour ago, NanLaew said:

Correct, thanks @Sheryl, and to add that pay attention to what is in your medical history as recorded by the health care provider.

 

When I signed up for a new health insurance policy just after Covid, I ticked the 'No' box against the personal history of hypertension question; it had never been an issue in my life. However, on reviewing my very limited Thai health care provider data that I agreed to release following a claim, they found a one-off instance of evidence of Stage 1 hypertension recorded during an offshore industry medical from about six years previous. That was enough for them to add a weighting (increase) to my 1-year premium, already paid. My medical claim was not related to hypertension in any way.

I had high pressure recorded at hospital after being bitten by a dog, otherwise always in the healthy green range, i bet they'd use that against me to deny a claim

[BE88]

13 hours ago, Ralf001 said:

 

 

 

 

13 hours ago, Ralf001 said:

 

 

How did this insurance company know my history ?

 

 

Maybe you haven't realized yet that you live in a world where everything is digitized and it's extremely easy to find everything about yourself and even how much you spend a month and how much money you have in the bank and even what you want to do in your near future by finding it on social networks that you love, or maybe not...

 

Welcome to the country of fools.

 

[OneMoreFarang]

A long time ago I did a checkup in a well-known private hospital in Bangkok. After lot of tests, I spoke with a doctor. He also asked me how much alcohol I drink. I answered truthfully that I drink seldom. But sometimes I go out and drink >10 whisky on that night.

Years later I asked for my records from that hospital. And what did I read: He drinks more than 10 glasses of whisky a night. Yeah, thanks for that! 

[jerrymahoney]

2 hours ago, OneMoreFarang said:

After lot of tests, I spoke with a doctor. He also asked me how much alcohol I drink.

So you are suggesting that being asked by the doctor how much alcohol you drink had nothing to do with your just having a lot of tests?

[Ralf001]

1 hour ago, BE88 said:

 

Maybe you haven't realized yet that you live in a world where everything is digitized and it's extremely easy to find everything about yourself and even how much you spend a month and how much money you have in the bank and even what you want to do in your near future by finding it on social networks that you love, or maybe not...

 

Welcome to the country of fools.

 

You think Iam a caveman still living under a rock ?

 

I don't for 1 second think hospitals share patient records outside of their own organization, hence my assumption there IS a medical record database in Thailand rings fairly accurate as far as iam concerned nor do I believe an insurance company requests records from every hospital in the world when a claim is filed.

 

As for how much I spend every month or how much is in my bank accounts.

I get paid on the first of every month, 80% is transferred to my home country, both accounts (Thai and home country) have their balance reduced to zero the same day.

I have zero money in the bank and other than my credit cards... it is impossible to know how much I spend each month.

 

 

[OneMoreFarang]

1 hour ago, jerrymahoney said:

So you are suggesting that being asked by the doctor how much alcohol you drink had nothing to do with your just having a lot of tests?

It's a long time ago. But I don't think so. It was one of those "do you drink? do you smoke?" questions which every doctor seems to ask routinely.

I never had a liver problem or anything else that is typically related to alcohol. 

 

Since I discovered that entry in my hospital records, I am very careful with volunteering information which can be misinterpreted. 

 

[BE88]

1 hour ago, Ralf001 said:

You think Iam a caveman still living under a rock ?

 

I don't for 1 second think hospitals share patient records outside of their own organization, hence my assumption there IS a medical record database in Thailand rings fairly accurate as far as iam concerned nor do I believe an insurance company requests records from every hospital in the world when a claim is filed.

 

As for how much I spend every month or how much is in my bank accounts.

I get paid on the first of every month, 80% is transferred to my home country, both accounts (Thai and home country) have their balance reduced to zero the same day.

I have zero money in the bank and other than my credit cards... it is impossible to know how much I spend each month.

 

 

 

1 hour ago, Ralf001 said:

 

I have zero money in the bank and other than my credit cards... it is impossible to know how much I spend each month.

 

 

It seems to me that you only superficially read my answer. If you continuously use your digital money transfers and then you are surprised that your insurer knows nothing about you and because you live in your own world and not in the real world.

 

Today an insurance company that knows nothing about its policyholders no longer exists or would have gone bankrupt long ago.

 

About your credit cards, your final statement is really funny.

 

 

 

 

[Ralf001]

1 hour ago, BE88 said:

 

It seems to me that you only superficially read my answer. If you continuously use your digital money transfers and then you are surprised that your insurer knows nothing about you and because you live in your own world and not in the real world.

 

Today an insurance company that knows nothing about its policyholders no longer exists or would have gone bankrupt long ago.

 

About your credit cards, your final statement is really funny.

 

 

 

 

I transfer from Thailand to my home country...then the money disappears, How can it be traced ?

 

Yes my credit cards tell my monthly daily spendings............ which part of that did you not understand ?