Medical Insurance.

[KhunLA]

40 minutes ago, retarius said:

Check ups are a rip off as well. Most medical care is a rip off. My advice is to start with a great diagnosis from the best physician you can afford, then after that it is pretty much routine to treat.

That's a ridiculous statement.  Check ups save lives.

 

How do you get that great diagnosis, without a check up, or symptoms requiring a diagnosis.

 

Not all illness have symptoms, and many, if having, well, too late now to treat.

 

Granted, all my check ups have been money spent for piece of mind, but that's fine.  10k baht a year ain't going to break the bank, and eliminates stress.

 

I've had polyps removed, no symptoms, even lied so they'd do the colonscopy.  Had other direction/endoscope done also, since there, and found a hiatal hernia, I didn't know I had.  Explains a lot, and now that I know, can manage it without surgery.

 

X rays/mamograms, and chickie check ups saves millions of lives every year.

[lopburi3]

2 hours ago, jerrymahoney said:

No symptoms of bladder-type issues prior to cancer diagnosis?

Bladder issues are not a normal symptom - blood in urine is most common first symptom (as it was for me).  With non invasive and easy ultra sound available now get any such blood issue checked ASAP.  It may only be exercise related as mine appeared - but cancer is a possibility.   

[mokwit]

4 hours ago, jerrymahoney said:

or should reasonably have
been) aware

Wriggle clause.

[jerrymahoney]

58 minutes ago, lopburi3 said:

Bladder issues are not a normal symptom - blood in urine is most common first symptom (as it was for me).  With non invasive and easy ultra sound available now get any such blood issue checked ASAP.  It may only be exercise related as mine appeared - but cancer is a possibility.   

With the case above where the cancer was "slow growing" and was there before the insurance was issued, it would seem the insurer felt there was at least some urological problem for which he should of sought medical intervention.

[scubascuba3]

2 hours ago, Ralf001 said:

Yeah I got denied claim early this year with the insurer citing pre-existing condition.

I was in Hospital with Pneumonia, the "pre-existing" condition was a minor stroke I had years ago !!

Yeah they will look for anything, they even use totally unrelated conditions to justify claim denied. It's a legalised con

[scubascuba3]

3 hours ago, jerrymahoney said:

You're welcome. From the CIGNA link above:

 

"or should reasonably have been) aware at the date cover commenced,"

 

So how long after he initiated coverage did he develop bladder cancer? No symptoms of bladder-type issues prior to cancer diagnosis?

No symptoms before, cancer was slow growing, maybe years, can take 10 years, 10 years is a great excuse for a claim denied, i might start a health insurance company, can't lose

[scubascuba3]

1 hour ago, Ralf001 said:

Thats the thing though.

 

I went to hospital on Jan 4th for what I thought maybe dehydration and possibly a bit of a chest cold... but defo feeling a bit ordinary.

Before the day ended I was in an induced coma on a ventilator..... my blood oxygen level was critically low they tell me. 

Does make you wonder, maybe income generated that month was a bit low, needed to get the money up, same when they fit stents, everyone thinks the Dr has saved their life but maybe it could be avoided and the cost

[KhunLA]

11 minutes ago, scubascuba3 said:

Yeah they will look for anything, they even use totally unrelated conditions to justify claim denied. It's a legalised con

I actually wouldn't expect an ins co. to cover me for anything expensive, especially if possible terminal diagnosis.   They'd just hedge their bet and hope I died.  At worse, pay small settlement, and only if family filed lawsuit.

 

Friend got a terminal diagnosis, (25 ish yrs old), and ins. co. dropped him like hot potato.   As if his day wasn't bad enough getting the news.

 

Turned out the diagnosis was completely wrong.  Not only was it not terminal, but not even cancer.  Scary they could have been that far off.

 

And yea, he sued the sh!t out of them, for huge pay off ????

 

So no, I wouldn't expect any company to honor their coverage, at my age, and especially with my past experiences.  6 times,  had to use courts to get compensation owed to me, from insurance underwriters, govt & private.

Edited August 20, 2023 by KhunLA

[jerrymahoney]

6 minutes ago, scubascuba3 said:

No symptoms before, cancer was slow growing, maybe years, can take 10 years, 10 years is a great excuse for a claim denied, i might start a health insurance company, can't lose

Great! and then you give hi-5's all around the office every time a claim is denied.

[Ralf001]

8 minutes ago, scubascuba3 said:

No symptoms before, cancer was slow growing, maybe years, can take 10 years, 10 years is a great excuse for a claim denied, i might start a health insurance company, can't lose

mine was detected by chance.

Whilst in hospital the drugs they were feeding me for Pneumonia (severe both lungs two different strains) were pretty hardcore they reckon and my large intestine called enough and perforated which result in emergency surgery for a cut, shut, bypass operation (healed now and colostomy bag removed 2 months ago)...... CT scan for intestine and lungs showed a 3cm kidney tumour... it is now 6cm and I have just started pissing blood.

Edited August 20, 2023 by Ralf001

[Ralf001]

4 minutes ago, scubascuba3 said:

Does make you wonder, maybe income generated that month was a bit low, needed to get the money up, same when they fit stents, everyone thinks the Dr has saved their life but maybe it could be avoided and the cost

They went a bit hardcore on me when I went into cardia arrest.

[scubascuba3]

3 minutes ago, jerrymahoney said:

Great! and then you give hi-5's all around the office every time a claim is denied.

Yes like this

[Ralf001]

5 minutes ago, KhunLA said:

 

 

So no, I wouldn't expect any company to honor their coverage, at my age, and especially with my past experiences.  6 times,  had to use courts to get compensation owed to me, from insurance underwriters, govt & private.

Had a stroke years ago.. fronted Bangkok Pattaya hospital, was in there for weeks many of which in ICU.

Bill was up around the 7 mill mark.... insurance did not blink an eye and approved immediately.

[jerrymahoney]

3 minutes ago, Ralf001 said:

Had a stroke years ago.. fronted Bangkok Pattaya hospital, was in there for weeks many of which in ICU.

Bill was up around the 7 mill mark.... insurance did not blink an eye and approved immediately.

That's too bad -- so they didn't get to ring the "claim denied" bell.

[Ralf001]

4 minutes ago, jerrymahoney said:

That's too bad -- so they didn't get to ring the "claim denied" bell.

Well.... they did make me sit in AE for 6 hrs before approving all costs so I guess it went to upper management for a decision but yeah at check out time... the bill to me was Bt.0.00.

To be fair though it was work supplied insurance... and the HR manager was driving the claim, maybe that helped.

To add on top of that, the meds the docs had me on totalled Bt.30,000 a month.... paid for by insurance.

I no longer take those meds.

Edited August 20, 2023 by Ralf001

[jerrymahoney]

2 minutes ago, Ralf001 said:

Well.... they did make me sit in AE for 6 hrs before approving all costs so I guess it went to upper management for a decision but yeah at check out time... the bill to me was Bt.0.00.

To be fair though it was work supplied insurance... and the HR manager was driving the claim, maybe that helped.

To add on top of that, the meds the docs had me on totalled Bt.30,000 a month.... paid for by insurance.

I no longer take those meds.

So I guess you are not a friend of Mr. AquaLung. All his friends get their claims denied.

[Ralf001]

1 minute ago, jerrymahoney said:

So I guess you are not a friend of Mr. AquaLung. All his friends get their claims denied.

Mixed bag mate... had a claim denied this year, different insurance company.

Unfortunately was already in for 300k when they denied... that hurt but managed to get it discounted down to just shy of 200k cash.

Edited August 20, 2023 by Ralf001

[bkk6060]

25 minutes ago, Ralf001 said:

Had a stroke years ago.. fronted Bangkok Pattaya hospital, was in there for weeks many of which in ICU.

Bill was up around the 7 mill mark.... insurance did not blink an eye and approved immediately.

There you go great example.  These "I stay in shape I am self insured" seem clueless how many have 7 mil waiting for care?  Arrogance really.  And, funny how they always come on here and say they are self insured yet never actually say how much...555.

There are no guarantees about anything in life which is why it is called insurance.  

Good luck.

[KhunLA]

17 minutes ago, Ralf001 said:

To be fair though it was work supplied insurance... and the HR manager was driving the claim, maybe that helped.

To add on top of that, the meds the docs had me on totalled Bt.30,000 a month.... paid for by insurance.

I no longer take those meds.

That would make a huge difference.

 

I was approved for hearing aids, but between the time of approval, and getting fitted with them, I got fired from the job.   Insurance coverage supposed to be continued for 30 day, no matter the reason to leaving company.

 

I'm in the chair, getting fitted (not in yet) and she calls the insurance carrier to get final authorization for specific units, and they decline the claim.   Talk about P'd off, she went ballistic on them.  I sued & they settled for $12k ????

 

Strangely, they approved, to my knowledge, a Chiro visit every other day for those 30 days.  Mind boggling who hand doesn't know what the other hand is dong.

 

That was a workman's comp claim, and add that to 2 other suits, I won against them.  Along with Soc Sec, and a private health insurance carrier.  

 

Even had to sue a homeowner insurance underwriter.

[georgegeorgia]

13 minutes ago, bkk6060 said:

There you go great example.  These "I stay in shape I am self insured" seem clueless how many have 7 mil waiting for care?  Arrogance really.  And, funny how they always come on here and say they are self insured yet never actually say how much...555.

There are no guarantees about anything in life which is why it is called insurance.  

Good luck.

Problem is risk of being denied.

I just spoke to a lady in my workplace who used to be a assessor in travel insurance.

 

It went in many factors in approving your claim , regular customer, etc 

 

If they were over budget they just made it difficult for you

 

eg refused your claim on some BS reason  even though it had good chance of success to await you to appeal and then will re assess it and still not happy you can take them to the insurance tribunal, of course they made you go through all these hoops & this and 95% of claimants would give up .

Edited August 20, 2023 by georgegeorgia

[KhunLA]

12 minutes ago, bkk6060 said:

And, funny how they always come on here and say they are self insured yet never actually say how much...555.

Way more money than I'm willing to spend, without selling any assets.   I'll go 1M maybe 2M, but I want guarantees I'm getting 5 more yrs of good, quality life.  That's something they can't give, at soon to by 69 yrs old.

 

Wife & kid can enjoy that money, instead of me hanging around for another year or so, full facilities or not.

 

In a couple year, my brother & myself will be the oldest ones ever, in our family tree.

Edited August 20, 2023 by KhunLA

[georgegeorgia]

1 minute ago, KhunLA said:

Way more money than I'm willing to spend, without selling any assets.   I'll go 1M maybe 2M, but I want guarantees I'm getting 5 more yrs of good, quality life.  That's something they can't give, at soon to by 69 yrs old.

 

Wife & kid can enjoy that money, instead of me hanging around for another year of so, full facilities or not.

There was a famous YouTuber several years ago who wasn't insured at 59 ( I thought he looked older but that's a other story)

 

Apparently got Cancer spent millions of baht ,ended up they couldn't cure him ,too late and went back to the UK to palliative care 

In hindsight he would of been better off going back immediately 

[Ralf001]

21 minutes ago, bkk6060 said:

There you go great example.  These "I stay in shape I am self insured" seem clueless how many have 7 mil waiting for care?  Arrogance really.  And, funny how they always come on here and say they are self insured yet never actually say how much...555.

There are no guarantees about anything in life which is why it is called insurance.  

Good luck.

I rarely get ill on any grand scale but when I do I do it proper.

Costs huge amounts and it aint something thats "cool thanks for the diagnosis doctor.... I'll go home and be treated for free by medicare" illness.

If I didnt have private insurance and Thai social security... there would be a 15mill+ hole in my pocket.

 

Edited August 20, 2023 by Ralf001

[scubascuba3]

49 minutes ago, Ralf001 said:

Well.... they did make me sit in AE for 6 hrs before approving all costs so I guess it went to upper management for a decision but yeah at check out time... the bill to me was Bt.0.00.

To be fair though it was work supplied insurance... and the HR manager was driving the claim, maybe that helped.

To add on top of that, the meds the docs had me on totalled Bt.30,000 a month.... paid for by insurance.

I no longer take those meds.

I've had health insurance through work they didn't blink when i claimed, even an operation which was arguably not essential, but costly. At work in farangland shouldn't be a problem. They could have easy said pre-existing condition and would have been correct, as it was from birth but didn't 

Edited August 20, 2023 by scubascuba3

[Ralf001]

3 minutes ago, scubascuba3 said:

I've had health insurance through work they didn't blink when i claimed, even an operation which was arguably not essential, but costly. At work in farangland shouldn't be a problem

The company that denied my claim this year.... was private health insurance provided by my employer.

When my comatised carcass was moved from Bangkok Pattaya to Phayathai Sriracha (my SS registered hospital) the private health did cover the private ward room and rehab costs once I got out of ICU.

Edited August 20, 2023 by Ralf001

[scubascuba3]

1 minute ago, Ralf001 said:

The company that denied my claim this year.... was private health insurance provided by my employer.

When my comatised carcass was moved from Bangkok Pattaya to Phayathai Sriracha (my SS registered hospital) the private health did cover the private ward room and rehab costs once I got out of ICU.

Sounds like Thai health insurance? you know, can't be trusted

[georgegeorgia]

We have free medical  (hospital)here in Australia....but the waiting list is high in public hospitals so I choose to pay the exhorted $225 AUD per month private health insurance BUPA and what do I get for it ?

 

Nothing !!!

it's a case of " just in case " 

Absolutely nothing back if your not sick 

 

They direct debit every month from my bank account of $225 and the promise of oh if you get sick you will go into a private hospital and be treated "quicker" than a government hospital, so they say anyway ,so they say 

 

Strangely I went to a urologist specialist in Australia last month ( Specialist here in Australia they aren't free to anyone still a " gap " fee to pay ) $150 for his 3 minutes of wisdom ,even pensioners have to pay this unless you wish to wait a few months to see one in a public hospital.

 

The first thing he was "Do you have private health insurance?

 

Yes I said 

His eyes lit up ...." Well we can put you in the private hospital next Thursday for a bladder check !

 

" of course there is a gap fee for the anthiesest and then the gap fee for the insurance but that's only $2000 !!!

He exclaimed 

 

"Do I really need one ? I said 

 

If I didn't have private health insurance and was a public patient would you bother with this bladder check?

 

The answer was no 

 

Bye I said 

 

 

 

 

 

Edited August 20, 2023 by georgegeorgia

[Ralf001]

7 minutes ago, scubascuba3 said:

Sounds like Thai health insurance? you know, can't be trusted

Tokico Marine.

[Ralf001]

7 minutes ago, georgegeorgia said:

We have free medical  (hospital)here in Australia....but the waiting list is high in Public hospitals so I choose to pay the exhorted $225 AUD per month private health insurance BUPA and what do I get for it ?

 

Nothing !!!

it's a case of " just in case " 

Absolutely nothing back if your not sick 

 

They direct debit every month from my bank account of $225 and the promise of oh if you get sick you will go into a private hospital and be treated "quicker" than a government hospital, so they say anyway ,so they say 

 

 

 

 

 

 

And when you get to hospital, BUPA goes "pre existing condition.... to bad too sad".

Edited August 20, 2023 by Ralf001

[retarius]

2 hours ago, KhunLA said:

That's a ridiculous statement.  Check ups save lives.

 

How do you get that great diagnosis, without a check up, or symptoms requiring a diagnosis.

 

Not all illness have symptoms, and many, if having, well, too late now to treat.

 

Granted, all my check ups have been money spent for piece of mind, but that's fine.  10k baht a year ain't going to break the bank, and eliminates stress.

 

I've had polyps removed, no symptoms, even lied so they'd do the colonscopy.  Had other direction/endoscope done also, since there, and found a hiatal hernia, I didn't know I had.  Explains a lot, and now that I know, can manage it without surgery.

 

X rays/mamograms, and chickie check ups saves millions of lives every year.

Checks up may save lives....but that is not what I said. And chickie checks certainly do not save millions of lives a year. What is your source for this? Hint: he hasn't got one because he made the number up. Evidently you cannot read. I said check ups are a rip off. It is about value for money not about how many lives you save. You need to know how many lives at what cost. And what you find often is that you spend millions to save a life or two. Most people's lives are not worth that much. Sadly, to some, you are worth what you have in assets, and sadly, few should have millions in assets. If you could save a million lives at the cost of a million each by annual testing that would bankrupt all healthcare systems. Annual check ups should be reserved for tests that have been chosen to save lives and are good value for money.