Question for April International (France) Policyholders

[Richard007]

I have been researching options for expat medical insurance for when I retire and move to Thailand early next year and I have been looking closely at April International (France).

Section 7.1 of April’s MyHealth International General Conditions 2023 booklet says:

  We provide you with a network of healthcare professionals who charge Reasonable and Customary costs. If You receive treatment in a medical facility that is not recommended and is not a member of the APRIL International network, You will be subject to a 20% Deductible applicable to the amount of your claim if the cost of your treatment exceeds local standards (except for vital emergencies).

I have been in contact with the sales department at April International (France) and asked a bunch of questions about their policy.  The one request that I have made (and repeated in several email exchanges) that they have refused to address is to allow me to have access to the list of hospitals that are members of the APRIL International network or let me know how to access the network online so I can see the names of the hospitals.  It’s shocking to me that they refused this request.  After all, their customers have a right to know exactly what it is that they are buying. 

If April’s focus is controlling costs by only including the inexpensive hospitals in the April International Network, and excluding more expensive ones, then this policy is not a good fit for me.  If I have a need for surgery sometime in the future, I don’t want to be subject to a 20% deductible if I don’t like the hospitals in the April network and the hospital I choose is more expensive than others. 

My questions to current April International (France) Policyholders are:

Do you feel that the hospitals included in the April International Network are high-quality hospitals?   If so, which other country’s hospital system have you been treated at as a basis for quality comparison, if any?

Is Bumrungrad International Hospital included in the April International Network?

Is Bangkok Hospital included in the April International Network?

Is Samitivej Sukhumvit Hospital included in the April International Network?

Is Siriraj Piyamaharajkarun Hospital included in the April International Network?

Is Ramathibodi Hospital included in the April International Network?

Did you ever have to pay the 20% deductible for a scheduled hospitalization (i.e. not an emergency) because the hospital was not in April’s network and April determined that the cost of your treatment exceeded local standards (i.e. exceeded Reasonable and Customary costs)?

Sorry for the long post and thanks in advance for any thoughtful replies.

[Etaoin Shrdlu]

April is an insurance broker, not an insurance company. They likely place their clients' business with several different insurers who have differing sets of approved hospitals. Additionally, some insurers have different insurance plans which differ in cost, coverage and approved hospitals.

 

It would first be necessary to know which insurer April is placing your coverage with and quite possibly which plan you wish to subscribe before April would be able to tell you which hospitals are on that particular insurer's approved list.

[Tropicalevo]

I was with April (France) and then I moved to Asia Expat. (At their suggestion.) I still pay my premiums to April (France).

Bangkok Hospital chain is NOT on their list of recommended hospitals. I do not know about others.

A friend of mine was looking to move to April and was told that his premiums would be higher if he used those hospitals.

I have only made one claim in 12 years so I am not up to date on their -20% policy but I stopped using Bangkok Hospitals as they are more expensive than others.

I self insure then claim from April for in-patient work.

April's back room systems are pretty krap though. 2 - 3 months for a reply to emails.

Unfortunately, I am too old to change insurers now.

[Richard007]

Etaoin,

 

According to section 9.1 of April’s MyHealth International General Conditions 2023 booklet, all of their medical insurance plans are insured by Groupama Gan Vie.   There are no other insurers listed for their medical cover. 

I did tell them which of their plans I was interested in.  The April sales rep claimed they do not have a hospital list or a network, which directly contradicts their General Conditions 2023 booklet which clearly states they do indeed have the “APRIL International network” and if you go outside that network, you may be subject to the 20% deductible.  I pushed this point multiple times with them, even citing the language in the general conditions, but got nowhere with them.  It seems to me that April is trying to hide which hospitals are in the network in order to make the sale.

[Richard007]

Tropicalevo,

Thanks – that’s good intel about Bangkok Hospital.  If they exclude Bangkok Hospital chain, then they probably exclude all of the more expensive hospitals in Thailand from their network, which means the 20% deductible would (or legally could) apply for a scheduled hospitalization at a more expensive out-of-network hospital.

I agree that the customer service I received from April’s sales team was pretty bad.  Either the sales rep was lying to me or knew nothing, because there were multiple times the rep stated things that were incorrect according to the General Conditions 2023 booklet, and after I pointed out the mistakes, the rep agreed with me.

[Sheryl]

The network does not apply to Thailand.  It is applicable in US (if you have worldwide cover that includes US) and maybe a few other  countries.

[Richard007]

Sheryl,

Thanks – where did you find the information that the network does not apply to Thailand?  I didn’t see any information about the network being applicable to only certain countries anywhere in the April MyHealth International brochure or in their General Conditions 2023 booklet. 

Their brochure says: 

How can I find out which hospitals, pharmacies and doctors are partners?

Nothing could be simpler. To do this, geolocate the healthcare professional or facility directly from your Easy Claim mobile app. Simply log on to the app, click on “Contact a doctor” and then on “Access the APRIL network”. Fill in your criteria, your location and that’s it!

So the brochure seems to indicate that the network always applies when you use the app. 

Nonetheless, I am quite disappointed at April’s lack of transparency on this issue.

If there is indeed no network in certain countries that could trigger the 20% deductible, then that should be stated clearly in the General Conditions 2023 booklet, and that would only help their business to grow.

[C3PO]

My understanding of this policy wording: You will only be refunded reasonable and customary costs (which is a standard clause for almost every insurance policy) and they provide you a list of hospitals that they believe charge reasonable costs. That doesn't mean you cannot use other hospitals or will automatically be charged 20% deductible, as long as the costs these hospitals charge are classifed by April as being reasonable. - just my understanding, best to clarify with the insurance directly. 

 

[Richard007]

C3PO,

Your understanding of the policy wording is the same as mine and I never had any questions about that policy wording.

The issue at hand is which hospitals are included in the April network, and which are not?  I would like to know this information in advance before I purchase the policy, i.e. am I buying a hamburger or a steak? 

[Richard007]

It seems that April International (France) is not popular here on the forum, but I know there are some policyholders out there.

My questions to current April International (France) Policyholders are:

Do you feel that the hospitals included in the April International Network are high-quality hospitals?   If so, which other country’s hospital system have you been treated at as a basis for quality comparison, if any?

Is Bumrungrad International Hospital included in the April International Network?

Is Bangkok Hospital included in the April International Network?

Is Samitivej Sukhumvit Hospital included in the April International Network?

Is Siriraj Piyamaharajkarun Hospital included in the April International Network?

Is Ramathibodi Hospital included in the April International Network?

Did you ever have to pay the 20% deductible for a scheduled hospitalization (i.e. not an emergency) because the hospital was not in April’s network and April determined that the cost of your treatment exceeded local standards (i.e. exceeded Reasonable and Customary costs)?

[Tropicalevo]

I am not up to date as I have not made a claim in years.

I had a prostate biopsy carried out in BNH in Bangkok.

Excellent hospital but.....

........when I told them that I self insured, the quote was for 70 - 80,000 baht all in (One night stay.)

When I asked for a detailed receipt, they worked out that that I had insurance and that my insurance company would pay for it. The bill was 140,000 baht. No negotiation.

April refunded the 140k to me but that was about 7 - 8 years ago. I would guess that BNH are on the 'higher premium' list.

I am currently trying to claim for a colonoscopy at Wattanapat hospital here in Samui.

All April claims have to be via a phone app. (I was in the software industry for 35 years. I do not use phone apps.)

After sending emails for three months asking how to claim, they finally responded  - snail mail to Asia Expat in Bangkok.

I asked for an alternative as we have had no post here on Samui all year (short staffed  - Covid).

No replay yet.

As I said earlier - their back office systems are Krap.

[Richard007]

Tropicalevo,

Thanks for sharing your experience.  At least they covered the 140K no problem.

I wonder if anyone here on the forum knows whether BNH Hospital is still currently in April’s network, i.e. no 20% deductible applies.

Good luck getting your claim reimbursed. 

[topt]

18 hours ago, Tropicalevo said:

No replay yet.

As I said earlier - their back office systems are Krap.

@Richard007

This is my current concern with April International. I am an existing customer, but no claims and have been trying to get information out of them on future premiums in the last month using email and their response form in the customer zone online...... I finally had to resort to having to ring someone who said I would get a reply within 48 hours - it took a week and I have just replied with questions that were left unanswered.

 

When AA Insurance (a broker here in Thailand) were able to interface it gave an extra level of help and consequently comfort. Unfortunately Thai based brokers are apparently not legally allowed  to offer cover from International insurers so along with a change to ownership of said broker that leaves me more than concerned about using April Int going forward. 

 

That you seem to be in regular email with them sounds like a result but perhaps they try harder for potential new customers........

 

When I took out my policy 2 years ago I I think I asked about the "Hospital Network" and was reassured that it was a non-issue for me.  

[Richard007]

topt,

thanks for your comments.

 

Yes, April’s sales team is trying very hard to make the sale but I am going in circles with them on the hospital in-network vs. out-of-network issue.  They keep dodging the request and trying to convince me it’s not important.  Clearly the 20% deductible is one way they keep their claim costs down and apparently they don’t want word to get out on this issue or else they would be willing to share the information I requested.  From the comments here on the forum, it seems another way they keep costs down is by not having strong customer support teams in place.

 

Since you are a current customer, are you able to login to April’s Easy Claim mobile app, click on “Contact a doctor” and then on “Access the APRIL network” and check if any of these hospitals are listed for Bangkok?

Bumrungrad International Hospital

Bangkok Hospital

Samitivej Sukhumvit Hospital

Siriraj Piyamaharajkarun Hospital

Ramathibodi Hospital

BNH Hospital

[topt]

11 hours ago, Richard007 said:

re you able to login to April’s Easy Claim mobile app,

Sorry I haven't bothered to download it.

[topt]

11 hours ago, Richard007 said:

and check if any of these hospitals are listed for Bangkok?

You could try asking them to confirm that those specific hospitals are listed and say you will apply for the policy if they will give you written confirmation of that fact......

However what's allowed now and what will be in 3 years or whenever is impossible to predict. If it is such a big issue for you I would advise using other insurance.

[Etaoin Shrdlu]

On 9/8/2023 at 12:33 AM, Richard007 said:

 

Etaoin,

 

According to section 9.1 of April’s MyHealth International General Conditions 2023 booklet, all of their medical insurance plans are insured by Groupama Gan Vie.   There are no other insurers listed for their medical cover. 

 

I did tell them which of their plans I was interested in.  The April sales rep claimed they do not have a hospital list or a network, which directly contradicts their General Conditions 2023 booklet which clearly states they do indeed have the “APRIL International network” and if you go outside that network, you may be subject to the 20% deductible.  I pushed this point multiple times with them, even citing the language in the general conditions, but got nowhere with them.  It seems to me that April is trying to hide which hospitals are in the network in order to make the sale.

 

I agree with Sheryl that the booklet was prepared for use in many different countries and the bit about network versus non-network may not be applicable to Thailand. So, rather than push April for a list of network hospitals that probably does not exist, ask them to confirm that none of the hospitals in Thailand would attract the 20% deductible for being out of network.

 

April is a fairly large insurance intermediary and is domiciled in the EU, which is quite well-regulated. I would not expect an April sales rep to intentionally withhold information on hospital networks. If you have written advice from the sales rep that April does not have a list of network hospitals in Thailand, that is likely the case.

 

 

 

[keithsimmonds]

13 hours ago, Richard007 said:

topt,

 

thanks for your comments.

 

 

Yes, April’s sales team is trying very hard to make the sale but I am going in circles with them on the hospital in-network vs. out-of-network issue.  They keep dodging the request and trying to convince me it’s not important.  Clearly the 20% deductible is one way they keep their claim costs down and apparently they don’t want word to get out on this issue or else they would be willing to share the information I requested.  From the comments here on the forum, it seems another way they keep costs down is by not having strong customer support teams in place.

 

 

Since you are a current customer, are you able to login to April’s Easy Claim mobile app, click on “Contact a doctor” and then on “Access the APRIL network” and check if any of these hospitals are listed for Bangkok?

 

 

Bumrungrad International Hospital

 

Bangkok Hospital

 

Samitivej Sukhumvit Hospital

 

Siriraj Piyamaharajkarun Hospital

 

Ramathibodi Hospital

 

BNH Hospital

 

I can say that if there is such a list(Paciifc Cross has one) then Bangkok Pattaya Hospital is on that list but there (sister hospital?) Jomtien Hospital is not on that list.

The deductible on the policy i have "My Health International..Basic) was 500$ which i just increased to 1000$.....i am told that there is a designated April (coordinator?)in BPH who handles most/everything to do with April in that hospital.

[Richard007]

Topt, thanks, I will try that.

[Richard007]

Etaoin, thanks I will ask them to confirm that none of the hospitals in Thailand would attract the 20% deductible for being out of network.

 

Regarding the booklet, if there are certain conditions that apply only to certain countries or zones, then that information should be spelled out in the booklet, just like they list every country that is included in Zone 0, Zone 1, Zone 2, Zone 3, and Zone 4 in the booklet.  There is nothing in the booklet about the 20% deductible only applying to certain countries, so from a legal point of view, it can apply to all countries if they choose to do so.  Same thing goes for the April network.

 

I did not expect that the April rep would give me the wrong information but unfortunately, I can confirm that there were multiple times where the information the sales rep gave me directly contradicts what is written in the booklet.

[Richard007]

keithsimmonds, thanks that’s good intel about Bangkok Pattaya Hospital and Jomtien Hospital. 

[Sheryl]

14 hours ago, Etaoin Shrdlu said:

 

April is a fairly large insurance intermediary and is domiciled in the EU, which is quite well-regulated. I would not expect an April sales rep to intentionally withhold information on hospital networks. If you have written advice from the sales rep that April does not have a list of network hospitals in Thailand, that is likely the case.

 

 

It actually does exist somewhere in writing already.    In the Member Guide,   the discussion of networks appears only on the page titled " Using direct billing services in the USA and Mexico".  And if you then follow the link  to find a network provider, it takes you directly to https://april.globalexcel.com/ which is for cover in US only. (It is actually a shared application with Aetna).

 

Definitely does not apply in Thailand, at least not as yet . The "network" arrangement is new and so far limited to US

[Richard007]

Sheryl, thanks for sharing that information.  I do not have access to the Member Guide as I am not a member yet.

[Richard007]

Here’s an update for anyone interested in April International (France).

 

I sent April my list of 6 hospitals in Bangkok and asked them to tell me whether or not each of the hospitals listed below charge Reasonable and Customary costs (Yes or No).  They refused.

 

I asked April to confirm that none of the hospitals in Thailand would trigger the 20% deductible because the cost of the treatment exceeds local standards.   They refused.

 

The only useful comment they made was the following: 

The costs have to be not much higher than local costs, it’s all.  You have to inform yourself as expat if the prices are similar to the local hospitals.  I cannot tell you YES or NO for each one.

 

So, in conclusion, April does not currently maintain a list of hospitals in Thailand that are in-network or a list of hospitals that are out-of-network.  Whether or not the 20% deductible applies is a case-by-case basis depending on the charges by the hospital for the claim and whether or not April determines that those charges exceed local standards. 

To avoid the 20% deductible on a scheduled hospitalization, the patient will need to go through the “Request for prior agreement” process with April.  If that process indicates that a 20% deductible will apply, then I believe the patient could switch to a different hospital that charges less.  It is definitely an issue to be aware of with April, but it only applies to scheduled hospitalizations.  The 20% deductible does not apply to urgent hospitalizations due to vital emergencies.

[818Pilot]

On 9/7/2023 at 10:19 PM, Richard007 said:

I have been researching options for expat medical insurance for when I retire and move to Thailand early next year and I have been looking closely at April International (France).

Section 7.1 of April’s MyHealth International General Conditions 2023 booklet says:

 

  We provide you with a network of healthcare professionals who charge Reasonable and Customary costs. If You receive treatment in a medical facility that is not recommended and is not a member of the APRIL International network, You will be subject to a 20% Deductible applicable to the amount of your claim if the cost of your treatment exceeds local standards (except for vital emergencies).

I have been in contact with the sales department at April International (France) and asked a bunch of questions about their policy.  The one request that I have made (and repeated in several email exchanges) that they have refused to address is to allow me to have access to the list of hospitals that are members of the APRIL International network or let me know how to access the network online so I can see the names of the hospitals.  It’s shocking to me that they refused this request.  After all, their customers have a right to know exactly what it is that they are buying. 

 

If April’s focus is controlling costs by only including the inexpensive hospitals in the April International Network, and excluding more expensive ones, then this policy is not a good fit for me.  If I have a need for surgery sometime in the future, I don’t want to be subject to a 20% deductible if I don’t like the hospitals in the April network and the hospital I choose is more expensive than others. 

 

My questions to current April International (France) Policyholders are:

 

Do you feel that the hospitals included in the April International Network are high-quality hospitals?   If so, which other country’s hospital system have you been treated at as a basis for quality comparison, if any?

 

Is Bumrungrad International Hospital included in the April International Network?

 

Is Bangkok Hospital included in the April International Network?

Is Samitivej Sukhumvit Hospital included in the April International Network?

Is Siriraj Piyamaharajkarun Hospital included in the April International Network?

 

Is Ramathibodi Hospital included in the April International Network?

Did you ever have to pay the 20% deductible for a scheduled hospitalization (i.e. not an emergency) because the hospital was not in April’s network and April determined that the cost of your treatment exceeded local standards (i.e. exceeded Reasonable and Customary costs)?

Sorry for the long post and thanks in advance for any thoughtful replies.

I had the same concerns as I live in CM and Bangkok Hospital is the closest to me and I currently use them for Physical and Occupational Therapy for an accident in the US (Out of pocket, but only $26 an hour compared to over $100 in Los Angeles).

I explored their site and found this, https://www.april-international.com/en/corporate/services/healthcare-networks . I then checked what network Bangkok Hospital is with and they are part of Bangkok Dusit Medical Services (BDMS) so it is in network according to their link above. You may want to check the others, but BDSM has the following as part of their group.

 

Bangkok Hospital
Phyathai Hospitals Group
BNH Hospital
Samitivej Hospital Group
Paolo Hospital Group
Royal Hospital Group (Cambodia)

 

Hope this helps!

[scubascuba3]

Maybe the thing to do is go to your desired hospital, speak to someone of a decent level and try and get a coherent answer from them.

 

Often hospitals seem to want payment by the patient upfront anyway, kinda like blackmail 

[Richard007]

818pilot, thanks for sharing that information.  That website falls under the “Corporate” tab not the “Individuals” tab.  I wonder if the same networks apply to the Individual plans?

 

Just curious, did you ever have a large hospitalization claim with April (i.e. >$2,000)?  If so, which hospital was it and did April hit you with a 20% deductible?

[Richard007]

scuba, that is a good idea to seek out someone competent in the insurance/billing dept. to see if they can shed some light.

According to April’s written policies, “In case of hospitalisation, you benefit from direct billing service, subject to prior agreement.” but I’m not sure how that works in practice.

[mania]

I wonder about the problem of not even having a say in which hospital your taken to if its an emergency?

Many times the ambulance is going to a certain hospital for various reasons. Proximity/agreement etc

You may or may not even be conscious

[Sheryl]

On 9/11/2023 at 10:38 PM, Richard007 said:

Here’s an update for anyone interested in April International (France).

 

 

I sent April my list of 6 hospitals in Bangkok and asked them to tell me whether or not each of the hospitals listed below charge Reasonable and Customary costs (Yes or No).  They refused.

 

 

I asked April to confirm that none of the hospitals in Thailand would trigger the 20% deductible because the cost of the treatment exceeds local standards.   They refused.

 

 

The only useful comment they made was the following: 

 

The costs have to be not much higher than local costs, it’s all.  You have to inform yourself as expat if the prices are similar to the local hospitals.  I cannot tell you YES or NO for each one.

 

 

So, in conclusion, April does not currently maintain a list of hospitals in Thailand that are in-network or a list of hospitals that are out-of-network.  Whether or not the 20% deductible applies is a case-by-case basis depending on the charges by the hospital for the claim and whether or not April determines that those charges exceed local standards. 

 

 

To avoid the 20% deductible on a scheduled hospitalization, the patient will need to go through the “Request for prior agreement” process with April.  If that process indicates that a 20% deductible will apply, then I believe the patient could switch to a different hospital that charges less.  It is definitely an issue to be aware of with April, but it only applies to scheduled hospitalizations.  The 20% deductible does not apply to urgent hospitalizations due to vital emergencies.

This is a somewhat different issue than the use of  "network"  hospitals (which as explained applies only to USA. Many insurers have such arrangements in US.)

 

April and pretty much every other insurer requires pre-authorization for hospitalization except in emergency when authorization should be sought as soon as possible after admission. Private hospital third party payment offices take care of arranging this. It is  a process wherein the hospital submits anticipated treatment costs, sometimes there is back-and-forth negotiation on it, and it ends with the insurer giving the hospital something called a "Guarantee of Payment" (GOP)  which promises to reimburse the hospital directly up to the approved amount. Hospital can go back to them at any time for additional GOP  if additional unforseen treatments/costs  become necessary.   

 

Again not unique to April, most insurers do this. What is perhaps less common is that April will potentially reimburse 80% of costs after the fact if pre-authorization was not otained either prior to admission or (if emergency) as soon afterwards as feasible.  Some insurers will refuse to pay anything in that case.

 

One exception worth noting in April policies is if total costs do not exceed US $2,000. In that case pre-authorization is not mandatory  and you can pay up front and be reimbursed. You aren't likely to have an inpatient hospitalization costing that little (except  at a government hospital for something fairly routine). But things categorized as day surgeries often do. I twice opted to go this route  for epidural spine injections as I was in a lot of pain and wanted quick relief and was willing to pay first to get it. (In a non -emergency situation pre-authorization usually  takes 5-10 working days). I was reimbursed in full but it did take a long time. 

 

A few other things to know about the pre-authorization process:

 

- Although it is not required (or, obviously, possible) to get the authorization in advance in case of emergency admission many Thai private hospitals will not agree to expensive treatments (e.g. surgery) on direct billing basis without a GOP in hand and may therefore ask for a credit card deposit, refunding it once they get the insurer's GOP. The processing time for a GOP in an emergency admission is  not limited to working days and is much faster than normal pre-authorization  but may still take several hours to a full day.  This happened to me after an accident  in 2019. Hospital provided  immediate emergency care and scans but then gave me a choice of either postponing surgery until the GOP came through  or making an advance payment myself  refundable upon receipt of the insurer GOP. I opted for the latter (my leg was torn wide open and while bleeding was by then controlled  there was real risk of infection) and signed for something like US 10-15k on a credit card.  By the time I was out of a 3 hour surgery and 1 hour recovery room stay the hospital had gotten the GOP from April so I never had to pay this (I forget if hospital just tore up the charge or credited the amount back but either way it worked).   This was on a Sunday and I arrived at hospital 11 AM our time so around 5 AM in France. 

 

-- Thai hospital 3rd party payment staff vary in their competence and work ethic. Not unusual for them to try to make their work easier by asking you to pay something that the insurer had issues with or even just asked for a more detailed breakdown of.  It is usually best to refuse and tell them you aren't paying, they need to work it out with the insurer. They almost always can,  just by showing the cost breakdowns in more detail or differently broken out/described. Common situations where this arises is when there is a "package price"  or regarding room rates. Some April policies limit reimbursement for private rooms but that refers solely to room charge not room + meals + nursing charge so simply breaking things out better and making sure the room charge is within their limit  will usually solve it. And hospital can easily do this but as mentioned sometimes staff are lazy and will first try to hit you up for the cost.  Happened to me on a back surgery in 2021. Hospital had a "package price" for it and whatever the hospital originally submitted put the room rate above the insurer maxium. They called me asking if I would pay it myself, I basically said no, you need to work this out with the insurer.  Within a few days the problem had magically disappeared and hospital got  a GOP for the full package price. Obviously just needed to resubmit the paperwork with more detailed breakown that was consistent with insurer limits on rate for room alone.

 

I have even heard of some hospital staff trying to get out of  doing their jobs  altogether by persuading the patient to just pay and get reimbursed later (shifting all problems to the patient....and good luck getting the kind of paperwork  details  needed after the fact once the hospital has already been paid). Hasn't happened to me but I've had reports from others especially where smaller private hospitals were involved.  If you encounter this stand firm. Tell them you will not pay, insurer will pay directly and they need to get GOP from the insurer or else you'll go elsewhere.