What's the point of getting health insurance if serious conditions are excluded?

[scubascuba3]

A facebook post earlier today, in Pattaya, guy in a well known private hospital, can't afford his bill after a stroke, his insurance doesn't cover due to hypertension. 

 

It would have been better if he saved up the premiums and used it in the event of a medical emergency, i.e now.

 

I wonder how many of you guys out there have health insurance but it's inadequate and won't cover the conditions most likely to be claimed for such as heart and stroke

[mfd101]

Health insurance is fine when you've been paying premiums for the previous umpteen years. Just the last 5 minutes? Not so good.

 

It's all about risk, not just yours but the company's too. So joining up here as an expat late in life is never going to work well for most people.

[Celsius]

This is why I quit my health insurance last year.

 

There really is no point.

 

For things like heart attack I don't expect to pay more than 1 million baht. I will rather self insure.

 

For something like cancer I am sure the insurance will find million and one reason not to pay. So in that case I can fly back to Canada. 

 

for everything else, there is MasterCard.

 

In all seriousness, the insurance company last year refused a relatively cheap procedure (less than 25k baht) based on completely unrelated issue in my medical records - hiatal hernia. So, I am  not going to give those scam artists any of my money.

 

[mokwit]

You need insurance for long therm debilitation but that seems to be something that isn't covered or won't be paid out on.

[Ralf001]

Yeah have had private insurance deny claim due to pre-existing, luckily I was only on the hook for a a coupla hundred K before I was moved to my SS hospital.... luckily though as the final bill to SS was 5 million+.

.

Recently had a kidney removed (cancer), my private insurance covered the whole stay at hospital.

[Moonlover]

1 hour ago, mokwit said:

You need insurance for long therm debilitation but that seems to be something that isn't covered or won't be paid out on.

No you don't An advance directive (living will) will do nicely and a lot cheaper. If I ever reach that stage, I won't want to be around anyway thank you.

[bkk6060]

I have insurance,  but with all the exclusions it is really accident insurance.  Having close calls on a motorbike, or even walking I will be covered unless I am reckless or drunk.

Other then that, it seems they can exclude coverage for just about anything else.

[retarius]

I don't have health insurance here, and never have. This past year has been the first year I've had any medical care in Thailand at all and I've been here 15 years so I've saved a bundle to date not paying insurance premiums.

 

I don't see the point in insurance when you get old. The exclusions and get out clauses written into healthcare polices are so numerous they pretty much guarantee the insurance company won't be on the hook for your big bills. That's why all non-Thai health insurance companies are rolling in money, and the Thai ones only went bust because of insane COVID policies.

 

I'm 70 and will continue to 'self insure'. We use an expensive private hospital in Bangkok for any medical needs for myself and my wife. I can afford to do so, at the moment, who knows in the future with inflation and taxes.

 

Statistically, you run up most of your medical expenses in the last 6 months of life....I intend to die at home in my own bed and have a Living Will to that effect.

 

I have no problem dying if I get sick, and don't want my wife to get a massive bill after I die. For example, if I get cancer, I would not take these way overpriced drugs to eke out another 6 months of poor quality life.

 

I have seen too many friends here in Thailand get ripped off very, very badly in hospitals with massively inflated bills and lots of unnecessary treatment and tests. As best I can, I want to control the costs of my healthcare. I don't mind investing a bit in diagnosis, provided what they are testing for has an established, researched and approved treatment.  But even having a treatment is another issue and I want it cost effective, and the best way to do that is to pay your own way and to read the cost effectiveness studies of the treatments. 

[retarius]

1 hour ago, Celsius said:

This is why I quit my health insurance last year.

 

There really is no point.

 

For things like heart attack I don't expect to pay more than 1 million baht. I will rather self insure.

 

For something like cancer I am sure the insurance will find million and one reason not to pay. So in that case I can fly back to Canada. 

 

for everything else, there is MasterCard.

 

In all seriousness, the insurance company last year refused a relatively cheap procedure (less than 25k baht) based on completely unrelated issue in my medical records - hiatal hernia. So, I am  not going to give those scam artists any of my money.

 

Heart attacks are interesting. Basically if you are alive after one day, you have an excellent chance of returning to a normal life without in-hospital treatment. Strokes are another issue, you can only hope the stoke kills you, and you can avoid living a low quality life. 

[scubascuba3]

3 minutes ago, retarius said:

Strokes are another issue, you can only hope the stoke kills you, and you can avoid living a low quality life. 

Talking of strokes this was posted by Bangkok Pattaya Hospital today on facebook, interesting what they can do, a guy i know had a stroke and went there, bill was 1M+ baht, reading the list he had a mechanical thrombectomy

[prakhonchai nick]

If you take out health insurance when you are younger and no health problems, most Insurers (Uk Insurers in particular) cover virtually everything.. That generally continues once you get old, and normally only chronic illnesses are excluded once initially claimed for. 

My health insurance taken out in the UK 37 years ago, with worldwide cover, covers my whole family. Amazingly one of the perks was that you remain the same age as when you took out the insurance, so no age increases, only inflation. My wife and my 3 kids are all just 21 years old. Me?  Just a bit older!   Unfortunately the Insurer ceased offering this cover many year ago to new applicants

[retarius]

I have a friend who had a stroke in the latter half of 2022. He had a ridiculously expensive (2M Baht operation) but still can't cut up his own food....and can barely speak. Realistically I'd rather be dead. I think the medical technology is still in its infancy and so I don't much care for modern. Basically 'modern tech' to me means tech that hasn't been really tested yet. I'd rather stick with older stuff. 

 

As an example 3 super common drugs, omeprazole for tummies, ciprofloxacin and simvastatin have been on the market for 40 odd years and been in billions of people. Omeprazole was considered so safe it could be sold in pharmacies OTC. Then they found it had problems, not serious enough to pull it from the market, but to recommend against regular use. 

Ciprofloxacin was found recently to cause severe tendonitis. This can be pretty serious and so it is now not the recommended go to drug for infections. And simvastatin, for hypercholesterolemia, and was supposedly proven to to prevent heart attacks, strokes etc has been found to be atherogenic. Simva, like omeprazole has been given long term to billions of patients around the globe. 

 

This was supposed to be a response to Superscuba. 

[Mike Lister]

I quit mine last year, actually, they quit me first but it was a close call. 150K per year to cover half my body, plus a 400K deductible, plus a 200k co pay. When something new arose and I tried to get an op pre authorized they declined and ended my policy, it just brought forward the inevitable that I should never have started.

[Baht Simpson]

2 hours ago, scubascuba3 said:

A facebook post earlier today, in Pattaya, guy in a well known private hospital, can't afford his bill after a stroke, his insurance doesn't cover due to hypertension. 

 

It would have been better if he saved up the premiums and used it in the event of a medical emergency, i.e now.

 

I wonder how many of you guys out there have health insurance but it's inadequate and won't cover the conditions most likely to be claimed for such as heart and stroke

Sounds like they got him on the "related symptons" ruse. That and the "reasonable care" ruse for accidents are easy get-outs. 

[brianthainess]

Depends how much money you have of course, but IMO as I've said a few times when this comes up,

if 3m baht doesn't cover me in a public hospital, then I think it's all over anyway, I'm 72 now, and if I had to have ongoing chemotherapy I don't think my quality of life would be worth it. 

[Baht Simpson]

What you have to remember with health insurance is that the agreement that you sign does constitute a contract, but it's not a negotiated contract. Basically you either accept their terms and definitions or you have to walk away. The advantage is therefore always in their court.

 

In business contracts there is nearly always an exchange in value and you negotiate terms to suit both parties. With insurance the value they supply is a rather nebulous promise that they may pay out.

 

They sell "peace of mind" but what you're buying is an expensive risk. 

[jerrymahoney]

What's the point of getting health insurance if serious conditions are excluded?

 

None.
You nailed it.
I rest my case.
This should be pinned.
I couldn't have said it better myself.

[Chris Daley]

I'm looking forward to cancer.  I wonder which one it will be.

[Lee65]

What Is Asymmetric Information?

 

Asymmetric information, also known as "information failure," occurs when one party to an economic transaction possesses greater material knowledge than the other party. This typically manifests when the seller of a good or service possesses greater knowledge than the buyer ...

 

Medical insurance is a classic case.

 

 

 

 

[OneMoreFarang]

2 hours ago, scubascuba3 said:

I wonder how many of you guys out there have health insurance but it's inadequate and won't cover the conditions most likely to be claimed for such as heart and stroke

I was part of a company group insurance. I left that company and now I can't be part of that insurance anymore.

I have diabetes. And that is something insurance companies don't like.

I applied at one insurance, and they refused to insure me at all. Now I am checking with another insurance. I am pretty sure if they insure me at all, then they will exclude diabetes (and probably anything that might be related to that).

 

When I applied for the new insurance, I answered all their questions truthfully. That makes it more difficult or maybe impossible to get insured.

If I would answer the questions not truthfully, then I could be insured. But that would be just the theory. Because if I would have an expensive problem, then they would check my past records. And then they would find out my preexisting conditions (which I might not have told them) and then they will deny payment for that reason.

Obviously, it's bad not to be insured. But pretending to be insured and paying for the insurance, but having the risk of no payment because of not reported preexisting conditions, is worse. 

[OneMoreFarang]

About insurance don't pay: A farang friend, living in Thailand for many years, had two strokes, one at home, after which he visited the hospital, and then he had another stroke in the hospital.

Bumrungrad, expensive in the hospital, and every follow up visit is expensive, and medication is expensive. And until now, maybe a year later, his private insurance paid everything.

So, it seems not all insurances are bad all the time.

[CartagenaWarlock]

If you are a US citizen and plan for healthcare expenses in retirement, you could have stashed more than 4 million baht in an HSA, tax-free, for over a decade. The money in the HSA is investable in any form, like buying index funds, etc., and you can use their VISA or MC to pay for all your medical expenses. All my friends have HSA cards in the US. I have one stashed with money that earned 24% last year alone. I used it twice at Bangkok Hospital, Pattaya. Besides, I have credit cards, each with a credit limit close to one million baht. Hopefully, I can survive an emergency in Thailand. 

[Ben Zioner]

3 hours ago, scubascuba3 said:

A facebook post earlier today, in Pattaya, guy in a well known private hospital, can't afford his bill after a stroke, his insurance doesn't cover due to hypertension. 

Maybe it was hypertension, preexisting condition, at the time of start of coverage? Which would make total sense in the case of stroke.

[Ben Zioner]

12 minutes ago, OneMoreFarang said:

About insurance don't pay: A farang friend, living in Thailand for many years, had two strokes, one at home, after which he visited the hospital, and then he had another stroke in the hospital.

Bumrungrad, expensive in the hospital, and every follow up visit is expensive, and medication is expensive. And until now, maybe a year later, his private insurance paid everything.

So, it seems not all insurances are bad all the time.

Of course, one has to chose carefully, and preferably before sixty, and stick to it. I have been in my plan for 32 years, so I doubt they could find any preexisting condition. Not even Gonorrhea. Otherwise, I am 71 and totally uninsurable.

[Liverpool Lou]

3 hours ago, scubascuba3 said:

I wonder how many of you guys out there have health insurance but it's inadequate and won't cover the conditions most likely to be claimed for such as heart and stroke

Usually only when there are associated pre-existing conditions.  Heart and stroke treatments are not automatic exclusions from health insurance policies, in general.     

[Liverpool Lou]

3 hours ago, scubascuba3 said:

in Pattaya, guy in a well known private hospital, can't afford his bill after a stroke, his insurance doesn't cover due to hypertension. 

I wonder if he disclosed his pre-existing hypertension to his insurer at inception or renewal?

[Liverpool Lou]

3 hours ago, Celsius said:

In all seriousness, the insurance company last year refused a relatively cheap procedure (less than 25k baht) based on completely unrelated issue in my medical records - hiatal hernia.

Was that something that you failed to disclose to the insurer?  Any false declaration, or failure to disclose. could void the entire policy

[scubascuba3]

24 minutes ago, Ben Zioner said:

Maybe it was hypertension, preexisting condition, at the time of start of coverage? Which would make total sense in the case of stroke.

Yep based on the limited info his friend posted

[Celsius]

Just now, Liverpool Lou said:

Was that something that you failed to disclose to the insurer?  Any false declaration, or failure to disclose. could void the entire policy

 

It wasn't. Otherwise how would they know about it. I send them my endoscopy results during my application.

[scubascuba3]

8 minutes ago, Liverpool Lou said:

Usually only when there are associated pre-existing conditions.  Heart and stroke treatments are not automatic exclusions from health insurance policies, in general.     

they seem to be when hypertension is a pre-existing condition