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

[scubascuba3]

  On 1/2/2024 at 11:44 AM, Liverpool Lou said:

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

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who knows but insurers can find out when checking with the hospitals of high blood pressure, so even if undeclared still pre-existing

[Liverpool Lou]

  On 1/2/2024 at 9:44 AM, bkk6060 said:

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.

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"...it seems they can exclude coverage for just about anything..."

Of course, they can, and all the exclusions will be listed in the policy document.  No one is forced to accept any policy if you don't like the exclusions.

[Liverpool Lou]

  On 1/2/2024 at 11:52 AM, scubascuba3 said:

  On 1/2/2024 at 11:44 AM, Liverpool Lou said:

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

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who knows but insurers can find out when checking with the hospitals of high blood pressure, so even if undeclared still pre-existing

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Yes, and if there is a record of that issue in his medical records he should have disclosed it at renewal.

[Liverpool Lou]

  On 1/2/2024 at 9:46 AM, retarius said:

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.

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"The exclusions and get out clauses written into healthcare polices...".

And they are all disclosed in the policy so the potential insured has the opportunity to decline the offer of cover before agreeing to the policy.  

[Liverpool Lou]

  On 1/2/2024 at 9:48 AM, retarius said:

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

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That's not exactly true, strokes can be both treatable and recoverable.

[Liverpool Lou]

  On 1/2/2024 at 10:17 AM, Baht Simpson said:

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

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They're neither "ruses" nor "easy get outs", they are conditions that are always laid out in the policy conditions to be read.

[Liverpool Lou]

  On 1/2/2024 at 11:16 AM, 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.

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That won't go down at all well here!

[scubascuba3]

  On 1/2/2024 at 11:56 AM, Liverpool Lou said:

Yes, and if there is a record of that issue in his medical records he should have disclosed it at renewal.

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Yes but many won't, I'd expect insurers check with labs also, one lab i went to last week now asking for more info incl date of birth, could be selling data

[Liverpool Lou]

  On 1/2/2024 at 11:50 AM, Celsius said:

  On 1/2/2024 at 11:49 AM, 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

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It wasn't. Otherwise how would they know about it.

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If you hadn't disclosed it they could find out about it without much difficulty from your medical records that you gave them access to when you signed up for the policy.

[Celsius]

  On 1/2/2024 at 11:52 AM, scubascuba3 said:

who knows but insurers can find out when checking with the hospitals of high blood pressure, so even if undeclared still pre-existing

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You have to wonder why hospitals here insist on taking your blood pressure every single time.

 

So you're a Farang just who just stepped out of BTS in scorching heat. You severed your toe and you're in pain. They take your blood pressure for your injured toe and it's 185/120....of course.

 

Now you are labeled as a risk by insurance company.

[DudleySquat]

  On 1/2/2024 at 8:00 AM, 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

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Until you get cancer, then all bets are off. 

I agree with you, having diabetes and high BP insurance pays for nearly nothing. 

 

 

[DudleySquat]

  On 1/2/2024 at 12:21 PM, Celsius said:

You have to wonder why hospitals here insist on taking your blood pressure every single time.

 

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It's an add-on to make money. Is it necessary for dental work? No. Eye testing, probably yes.

[JeffersLos]

  On 1/2/2024 at 8:08 AM, mfd101 said:

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

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Health insurance companies base whether they payout or not on how long the customer has been with them? 

[mfd101]

  On 1/2/2024 at 12:50 PM, JeffersLos said:

 

Health insurance companies base whether they payout or not on how long the customer has been with them? 

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(1) Insurance companies have to make a profit. Otherwise they cease to exist.

 

(2) How long you've been a customer when you front up with a major claim will undoubtedly affect their consideration & decisionmaking. Why wouldn't it? You've been paying for 20 years and this is your first claim, for a heart attack. Fine. You've been in 3 months and you said all was fine and now you're claiming for a heart attack? Mmmmm ...

[Baht Simpson]

  On 1/2/2024 at 12:07 PM, Liverpool Lou said:

They're neither "ruses" nor "easy get outs", they are conditions that are always laid out in the policy conditions to be read.

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Perhaps ruse is a bit strong but the fact remains that reasonable care especially is subjective and is a deliberately broad term and has been used unfairly in the past to deny claims. It's as well to be aware of that.

[Baht Simpson]

  On 1/2/2024 at 12:33 PM, DudleySquat said:

 

It's an add-on to make money. Is it necessary for dental work? No. Eye testing, probably yes.

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As I understand it, it is prudent to take BP readings for surgical dental work as there have been patients who have had heart attacks in the chair. It may be an insurance issue if they are seen to be negligent by not checking.

[JeffersLos]

  On 1/2/2024 at 1:30 PM, mfd101 said:

(1) Insurance companies have to make a profit. Otherwise they cease to exist.

 

(2) How long you've been a customer when you front up with a major claim will undoubtedly affect their consideration & decisionmaking. Why wouldn't it? 

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Because you have specified coverage as per the contract. Either your illness is covered or it isn't. 

 

How long you've had the contract doesn't/shouldn't have anything to do with it. 

[mfd101]

  On 1/2/2024 at 2:27 PM, JeffersLos said:

Either your illness is covered or it isn't. 

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That's what all the ifs & buts written in to the contract are for. It's not black & white.

 

It's grey and a matter for judgment. Whose judgment? Theirs, not yours.

[advancebooking]

  On 1/2/2024 at 9:48 AM, retarius said:

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

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and you dont have to then pay the bill bc you are dead

[advancebooking]

  On 1/2/2024 at 2:14 PM, Baht Simpson said:

As I understand it, it is prudent to take BP readings for surgical dental work as there have been patients who have had heart attacks in the chair. It may be an insurance issue if they are seen to be negligent by not checking.

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Not if the dentist has medical malpractice insurance. Such policies only pay out if the dr is negligent ie if they have done something wrong in the treatment. However if they dont have that ins policy then yes you are correct and they will have to pay out of their own money. 

[advancebooking]

  On 1/2/2024 at 10:04 AM, Mike Lister said:

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.

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bloody hell. what a waste of money. just self insure

[scubascuba3]

  On 1/2/2024 at 12:21 PM, Celsius said:

 

You have to wonder why hospitals here insist on taking your blood pressure every single time.

 

So you're a Farang just who just stepped out of BTS in scorching heat. You severed your toe and you're in pain. They take your blood pressure for your injured toe and it's 185/120....of course.

 

Now you are labeled as a risk by insurance company.

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Exactly, i went to hospital after a dog bite, nurse says your blood pressure is high, not surprising, but I'm sure insurers would hold it against me, even though my blood pressure is normally in the normal range 

[scubascuba3]

  On 1/2/2024 at 12:33 PM, DudleySquat said:

 

Until you get cancer, then all bets are off. 

I agree with you, having diabetes and high BP insurance pays for nearly nothing. 

 

 

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Even cancer is 10 years growing, would they cover it and if so how much

[Ralf001]

  On 1/2/2024 at 12:21 PM, Celsius said:

 

You have to wonder why hospitals here insist on taking your blood pressure every single time.

 

 

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Its annoying.

Pre-operation check-up December last year had to visit 4 hospital departments.

Medicine.

Cardiology.

Surgery.

Neurology.

Each one. Height, weight and BP check.

[AlexRich]

I think it makes sense to have insurance, and some money on the side for any eventuality. The concern is that you are admitted to hospital unconscious and they cannot find any evidence that you are insured ... so you end up in a public facility, which might result in a poor outcome. 

 

I recall a controversial You Tuber in Chiang Rai, who was often accused of being an e-beggar (Graham?). His girlfriend was called Pie. He posted a video about a heart condition and sought to raise some money for treatment and was accused by all and sundry of lying. He ended up on the operating table with a travelling surgeon, and never survived. He stood a better chance in Bangkok, but was uninsured. You really need insurance to ensure the best possible treatment. 

[Liverpool Lou]

  On 1/2/2024 at 2:09 PM, Baht Simpson said:

the fact remains that reasonable care especially is subjective and is a deliberately broad term and has been used unfairly in the past to deny claims.

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"...has been used unfairly in the past to deny claims".

Really? Do you have one evidence-backed specific example of that "fact"?

[Ralf001]

  On 1/3/2024 at 1:25 AM, Liverpool Lou said:

"...has been used unfairly in the past to deny claims".

Really? Do you have one evidence-backed specific example of that "fact"?

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I had my Pneumonia claim refused last year.

 

Based on pre-existing condition, I had a minor stroke in 2015.

[ozimoron]

I have had a decades long history of high blood pressure and high cholesterol. My understanding is that any insurance I get might be good for accidents.

[JoseThailand]

That's why paying for Thai social security makes sense! There are no exclusions or pre-existing conditions.

[racyrick]

Not everyone is able to self insure!