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

[scubascuba3]

4 hours ago, 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"?

I'm aware of someone who not only had a claim denied because of a disputed pre-existing condition (court case because of it) but previous claims were requested to be repaid, policy cancelled and premiums refunded

Edited January 3 by scubascuba3

[Liverpool Lou]

1 hour ago, Ralf001 said:

4 hours ago, 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"?

 

I had my Pneumonia claim refused last year.

 

Based on pre-existing condition,

So nothing to do with the "reasonable care" claim of Baht Simpson that I asked about, then.

Edited January 3 by Liverpool Lou

[Liverpool Lou]

19 minutes ago, scubascuba3 said:

4 hours ago, 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"?

I'm aware of someone who not only had a claim denied because of a disputed pre-existing condition (court case because of it) but previous claims were requested to be repaid, policy cancelled and premiums refunded

So nothing to do with the "reasonable care" claim of Baht Simpson that I asked about in my comment that you quoted, then.

[bunnydrops]

You tend to live a lot longer if you have insurance. Far less money to spend on your vices.

[Baht Simpson]

5 hours ago, 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"?

Sure:

 

"There is still a continuing debate in New Zealand on the differences between subjective (i.e. the person’s own viewpoint) and objective (i.e. a reasonable person’s viewpoint) recklessness, and which “type” of recklessness should be required.  However, it is clear that recklessness, not just a lack of reasonable care, is the standard required to breach a reasonable care condition.

 

In Roberts v State Insurance General Manager [1974] 2 NZLR 312 (NZSC), it was argued that an insured motorcycle owner was reckless for leaving his broken down motorcycle on the side of the road, though he was planning to come back and collect it.  The motorcycle was subsequently stolen.

While the insurance company accepted that the required standard was recklessness, they argued that the insured could have taken a number of alternative steps, such as pushing the motorcycle along the road, or asking local authorities for help, in order to reduce the risk of theft.  In other words, the insured had not taken all reasonable steps under the insurance policy, to safeguard the motorcycle from loss.

 

The Court rejected this argument.  In applying the test of Fraser outlined by Diplock LJ, the Court noted the insured had not contemplated that his motorcycle could be stolen, and had actually made arrangements to collect the motorcycle (albeit, the day after it had broken down).  In summing up the decision, McMullin J held:

He [the insured] neither appreciated the risk that his motor cycle might be stolen and chose to ignore it nor did he act in a grossly negligent way. His claim for indemnity ought to have succeeded."

 

https://mccawlewis.co.nz/publications/reasonable-recklessless-a-guide-to-reasonable-care-conditions/

 

Insurance is of course good in many cases but you need to be aware of what could happen. 

[retarius]

1 hour ago, racyrick said:

Not everyone is able to self insure!

 

1 hour ago, racyrick said:

Not everyone is able to self insure!

Correct, to self-insure you must have assets, and to get those assets, you needed to have a decent job and to have saved and lived prudently within your means.

 

Insurance is for those those that spent all they earned trying to impressing the neighbours and saved nothing; had poor IQ or education and consequently a lousy job; had bad luck and/or a poor pension are going to have a bad time self-insuring.

 

So if you cannot self-insure, then insure. If even that is too expensive (it is a rip-off imho) then that's what GoFundMe (GFM) is for. But it doesn't work for everyone and those of us who have lived our lives outside the Uk as ex-pats might have a hard time finding friends to contribute.

 

A cautionary tale: Some UK mates of a friend of mine set up a GFM page for my mate but all he got was peanuts and died without any dignity in an open ward in a public hospital lying for days in his own urine. A vile death that I wouldn't give to a street dog. I was shocked at the laziness and callousness of the nurses. Me, I want a bit of dignity in death not to be in a ward with 7 others who were dying and receiving no care from the nurses. Then the bastards screwed his missus for 40,000 baht to release his money. She had to go to a loan shark. How the other half live? He was good bloke in the pub, but had to impress everybody with his car, his truck, etc etc

[Mike Lister]

2 minutes ago, retarius said:

 

Insurance is for those those that spent all they earned trying to impressing the neighbours and saved nothing; had poor IQ or education and consequently a lousy job; had bad luck and/or a poor pension are going to have a bad time self-insuring.

 

 

Dear god, please tell me you're winding up everyone and that you don't really believe that!

[jaideedave]

21 hours ago, 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.

Same here, I've had bypass surgery previously and my exclusion list is a whole page.I refer to my coverage as from my " chin up and my knees down" Virtually useless.At 73 I have a DNR Form signed in with my Thai Dr. My Etna/Allianz premium is only 3500/month so like you its really only accident insurance.When it gets much higher I'm stopping it all together.I tried to quit them 2 years ago and the rep practically begged me to keep it. I said ok but knock off some exclusions..he said he can't.555 

[scubascuba3]

9 minutes ago, Mike Lister said:

Dear god, please tell me you're winding up everyone and that you don't really believe that!

He has a good point, why would someone with money bother to get insurance which may end up with a denied claim when it matters?

[Baht Simpson]

18 minutes ago, scubascuba3 said:

He has a good point, why would someone with money bother to get insurance which may end up with a denied claim when it matters?

I think it's a moot point. If I was super-rich would I buy health insurance or self-insure? On the one hand having the best available cover would provide good access to expensive medical procedures. On the other hand why would I waste money when I could probably buy my own hospital? Lol. Not that it applies to us here.

Edited January 3 by Baht Simpson

[Baht Simpson]

I think once you get to a certain age there's a tipping point where medical insurance loses most of its value. This is probably around 70 when premiums become inordinately high. I know this reflects the increased risk but if you've enough to self-insure then this becomes the better option imo. It does depend on current health and lifestyle though.

Edited January 3 by Baht Simpson

[The Fugitive]

10 hours ago, Ralf001 said:

 

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.

My local and regional government hospitals use the large 'whole arm' blood pressure/pulse machines. Notoriously inaccurate. Lord knows what damage they are doing to peoples medical history records?

[The Fugitive]

50 minutes ago, retarius said:

A cautionary tale: Some UK mates of a friend of mine set up a GFM page for my mate but all he got was peanuts and died without any dignity in an open ward in a public hospital lying for days in his own urine. A vile death that I wouldn't give to a street dog. I was shocked at the laziness and callousness of the nurses. Me, I want a bit of dignity in death not to be in a ward with 7 others who were dying and receiving no care from the nurses. Then the bastards screwed his missus for 40,000 baht to release his money. She had to go to a loan shark. How the other half live? He was good bloke in the pub, but had to impress everybody with his car, his truck, etc etc

Can I ask whether your friend was already diagnosed as untreatable when he was placed on the dying ward? Or, was he receiving treatment that was discontinued because of his inability to pay his bill and therefore left to die of his condition?

[scubascuba3]

20 minutes ago, Baht Simpson said:

I think once you get to a certain age there's a tipping point where medical insurance loses most of its value. This is probably around 70 when premiums become inordinately high. I know this reflects the increased risk but if you've enough to self-insure then this becomes the better option imo. It does depend on current health and lifestyle though.

70+ people are looking at 200k+ for good health insurance, at 80 300k, that's now, in the future it's much more.

 

If people plan to cancel when premiums get unaffordable, why bother now, save the money ahead of time

[The Fugitive]

On 1/2/2024 at 3:00 PM, 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

Various possibilities. When taking out the policy he could have failed to disclose previous diagnosis and treatment of high blood pressure. He could have developed raised B.P. subsequently and not disclosed it when renewing premiums. Most disturbingly could he have developed it but genuinely never become aware e.g. he didn't have annual medicals and had never visited a hospital or clinic since taking out the policy?

[Mike Lister]

1 hour ago, scubascuba3 said:

He has a good point, why would someone with money bother to get insurance which may end up with a denied claim when it matters?

Insurance is how rich people stay rich. Who buys a car and doesn't insure it, who buys a house and doesn't insure it! We'd all buy 100% coverage, gold plated, global health insurance if we could afford it.

Edited January 3 by Mike Lister

[The Fugitive]

18 hours ago, 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.

My dentist in U.K. asks if I am in good health and taking any regular medication? My dentist in Thailand takes my B.P. and pulse and also asks if everything was OK at my last annual medical?

[retarius]

30 minutes ago, The Fugitive said:

Can I ask whether your friend was already diagnosed as untreatable when he was placed on the dying ward? Or, was he receiving treatment that was discontinued because of his inability to pay his bill and therefore left to die of his condition?

He had prostate cancer and refused to even go for the biopsy or have treatment. He couldn't afford it. The GoFundME page was to rate money for him to go to a large private hospital and have a biopsy for the definitive diagnosis. His PSA score was over 100 and the velocity was accelerating. He was receiving treatment from a local doctor who didn't treat him for the prostate cancer but for his inability to urinate, and pain. He fell over in his bathroom and did something awful to his shoulder, it had a huge and extremely painful lump behind it. So he was hospitalised for his shoulder, but died in hospital after 5 days or so. His doctor was not impressive. His death certificate said he died of a heart problem. He received no treatment in hospital except with he medicines he had from his 'GP' brought in by his wife. It was terribly sad. I told his wife to sue the hospital but they don't do that sort of thing here enough. 

[retarius]

4 minutes ago, The Fugitive said:

My dentist in U.K. asks if I am in good health and taking any regular medication? My dentist in Thailand takes my B.P. and pulse and also asks if everything was OK at my last annual medical?

My dentist diagnosed my obstructive sleep apnea (OSA). At age about 40 and pretty fit as a fiddle, my dentist noted persistent high readings which my cardiologist did not pick up. The reason is OSA patients have high BP in the mornings when I had my dental appointments, and I saw my cardio gut in the afternoons after work. The cardio gave me losartan; and the dentist gave me a variety of device to put in my mouth and sleep with, none of which were any use at all. I now have a CPAP machine which I hate. 

[simon43]

I think if you have high blood pressure, then that could be an opt-out for almost any reason to deny an insurance claim.  My claim for prostate cancer investigation was denied because I had failed to disclose my mildly-enlarged prostate BPH), even though an enlarged prostate doesn't cause prostate cancer.

 

When I insured again with a different company, I disclosed absolutely every single medical incident/treatment etc from birth, including a bunion on my right foot and a small scar on my leg when a motorbike hit me when I was11 years old.  The insurer probably laughed at my page-long list of minor ailments from 40 years ago, but as a result of disclosing all these things I'm fairly sure that no opt-out reason can be used to deny a future claim.  They insured me for everything except my BPH.

 

However, apart from BPH, I'm pretty healthy, no high BP, no high cholesterol, not a lard-bucket etc.

[The Fugitive]

23 minutes ago, retarius said:

He had prostate cancer and refused to even go for the biopsy or have treatment. He couldn't afford it. The GoFundME page was to rate money for him to go to a large private hospital and have a biopsy for the definitive diagnosis. His PSA score was over 100 and the velocity was accelerating. He was receiving treatment from a local doctor who didn't treat him for the prostate cancer but for his inability to urinate, and pain. He fell over in his bathroom and did something awful to his shoulder, it had a huge and extremely painful lump behind it. So he was hospitalised for his shoulder, but died in hospital after 5 days or so. His doctor was not impressive. His death certificate said he died of a heart problem. He received no treatment in hospital except with he medicines he had from his 'GP' brought in by his wife. It was terribly sad. I told his wife to sue the hospital but they don't do that sort of thing here enough. 

Thanks for taking the trouble to explain. Very sad. Sounds as if the local GP might have known full well so was only managing the symptoms to make your friend more comfortable. The hospital should have given him all necessary pain relief and sedation in the final stage. That they didn't is inexcusable as you say. 

[Baht Simpson]

59 minutes ago, Mike Lister said:

Insurance is how rich people stay rich. Who buys a car and doesn't insure it, who buys a house and doesn't insure it! We'd all buy 100% coverage, gold plated, global health insurance if we could afford it.

Well, yes and no, Mike. The rich stay rich by not wasting money on things of poor value, which could include some health insurance.  The extremely wealthy perhaps can't even be bothered to think about it and just get the top cover. Us mortals have to think about it.

 

If Elon Musk got ill I doubt he'd be thinking, "Thank God I've got Cigna, Premium plus." Lol 

[Mike Lister]

2 minutes ago, Baht Simpson said:

Well, yes and no, Mike. The rich stay rich by not wasting money on things of poor value, which could include some health insurance.  The extremely wealthy perhaps can't even be bothered to think about it and just get the top cover. Us mortals have to think about it.

 

If Elon Musk got ill I doubt he'd be thinking, "Thank God I've got Cigna, Premium plus." Lol 

There isn't one AN member over 60 who wouldn't have that all singing all dancing health insurance policy, if they only had enough spare money....not one.

[scubascuba3]

12 minutes ago, Mike Lister said:

There isn't one AN member over 60 who wouldn't have that all singing all dancing health insurance policy, if they only had enough spare money....not one.

sure there are if the policy had exclusions which made it not worth it

[Mike Lister]

1 minute ago, scubascuba3 said:

sure there are if the policy had exclusions which made it not worth it

We're not talking about somebody aged 70, diving in and trying to get it for the first time. We're talking about if the person had been able to afford it for most of their life, those exclusions wouldn't be an issue because they would have developed whilst having coverage. But honestly, I think almost everyone would buy it, despite exclusions, if they could afford it. Why? Because it only makes sense to cover those parts that can be covered. 

 

The problem is that people like me and probably lots of others too, look after ourselves and if something is not right, we go and get it checked out. Doing that almost immediately excludes that body part from many policies, even though there was nothing really wrong. My policy covered bits that weren't broken or checked, which meant I had 32 million to spend on ingrown toenails, when they became a problem!

[noobexpat]

If the premium was calculated on the health and lifestyle of 10,000 noobexpats it would be the deal of the century.

 

The problem is that its calculated on 10,000 people far less conscientious, so why should i accept that.

 

Can you imagine the data on 10,000 thailand expats 555

 

 

[Mike Lister]

2 minutes ago, noobexpat said:

If the premium was calculated on the health and lifestyle of 10,000 noobexpats it would be the deal of the century.

 

The problem is that its calculated on 10,000 people far less conscientious, so why should i accept that.

 

Can you imagine the data on 10,000 thailand expats 555

 

 

Except under Thai insurance company rules, premiums are not only adjusted according to the average of the group, they are adjusted based on the actions of the individual and whether or not they claim. So if you claim, you can see your premiums increase by 25% or you can see your policy cancelled as a result. It's a totally different set up here.

[jerrymahoney]

When I worked in advertising a long time ago, when there were still newspaper grocery store coupons, there was a given norm:

 

The 2 groups of people who most used those coupons were from either the very poor or the very rich.

 

With health insurance, it is possible get out of it a lot more than you put in. And the typical rich person would be kicking themselves silly if they DID get real sick and had to pay the bill far exceeding what even high care insurance would have cost.

Edited January 4 by jerrymahoney

[paddypower]

On 1/2/2024 at 3:20 PM, 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.

 

how are you eligible for ins. in Canada, unless you are covered and paying premiums under a provincial insurance plan AND you qualify under the residency rules. once we (Canuck couple) left, after 6 months, we did not qualify for BC Ins. 

[paddypower]

On 1/3/2024 at 2:03 PM, Mike Lister said:

Dear god, please tell me you're winding up everyone and that you don't really believe that!

Mike, I have spent the last 1 1/2 hours trolling through AN, reading as many HEATH Ins related posts as I can. AN does provide an invaluable service - but one is often referred back to posts going back to 2020.. On one one older forum, a moderator wrote - 'moved to INSURANCE''. what we need, respectfully, is a Health Insurance forum. id say its a minority that want to know about life ins. but everybody living here wants to know the latest on health ins. expecially since there is a new player in town, with (from what I am hearing from many sources ) has  a hazy corporate background.  I believe that AN would be doing a major service if it set up a separate forum topic...and it would attract a lot of new members who are lost for advice (the raison dêtre for AN) and why I subscribed in 1998 . thanks in advance

Edited January 18 by paddypower
spell