Health Insurance Refused Because I Take Statins.

[The Fugitive]

11 minutes ago, brewsterbudgen said:

My policy document states clearly the medication I take for mild hypertension and cholesterol.  I've assumed that a related problem (heart attack, stroke) would mean I'm covered.  Maybe I have too much faith!

I haven't even taken out my policy yet and you've got me worried! Is there a field or a panel anywhere on your documents that indicate exclusions? If there is and it's blank I would think it's safe to assume no exclusions apply.

[brewsterbudgen]

2 minutes ago, The Fugitive said:

I haven't even taken out my policy yet and you've got me worried! Is there a field or a panel anywhere on your documents that indicate exclusions? If there is and it's blank I would think it's safe to assume no exclusions apply.

Just the usual stuff about 'pre-existing conditions'.  I asked them to add the medications a couple of years ago, which they did.  My broker assures me that I would be covered 🤔

[Letseng]

18 hours ago, Jumbo1968 said:

I recently applied for Health Insurance, aged 72 with a company whose name is what you use for chopping firewood, I don’t want to mention their name. I have been taking 20mg statins for 2 years, my cholesterol was around 6 now around 4 after taking the statins.

Their reply was, I don’t have heart disease. I thought they would refuse me because I had Prostate Cancer but was discharged in 2017.

 

The company will not pay benefits for investigations and treatment related to

- Hyperlipidaemia & associated conditions . By this we mean ischaemic heart disease stroke and cardiac

arrhythmias.

 

I don’t have heart disease. I thought they would refuse me because I had Prostate Cancer but was discharged in 2017 after radiotherapy, do they refuse insurance to everyone on statins then ?

I'm with the same insurer. They don't refuse you but exclude any event which can be caused by high cholesterol eg heartattack.

In my case it is a knee issue.

[Liverpool Lou]

3 hours ago, HappyExpat57 said:

I dated an insurance agent for a year and got to see how the sausage is made.

 

Purely legalized extortion. Her main job was to find any technicality for denying payments. Nothing but a bunch of heartless leeches.

Insurance agents (employees of the insurer or brokers) do not make those decisions.  

[Liverpool Lou]

2 hours ago, The Fugitive said:

From what I've heard she would have been paid a bonus for successfully denying claims.

Complete nonsense.

[Liverpool Lou]

2 hours ago, The Fugitive said:

Absolutely. I emailed Cigna Global requesting they attach a sample of their Health Questionnaire. 

Health questionnaire...

https://www.cignaglobal.com/dvc-pdfs/CLICE-EP19/en/CGHO Application Form Broker_EN_09_2020.pdf?elqTrackId=6a8f5f2511d44710b9f842a67a04a3f5&elqaid=804&elqat=2

[The Fugitive]

2 minutes ago, Liverpool Lou said:

Complete nonsense.

I worked with a lady who previously worked for a large UK Insurance company (the one that has it's roots in Rochdale). She told me her job was 'sifting' claims using a checklist. Staff received productivity bonuses.

[Liverpool Lou]

2 minutes ago, The Fugitive said:

I worked with a lady who previously worked for a large UK Insurance company (the one that has it's roots in Rochdale). She told me her job was 'sifting' claims using a checklist. Staff received productivity bonuses.

There's a difference between a productivity bonus and a "bonus for successfully denying claims".   I worked for a large UK insurer and also had a business as a broker.

[The Fugitive]

7 minutes ago, Liverpool Lou said:

Health questionnaire...

https://www.cignaglobal.com/dvc-pdfs/CLICE-EP19/en/CGHO Application Form Broker_EN_09_2020.pdf?elqTrackId=6a8f5f2511d44710b9f842a67a04a3f5&elqaid=804&elqat=2

Thanks for this. I see the date on the form is September 2020. I'm waiting for a 'phone call from Dubai from them. I can keep this on my screen and compare it with the questions as they ask them.

[The Fugitive]

4 minutes ago, Liverpool Lou said:

There's a difference between a productivity bonus and a "bonus for successfully denying claims".   I worked for a large UK insurer and also had a business as a broker.

If your job is 'sifting' claims for the purpose of denying them how else could your performance be measured?

[Liverpool Lou]

8 minutes ago, The Fugitive said:

If your job is 'sifting' claims for the purpose of denying them how else could your performance be measured?

In general, around 90% of all insurance claims are met.  All claims are vetted and the only claims that can be denied are those that do not comply with the policy conditions or fraudulent claims. Having years of experience in the industry, I doubt the veracity of your specific description of her job.

[Jumbo1968]

1 hour ago, brewsterbudgen said:

Just the usual stuff about 'pre-existing conditions'.  I asked them to add the medications a couple of years ago, which they did.  My broker assures me that I would be covered 🤔

Being the ever pessimist the broker will say yes but he is not the insurance company who decide wether a claim is met or not.

[Jumbo1968]

1 hour ago, Letseng said:

I'm with the same insurer. They don't refuse you but exclude any event which can be caused by high cholesterol eg heartattack.

In my case it is a knee issue.

Not much of your health left to insure as cholesterol’s could be blamed for all kinds of ailments even though mine is regular with a daily 20g statin the premium they quoted didn’t even include accident or covid insurance.

[Jumbo1968]

Axa have just confirmed if I pay a premium of ฿34675 annually it would only cover me for Accident and Covid Insurance, I didn’t even bother to reply.

[simon43]

Perhaps the moral of all this is to look after your health so that you do not have high blood pressure, or take statins or have diabetes or have high cholesterol... because any of those conditions is a 'get-out' clause to deny almost any claim that you make on your medical insurance. Insurance companies don't really want to insure 'unhealthy' people - why should they?.

[Robert Paulson]

6 hours ago, The Fugitive said:

From what I've heard she would have been paid a bonus for successfully denying claims.

Exactly, they are extortionists criminals. This is why the graph of usa healthcare vs outcomes is so bad in my opinion, because we have to pay these people who do nothing except make money off of sick dying people and get promotions for it. 

[Celsius]

The company did you a favor. If it was another 3 letter company they would take your money and never pay out.

 

You are high risk. They can and will use the word pre existing for just about everything.

 

 

 

 

[Robert Paulson]

There’s this woman who got cancer, and she researched the hell out of it and she concluded she wanted a certain non-conventional procedure from a top level doctor. She was insured up the yin Yang, the insurance company got back to her and said “we will cover this, if you do this more conventional procedure first”. 
 

She basically had no choice. She did the conventional procedure, and died. A big win for the insurance companies who now didn’t have to pay for the expensive procedure she actually decided she wanted. 
 

This is how insurance companies well everyone. They are quite literally merchants of death. You pay them to kill you. 

[brewsterbudgen]

3 hours ago, Jumbo1968 said:

Being the ever pessimist the broker will say yes but he is not the insurance company who decide wether a claim is met or not.

Yes; he's just keen to keep me as a client!

[Sheryl]

7 hours ago, HappyExpat57 said:

I dated an insurance agent for a year and got to see how the sausage is made.

 

Purely legalized extortion. Her main job was to find any technicality for denying payments. Nothing but a bunch of heartless leeches.

 

Do not confuse the practices of Thai companies with those of international companies. Totally different regulatory environments. And very different levels of medical knowledge and initial underwriting practices.

[Sheryl]

3 hours ago, The Fugitive said:

Thanks for this. I see the date on the form is September 2020. I'm waiting for a 'phone call from Dubai from them. I can keep this on my screen and compare it with the questions as they ask them.

 

Do not allow a broker (or anyone else) to fill in your health questionnaire for you based on a phone call. Too much is at stake.

 

Refuse this, insist on completing it yourself, and keep a photocopy.

 

Among other things this allows you to add additional relevant medical information. Which you should definitely do if you are on any regular medications or had a surgery or hospital admission in past 5-10 years, or cancer at any time in the past. 

 

Broker has an incentive to get you the policy...and is not a medically trained person.

[Sheryl]

4 hours ago, Liverpool Lou said:

There's a difference between a productivity bonus and a "bonus for successfully denying claims".   I worked for a large UK insurer and also had a business as a broker.

Practices by most Thai companies differ dramatically from those in the West. 

 

Thai insurers usually do not do complete medically underwriting but rather rely on post-claim (or pre-authorization)  investgations to root out things related to pre-existing conditions. These are conducted with, shall I say, excessive zeal, and by people with no medical background whatsoever. Many of the conclusions drawn thereeby are beyond absurd.

[Baht Simpson]

Do they take account of family history, say, of heart disease or genetic problems? 

[The Fugitive]

1 minute ago, Baht Simpson said:

Do they take account of family history, say, of heart disease or genetic problems? 

This is the Health Questionnaire kindly provided by Liverpool Lou; https://www.cignaglobal.com/dvc-pdfs/CLICE-EP19/en/CGHO Application Form Broker_EN_09_2020.pdf?elqTrackId=6a8f5f2511d44710b9f842a67a04a3f5&elqaid=804&elqat=2

[Sheryl]

5 hours ago, The Fugitive said:

I haven't even taken out my policy yet and you've got me worried! Is there a field or a panel anywhere on your documents that indicate exclusions? If there is and it's blank I would think it's safe to assume no exclusions apply.

 

A policy document would indicate exclusions, yes.

 

But need to consider if a policy was issued under full medical underwriting or on a moratorium basis. Thai insurers tends towards the latter.

[Baht Simpson]

24 minutes ago, The Fugitive said:

This is the Health Questionnaire kindly provided by Liverpool Lou; https://www.cignaglobal.com/dvc-pdfs/CLICE-EP19/en/CGHO Application Form Broker_EN_09_2020.pdf?elqTrackId=6a8f5f2511d44710b9f842a67a04a3f5&elqaid=804&elqat=2

I can't see anywhere that family history is mentioned, just information relating to the applicant and any dependents. I find that astonishing. There is a section where you can add details but again that only mentions the applicant and dependents. 

 

I would have thought that family history of heart conditions, cancer and possible genetic illnesses would be crucial but obviously not.

 

 

[The Fugitive]

3 minutes ago, Baht Simpson said:

I can't see anywhere that family history is mentioned, just information relating to the applicant and any dependents. I find that astonishing. There is a section where you can add details but again that only mentions the applicant and dependents. 

 

I would have thought that family history of heart conditions, cancer and possible genetic illnesses would be crucial but obviously not.

Agree. Surprising lack of questions! When I applied previously (to another company) I was told that any and all previous conditions would be excluded. According to Cigna Global if no recurrence and no medication prescribed since, no exclusions apply.

[Jumbo1968]

If you have a heart attack or a stroke some thing has caused it, it’s not a natural occurrence so any insurance company could say it was caused by pre existing conditions and wouldn’t pay out.

[The Fugitive]

3 hours ago, simon43 said:

Perhaps the moral of all this is to look after your health so that you do not have high blood pressure, or take statins or have diabetes or have high cholesterol... because any of those conditions is a 'get-out' clause to deny almost any claim that you make on your medical insurance. Insurance companies don't really want to insure 'unhealthy' people - why should they?.

That's the ideal Simon! Someone who hasn't been near a doctor all their lives, never had an annual medical, never been admitted to hospital has a completely clean sheet. An insurance company would gleefully cover them without any exclusions.

[simon43]

16 minutes ago, The Fugitive said:

That's the ideal Simon! Someone who hasn't been near a doctor all their lives, never had an annual medical, never been admitted to hospital has a completely clean sheet. An insurance company would gleefully cover them without any exclusions.

 

Absolutely! And be careful of disclosing that annual medical check-up, because unscrupulous insurers could claim that you had the check-up because you suspected a health issue! I never go to a mainstream hospital for tests etc, because I do not want that information recorded in my medical history, even if the results are all good.

 

Insurance companies can exclude pre-existing conditions which are specific, such as the BPH that I have (slightly enlarged prostate). But diabetes and high blood pressure can lead to a whole range of illnesses, whereas my BPH can really only lead to an ability to pee, UTIs etc.

 

I guess insurance companies love to provide insurance for those with diabetes or high blood pressure, because they can exclude those conditions from cover, (or charge a premium), AND they can then also deny any subsequent claim for cover if you go down with a medical condition that has only the slightest relationship to your high blood pressure etc.