Health Insurance Refused Because I Take Statins.

[Sheryl]

8 hours ago, Jumbo1968 said:

 A friend of a friend was receiving daily radiotherapy for Prostate Cancer, no overnight stay, the insurance company would not pay out because they classed it as out patient treatment which wasn’t included in his policy.

 

Many internationally issued hospitalization-only policies include outpatient cancer care, as well as outpatient dialysis.

 

One of the things to look for when selecting a policy, since both of these can be quite costly.

[Sheryl]

On 7/19/2024 at 9:08 PM, Jumbo1968 said:

My last blood test, I take 20mg statins 1 a day.

OK so you were  referring to your total cholesterol, which is not a meaningful metric.

 

What was your LDL cholesterol before starting the statin?

[Satcommlee]

On 7/19/2024 at 8:56 AM, Henryford said:

They only insure healthy people.

This what my Allianz policy looks like.. I was charged extra based on being a fat smoker with a history of high cholesterol 🙂

[Kalasin Jo]

On 7/20/2024 at 10:56 AM, Jimjim1 said:

medical profession for the sake of medical expediency log it down as reduced immunity

Hi Jimjim1, this bit bothers an overcautious lawyerly me. Some, particularly syndicates, use every and any possible excuse.. Is reduced immunity  in your medical records? If so is it expressly and only because of this loss of skin pigmentation affliction and expressly stated that they use the reduced immunity as a sweep up category in the absence of any other specific category? 

[Jimjim1]

5 minutes ago, Kalasin Jo said:

Hi Jimjim1, this bit bothers an overcautious lawyerly me. Some, particularly syndicates, use every and any possible excuse.. Is reduced immunity  in your medical records? If so is it expressly and only because of this loss of skin pigmentation affliction and expressly stated that they use the reduced immunity as a sweep up category in the absence of any other specific category? 

Hello Jo,

I believe vitiligo is logged in my medical records, although my doctor has never sent me for tests, however this same doctor is an extreme pusher of statins and demanded that I take them because of my reduced immunity but when I asked to speak at length about them some brain dead wet behind the ears assumed 18 year old expert called me and told me that as I had a heart, stroke and cancer problem within my family I had to take them, this was utter rubbish as none of my family extended or otherwise has ever had these problems, and as for me I am in my 78th year and have never taken any regular meds, I am very fit and healthy so much so that last week I caught covid from a friend who had just returned from a gig in London where 50,000 others had been and I shifted it out of my system in 2 days.

Needless to say I have dumped this ill informed doctor and moved to a new one.

I get invites from my doctor which I believe is a follow on from the other doctor regarding Covid vacs because of my age and reduced immunity, ( their words )the two always being used together in any invite, so I feel that it is probably a pat suggestion with age being uppermost because there is never a follow up to see why I don’t have the vacs.

I have no other symptoms that may be construed as needing regular meds, I eat good wholesome organic food, no processed and I have never had any junk fast food, McDonald and the like, I find them to be particularly abhorrent and highly carcinogenic, but I do not cast any aspersions to those who are glued to this rubbish, good luck to them we all make our own choices and suffer the consequences.

I am still not sure if I should inform my travel insurers but on reflection and given the medical sweep they use to deny a policy payout prudence says tell them.

Thanks for replying to me.

jimjim

 

Moderator.
I have no problem with discussing this matter in an open forum and it can only be to the good if some learn from it.

[Letseng]

On 7/19/2024 at 3:59 PM, Jumbo1968 said:

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.

That's how insurers make money.

[khlongtoey]

surprised anyone can get any insurance at 72 in Thailand. I was told by a rep that to get AIA I need to be no older than 59 , and also was asked "has any Thailand hospital any records or you having any diagnosis?", in my case "no" was the answer.

 

based on this I'm considering a low-end plan soon , on a non-imm O , though, no plan to live in Thailand full time

 

 

[The Fugitive]

3 minutes ago, khlongtoey said:

surprised anyone can get any insurance at 72 in Thailand. I was told by a rep that to get AIA I need to be no older than 59 , and also was asked "has any Thailand hospital any records or you having any diagnosis?", in my case "no" was the answer.

 

based on this I'm considering a low-end plan soon , on a non-imm O , though, no plan to live in Thailand full time.

I live in Thailand most of the time. Recently asked Cigna Global for a quote (there is no age limit on their international plans). My previous diagnosed conditions were disregarded (no exclusions apply) because they are regarded as 'resolved' and I'm not receiving any current medication. Monthly premium for their silver plan is $565.48 USD.

[Sheryl]

9 hours ago, khlongtoey said:

surprised anyone can get any insurance at 72 in Thailand. I was told by a rep that to get AIA I need to be no older than 59 , and also was asked "has any Thailand hospital any records or you having any diagnosis?", in my case "no" was the answer.

 

based on this I'm considering a low-end plan soon , on a non-imm O , though, no plan to live in Thailand full time

 

 

Don't confuse Tha insurers with international insurers who provide expat plans that will cover you in Thailand.

 

Very few Thai insurers will newly enrol someone 72 or older and premiums are very high.

 

Several international insurers will. provided no significant pre - existing conditions. 

 

Work with an internationally (Western based) broker who specializes in expat policies.  Ask specifically about Cigna Globsl (Clise Care and Silver plans). 

 

The broker I use is https://www.aoc-insurancebroker.com/

 

There are no doubt others. 

 

 

[khlongtoey]

is AIA a "thai insurer" ? I am thinking they are based out of Hong Kong with local subsidiaries?

 

Maybe some advantages of having a Thai Insurer?

[Sheryl]

41 minutes ago, khlongtoey said:

is AIA a "thai insurer" ? I am thinking they are based out of Hong Kong with local subsidiaries?

 

Maybe some advantages of having a Thai Insurer?

AIA Thailand -- which is the only AIA policy a Thai broker can sell -- is a Thai insurer.

 

If wanting genuine health cover, no advantage to a Thai insurer and many disadvantages. 

 

But if wanting only to be insured on paper (eg for O-A visa extension  purposes) there are Thai insurance products that do that while international ones do not. 

[khlongtoey]

what are the many disadvantages?

 

I was thinking Thai Insurance, Thai hospitals, that would be more straightforward for any hospital in Thailand for accessing care and payments.

 

I'm wanting to establish healthcare for the future, and know some expats that have AIA, and am told after age 59, with AIA it may not be possible.

 

 

[Sheryl]

6 hours ago, khlongtoey said:

what are the many disadvantages?

 

I was thinking Thai Insurance, Thai hospitals, that would be more straightforward for any hospital in Thailand for accessing care and payments.

 

I'm wanting to establish healthcare for the future, and know some expats that have AIA, and am told after age 59, with AIA it may not be possible.

 

 

Much less favorable regulatory environment which allows practices not legal in the West, like raising rates based on claims history, introducing new exclusions at time if renewal etc. 

 

Much less professional intake and claims  procedures. Little or no medical scrutiny when you apply, wait until you make a claim then go through all your medical records (including at other hospitals, going years back) to find reason disallow the claim. Reasons can sometimes be absurd. 

 

Generally poor track record in paying claims. Some are worse than others in this regard  and problems are especially likely with  claims in first 5 years of a policy.

 

Generally low levels of coverage, sometimes ludicrously so.

 

Only a few guarantee lifetime renewal. Those that do, have  extremely high premiums after about age 70, higher than international insurers. Factoring in the additional increases based on claim history/change in health status and basically they  will price you out in old age, just when you need the policy the most and can't get another. 

 

It is no problem at all to use international insurance in Thailand assuming you select an insurer who has direct payment arrangements with Thai hospitals (most do).  Private hospitals here deal with international insurers all the time. 

 

[The Fugitive]

5 minutes ago, Sheryl said:

Much less favorable regulatory environment which allows practices not legal in the West, like raising rates based on claims history, introducing new exclusions at time if renewal etc. 

 

Much less professional intake and claims  procedures. Little or no medical scrutiny when you apply, wait until you make a claim then go through all your medical records (including at other hospitals, going years back) to find reason disallow the claim. Reasons can sometimes be absurd. 

 

Generally poor track record in paying claims. Some are worse than others in this regard  and problems are especially likely with  claims in first 5 years of a policy.

 

Generally low levels of coverage, sometimes ludicrously so.

 

Only a few guarantee lifetime renewal. Those that do, have  extremely high premiums after about age 70, higher than international insurers. Factoring in the additional increases based on claim history/change in health status and basically they  will price you out in old age, just when you need the policy the most and can't get another. 

 

It is no problem at all to use international insurance in Thailand assuming you select an insurer who has direct payment arrangements with Thai hospitals (most do).  Private hospitals here deal with international insurers all the time. 

Thank you for all the time, thought and effort involved in writing this. Much appreciated!

[rumak]

On 7/19/2024 at 6:48 PM, Celsius said:

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.

 

 

 

 

 

Well,  it seems like more than a few members agree with my long held assertion that 

paying more and more every year ,  with more and more exclusions,  and then in many cases being denied (what chance does the policy holder have,  when they already have your money.... and then put people through the ringer when time to pay out) .

No matter how many times someone tries to refute my statement... it still remains true !  Even the NY Times.... a media favorite.... chimes in :  

https://www.nytimes.com › 2023 › 06 › 15 › health › health-insurance-medical-bills.html

It's Not Just You: Many People Confront Health Insurance Obstacles on ...

Jun 15, 2023Nearly 60 percent of Americans with health insurance had a problem with their coverage over the past year. https://www.nytimes.com/2023/06/15/health/health-insurance-medical-bills.html

 

 

[Sheryl]

12 hours ago, rumak said:

 

Well,  it seems like more than a few members agree with my long held assertion that 

paying more and more every year ,  with more and more exclusions,  and then in many cases being denied 

 

 

With an internationally issued policy from a reputable company there are not "more and more exclusions". Only any exclusions apllied when you first got the  policy. They cannot add new ones later. 

 

Nor are there frequent claims denials. Denials ard very rare and usually stem from dishonesty at time of application. 

 

Premiums do go up as you age, of course. So does likelihood of  needing to use the insurance. 

 

Issues relating to US health care sydtem are quite specific to it and not generalizable. Most problems are for peoplf undrf mdnaged care type policies. Not a factor in international pat insurance. 

 

By all means remain uninsured if you like. But this aggressive campaign to persuade others to forgo insurance is harmful and misleading. 

[rumak]

xxxx  

[Letseng]

On 7/27/2024 at 11:11 PM, Sheryl said:

Don't confuse Tha insurers with international insurers who provide expat plans that will cover you in Thailand.

 

Very few Thai insurers will newly enrol someone 72 or older and premiums are very high.

 

Several international insurers will. provided no significant pre - existing conditions. 

 

Work with an internationally (Western based) broker who specializes in expat policies.  Ask specifically about Cigna Globsl (Clise Care and Silver plans). 

 

The broker I use is https://www.aoc-insurancebroker.com/

 

There are no doubt others. 

 

 

My question is a bit off the main topic. My husband has had travel insurance with an internat. insurer. Policy originally had no age limit. A few weeks ago he was notified that they will no longer cover above the age of 80. Change of conditions just before renewal. Are you aware of an insurer which covers above 80 for travel?  Tks.

[Sheryl]

1 hour ago, Letseng said:

My question is a bit off the main topic. My husband has had travel insurance with an internat. insurer. Policy originally had no age limit. A few weeks ago he was notified that they will no longer cover above the age of 80. Change of conditions just before renewal. Are you aware of an insurer which covers above 80 for travel?  Tks.

There are a number of them. Usually best to get a policy isdued in your home country, where are you & he from?

[Etaoin Shrdlu]

Delete

 

[Etaoin Shrdlu]

On 7/27/2024 at 11:49 PM, khlongtoey said:

is AIA a "thai insurer" ? I am thinking they are based out of Hong Kong with local subsidiaries?

 

Maybe some advantages of having a Thai Insurer?

AIA has offices in several Asian countries. It used to be part of AIG.

 

AIA Thailand can't issue a straight medical insurance policy, they can only issue a life insurance policy with a medical expense rider attached. Not a problem if you want or need life insurance, but you're paying for life insurance on top of medical insurance.  It will also likely be a whole-life policy with a cash value which can attract FBAR reporting requirements if you are American.

[Etaoin Shrdlu]

On 7/20/2024 at 5:38 AM, Patong2021 said:

Many of the comments are written from a biased perspective and incorrect assumptions. An insurance policy is a risk transfer contract. You, the insured are asking a third party to assume the financial liability for expenses arising from circumstances or events as set out in the contract. The intent is to transfer the sudden and accidental losses of a few amongst the many. The third party accepting the risk sets a cost for that assumption of the risk. It includes the medical costs associated with the covered events, claims management, selling and administration expenses. Loss ratios for Asian health insurers typically range from 80-85%. That does not leave the excessive profits some of the comments claim. It also means that contrary to the comments made, the insurers are paying claims.

 

Why is there an expectation that  the insurer should take on a high risk at a cost that does not cover that assumed risk?   If you believe that your risk is so low, keep the risk. Don’t expect another party to subsidize your healthcare. 

 

The core clauses of a health insurance policy are similar. Where they differ is on the extensions, the deductibles, and treatment of pre-existing conditions.  The actuarial tables used by insurers are similar and they know which age groups are likely to experience health crises, and which health conditions will result in expensive medical costs. Some insurers  invest more in their actuarial analysis.  If an insurer is excluding  cardiac and circulatory events for some people it is because the  actuarial results show that the X% of people who have certain characteristics will incur X amount of losses. Some insurers will provide coverage if there is a stability of the condition, i.e. 6 or 12 months.

 

Read the policy wording. It is your obligation to read the contract and to know what you are agreeing to. If you don't read the contract and then have a problem  because you claim you did not know, that's your responsibility. 

 

If you are hit by a car or fall down and suffer a critical brain injury or if have food poisoning and subsequent kidney damage, there would be coverage. If you develop colon cancer or an eye disease, or have parasites all needing treatment, you would have coverage.  You have a serious health condition related to your lipid levels and cannot expect an insurer to cover that existing medical problem. However there are 1001+ other ailments that you can have that benefit from having the coverage.

 

A questionnaire forms part of the insurance policy. The questionnaire might be completed on the phone for the purposes of an estimate, but you would still be required to complete a more detailed form, sign and submit that form. Coverage would only be  granted upon acceptance of the complete underwriting questionnaire.

 

That is not how claims are managed. When there are contestable claims, a reservation of rights letter is first issued, stating where coverage is available and what is payable. If there is a basis for denying all or part of a claim, the relevant sections are cited. Insurers have their own in house legal counsels and paralegals who draft these letters. The burden of proof is on the insurer to show why a claim is not payable. If an insurer cites sections of a policy that excludes coverage, an claimant just responds with an explanation or with documentation  countering that position. An insurer has an obligation to protect the best interests of its shareholders and other policy holders by responsibly managing claims.

 

Read the sections that apply for pre-existing conditions, and for conditions deemed stable.  If you have  doubts, ask  the specific question in writing and request a written response.

 

The broker is not the claim adjuster and does not control the  grant of coverage. Only the insurer has that power. When in doubt, as for an opinion from the insurer claims manager.

 

Good post!

 

 

[khlongtoey]

34 minutes ago, Etaoin Shrdlu said:

 

Good post!

 

 

what did you find "good" about it?

 

I supposed they meant "ask" here, "When in doubt, as for an opinion from the insurer claims manager. "

 

I might some more suggestions on how to use https://www.aoc-insurancebroker.com/International-Health-Insurance-Comparison

 

or should one use this one?

https://www.aoc-insurancebroker.com/Private-Health-Insurance-Asia

 

or in general any hints/ use cases

 

 

thanks

[beautifulthailand99]

On 7/19/2024 at 1:14 PM, Sheryl said:

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.

Democracy , justice and the rule of law aren't cheap - but if moved to Thailand you wanted cheap which is what you got. Caveat emptor.

[Letseng]

20 hours ago, Sheryl said:

There are a number of them. Usually best to get a policy isdued in your home country, where are you & he from?

We live permanently in Thailand. So no home country/ address. Hubby is from UK. UK insurer will not renew due to reaching 80. He never had a claim ever. The Austrian option requires an Austrian  registered address & membership to Austrian healthcare which will take over in case of repatriation. 

Similar with German insurers.

 

[Sheryl]

3 hours ago, Letseng said:

We live permanently in Thailand. So no home country/ address. Hubby is from UK. UK insurer will not renew due to reaching 80. He never had a claim ever. The Austrian option requires an Austrian  registered address & membership to Austrian healthcare which will take over in case of repatriation. 

Similar with German insurers.

 

Could try https://www.staysure.co.uk/senior-citizen-travel-insurance/

 

But if living permanently in Thailand with no home country address why a travel policy? Or is it for trips elsewhere out of Thailand? 

[Jumbo1968]

1 hour ago, Sheryl said:

Could try https://www.staysure.co.uk/senior-citizen-travel-insurance/

 

But if living permanently in Thailand with no home country address why a travel policy? Or is it for trips elsewhere out of Thailand? 

You have to have lived in the U.K. for the last 6 months out of 12 months and be registered with a U.K. GP and a Doctor where you live.

[Sheryl]

1 hour ago, Jumbo1968 said:

You have to have lived in the U.K. for the last 6 months out of 12 months and be registered with a U.K. GP and a Doctor where you 

 Actually residing in your home country and having health cover there are pretty much the  assumption hor any travel policy. 

In addition to covering only emergent  care, a travel policy can simply pay to help you get back "home" rather than pay for care jn Thailand.  Or it can pay just for getting you stabllized then flown home. 

 

So not usually a good alternative for people permanently settled in Thailand. 

[Letseng]

On 7/31/2024 at 8:24 PM, Sheryl said:

Could try https://www.staysure.co.uk/senior-citizen-travel-insurance/

 

But if living permanently in Thailand with no home country address why a travel policy? Or is it for trips elsewhere out of Thailand? 

It is for trips out of Thailand.

[Letseng]

On 7/31/2024 at 8:24 PM, Sheryl said:

Could try https://www.staysure.co.uk/senior-citizen-travel-insurance/

 

But if living permanently in Thailand with no home country address why a travel policy? Or is it for trips elsewhere out of Thailand? 

Tks for the link. I will check it out.