Lmg Pacific Comprehensive

[eek]

In the Expander option it says:

Surgeon's Fee (Per surgical Schedule) Up to 50% of eligible amount payable under Basic Plan

Sorry for my ignorance...but what the heck does that mean exactly?

[madmitch]

It means your limit is 50% more than the limit in the basic plan, i.e. if the basic plan has a 10,000 baht limit, if you purchase the expander option, your limit becomes 15,000 baht.

I had one of these policies up to this year.

[eek]

tnx

[eek]

Hmm..actually, for those with experience of Lmg Pacific, would you recommend them? Do you have to claim back any medical expenses or is the payment sorted out then and there?

Im just having a final think about whether to go with them or Bupa.

Thanks.

[Gary A]

I had appendicitis a couple of years ago. My bill was 41,000 baht and they paid all except 15 baht. That charge was for a Pepsi for my wife. I didn't complain.

I have the expander too.

[eek]

Thanks Gary.

Did they also sort it all out there an then or did you have to have the money reimbursed?

[eek]

Just found the answer. Direct payment regarding medical fees, no reimbursing (for anyone interested).

[madmitch]

Direct payment subject to the hospital being in their system. Most of the larger ones are.

If you make a claim get the insurance sorted at the hospital before you are ready to leave as it can take some time to get the claim agreed.

The limits on the plans you are looking at may not be sufficient if you use one of the larger more expensive hospitals such as Bumungrad or Phuket Bangkok but you can always pay the residue if you choose one of these hotel-like establishments.

Financially they have good backing.

[Gary A]

As I was checking out of the hospital there was a guy in a suit and tie. My wife said he was the insurance man. As it turned out he was, but NOT my insurance company. He was a high pressure salesman from AIA. I wasn't feeling real sociable and just wanted to get home. I guess I was quite rude to him. That bastard came to our house anyways still trying to sell me insurance so I apparently wasn't rude enough. I finally had to tell him that NO WAY would I ever deal with a high pressure company like AIA and that he would be better off to save his time and especially my time. I still feel that way. He simply didn't understand no. Did I mention that I hate salesman.

ADDED - Most hospitals are on the LMG Pacific automatic pay list and if they are not, they will reimburse you for what they call reasonable and normal charges.

Edited July 15, 2009 by Gary A

[jfchandler]

I've had an LMGH health policy the past two years, and generally had good experience for routine claims. As said, they do direct reimbursements with most of the major hospitals (BKK and upcountry), and can give you a list of those they handle that way. The few others, it's on a reimbursement basis.

But, I don't expect to be renewing with them. I had a dermatology procedure (growth removal) where there was some question about whether my insurance would cover it. Prior to the procedure, my agent got involved, and was promised by the company they'd cover it up to a certain baht amount that had been estimated by the doctor. I then did the procedure and the actual bill was under the limit they had set.

After that, when the claim was submitted, the company delayed, delayed and then finally balked at paying the bill in the amount they had promised. Supposedly, a claims agent made the promise to my agent without getting the signoff of their superior. In the end, LMGH paid 50% of the bill, and my agent paid another 25%, leaving me 25% un-reimbursed.

The amount involved, and my resulting share, wasn't so great. But I don't want to do business, and pay a hefty policy premium, to a company like LMGH that I can't trust to keep its word and honor the commitments they make. If it had been a costly/complicated procedure, I would have been screwed....

[wpcoe]

Supposedly, a claims agent made the promise to my agent without getting the signoff of their superior. In the end, LMGH paid 50% of the bill, and my agent paid another 25%, leaving me 25% un-reimbursed.

That sounds unusual (in a good way) that the agent paid 25%. Was that a LMGH agent, or a broker?

[jfchandler]

The agent who kicked in the extra 25% was my own independent insurance broker based in BKK...not anyone employed by or directly affiliated with LMGH. She had negotiated with LMGH over the original issue, and then relayed to me their supposed commitment to cover the procedure, before I went to have it done. So in a sense, she was partly responsible for the snafu.

However, legally speaking, I'm sure she had no absolute obligation to help reimburse me. She was just trying to help make things right. And I think that particular agent/broker is an excellent businesswoman and representative who has gone out of her way to help anytime there's been any kind of issue. I'd recommend her wholeheartedly. But I wouldn't recommend LMGH.

Supposedly, a claims agent made the promise to my agent without getting the signoff of their superior. In the end, LMGH paid 50% of the bill, and my agent paid another 25%, leaving me 25% un-reimbursed.

That sounds unusual (in a good way) that the agent paid 25%. Was that a LMGH agent, or a broker?

[vagabond48]

jfc, I just signed up at the beginning of the year for LMG mega maxi care. They appear to have excellent coverage and great pricing.

do you mind sharing which of the LMG plans you got Mega maxi or ultra, or comprehensive?

Was this an inpatient or outpatient procedure?

Is dermatology one of these gray area procedures where one should get a written authorization letter if time isn't of the essence.

[jfchandler]

Sorry for the delay....I was traveling the past few days.... Re the question above...

My experience with LMGH is via their Mega Series, Maxi Care policy, covering in and out patient, and has limits of 5m baht per one disability and 20m baht lifetime.

That policy comes with a 20-plus page terms and conditions document that details all the things they will and won't cover. Anyone considering taking out their policy should read it closely BEFORE signing on the dotted line. I didn't... I should have.... It is much more specific and clear than their general policy documents and information (as I suspect would be any comparable document from other Thai medical insurance providers).

I got caught up in "waiting period" exclusion language that I wouldn't normally expect to find in such a policy.... Specifically, they exclude anything arising within 120 days after the policy is first in force that they consider "tumors, cyst or all kinds of cancer.' As well as -- though not pertinent in my case -- hemorrhoids and any hernia that is not a congenital condition. How they came to decide on those waiting period exclusions, other than the cancer one, is a mystery to me.

In this case, arising didn't mean the date I went to the Thai doctor here to seek treatment. Arising meant when the doctor routinely asked when had I first noticed the growth, and I answered it was some time back (because I had thought it to be just some routine irritation or allergic reaction, but then it didn't go away). So it was my statement of when I had originally noticed the problem that came back to cause a problem under the terms of the policy.

In the end, I had a small, unremarkable skin growth removed via scalpel as an outpatient procedure (took about 10 minutes from start to finish) after getting assurances from my broker than LMGH would cover it up to a certain amount (which the actual procedure did not exceed). It was non-cancerous, based on biopsy. And the doctor didn't consider it a cyst or tumor. But the insurance company, to my surprise, classed under that exclusion language. And that's where the problems began, and the gray area negotiations over what they would and wouldn't pay.

Unfortunately, one could read and understand all the general policy information you receive, and never know they have the waiting period exclusions as listed in the terms and conditions document.

Likewise, my LMGH terms and conditions document has a 26-item-long list of "general exclusions" listing all the things they won't cover period... A lot of them are things you'd expect, like terrorism and war and such. But a number of them are related to regular medical issues that could come to pass in a person's life...

[vagabond48]

jfc, thanks for the thorough reply.

My broker gave me 2 pages of information about pre-existing condition, waiting period and general exclusion so I was able to see right away what I was getting. I had to be extremely cautious as I was replacing my US based insurance with a Thai one. I questioned a number of the general exclusions but got what I thought were reasonably answers.

I certainly would not be happy if a LMG company representative verbally approved a procedure which later could be denied or the monetary agreement reduced. I guess if in doubt, get it in writing.

I hope I have better experiences.

After doing extensive research I thought that LMG, being a US subsidiary of Liberty Mutual and based on my requirements (61yo, 40kbaht deductible, no outpatient or NA or EU coverage) was quite inexpensive compared to my BCBS $10kUS deductible and 40%/60% co-pay.

I can only hope that on my death bed about 100 years from now, I can bitch about all the health insurance money I spent over the years and was never seriously sick enough to put in for a claim.

[jfchandler]

To be balanced, LMGH has a well priced, comprehensive coverage medical insurance product. And for other claims I've had, all small/smaller, they've directly reimbursed the involved providers without any problems.

However, while I didn't have the commitment in writing from LMGH direct to me, I did have it in writing from my broker, who related that commitment from LMGH. When later, after the procedure, LMGH reneged on the commitment they'd made to my broker, and ultimately to me, it left me with the feeling I couldn't trust them and their commitments.

Supposedly, in my case, some line-level LMGH rep made the commitment verbally to my broker. And later, when the actual claim was submitted, the LMGH rep was overruled by his/her manager/supervisor.

As I said to my broker, what if the procedure was a different one and some major expenses were involved, how would I feel doing business with them in the future? That's the reason, pretty much, I've decided not to renew with them on the next annual cycle.

[manzan]

Personally i have been having good experiences with LMG Maxicare. All but one claim were immediately taken care off

The one claim that was initially refused was a emergency, and it was clearly a policy exclusion. i paid myself (20k baht) and when i tried to claim it back personally later, they found a way to cover it anyways, and reimbursed me...

they are also much better priced then the others with that kind of coverage

[ehs818]

I've also had some problems with LMG and recently they declined to pay for my full hospital stay. They paid for 6 of 15 days, at 75% of the fees. I want to go to Arbitration on this as the bill is huge. Anyone know how this is done?Anyneed for an attorney? Any recommendations?

ERIC

[Firefan]

Vagabond: I noticed in the 2010 pricing sheet that Thaivisa send me for Maxi LMG that the "no cover discount for US, EU" of 20% no longer is an option. Will they "grand father" you in, or should you expect a 20% jump in premium at next renewal?

Cheers!

[ThaivisaInsurance]

I've also had some problems with LMG and recently they declined to pay for my full hospital stay. They paid for 6 of 15 days, at 75% of the fees. I want to go to Arbitration on this as the bill is huge. Anyone know how this is done?Anyneed for an attorney? Any recommendations?

ERIC

Can we suggest you contact the O.I.C. (Office of the Insurance Commission) as they are the ‘governing body’ for all matters relating to insurance in Thailand ?

[ehs818]

Thanks for the direction. Now I'll just have to locate a phone number for them. HAHA...And hope they speak English. Any idea on how/who to contact there? Thanks ...........

[vagabond48]

Vagabond: I noticed in the 2010 pricing sheet that Thaivisa send me for Maxi LMG that the "no cover discount for US, EU" of 20% no longer is an option. Will they "grand father" you in, or should you expect a 20% jump in premium at next renewal?

Cheers!

Last year I opted to take that 20% discount. I just got billed and yes that option is no longer part of the discount structure but the base premium was lowered by 20%. My agent did say that they will still offer that coverage but I think it will be some type of special add on and will probably more expensive.