Medical Insurance

[johnfb]

I am living in the Philippines having moved from Thailand last year. I am entitled to comprehensive health insurance with my job. The policy in 2009 that was selected was with Blue Cross but I have been very disappointed with them. They query every claim and nearly all claims have either not been paid or I have to fight hard to get thru. I am 54 and want a health insurance that covers almost everything health wise. In 2009 it was found that I have a blood sugar problem and Blue Cross threw that out saying it was a pre existing condition. I had no history before of this. I had skin tags removed in 2010, they would not pay this (no previous history again). I needed some vaccines (upper respiratory pneumonia) and they would not pay that.

Ideally I would like a medical policy that's cashless and one that covers nearly all eventualities. Should I stay with Blue Cross in the hope that second year is better? Or if not who shall I move to? I would also like an annual comprehensive check up provided free too.

[ThaivisaInsurance]

I am living in the Philippines having moved from Thailand last year. I am entitled to comprehensive health insurance with my job. The policy in 2009 that was selected was with Blue Cross but I have been very disappointed with them. They query every claim and nearly all claims have either not been paid or I have to fight hard to get thru. I am 54 and want a health insurance that covers almost everything health wise. In 2009 it was found that I have a blood sugar problem and Blue Cross threw that out saying it was a pre existing condition. I had no history before of this. I had skin tags removed in 2010, they would not pay this (no previous history again). I needed some vaccines (upper respiratory pneumonia) and they would not pay that.

Ideally I would like a medical policy that's cashless and one that covers nearly all eventualities. Should I stay with Blue Cross in the hope that second year is better? Or if not who shall I move to? I would also like an annual comprehensive check up provided free too.

As a Thai Visa member may we suggest you go Here for the different options open you yourself ?

[travelerjim]

John,

I assume you are on an employers group health policy.

Your best bet, in my opinion, is to stay with Blue cross policy you now have

and APPEAL every decision they have made in denying your valid claims.

If it as you state, you had NO pre-existing condition regarding sugar in blood..,

they should pay the benefit in your policy.

Any new policy - especially issued an an individual - surely will consider

the conditions you have now experienced as pre-existing and deny claims or deny the policy to you.As for a cashless policy..Good luck!

John..are you an American? If so, there are several policies available which will cover the "sudden and unexpected recurrence of a pre-existing condition".

tj

[madmitch]

John,

I assume you are on an employers group health policy.

Your best bet, in my opinion, is to stay with Blue cross policy you now have

and APPEAL every decision they have made in denying your valid claims.

If it as you state, you had NO pre-existing condition regarding sugar in blood..,

they should pay the benefit in your policy.

Any new policy - especially issued an an individual - surely will consider

the conditions you have now experienced as pre-existing and deny claims or deny the policy to you.As for a cashless policy..Good luck!

John..are you an American? If so, there are several policies available which will cover the "sudden and unexpected recurrence of a pre-existing condition".

tj

Agree with the above.

You now do have a pre-existing condition if you change insurers.

What was your claim for? Did you have treatment following a complication or was it purely found during a checkup? And did you pay for any drugs?

Do you handle your own claims or does your company do the paperwork for you? If the latter I would try to take over. Blue Cross are wrong to deny any claim on the basis of it being a pre-existing condition if they have no proof that you already knew about it. Send them the results of your last medical checkup where there was no mention of high blood sugar (assuming you have one). You need this removed as a pre-existing condition as this could jeopardise any treatment due to future complications or problems.

Finally READ YOUR POLICY to make sure that these claims would normally be covered under the terms and conditions of the policy. Preventative medicine, i.e. your vaccines would probably not be covered and the skin tag removal could quite easily be deemed cosmetic surgery which again would generally be excluded. It is the type of surgery where you should check with your insurers beforehand and get clearance in writing.

[thaiericsweden]

The only way to protect yourself from a claim dispute in the first few years of the health policy is to have a full medical check-up at the start of the policy. The problem in your case is that you are into the first year of this policy. I personally would look for a different health insurance company. This way you can have a medical check-up at the start of the new policy and have a better chance at getting claims covered if there is a dispute in the first year. Your pre-existing conditions cannot be denied, if there are any, then they are there. Your only hope is to keep additional conditions from being suspected and not covered.

Check-ups are a valuable tool in helping the customer when there is a dispute in a claim with the insurance company in the first year of the policy.

1.Hypothetical situation. The customer is treated by a doctor that makes a mistake in diagnosis of the customer's medical condition.

2.If the doctor mistakenly declares the medical condition is pre-dating the start-date of the policy, the insurance company has to deny payment of the claim based on the medical information provided.

3.If the customer has the results of a medical check-up (taken at the start of the policy) and these results dispute the mistaken diagnosis of the treating doctor, the customer has a good chance the insurance company will agree to a second doctor's diagnosis to review the claim and pay.

The positive benefits of a check-up far outweigh the negative aspects. Annual check-ups are a part of normal healthy life. Early detection of a medical condition is always to the benefit of that person. Check-up or no check-up; if the customer has a pre-existing medical condition, even if there is no medical record at a hospital, the insurance company has to rely on the results of the treating doctor to state when this condition was present. You are relying on the treating doctor to asses you condition. The treating doctor has to make an educated guess to when this condition first manifested itself. The doctor can easily make a mistake. A medical check-up eliminates the chance of a mistake.

[Awk]

The only way to protect yourself from a claim dispute in the first few years of the health policy is to have a full medical check-up at the start of the policy. The problem in your case is that you are into the first year of this policy. I personally would look for a different health insurance company. This way you can have a medical check-up at the start of the new policy and have a better chance at getting claims covered if there is a dispute in the first year. Your pre-existing conditions cannot be denied, if there are any, then they are there. Your only hope is to keep additional conditions from being suspected and not covered.

Seems to make a lot of sense. Is there a name for this type of check-up? I.e., what do you ask for in the hospital

if this is what you want?

With kind regards,

[ThaivisaInsurance]

The only way to protect yourself from a claim dispute in the first few years of the health policy is to have a full medical check-up at the start of the policy. The problem in your case is that you are into the first year of this policy. I personally would look for a different health insurance company. This way you can have a medical check-up at the start of the new policy and have a better chance at getting claims covered if there is a dispute in the first year. Your pre-existing conditions cannot be denied, if there are any, then they are there. Your only hope is to keep additional conditions from being suspected and not covered.

Seems to make a lot of sense. Is there a name for this type of check-up? I.e., what do you ask for in the hospital

if this is what you want?

With kind regards,

Insurance companies require a medical over a certain age (usually 60) so the best way to counter any problems is to ask for the medical application form required by the company ( you are wanting to join) for older persons.