How Do Thai Insurers Verify Pre-Existing Conditions?

[gguy]

Friend needs medical insurance and has attended two hospitals in Thailand.

He want to go no pre-existing conditions route.

If he avoids the hospitals he has already visited, is he safe?

Does anyone know if there is any sort of data bank in Thailand that insurers use to verify pre-existing conditions?

[FBN]

If these were significant medical conditions, going the no-disclosure route is not advisable as will come back and bite at a most inconvenient time.

Not aware of any databases but many insurance companies use medical experts to evaluate claims and, if the condition seems likely to have been pre-existing, a claim may be refused. the medical advisor may also ask for a permission to release medical information from the treating physician at the time and, if a medical history indicates a pre-existing condition it will be possible to find out that way.

[slapout]

Think real hard about what your 'friend' is contemplating, and what you are asking is for info as to whether he has a chance of getting by with it. You do not mention what past aliments were, serious/minor/recurring, etc.

I know doctors and hospitals do not seem to cooperate well here in CM as far as giving info out Your friend may get by with his deception, until the autopsy takes place.

[jayinoz]

Insurance companies work like this--- any chance it was a pre-existing condition then refuse the claim then see what the claimant does. Especially if it is to cost them big money then the Onus is put back onto you. As they know the majority do not take it any further. For example if you had Hep C, then chances you had it previous to signing up were high. If they did not screen for it. If a year later you claiming Hep C medication and treatment, no way will you be covered.

Months or years later they may decide your claim is ligite, after you fight them tooth and nail. It difficult to beat these companies. They will refuse for so many real and pretend reasons then in some circumstance you need to take them to court. They need to know that the litigation suit against them will cost them far more than you medical cost for life.

It all done on a risk reward basis. What will cost them less.

Good Luck

[gguy]

I never purchased individual insurance in Thailand because the insurance companies can hassle you without recourse.

For example, if you have a !00K hospital bill, it would cost you more to litigate than the original bill.

If its s small bill and you are a long time customer, it is in their best interest to pay. If you have cancer and it is going to cost the policy limits, the insurance company will definitely claim some sort of pre-existing condition or exposure.

Insurance is just a contract and if you do not trust the other party and the courts do not offer cost effective relief, you are stupid buying such a product. The only exception maybe is a group policy to an association. The insurance company may value the association relationship. But if you are an individual buyer watch out.

Edited August 5, 2010 by gguy

[Sheryl]

Any claim submitted for something that might have been pre-existing will be closely scrutinized. They'll get all your hospital records and may also ask the doctors who treated you to indicate how long the condition, in their opinion, was present.

if the claim was submitted within say a year of taking out the policy it will get especially vigilant scrutiny. In fact you can pretty well be assurred of denial of any claim submitted in the first year for something that is of a chronic type. (Accidents and the like obviously don't count).

be advised that, if your firend is found to have lied or withheld information on his application, t could invalidate the entire policy.

[crazydrummerpauly]

I don't understand the answers posted so far - they are all far too VAGUE

as to the methodology by which insurance companies will find out for sure

the medical history of an individual claimant. In fact, they are a bunch of

answers that simply don't answer the OP's original question : Is there any

kind of DATABASE of medical interventions in Thailand ? Any answers

focussing on this ?, nope. All the answers say, roughly, is: Insurance companies

are bad folks who try their best NOT to pay up - well, what a shock. The

point is, if the OP's friend or anyone else going down the same route

witholds all inormation about other doctors and hospitals visited at any

time - without a database such a person is at least in a battle of wits (and

yes, possibly of lawyers) rather than being easily exposed as a fraudster

by a quick foray onto a computerised database. I am as interested as the

OP - IS there a medical database in Thailand ???

[rak sa_ngop]

Any claim submitted for something that might have been pre-existing will be closely scrutinized. They'll get all your hospital records and may also ask the doctors who treated you to indicate how long the condition, in their opinion, was present.

if the claim was submitted within say a year of taking out the policy it will get especially vigilant scrutiny. In fact you can pretty well be assurred of denial of any claim submitted in the first year for something that is of a chronic type. (Accidents and the like obviously don't count).

be advised that, if your firend is found to have lied or withheld information on his application, t could invalidate the entire policy.

I assume your comments relate to Thai health insurance companies.

What about international policies offered by European companies (premiums and benefits priced in GBP, Euros or USD). I believe that these companies operate under UK/EU regulations and the customer has better protection i.e policies cannot be cancelled on reaching a certain age, or for excessive number of claims etc.

Are these companies also likely to chase up overseas records?

I think that most people filling in the insurance application forms are in a real quandry deciding what to include as pre-exiasting conditions. Some forms want to know if you have visited a doctor in the last 5 years and why (giving you a space of only 2 lines to include all the info).

Do you include every twinge, sprained ankle, minor body defect etc? Of course not. I think many/most people just say 'no pre-existing conditions' and hope that they do not need to make a claim for their high blood-pressure, high blood sugar, high cholesterol etc related conditions for the first few years. (Well I do anyway).

The whole business seems to be in a 'grey' area where the insurance company has the upper hand in deciding on claims. Maybe that is why it is better to stick with one of the more expensive UK/Euro based companies?

.

[Sheryl]

I don't understand the answers posted so far - they are all far too VAGUE

as to the methodology by which insurance companies will find out for sure

the medical history of an individual claimant..... I am as interested as the

OP - IS there a medical database in Thailand ???

Individual hospitals have their own databases containing all patient records. And the main international hospitals (Bumrungrad, Bangkok etc) are all owned by the same parent company. So I think they would have no difficulty accessing each other's files.

As to privacy issues, when you put in an insurance claim you have to sign something that authorizes them to retrieve all relevant medical records.

In many cases though they do not even bother with looking for a paper trail if the policy is recent and the condition one that is chronic. I have known them to simply state that it must have been a pre-existing condition, and that the policy holder either must have known of it or should have.

Level of scrutiny is much less if the policy has been in effect for some years before a claim for that condition comes through.

[crazydrummerpauly]

I don't understand the answers posted so far - they are all far too VAGUE

as to the methodology by which insurance companies will find out for sure

the medical history of an individual claimant..... I am as interested as the

OP - IS there a medical database in Thailand ???

Individual hospitals have their own databases containing all patient records. And the main international hospitals (Bumrungrad, Bangkok etc) are all owned by the same parent company. So I think they would have no difficulty accessing each other's files.

As to privacy issues, when you put in an insurance claim you have to sign something that authorizes them to retrieve all relevant medical records.

In many cases though they do not even bother with looking for a paper trail if the policy is recent and the condition one that is chronic. I have known them to simply state that it must have been a pre-existing condition, and that the policy holder either must have known of it or should have.

Level of scrutiny is much less if the policy has been in effect for some years before a claim for that condition comes through.

Mmmmm - all rather depressing, but thanks for the informed input. I guess I was thinking about 'databases'

on an International scale - for the many ex-pats who have or recently had, a GP back home - is it normal for

Thai insurance companies to ask for/demand one's medical records from the home GP practice before paying

out on a claim ?

( GP: General Practitioner / family doctor - for the non-UK members.)

[Robby nz]

If its s small bill and you are a long time customer, it is in their best interest to pay. If you have cancer and it is going to cost the policy limits, the insurance company will definitely claim some sort of pre-existing condition or exposure.

Sorry GGUY you have that one wrong'

I have a policy with BUPA here in TL and have already claimed to the full extent of the policy.

Recently I had another problem which could possibly have been argued to have some connection to the previous claim but they paid out promptly and without question when I claimed on they latest problem.

I cant speak highly enought of the service I have received from them, even got phone calls from their rep asking how treatment was going on the first claim.

Trying to cheat them is not on.

If your not prepared to do things honestly and correctly dont do it at all.

Would you like to be cheated?

[Sheryl]

- is it normal for

Thai insurance companies to ask for/demand one's medical records from the home GP practice before paying

out on a claim ?

( GP: General Practitioner / family doctor - for the non-UK members.)

I have never heard of that happening.

However I have heard of them denying claims on the grounds that it was pre-existing based solely on the nature of the condition and duration of the policy, without any medical record trail.

[crazydrummerpauly]

- is it normal for

Thai insurance companies to ask for/demand one's medical records from the home GP practice before paying

out on a claim ?

( GP: General Practitioner / family doctor - for the non-UK members.)

I have never heard of that happening.

However I have heard of them denying claims on the grounds that it was pre-existing based solely on the nature of the condition and duration of the policy, without any medical record trail.

This is a hornet's nest of medical argumentation - but it is hugely valuable to be warned that insurers will operate with a set of undeclared

assumptions about the aetiology and course of certain illnesses. Your phrase: "Based solely on the nature of the condition..." really grabs

one's attention - it would be fascinating to see a list of conditions that they have at the back of their mind. I'm briefly (thank god) back in

England at the moment, and in a shop today, the rather down + exhausted older shop assistant told me that she had 'lost' her husband of

40 years - at the age of 61 - within a few months of a sudden onset of cancer of the liver. The point being, he had never been seriously ill

before. I wonder - would a medical insurance co. have tried to say that liver cancer MUST have come from a pre-existing condition ? In one

sense, there is no such thing as an illness without a pre-existing condition - cancer for example, is preceded by "pre-cancerous cells" !

The whole business (which it is) makes me ill...

[ricequeen]

i had a colonoscopy done at bph 3 yrs ago. it was covered by axa.

when i tried to do one at the same hospital this year using bupa, which rejected my claim saying it's a pre-existing condition. also, the dr. stated on the claim form that i had one done before.

if u want bupa to pay, u have to use a new/different hospital with no prior record for the same procedure.

of course, i fired them

most insurers can't access your medical records, because bupa wanted me to sign a form to get all my records at bph.

Edited August 13, 2010 by ricequeen

[crazydrummerpauly]

i had a colonoscopy done at bph 3 yrs ago. it was covered by axa.

when i tried to do one at the same hospital this year using bupa, which rejected my claim saying it's a pre-existing condition. also, the dr. stated on the claim form that i had one done before.

if u want bupa to pay, u have to use a new/different hospital with no prior record for the same procedure.

of course, i fired them

most insurers can't access your medical records, because bupa wanted me to sign a form to get all my records at bph.

That's interesting - so as long as commercial rivalry stops hospitals co-operating with each other,

the absence of a national database at least gives everyone some chance of handling the ingrained

impulse of insurance companies to avoid paying out. Do other members think that "Musical Hospitals"

is the answer ?

[Sheryl]

... Your phrase: "Based solely on the nature of the condition..." really grabs

one's attention - it would be fascinating to see a list of conditions that they have at the back of their mind. I'm briefly (thank god) back in

England at the moment, and in a shop today, the rather down + exhausted older shop assistant told me that she had 'lost' her husband of

40 years - at the age of 61 - within a few months of a sudden onset of cancer of the liver. The point being, he had never been seriously ill

before. I wonder - would a medical insurance co. have tried to say that liver cancer MUST have come from a pre-existing condition ? In one

sense, there is no such thing as an illness without a pre-existing condition - cancer for example, is preceded by "pre-cancerous cells" !....

I hope I have not given the wrong impression. I was referring to situations in which a claim was made within a comparatively short time of taking out the policy such that it was deemed probable the individual knew they had a pre-existing condition and withheld that information. Claims submitted within a year of taking out a new policy -- and especially within the first 6 months -- are automatically flagged for extra scrutiny.

I have not heard of anyone with a policy in effect for say over a year being denied coverage on hair-splitting grounds such as you mention.

The moral here is to take out insurance while still healthy. Attempts to get it after one has a chronic illness and to disguise that fact (which appears to have been the context of the OP) are quite likely to fail and may indeed jeopardize coverage altogether (they can void the whole policy if you are found to have intentionally concealed something/lied, even in regards to unrelated problems).

With regard to ricequeen's post, BUPA does not automatically disallow a procedure as such. However if the need for the procedure is related to a pre-existing condition, they likely will.

"pre-existing" means conditions that existed before the policy. Contrary to what some posters have implied, it has not been my experience that once you make a claim they will in future not pay for anything related to that same problem. They will, however, probably refuse to allow you to upgrade your coverage for it. For example, I have BUPA, I had carpal tunnel surgery (for which they paid with no problems, but I had already held the policy for a coupkle of years at that point). I later on decided to up my coverage to the most comprehensive policy. They let me do that bt with the rider that the increased level of coverage would not apply to carpal tunnel syndrome -- I am still covered for that, but at the prior level of coverage, not the enhanced.

I don't think these practices per se are unique to Thai insurers. However what they do not seem to have is any type of ombudsman or appeals process for denied claims, which western insurance companies do, and that is definitely an advantage.

[crazydrummerpauly]

... Your phrase: "Based solely on the nature of the condition..." really grabs

one's attention - it would be fascinating to see a list of conditions that they have at the back of their mind. I'm briefly (thank god) back in

England at the moment, and in a shop today, the rather down + exhausted older shop assistant told me that she had 'lost' her husband of

40 years - at the age of 61 - within a few months of a sudden onset of cancer of the liver. The point being, he had never been seriously ill

before. I wonder - would a medical insurance co. have tried to say that liver cancer MUST have come from a pre-existing condition ? In one

sense, there is no such thing as an illness without a pre-existing condition - cancer for example, is preceded by "pre-cancerous cells" !....

I hope I have not given the wrong impression. I was referring to situations in which a claim was made within a comparatively short time of taking out the policy such that it was deemed probable the individual knew they had a pre-existing condition and withheld that information. Claims submitted within a year of taking out a new policy -- and especially within the first 6 months -- are automatically flagged for extra scrutiny.

I have not heard of anyone with a policy in effect for say over a year being denied coverage on hair-splitting grounds such as you mention.

The moral here is to take out insurance while still healthy. Attempts to get it after one has a chronic illness and to disguise that fact (which appears to have been the context of the OP) are quite likely to fail and may indeed jeopardize coverage altogether (they can void the whole policy if you are found to have intentionally concealed something/lied, even in regards to unrelated problems).

With regard to ricequeen's post, BUPA does not automatically disallow a procedure as such. However if the need for the procedure is related to a pre-existing condition, they likely will.

"pre-existing" means conditions that existed before the policy. Contrary to what some posters have implied, it has not been my experience that once you make a claim they will in future not pay for anything related to that same problem. They will, however, probably refuse to allow you to upgrade your coverage for it. For example, I have BUPA, I had carpal tunnel surgery (for which they paid with no problems, but I had already held the policy for a coupkle of years at that point). I later on decided to up my coverage to the most comprehensive policy. They let me do that bt with the rider that the increased level of coverage would not apply to carpal tunnel syndrome -- I am still covered for that, but at the prior level of coverage, not the enhanced.

I don't think these practices per se are unique to Thai insurers. However what they do not seem to have is any type of ombudsman or appeals process for denied claims, which western insurance companies do, and that is definitely an advantage.

A teriffic overview of the situation and several crunch-points - Sheryl, you should write the 'Claimant's Handbook' !

My overall feeling is that given your eminently logical points about starting a policy before one is ill, and never never

concealing anything, many cases will pan out due partly or largely to the good or bad intentions of the insurer. As in

law, there is the Letter, and the Spirit, and a company that is doing well might well lean towards the Spirit of the cover

and a struggling company will look hard at the Letters to find ways NOT to pay out - that's economic realism I feel.

And as you say, without a governing body to appeal to, outcomes are nigh-on impossible to challenge let-alone overturn.

I guess that what ultimately worries me is grounded in the sheer complexity of the human organism and its pathologies -

I mean, are there ANY conditions ( accidents aside ) that absolutely could not be traced to some kind of prior cause ?

A classic example: previous high blood-pressure and a stroke ? And what if one had consulted a doctor for obesity and

then developed diabetes ? There must be 100's of such linkages, so (as a career paranoic) I would always be on edge

until a claim had actually cleared all hurdles. Wishing good health to everyone.

[wpcoe]

Some anecdotal information about how "thorough" BUPA is:

About 5 years ago, I submitted to surgery at BNH to correct a deviated septum. When it came time to pay the bill, BUPA turned me down. Reason: 3 years prior, I had attended Bumrungrad hospital after suffering aerotitis (blocked ears) upon landing. The treating physician indicated in my chart that the aerotitis was probably due to "chronic sinusitis." Based on a "probable" history of runny noses, BUPA said they wouldn't pay to correct my deviated septum. "Pre-existing condition." I jumped through a few hoops, got the Bumrungrad doctor to amend my chart and then BUPA relented to pay.

Three years apart, two different hospitals, and BUPA put one plus one together and came up with three...

[crazydrummerpauly]

Some anecdotal information about how "thorough" BUPA is:

About 5 years ago, I submitted to surgery at BNH to correct a deviated septum. When it came time to pay the bill, BUPA turned me down. Reason: 3 years prior, I had attended Bumrungrad hospital after suffering aerotitis (blocked ears) upon landing. The treating physician indicated in my chart that the aerotitis was probably due to "chronic sinusitis." Based on a "probable" history of runny noses, BUPA said they wouldn't pay to correct my deviated septum. "Pre-existing condition." I jumped through a few hoops, got the Bumrungrad doctor to amend my chart and then BUPA relented to pay.

Three years apart, two different hospitals, and BUPA put one plus one together and came up with three...

Oh, how depressing - but very valuable input. Proves my former point precisely.

Insurance companies - don't you love 'em ? They exploit our fears and disasters

for material gain - which is bearable if they stand by us when the stuff hits the fan,

but if they welch on the deal - they're lower than scum. It is very interesting that

wpcoe managed to get support and massaging of the history from a Bumrungrad

doctor...this occurs to me: if one finds oneself face-to-face with a hospital bill and

hears that the insurance co. is minded not to pay out - maybe the massaging of the

diagnosis will be even more likely if one flatly states to the hospital that owing to

one's own near-penury, if the insurers don' pay out, there is no way they'll get their

money. Course, this only applies AFTER the treatment !

What I would like to know from wpcoe is - how much unintended help did you give to

BUPA by declaring everything that had gone before ? And could you have got an easier

progress through the system if you had not mentionned the original treament for

aerotitis ? Thanks.

Edited August 14, 2010 by crazydrummerpauly

[wpcoe]

What I would like to know from wpcoe is - how much unintended help did you give to

BUPA by declaring everything that had gone before ? And could you have got an easier

progress through the system if you had not mentionned the original treament for

aerotitis ? Thanks.

I never mentioned the Bumrungrad aerotitis episode to either my BNH doctor or to BUPA. BUPA sleuthed it out all on their own. Different hospital, several years prior ... and they found it.

My memory is fuzzy on the details, but I do recall it was not easy to get the Bumrungrad doctor to amend my medical records.

[crazydrummerpauly]

What I would like to know from wpcoe is - how much unintended help did you give to

BUPA by declaring everything that had gone before ? And could you have got an easier

progress through the system if you had not mentionned the original treament for

aerotitis ? Thanks.

I never mentioned the Bumrungrad aerotitis episode to either my BNH doctor or to BUPA. BUPA sleuthed it out all on their own. Different hospital, several years prior ... and they found it.

My memory is fuzzy on the details, but I do recall it was not easy to get the Bumrungrad doctor to amend my medical records.

Thanks for that - it really is valuable to know that they 'sleuthed it out all on their own', because that takes us

right back to the beginning of this thread - the idea that there is some kind of 'Data-base' of treatments. It

appears that even if there is not something as formal as a Thailand-wide database, ( which has still not been

established one way or the other ) - there is certainly a 'network' of information-sharing crossing barriers between

hospitals - but it does raise a further question, which is: how national or regional might it be ? ( or is it only a

BKK or other single-city phenomenon ? )

[wpcoe]

I doubt there is a nationwide database, but perhaps there is.

I put it down to BUPA sending requests to the hospitals that most farang are most likely to to attend, and then ask for records. Bumrungrad, BNH (where I already was), Bangkok Hospital, and the Christian Hospital on Silom (not sure the exact name) are probably routine places for BUPA to check.

Sorry to take so long to reply. Life got in the way: overseas trip followed by a herniated disc. So far, BUPA has paid B40,000 out of B50,000 for a 3-day stay at BNH. My continuing physical therapy needs to be paid by me directly to the hospital and then I submit a claim later.