Anyone using ACS Asia Insurance in Thailand better read your small print...

[mark131v]

Mods I know this relates to Insurance but I think it should stay general as it may relate to many members on here who wont necessarily check in the insurance board as they probably think they are covered...

Brief background I recently had to attend hospital with difficulty breathing as a long term resident I have cover for myself and my family through ACS insurance which I got through one of the sponsors on the site, long story short I was diagnosed with blood clots on both lungs and given treatment to stabilise the condition all seemed straight forward......

Tried to claim back the costs and I have been told that because I was not bedded down in the ward then I am not covered for life threatening medical emergencies in Thailand. Seems crazy to me that I hold insurance have had a life threatening medical emergency requiring instant treatment and this is not covered though if I was on a trip to somewhere else it would be...<deleted>...

Like I said make sure you read the small print and do not rely on the insurance brokers who if my experience is anything to go by are pretty much useless, I will be getting on to BUPA as no point paying thousands of $ for stuff that does not cover you....

The clots where probably caused due to working offshore and having to endure long flights every few weeks so anyone who is doing that should be doubly careful as Pulmonary Embolism is a common complaint and if it can happen to me it can happen to you

[partington]

If you mean you were an outpatient, that is, just visited the hospital for a few hours and were not admitted, then this lack of coverage is not "small print".

When you first buy your insurance the type of coverage is actually defined by whether they include outpatient treatment or not, so far from being hidden away, this is actually one of the main features that differentiates between the ACS insurance options you choose, and defines their cost.

In general, because outpatient treatment is relatively cheap in Thailand, the extra premium you pay for the outpatient-included version generally works out to far more per year than the cost of outpatient treatment, so it is usually cheaper to opt for the outpatient-excluded version, unless you know you have a condition that requires you to visit hospital frequently.

I also would not rely much on broker's advice, as a broker primarily wants to sell you something. But It is completely your responsibility to read all the documents before choosing your insurance-this is just common sense.

It might make you feel better if you go to the ACS site, find the outpatient-included version of the insurance you bought, and work out whether you have lost or gained money by not having this version. Even with the expense of the visit you describe you have probably come out ahead.

BUPA will cost a lot more, so make sure you read all the documents before you buy it, so that you know this time what will be covered and what will not. There will be an outpatient-excluded version for BUPA also!

EDIT: to make it very clear-in the introductory material ACS clearly show they have two kinds of policy- hospitalisation only, and complete. This is the very first bit of information you are given!

Edited September 5, 2014 by partington

[samran]

Indeed, my cover is strictly inpatient. In practice for my policy this means you have been admitted for 6 hours or more to be covered. Outpatient in Thailand tends to be reasonable enough to pay out of pocket.

What I'm describing is pretty standard and it sounds like you were treated as an outpatient.

More than happy to be corrected.

[mark131v]

I know what you say about outpatient only and agree with you however emergency treatment is covered and I have checked the small print many times this is what it says on emergencies:

Emergency: a term used in the event of an accident, natural catastrophe, the beginning of sudden worsening of a

serious illness requiring immediate measures and medical treatment for the Insured or one of the Insured's

dependents. Only medical treatment given by a doctor, generalist or specialist or hospitalization occurring within

twenty-four (24) hours of the direct cause of the emergency shall be considered conditions necessary for

reimbursement.

It doesn't say you need to be hospitalised and there are many conditions that are life threatening and don't require hospitalisation but if untreated will kill you, allergic reaction etc

from the schedule on emergency treatment:

Emergency treatment worldwide (trip of up to seven

weeks) 100% of actual expenses

I have pointed this out but they are treating worldwide as somewhere other than where I live ie Thailand

I am simply pointing out that if you hold ACS insurance Module 1b then you are not covered for any life threatening emergency treatment whilst in Thailand unless you are subsequently bedded down in the hospital, this to me seems <deleted> to be honest and makes you question the entire point of having insurance if it does not cover you for life threatening emergencies of which my complaint most certainly is

My experience of the whole situation from the Broker to the insurance company has been poor so if someone learns from my mistakes it is good, also if somebody rethinks how they would like to be covered in case of an emergency then that too can only be good....

[mark131v]

From an earlier e mail to the insurance company and broker and something I have asked numerous times but never received an answer to...

Direct question - are you telling me that emergency treatment if required in Thailand is not covered??? this is a direct question that is important, if you say that I am not eligible for emergency treatment what is the point of Insurance coverage???

[partington]

Fair enough- you didn't make it clear that it was the emergency treatment within Thailand that was not covered.

As someone with ACS insurance I wasn't aware of that, so it's useful to know that an emergency that doesn't require hospitalisation would have to be paid for if you are within Thailand.

I think I still find that acceptable though, given the lowish costs involved in outpatients visits.

Are you willing to say how much your treatment cost?

To give you an idea, in 2012, for someone age 50, the ACS premium was around $800 for hospitalisation only and $2000 for complete! That is, you paid $1200 a year more for outpatients visits to be covered. Unless you have a really expensive treatment you probably come out ahead just paying out of your own pocket!

[mark131v]

Mate I am in good health and condition but believe you me Pulmonary Embolism can hit any of us especially if you travel by plane, to treat it it needs to be diagnosed to diagnose it requires scans,ecg, ekg etc etc the medication required in the UK is 6 weeks of treatment and the tablets are in the UK for a 14tab pack is GBP 29.40 (1 Tablet twice a day) in Thailand it is Baht 4500 for what is essentially a weeks treatment to stop the condition worsening, you need it so you have to pay it so beware like I said it can happen to anyone and is not an uncommon condition and if like me you think you are covered you need to think again. Certainly didnt expect this bill when I was sat in emergency unable to breath and dont expect any help from the brokers either, like I said an all round shitty experience....

[partington]

OK granted, it's a very unpleasant experience to find you aren't covered when you're in a medical emergency, and not what you want to hear.

But once the stress is over, and thinking calmly about it, if you really only had to pay 4500baht ($140), you are still way ahead compared to the price you would have had to pay for ACS insurance that would cover this (at least $1200 a year).

I always planned that I would have to pay for any day visits to a doctor or hospital, so I probably wouldn't have been quite as upset as you.

Have a look at BUPA, but plan to pay quite a lot more!

[mark131v]

Mate that is the cost for a week of medication on top of in the region of another 60,000 baht for CT Scan and all the rest..

like I said the treatment regime is 6 weeks initially but with treatment for a further 6 weeks after that

I have had the insurance for me and the family since 2011 without making a claim so to find when you do need it that it is not worth the paper it is written on is a bit off really, like I said if it helps someone re-evaluate and saves them going through the same as me that can only be good.

Also all the gumpf about the brokers helping and assisting is just noise as well that has been very painful

I hear you with what you say of BUPA and that was what kept me with ACS but to find out that actually the cover was none existent in my case forces you to have another look, maybe that is the reason it is more expensive the fact that I would be covered in the case of a life threatening emergency in Thailand and not left bitter and twisted as I am now.....

[stevenl]

If you look at the definition of 'emergency' it is clear that this is not a 'sudden event or within 24 hours of the cause of the emergency', so yes, there is no cover. Without checking all the conditions of other health care providers, I would guess that this will not be covered on any of them.

Totally disagree with this BTW "I also would not rely much on broker's advice, as a broker primarily wants to sell you something." A broker wants to advise and should therefor recommend the cover that best fits the client. On top of that, a broker should assist with a claim, and be able to explain why it is not covered and whether there are alternative options.

Edited September 5, 2014 by stevenl

[mark131v]

Just had a chat with the missus wasn't 60,000 it was actually only 35,000 baht so far so a bargain really! oh forgot the $1500 in 2011 which has raised to about $2000 last year, still you live and learn....

[partington]

Yes that is a huge expense-and it is helpful to remind people on ACS module1 that prescribed drugs are not covered either!

Remember though that the point of insurance is to save you money in the end, and given your situation, if you were insured since 2011, to be covered for this incident you would have already paid out the money that this incident cost in extra premiums.

Insurance is a bit of a con frankly, and I have insurance simply to guard against having to fork out many thousands for a serious illness, operation, or traffic accident, all at once.

Thanks for posting this though-I think it does inform people what they might not have realised.

[mark131v]

Good luck there Stevenl!!

Cant work out what you are disagreeing about as I cannot see where any of that was written but what I can catagorically state is that the brokers in this case have been useless

A medical emergency is something that requires immediatte attention in order to help stabilse and save life

This is what Patient. co .uk says about my condition and they don't appear to agree with you but what do they know....

Pulmonary embolism is a medical emergency. It may present with very few clinical signs and/or symptoms, making it easy to miss, and a high index of suspicion is warranted.

Pulmonary embolism (PE) results from obstruction within the pulmonary arterial tree. The emboli can be caused by:

• Thrombosis - accounts for the majority of cases and has usually arisen from a distant vein and travelled to the lungs via the venous system.
• Fat - following long bone fracture or orthopaedic surgery.
• Amniotic fluid.
• Air - following neck vein cannulation or bronchial trauma.^[1]

The rest of this article deals with thrombotic PE.

Edited September 5, 2014 by mark131v

[stevenl]

Cant work out what you are disagreeing about as I cannot see where any of that was written but what I can catagorically state is that the brokers in this case have been useless

Partington wrote that part I disagreed with.

Why has the broker been useless BTW, because he did not agree with you or because he did not do his job?

You know BTW that you can appeal a decision made by the insurance company with an independent institution?

Edited September 5, 2014 by stevenl

[DogNo1]

So are you massaging your calves and twiddling your feet now when flying? That is said to reduce the chance of deep-vein thrombosis.

[mark131v]

Cant work out what you are disagreeing about as I cannot see where any of that was written but what I can catagorically state is that the brokers in this case have been useless

Partington wrote that part I disagreed with.

Why has the broker been useless BTW, because he did not agree with you or because he did not do his job?

You know BTW that you can appeal a decision made by the insurance company with an independent institution?

Because they did not do their job as an example they had received the decision on the morning but never bothered getting in touch to tell me, it took me to get in touch with the administrators to find out anything....

I have got in touch with the French mediation service after finding the address on-line I had asked this information off both the broker and the insurance company directly several times but never received anything back, I also know there is an ombudsman which I can use but again I have asked for a contact directly to the broker and the insurance company and again they have not bothered to reply...you get the picture...

[mark131v]

So are you massaging your calves and twiddling your feet now when flying? That is said to reduce the chance of deep-vein thrombosis.

Did not have a DVT or if I did I never realised it but I have been doing some horrendous flights this year so that appears to be the source of the problem....

[stevenl]

Cant work out what you are disagreeing about as I cannot see where any of that was written but what I can catagorically state is that the brokers in this case have been useless

Partington wrote that part I disagreed with.

Why has the broker been useless BTW, because he did not agree with you or because he did not do his job?

You know BTW that you can appeal a decision made by the insurance company with an independent institution?

Because they did not do their job as an example they had received the decision on the morning but never bothered getting in touch to tell me, it took me to get in touch with the administrators to find out anything....

I have got in touch with the French mediation service after finding the address on-line I had asked this information off both the broker and the insurance company directly several times but never received anything back, I also know there is an ombudsman which I can use but again I have asked for a contact directly to the broker and the insurance company and again they have not bothered to reply...you get the picture...

Yes, they're not doing their job.

[chakatee]

The coverage scheme clearly says "Emergency treatment worldwide (trip of up to seven weeks)" so if Thailand's your country of expatriation, one cannot consider that as a "trip up to seven weeks"

[mark131v]

Had a reply from the Insurance Company so like I said if you have the ACS module 1B you are effectively not covered for any emergency in Thailand unless you are bedded down in the ward for 24 hours and have some kind of surgical procedure, I should have read it more thoroughly and if I had I would not have wasted time and money on them and gone with BUPA straight away, still you live and learn.....

Hospitalization less than 24 hours

In the case of a stay of less than 24 hours in a hospital is admitted to be a hospitalization and only if the insured receives a Formal Hospital Admission, in case of :

• Surgical Procedures

• fibrescopy, colonoscopy, Endoscopy, or

· chemotherapy, radiotherapy or dialyses treatments.

Stays of less than 24 hours for emergency rooms visits which do not result in Surgical Procedure (*) are deemed to be outpatient treatments and are not reimbursed as hospitalization expenses.

(*) surgical procedures are acts carried out under general or local anaesthetic or the reaching of an organ to be treated after an incision.

In other words, even if your case was an emergency case, the exams and treatments your received were given on an outpatient basis, and no hospitalization was required by the doctor.

Also, and as you may understand, “emergency” does not necessarily means” hospitalization” as one may go to a hospital for an emergency case but the treatment does not necessarily require a “hospitalization” as defined above.

At last, and so as to clarify my colleague‘s words regarding “emergency”, she was referring to the fact that the policy allows the clients to be covered (up to the level of coverage he/she has subscribed) in any country which is not included in his geographical area of coverage, only in case of medical emergency and for stays not exceeding 7 consecutive weeks. In such a situation, the notion of emergency is being defined that way in our policies : “a term used in the event of an Accident or the beginning of a serious illness requiring immediate measures and medical treatment for the Insured or one of the Insured's dependents. Only medical treatment given by a doctor, generalist or specialist or Hospitalization occurring within twenty-four (24) hours of the direct cause of the emergency shall be considered conditions necessary for reimbursement”. Indeed, your case at stake does not apply to this situation as you are in your geographical area of coverage.

I hope this will help to clarify your understanding and remaining at your disposal for any further explanation

[stevenl]

Where are you living? Where was the policy issued? Is your broker based in Thailand?

[mark131v]

Thailand, Thailand and yes..

[JoePai]

Seems the Op is going a little over top. The policy does not say you are covered for emergencies in Thailand – if you are not hospitalised - so no argument. If not admitted then generally not too serious as they seem to keep you in these days for the slightest thing just to rack up the bill. One other thing checking ACS with BUPA, the BUPA policy (even the top one) is nowhere near the benefit level of ACS and far more expensive !

[AnotherOneAmerican]

You just ask the doctor to admit you for a night, and you're covered.

This isn't brain surgery.

[mark131v]

Joe I think you are missing the point, you are right I should have read the small print a bit closer but I would expect to be covered for life threatening emergencies in the country that I live in and where I bought the cover

The policy specifically says you are covered for emergencies worldwide and it is only when you dig a lot deeper that you find out that is not the case and actually in Thailand you are not covered unless you are bedded down for 24 hours or undergo a surgical procedure

Ref not being bedded down if you attended with chest pain or shortness of breath, like I did, you would not necessarily be hospitalised exactly the same if you required treatment for anphalaxis or many other things but you would require a full range of tests to try and work out what is going on and to make a diagnosis all of which will cost you dear

Hindsight is a wonderful thing and yes if I was in the same position I would ask to stay in the night in hospital but there will be people out there who have been paying this insurance for years thinking they are covered when actually they aren't

I do not know the specifics of BUPA cover but I do know that when I needed the ACS cover it wasn't there so like I said you live and learn

[partington]

Had a reply from the Insurance Company so like I said if you have the ACS module 1B you are effectively not covered for any emergency in Thailand unless you are bedded down in the ward for 24 hours and have some kind of surgical procedure, I should have read it more thoroughly and if I had I would not have wasted time and money on them and gone with BUPA straight away, still you live and learn.....

Hospitalization less than 24 hours

In the case of a stay of less than 24 hours in a hospital is admitted to be a hospitalization and only if the insured receives a Formal Hospital Admission, in case of :

Surgical Procedures

fibrescopy, colonoscopy, Endoscopy, or

· chemotherapy, radiotherapy or dialyses treatments.

Stays of less than 24 hours for emergency rooms visits which do not result in Surgical Procedure (*) are deemed to be outpatient treatments and are not reimbursed as hospitalization expenses.

(*) surgical procedures are acts carried out under general or local anaesthetic or the reaching of an organ to be treated after an incision.

The English in this explanation is atrocious, and so not easily understandable. However the important thing this passage seems to be saying is that stays of less than 24 hours (if you are Formally Admitted, whatever the hell that means) ARE reimbursable if they are for surgeries, the diagnostic procedures mentioned, or treatments like chemotherapy which don't take a whole day.

This is very significant if true, and makes the plan better than I thought!

Edited September 9, 2014 by partington

[mark131v]

I know what you mean it is all as clear as mud....your right though if you have cancer or kidney failure or need a camera up the jacksy it does appear to cover you but I rereally hope I never have to put that one to the test!!

[Trujillo]

Sorry, so the medication was 4,500 baht for 14 pills, which you had to buy six times? Is that right?

So how much was the total bill that you thought ought to have been covered by this insurer?

[Overcome]

This appears to support the view that I have that having your health insurance with an offshore company and/or getting advice from a broker outside Thailand sounds great until you strike a problem and then might you kick yourself. At least in your case you didn't deal with an offshore sales person ... these vultures circle the Thai expat population who think that it's all no problem to deal with - for example - a brokerage from Hong Kong saying they specialise in the expat market and can get you the best options ... when in reality you would be less at risk taking a weekend vacation with a HIV-positive leper with Ebola.

But I am puzzled by one thing - it's my understanding that being licensed as an insurance broker by the Thai regulator (similar to most countries) means you are only able to sell products also regulated by the same body. But if you were sold a non complying offshore product by a locally registered broker then either I am wrong on this or the broker is not adhering strictly to the rules.