Health - premium increase after operation?

[THAIPHUKET]

Wife is insured with LMG, had pin hole operation of which we paid say 40%, don´t remember. This is ok, we did not want a big scar. After that premium was increased. Is that customary? If, yes after each event, how to calculate cost? How to compare insurance companies, I bet that there is no yard stick?

How do you insure your female partner well, age 40. With whom?

[Rooo]

As per OP request, moved to health.

[Sheryl]

It is not at all normal or customary for insurance premiums to go up after a claim, though they do go up periodically as the insured gets older (and there is sometimes an across the board increase in rates due to inflation). Are you sure this was a special increase due to your wife's surgery and not the usual increase due to age or overall increase in everyone's rate?

LMG is not a usual provider of health insurance. They primarily provide motor insurance, home insurance and the like. In fact their website does not even show a general health insurance product, only personal accident cover and a special policy for cancer. What exactly is your policy called?

It is usually best not to get health insurance from companies that do not specialize in it. That said, now that your wife has had an illness that required surgery, any new policy she gets is likely going to exclude the condition she was treated for. How much of a problem that is, depends on what the "pin hole" surgery was for.

The largest/most common insurer in Thailand is BUPA.

[THAIPHUKET]

Sheryl, I confirmed my suspicion about the increase. The op was to take a uterus cyst out. Which, you are very right, may come back. What wider areas can be declared per-conditioned because of the cyst?
No indication of that but always on the guard with insurers and the like= cancer?

Can you add a word on out patient insurance. That financial risk is potentially much higher than a hospital treatment.

[Sheryl]

I doubt she had a uterine cysts removed. More likely she has endometriosis and a chocolate cyst(s) was removed laparascopically, these cysts are not in the uterus but rather outside of it.

Endometriosis has nothing to do with cancer and is not a risk factor for it, and there would be no reason not to insure anyone with it -- but you can be sure any new policy will exclude coverage for anyhting related to endometriosis since it is now a pre-existing condition. That would include any future treatments for chocolate cysts and also possible surgery for intestinal adhesions, which are often a complication of endometriosis.

The cost of including outpatient cover in an insurance policy is almost never worth it - what you pay in extra premiums and the maximum they will cover are virtually the same.

If your wife is Thai, she has the option of getting free care at a government hospital for her endometriosis, so that would be one option. Also note that the problem resolves after menopause, so depending in her age, it may not be an issue for that much longer.

[inbangkok]

I know with BUPA, if you make a few major claims or get an expensive surgery, your premium will go up when you renew. It can be between 5 and 30 percent depending how many claims you made and the total cost of the claims. This is clearly stated in their policy (the fine print of course) and it has happened to me.

[THAIPHUKET]

1. She'll as usual was right with her cyber diagnosis =chocolate cyst, bitter sweet

[THAIPHUKET]

@In Bangkok can you please give link or take photo of that particular section. Really want to see the definitions. It sounds at least in theory premium could go up endlessly in case you become an accumulator of illnesses over time.

[THAIPHUKET]

Cyber diagnosis ==Sorry, I wrote Sheryl but program doesn't like that name

[THAIPHUKET]

Just to illustrate potential risk. In our case the LMG premium was increased right after the very first operation, previous 5 years no claims. Sounds different from what InBkk is indicating.

[Sheryl]

I've twice had claims with BUPA and no change in premium. That's claims spaced out over many years though.

Would very much like to see the exact "fine print" on this. Sounds egregious.

[THAIPHUKET]

Now it is getting interesting. My agent said No specifics in the policy, only reference in General Business Conditions. Increases after event of claim according to the law. Apparently the law allows for increases not to exceed 25%

I hope someone with competent insurance knowledge will respond.

[Sophon]

It is not at all normal or customary for insurance premiums to go up after a claim, though they do go up periodically as the insured gets older (and there is sometimes an across the board increase in rates due to inflation). Are you sure this was a special increase due to your wife's surgery and not the usual increase due to age or overall increase in everyone's rate?

LMG is not a usual provider of health insurance. They primarily provide motor insurance, home insurance and the like. In fact their website does not even show a general health insurance product, only personal accident cover and a special policy for cancer. What exactly is your policy called?

It is usually best not to get health insurance from companies that do not specialize in it. That said, now that your wife has had an illness that required surgery, any new policy she gets is likely going to exclude the condition she was treated for. How much of a problem that is, depends on what the "pin hole" surgery was for.

The largest/most common insurer in Thailand is BUPA.

The OP probably have the same insurance that I have through LMG Pacific Healthcare.

To the OP: You say that you had your suspicions confirmed about the premium increase being because of the operation, how was that suspicion confirmed and how much was the increase? I note that you mention your wife's age is 40, which would be a normal age for a rate increase. Are you sure that the increase (or at least part of it) is not because your wife has entered into a new age bracket?

Sophon

Sophon

Edited October 20, 2014 by Sophon

[inbangkok]

Here is the fine print which allows BUPA to raise premiums. I inquired to this and BUPA told me it is between 5% and 30% depending on risk. My premium was raised 25% after some expensive claims when I renewed.

Sheryl, 2 claims spread out over years is clearly not going to result in a premium adjustment.

[THAIPHUKET]

Uuufff, @InBkk what a charming eye opener.

Up to 30% as per law. Plus not a hint of a yardstick to go by= how much increase for what. Each insurer and each insured on its own.

And reading the rest basically means you are not insured, when the worst comes to the worst. At least not without a legal fight and slim chances of prevailing.

I wish, someone with real legal knowledge will prove me completely wrong.

[Issangeorge]

That's one reason I have always been hesitant to get insurance. I'm afraid they will screw me around if it's an expensive claim. I have high BP, under control 120 over 80 last check, but if I have an expensive medical problem, it's likely to be cardiovascular, or cancer. If it's cardiovascular, I'm afraid they will say I had a pre existing condition and won't pay. If it's cancer I figure I can make it to my home country. However if the government ever reintroduced the insurance for Foreigners at a sustainable cost, I will get that for sure.

[THAIPHUKET]

Sophomore, will answer your questions when back home. But note that a BUPA business condition is being cited. I. E. It's not a LMG issue It's very much a general theme. What insurers do or don't, is of no concern, only what their legal rights are. That's what will come to cause misery.

[Sheryl]

Here is the fine print which allows BUPA to raise premiums. I inquired to this and BUPA told me it is between 5% and 30% depending on risk. My premium was raised 25% after some expensive claims when I renewed.

Sheryl, 2 claims spread out over years is clearly not going to result in a premium adjustment.

As I read the small print, it is not having claims of any specified number or amount that would lead to an upward adjustment but rather a change in your "risk profile". That is not quite the same thing (though also a concern should you for example develop cancer).

Is it me or do sections 2 and 3 contradict each other (re right to renew?)

[offset]

My son has LMG insurance and had an hospital stay costing 55000 baht after he swallowed a battery they paid up with no problems and no increase in premium

[Sheryl]

My son has LMG insurance and had an hospital stay costing 55000 baht after he swallowed a battery they paid up with no problems and no increase in premium

That would be consistent with the idea that adjusts to premiums for reasons other than age are based on changes in risk rather than claims as such. I suspect that somewhere in the LMG Pacific policies there is a clause similar to what we saw from BUPA.

In the case of the OP, the only thing his wife is at increased risk of is further surgery related to endometriosis, and that only for probably a few years more. However it is quite likely that the nature of the problem and care she got was either inadequately documented by the hospital or misunderstood by the insurance adjustors. They may indeed have incorrectly thought it was a tumor. Thai use and understanding of English medical terms not being the best. It will be a hassle but probably worth trying to clear it up.

This has been a very useful thread as it flags a major issue. It's got me reconsidering my own insurance.

[THAIPHUKET]

I wanted just that = understand the potential risk. (case of my wife is one year old..therefore of no concern. It is now that I want to increase the Insurance cover which reminded me of the case.)

Fact is the wording of conditions is so ambiguous that the interpretation is completely at will of any insurer and any claim handler.

That is all that counts in legal disputes. The insured is bound to lose.

Side note = I had posted the same at first in the Insurance Forum. SameSame deafening silence by insurance agents /experts like here.

[Sheryl]

Ambiguous wording combined with the fact that insurance claim adjustors are not medical professionals could easily have led to the incorrect impression that your wife had cancer or a pre-cancerous condition.

It might be worth seeing if you can get this clarified to the insurance company since they may have been acting on a misunderstanding.

I don't know what the wording of the law is, but I think we have clarified that it is not a claim per se but rather a claim for a condition that sigificantly changes your risk profile that leads to rate increases.

[THAIPHUKET]

Sheryl, I may have misled you, The cancer issue was a purely hypothetical thought, always expecting the worst from insurers.

But you are right, after each sickness (definition?) one should get in writing which future likenesses from now on will be considered PRE-CONDITIONED. I only foresee that the insurance companies would hand out an endless list,

declaring your own BIRTH a PRE-CONDITION

[inbangkok]

OK, hopefully I can share a few things and help clear things up.

First, I have no idea if BUPA raising premiums by 5%-30% has anything to do with having the legal ability to do this. The fact is that BUPA is a business and they are not going to continue taking a loss on high risk individuals. This is why they clearly state they reserve the right to raise premiums. As for Sheryl sharing that she made two claim against BUPA over several years, or offset saying his kid swallowed a battery and the hospital stay was 55,000 baht. These are not high risk situations. Sheryl made 2 claims over several years which is quite low, and the chance of this kid swallowing another battery is quite low as well.....if he continues swallowing batteries and ending up in the hospital, I can pretty much guarantee your premiums will go up because your kid obviously has a problem with eating batteries and has become a high risk customer for BUPA to insure.

I don't know exactly why my rates were raised and BUPA does not seem to disclose the exact method or calculations used to increase premiums. However I can tell you this.....I don't know the exact cost of my medical bills for the year, but it was probably over 500,000 baht and it was all the going towards the same condition. A 55,000 hospital stay because a kid swallowed a battery by accident is pretty minor in comparison. As mentioned, if your the kid keeps swallowing batteries, the premium will go up.

Another example is this......if you start having pain in your arm and numerous diagnostic tests are run over the course of a year, a few surgeries maybe and lots of medication, you become high risk as the insurance company is assuming you will need all of this treatment repeated the following year. If you make no claims regarding your arm the following year, your premium will most likely drop in price when you renew again.

As for a few people talking about how they won't buy insurance and people saying they will reconsider their insurance. I highly advise against this. If you come from a western country and are used to a certain level of care, and something serious happens, you do not want to end up in a Thai government hospital. Something might not even be your fault. You might get hit by a bus. A small cut needing stitches might be fine at a government hospital. But I know that if I need surgery or need to be hospitalized, being stuck in a government hospital would be my worst nightmare. I feel comfort in knowing that I can always go to Bumrungrad and get the absolute best and most aggressive care by well trained and experienced doctors.....even if I have to pay for it.

I understand insurance quite well because I am American.....and as everyone knows we are pretty much the only developed country in the world without some form of universal or subsidized healthcare.

Edited October 22, 2014 by inbangkok

[THAIPHUKET]

INBKK , helpful clarification. But not for us , who come from a different medical insurance system. Can´t speak for Europe as a whole, but in Germany at least health insurance is not related to the risk of the individual, rather to group (professional) risk. The individual risk assessment is completely against the concept= Protection against Personal Mishaps. Only Statistical Evidence will balance the risk out.

Evrthingelse is subject to willful or not willful misinterpretation of the personal risk

[inbangkok]

INBKK , helpful clarification. But not for us , who come from a different medical insurance system. Can´t speak for Europe as a whole, but in Germany at least health insurance is not related to the risk of the individual, rather to group (professional) risk. The individual risk assessment is completely against the concept= Protection against Personal Mishaps. Only Statistical Evidence will balance the risk out.

Evrthingelse is subject to willful or not willful misinterpretation of the personal risk

It is clearly up to BUPA to determine the risk. The system in Germany is different, as I understand it is indeed a system that is partially subsidized by the taxpayers..... Correct? Therefore buying private in insurance in a foreign country that you are not able to claim benefits in is not comparable.

However, it is very comparable to the American system, up until very recently has been essentially unregulated and they can charge whatever they want, whenever they want.

I don't know what your age is, risk factors, overall health, etc........ But you need to make a very serious decision. If you are extremely rich... Than you might not need insurance and you can pay for care at an international hospital out of pocket. Otherwise, of something serious happens, you will be forced to seek treatment at a government hospital because international hospitals will simply be too expensive. As I made clear, my personal decision is that it would be living hell for me to be in a government hospital if something were to happen to me. I have visited many government hospitals and went with my girlfriend on a few occasions because she is covered by Social Security. I was so unimpressed at the quality of care, knowledge of the Dr's and nurses, and facilities...... I can not even begin to explain.

Edited October 22, 2014 by inbangkok

[Sheryl]

Sheryl, I may have misled you, The cancer issue was a purely hypothetical thought, always expecting the worst from insurers.

But you are right, after each sickness (definition?) one should get in writing which future likenesses from now on will be considered PRE-CONDITIONED. I only foresee that the insurance companies would hand out an endless list,

declaring your own BIRTH a PRE-CONDITION

What I was trying to explain is that from my knowledge of how this is likely to have appeared in the medical notes and forms given the insurance company it is very likely that it did indeed give the insurance company the erroneous impression that some sort of tumor was involved.

What do "pre-conditions" have to do with this? A pre-exisitng condition is something that was wrong before the policy issued. Nothing to do with your problem that I can see, and I have not known Thai insurerers to make an issue over pre-exisitng except when claims are submitted fairly soon after a new policy was issued, in which case they do go over wit with a fine-toothed comb if the claim was for something potentially elated to a chronic condition.

Your problem seems to be that the insurance company believes your wife to now be in a high risk category (and unfortunately Thai insurance law seems to allow them to raise rates under that situation).

It would be orth some effort to be sure that they did not base that determination on a misunderstadning of her diagnosis and the procedure performed because they may have.

[THAIPHUKET]

I was always talking in the abstract, my wife served only as a sample. Same with cancer, only to illustrate the problem.

You are insured , have a cyst removed, insurer increases the premium, Not a word about what new risks may cause the increase. Not a word about cancer OUR HOLY assessment says YOU ARE A HIGHER RISK.

Fact is there are no legal definitions, no binding yard sticks , to go by.

Sheryl , can you not get a real expert into this discussion, start a completely new and pinned subject title? It really important for TV members.

PS No ;

German Tax payers don´t pay, it´s the mass of millions of insurance payers balancing out the risk. Health is mostly fate. We fared all very well under this system introduced by Bismark 1883

[inbangkok]

I was always talking in the abstract, my wife served only as a sample. Same with cancer, only to illustrate the problem.

You are insured , have a cyst removed, insurer increases the premium, Not a word about what new risks may cause the increase. Not a word about cancer OUR HOLY assessment says YOU ARE A HIGHER RISK.

Fact is there are no legal definitions, no binding yard sticks , to go by.

Sheryl , can you not get a real expert into this discussion, start a completely new and pinned subject title? It really important for TV members.

PS No ;

German Tax payers don´t pay, it´s the mass of millions of insurance payers balancing out the risk. Health is mostly fate. We fared all very well under this system introduced by Bismark 1883

The last part about all the German insurance payers balancing out the risk......that is kinda' the attempt with Obamacare. If healthy people are forced to buy insurance, it will balance out when people get sick and need to claim.

Unfortunately, that's just not the reality of the situation here in Thailand for us foreigners.

I just cannot imagine how foreigners don't but insurance and sooner or later I would not be surprised if the government forces it on expats. I read all the time about someone in Phuket who crashes his motorbike, or something here in BKK that leaves an individual seriously injured and they cannot pay for their medical bills or medical transport to their home country.

I think the Thai government has some very questionable policies directed at foreigners who reside here for a long time. However, I would have no problem if they required expats to maintain private insurance.

[Issangeorge]

I was always talking in the abstract, my wife served only as a sample. Same with cancer, only to illustrate the problem.

You are insured , have a cyst removed, insurer increases the premium, Not a word about what new risks may cause the increase. Not a word about cancer OUR HOLY assessment says YOU ARE A HIGHER RISK.

Fact is there are no legal definitions, no binding yard sticks , to go by.

Sheryl , can you not get a real expert into this discussion, start a completely new and pinned subject title? It really important for TV members.

PS No ;

German Tax payers don´t pay, it´s the mass of millions of insurance payers balancing out the risk. Health is mostly fate. We fared all very well under this system introduced by Bismark 1883

The last part about all the German insurance payers balancing out the risk......that is kinda' the attempt with Obamacare. If healthy people are forced to buy insurance, it will balance out when people get sick and need to claim.

Unfortunately, that's just not the reality of the situation here in Thailand for us foreigners.

I just cannot imagine how foreigners don't but insurance and sooner or later I would not be surprised if the government forces it on expats. I read all the time about someone in Phuket who crashes his motorbike, or something here in BKK that leaves an individual seriously injured and they cannot pay for their medical bills or medical transport to their home country.

I think the Thai government has some very questionable policies directed at foreigners who reside here for a long time. However, I would have no problem if they required expats to maintain private insurance.

I agree the government should have foreigners incurred, but the only way they can make it work is by having all foreigners incurred under a single pay system so the healthy subsidise the unhealthy, otherwise a large amount of retirees would not be able to get insurance, a lot of these people spend a lot of money in Thailand and look after extended families. There would definitely be a drop in GDP, if they had to leave.