Thai Health Insurance- A Cautionary Tale

[movsrus]

I am posting my experience with a Thai insurance company as a warning to others who may have problems similar to mine. I purchased a hospitalization policy from a major Thai insurance company (I don't know if it is against the TVF rules to state the name of the company but if you PM me I will be glad to provide it) paying over 55,000 baht for the first year premium. I was 65 years old and while the premium seemed high I thought it was acceptable given my age. When I applied for the policy I provided a detailed history of my health, what prior surgeries I had and what drugs I was taking. The insurance company reviewed my health history and approved a policy.

Approximately 11 months later, I was hospitalized at Rajavej Hospital in Chiang Mai in preparation for a test. The test was performed after which I had considerable pain and discomfort. The physician told me that I needed to stay in the hospital overnight and have a series of IV antibiotics as well as to ensure the pain would abate. The following day I felt much better and following the final course of antibiotics I was approved for discharge.

Prior to being admitted to the hospital, the insurance company was contacted and approved the pre-admission coverage. When it came time to check out I was told the insurance company had not paid for the admission and was holding the payment up for additional review. I was forced to pay 31,000 baht out-of-pocket for the hospitalization expense.

After returning home, I contacted the agent who sold me the policy and asked what the problem was. He said it would require a review by the Bangkok office before it would be paid and that it could take a week or so. I had no contact from anyone at the insurance company other than the salesman so after a week I called him back to find out what the status of the claim was. He said it was still under review and could take several more weeks before a decision was made. I waited a few weeks then called him back and now he said the company has 3 months by Thai law to resolve the issue and that I needed to wait. The only contact I have had with the insurance company is when I call the agent- not letter or office correspondence has been given me explaining what the problem is and why it takes so long to be resolved.

My Thai girlfriend has called several times and each time gets the run around. It is either "we will call you back" or check with us tomorrow but nothing ever happens- no call backs, no information concerning the issues with the claim- nothing.

I have filed complaints with the Office of Consumer Protection Bureau in Bangkok and the Department of Insurance in Chiang Mai but nothing has happened. I am now considering retaining a solicitor to assist me as the premium for the following year has been taken from my bank account and now there is over 125,000 baht that I have paid for which I have gotten nothing.

This cautionary tale is for those who are thinking of getting hospitalization insurance in Thailand- especially if you are elderly. It is better for you to set aside whatever would be the yearly premium and pay for your hospitalization costs out-of-pocket than to pay the yearly premiums only to find out that when you file a claim it will not be honored.

[CMKiwi]

Firstly, I feel sorry that this has occurred to you and understand it could happen to anyone. Its obvious you did the groundwork before hand and also provided your medical history to the company prior to them accepting the risk and taking your premium.

So often I hear of insurance companies scamming or defaulting customers out of their cover and money. As a result I am eternally pessimistic with any insurance agent or policy. Ive been burned in the past and wont let it happen again. Luckily my health is good although age is creeping up...;along with beer consumption!

Hope you manage to get something back out of this outfit but Im doubtful

Regards

CMKIWI

[worgeordie]

Banks,Lawyers and Insurance companies,I don't trust

any of them,having to been taken advantage of, by them

all,they always find something in the fine print that lets

them wriggle out of any responsibility.

regards worgeordie

[Seligne2]

Thanks for this. Well done and valuable!

[bangmai]

I would give it the 90 days....There is a difference between pre-certify and direct payment. What is your company rated by AM Best or S & P? I also see some foul play by the hospital. hat might be a fair warning to some people to tell the hospital to not provide services until they have been paid.

[movsrus]

I would give it the 90 days....There is a difference between pre-certify and direct payment. What is your company rated by AM Best or S & P? I also see some foul play by the hospital. hat might be a fair warning to some people to tell the hospital to not provide services until they have been paid.

The company is AIA which is well rated- at least in the US.

I don't think the hospital was at fault. As soon as they saw it was an insurance claim I was given a private room with a view but that is to be expected since insurance claims are always charged at top dollar (or baht). The room rate was above the amount covered by the policy but only a few hundred baht so I knew I would pay something out-of-pocket. I don't have a problem with that but to reject the whole claim and to give no reason makes me very displeased.

Rajavej Hospital seemed to be OK. They have a foreigners office staffed by native English speakers and were up front in telling me the range of costs for the procedure so I really don't think the problem was with them. The admissions clerk did send a fax to the insurance company and got a response which allowed me to be admitted and have the procedure without placing a cash deposit prior to being admitted. From this I assume (yes, I know to assume makes an ass out of you and me) the hospital was satisfied as my experience is that you don't get very far in a hospital here unless you put some cash upfront or have insurance the hospital will accept.

I don't know if insurance companies pre-pay for claims here in Thailand. My experience in the US is that once you are discharged, the final bill is calculated and sent to insurance for payment but perhaps that is not how things are done here.

I am going to go to the Department of Insurance in Chiang Mai tomorrow and see if there is a procedure for registering a claim or if I can get someone there to call AIA insurance and find out what is the problem.

Forum moderator- If listing the company name is a violation of TVF rules please strike this response.

[MaeJoMTB]

Government Hospital (Nakorn Ping)

IV + IV pain killers + IV antibiotics, less than 400bht/night in the public ward.

1,000bht extra per night for a private room.

31,000Bht, is why I avoid the private hospitals.

[bangmai]

AIA is not rated by AM Best. Hospitals use a billing system similar to the SWIFT wire transfer system. Each entity has its own code.

[konying]

One word-sucks.

From my experience, insurance company approves the procedure and issued a note to the hospital.

I did not have to pay a single baht.

May be and i do say may be as i do not know how this company works for the future, ask for promise of payment from the insurance company prior to doing any procedure, so this way you would not have to pay.

The OCPB takes time and you do need to contact them a few times, as claims get lost. Make sure to the claim number and if you do not have one, it means your case has not been received as yet.

Also get your GF to get in touch with senior management, or even go to their head office,

Just like with many things in Thailand, staff are not always most competent or reliable.

Also, i am pretty sure if Insurance company pre approved it, there is nothing to review, would appear someone who handled the claim has screwed up and now trying to cover up their mistake, so again contact senior management,

[MaeJoMTB]

There are some foreigners allegedly operating a health insurance scam in CM at the moment.

Scam is, they take your payment, but don't insure you with the company.

Have you actually had any contact with the insurance company, or just the agent?

(conspiracy theory)

[magnacarta]

Banks,Lawyers and Insurance companies,I don't trust

any of them,having to been taken advantage of, by them

all,they always find something in the fine print that lets

them wriggle out of any responsibility.

regards worgeordie

If you could comment on a topic you have never experienced then posters might take some notice,this includes all the other experts on here posting with time on their hands.I relate the number of posts to a poster having a boring life,you know who you are.Bring on the cavalry!!!!!!!!!!!!!!1

[bangmai]

I would give it the 90 days....There is a difference between pre-certify and direct payment. What is your company rated by AM Best or S & P? I also see some foul play by the hospital. hat might be a fair warning to some people to tell the hospital to not provide services until they have been paid.

The company is AIA which is well rated- at least in the US.

Got news for you: It ain't rated for toilet paper in the US. It was a part of AIG, which collapsed during the GFC. It is now a Chinese company listed on the HK stock exchange. AIA Thailand is a subsidiary of that company.

https://en.wikipedia.org/wiki/AIA_Group_Limited

[CNXBKKMAN]

There are some foreigners allegedly operating a health insurance scam in CM at the moment.

Scam is, they take your payment, but don't insure you with the company.

Have you actually had any contact with the insurance company, or just the agent?

(conspiracy theory)

If i was not getting any news from the insurance company and the agent was saying next week, next month etc i would be thinking has the agent pocketed the premium and do i have any insurance at all? Anything in Thailand where you have to spend big baht its always best to deal only with the most reputable companies, recommended by people who have dealings with them over the years. Hopefully in the op's case he will be paid out and the insurance company is just waiting till the final moment to pay which wouldnt be unusual anywhere in the world.

[gamini]

My wife had an accident policy with AIA and when she got to 60 said that they would cancel a policy because of her age in spite of the fact that she had no claims. I think they were just trying to pull a fast one on my wife because they don't like to ensure old people and I kicked up a big fuss and threatened to mention them on Facebook and eventually they agreed to insure my wife until aged 70 at an increased premium. I think I remember also having a problem with this company in Singapore on a house burglary claim, they picked up on a tiny clause that was quite irrelevant and didn't pay me.

[konying]

My wife had an accident policy with AIA and when she got to 60 said that they would cancel a policy because of her age in spite of the fact that she had no claims. I think they were just trying to pull a fast one on my wife because they don't like to ensure old people and I kicked up a big fuss and threatened to mention them on Facebook and eventually they agreed to insure my wife until aged 70 at an increased premium. I think I remember also having a problem with this company in Singapore on a house burglary claim, they picked up on a tiny clause that was quite irrelevant and didn't pay me.

It's not only this company , many cancel and stop insuring after certain age, irrespective of how many claims were made.

Ones without age limit are more expansive and this is price you pay for being insured past certain age.

[elektrified]

I've had nothing but good luck with insurance companies in Thailand; both health insurance and auto insurance as well as those policies they used to have where you got paid - I think it was 800 Baht for each day your child was ill (no longer available). My family has had AIA, Allianz Ayudhya, and Thai Health over the years (we still have AA and Thai Health). The one company that would not pay the bill directly was AIA. But our agent at the time assured my wife as she was being discharged that all she had to do was pay the bill for an admission at Sriphat , and they would send her a check in the post reimbursing her. The agent said the bill was approved but that she had to advance the money which she did (about 85,000 Baht). Admittedly she was nervous about it, and it ended up taking longer than she was told - which made her even more nervous, but about 3 1/2 weeks later the check showed up in the post for all but around 500 Baht of the bill (drinks from the fridge or something like that).

[elgordo38]

Banks,Lawyers and Insurance companies,I don't trust

any of them,having to been taken advantage of, by them

all,they always find something in the fine print that lets

them wriggle out of any responsibility.

regards worgeordie

Better throw in politicians for good luck. The only time you see them is when they knock on your door asking for your vote. I would put them down as number 1.

[DogNo1]

There have been many threads about how older people should pay for their health care expenses. The consensus has been that it's best to self-insure. When you know you're paying up front, you are very cognizant of the costs and can bargain for a good price. Good luck with getting your claim paid.

[movsrus]

There are some foreigners allegedly operating a health insurance scam in CM at the moment.

Scam is, they take your payment, but don't insure you with the company.

Have you actually had any contact with the insurance company, or just the agent?

(conspiracy theory)

If i was not getting any news from the insurance company and the agent was saying next week, next month etc i would be thinking has the agent pocketed the premium and do i have any insurance at all? Anything in Thailand where you have to spend big baht its always best to deal only with the most reputable companies, recommended by people who have dealings with them over the years. Hopefully in the op's case he will be paid out and the insurance company is just waiting till the final moment to pay which wouldnt be unusual anywhere in the world.

I got receipts from both the agent when he took my initial payment and from the insurance company acknowledging payment. The receipts from AIA came in the mail and everything looked legit. Subsequently, I got the policy, ID cards and a lot of information (in Thai) from the company. It could be a scam but if so it was done with all the finesse the Wall Street bankers used to screw the American taxpayer.

[movsrus]

There have been many threads about how older people should pay for their health care expenses. The consensus has been that it's best to self-insure. When you know you're paying up front, you are very cognizant of the costs and can bargain for a good price. Good luck with getting your claim paid.

You are right and it was an expensive lesson I learned which is the reason I posted it for others who might be in a situation similar to mine. I will begin to set aside a sum of money each year to pay for any health claim and take my chances. I guess I will chalk it up to the learning experience one has to go through when living in a foreign country. Oh well.....

[chiang mai]

I've heard similar stories in the past about AIA.

From past experience, Rajavej appears quite solid so no concerns there.

[mania]

To the OP so sorry to hear this & it is not re-assuring in regards to how this odd system works here.

As for naming AIA I do not think it is anymore a problem than how many folks say McDonalds or some restaurant is terrible

taste & service wise. More likely they would disallow you naming the agent himself

I am curious if when you bought your policy did you then get a policy in the mail from the main company office?

Or was all things like policy, card etc given to you by this agent?

Lastly when the hospital got pre-approval you said it was for pre-admission coverage? Was the procedures to be done mentioned?

Also did they contact AIA or your agent?

To the conspiracy theories I would say this conspiracy theory only has legs if all the above is only with an agent.

If a scam & policy was never turned in no contact with main office would be possible as policy exists only in an agents pocket.

Like a bookmaker who does not turn in a bet hoping it is never claimed etc. But also knowing if buyer wins bet he is on the hook for payout

Good Luck OP hope you get some satisfaction as you should for what you paid for.

[movsrus]

To the OP so sorry to hear this & it is not re-assuring in regards to how this odd system works here.

As for naming AIA I do not think it is anymore a problem than how many folks say McDonalds or some restaurant is terrible

taste & service wise. More likely they would disallow you naming the agent himself

I am curious if when you bought your policy did you then get a policy in the mail from the main company office?

Or was all things like policy, card etc given to you by this agent?

Lastly when the hospital got pre-approval you said it was for pre-admission coverage? Was the procedures to be done mentioned?

Also did they contact AIA or your agent?

To the conspiracy theories I would say this conspiracy theory only has legs if all the above is only with an agent.

If a scam & policy was never turned in no contact with main office would be possible as policy exists only in an agents pocket.

Like a bookmaker who does not turn in a bet hoping it is never claimed etc. But also knowing if buyer wins bet he is on the hook for payout

Good Luck OP hope you get some satisfaction as you should for what you paid for.

I got mail from the main office of AIA in BKK which included the policy ID card, a notebook full of Thai that defined the policy and specified the limits of coverage and I have gotten mail from them acknowledging receipt of the payment for premiums. I don't think the agent is scamming me. He has invited us to his home on several occasions and I think he is legitimate and honest. As for the pre-admission questions, I don't know what was specified as the admissions clerk sent a form to AIA and got a fax reply. My assumption is that if there had been a problem with coverage I would have been asked to place a cash deposit prior to admission. The hospital didn't ask for any money up front so I assume (again the problem with assumptions is mine) they were satisfied. My girlfriend contacted the agent on the day I was admitted and he said everything was OK.

In a prior response to the original post, someone said that AIA would not direct bill and they got payment several weeks after their hospitalization but were required to pay up-front when leaving the hospital. Perhaps this is how AIA does business. I am going to go to the AIA office in Chaing Mai today and speak with the agent (and hopefully his supervisor) to inquire why the claim has not been honored and if they require additional information either from me or the physician.

I will follow up with a post as to what transpires today. I am not out to slander AIA or health care in Thailand but rather to make people aware that insurance here has problems that they may never had to deal with in their home country. Had I known this would be a problem, I still would have had the procedure and paid out-of-pocket. My major complaint is that there is no information coming from AIA as to why the claim has not been paid and what, if anything, I can do to expedite the process.

[MaeJoMTB]

He has invited us to his home on several occasions and I think he is legitimate and honest.

Sounds like a scam ...... why would you want to visit a Thai Insurance agents home?

(foreigners aren't allowed to sell health insurance in Thailand, it is a prohibited occupation, Thai only)

[Konini]

Banks,Lawyers and Insurance companies,I don't trust

any of them,having to been taken advantage of, by them

all,they always find something in the fine print that lets

them wriggle out of any responsibility.

regards worgeordie

If you could comment on a topic you have never experienced then posters might take some notice,this includes all the other experts on here posting with time on their hands.I relate the number of posts to a poster having a boring life,you know who you are.Bring on the cavalry!!!!!!!!!!!!!!1

That's bordering on unpleasant, but even if you disagree it's totally unnecessary.

We have a friendly, community sprited forum here in Chiang Mai where we don't object to each other's musings and opinions. The post you railed against had a good and valid point in relation to professions that find ways to wriggle out of their obligations.

Keep it nice ,eh?

[worgeordie]

Banks,Lawyers and Insurance companies,I don't trust

any of them,having to been taken advantage of, by them

all,they always find something in the fine print that lets

them wriggle out of any responsibility.

regards worgeordie

If you could comment on a topic you have never experienced then posters might take some notice,this includes all the other experts on here posting with time on their hands.I relate the number of posts to a poster having a boring life,you know who you are.Bring on the cavalry!!!!!!!!!!!!!!1

Eh !

regards Worgeordie

[movsrus]

He has invited us to his home on several occasions and I think he is legitimate and honest.

Sounds like a scam ...... why would you want to visit a Thai Insurance agents home?

(foreigners aren't allowed to sell health insurance in Thailand, it is a prohibited occupation, Thai only)

I think they were just being hospitable in inviting us to visit them. We called the AIA company in Bangkok today and got confirmation the policy was legitimate and in effect. We were told that the person with whom we spoke would investigate the problem and get back to us by Monday. I will update this post when I get more information.

[elektrified]

He has invited us to his home on several occasions and I think he is legitimate and honest.

Sounds like a scam ...... why would you want to visit a Thai Insurance agents home?

(foreigners aren't allowed to sell health insurance in Thailand, it is a prohibited occupation, Thai only)

I think they were just being hospitable in inviting us to visit them. We called the AIA company in Bangkok today and got confirmation the policy was legitimate and in effect. We were told that the person with whom we spoke would investigate the problem and get back to us by Monday. I will update this post when I get more information.

Not so unusual at all. Often insurance agents in Thailand have a home office too. Years ago when we were with one agent who sold Allianz Ayudhya, I would sometimes go to his home office to make a payment as his office in town was sometimes closed during business hours. Now there's the option to pay on-line.

[movsrus]

July 23, 2015

Follow up to the OP.

I followed several of the suggestions posted in reply to my post about health insurance claims problems and am happy to state that things were resolved to my satisfaction and AIA insurance sent me a check for the amount minus the overage charges for the private room rate. I am satisfied that the claim is resolved but still unhappy about how it was handled by the Chiang Mai AIA office. I have several observations- for what its worth- about the problems and what I think about Thai health insurance for an elderly foreigner.

1. I would never have been able to resolve this issue without the help of my Thai girlfriend. My Thai is very basis and I would not have been able to communicate my concerns and issues if I were to rely only on speaking with the AIA people in English. We probably spent 25-30 hours dealing with various people on the phone, doing research to provide justification for the procedure and providing documentation that the procedure was not a result of a pre-existing condition. I think our perseverance was the deciding factor in getting the matter resolved. Had we not been the proverbial pain in the ass I don't think this claim would have been paid.

2. I am still mystified by how poor the customer service was with AIA. Perhaps it is a function of the mindset I have from dealing with insurance companies in the US but I expect if there is a problem that the insurance company contact me explaining the problem and listing steps that can be taken to resolve the issue. In the case of my AIA claim, we never received anything from the company- only a couple calls from the agent who sold me the policy saying it would take time for the claim to be paid even after I provided detailed descriptions of the procedure, why it was done and why it was not a case of an existing condition. The feedback from the agent was entirely unsatisfactory as he kept saying "wait" but providing no additional information.

3. It wasn't until we called the AIA office in Bangkok and finally got in touch with someone who looked at the claim and gave us his private telephone number that we began to make some progress. The BKK agent said the claim had languished in the Chiang Mai office for almost 4 weeks before it was forwarded to BKK for review. I have no way of verifying this as the Chiang Mai agent told me it had been sent to BKK soon after the claim was made. Perhaps it was a classic case of bureaucratic incompetence- who knows. Having the phone number of the person in the BKK office allowed us to call the same person and not have to start over each time we called with a new person who was unaware of the problems. This made final resolution of the issue much easier.

4. I did send letters with accompanying documentation to both the Office of Consumer Protection Bureau and the Department of Insurance however I left Thailand soon after the letters were sent and I do not know if they were received and responded to by the government agencies. Since the letters were in English, I suspect it would have been difficult for the two agencies to understand my problem.

5. I have to think that it may be best for me in my situation to forego buying insurance and instead put the amount I would pay for a premium each year in an account and pay for any hospitalization out of pocket. My health is good and I am not overly concerned about a hospitalization although I know things can change in an instant and I could be involved in an accident which could result in hospitalization. To date, I have paid over 125,000 baht for premiums over two years. The rate of increase in the premium will soon be a limiting factor in continuing with coverage. The premium for this year was over 66,000 baht and represented a 20% increase from the first years premium. If this is typical, then soon it would be too costly to continue with coverage.

I realize there are people who may be in my age group and have good experience with Thai health insurance but, unfortunately, that was not my experience. I will keep coverage through the end of the policy for this year then let it lapse and set aside money to pay out-of-pocket for my future hospitalizations.

For what its worth- that was my experience with Thai health insurance from AIA.

[bangmai]

Good for you. If the law is 90 days as they told you; then you can bet on it taking most of that time. I've always noticed in the US, that a fairly large check, like from a matured CD, will take 9 days to travel 100 miles, when I have sent 100 letters coast to coast, that arrived in two days with a basic stamp. Heard a lot of reports here of the large banks frequently sitting on large outbound wires for an extra day, or even knowingly making an error on the first try. It is even more prevalent in times of higher interest rates.

And you lived to tell about it.