Pre-Existing Conditions and Related Ailments

[tonray]

Today...had a discussion with BUPA about policy option. Was going to sign up for the platinum plan but of course being the honest moron that I am, disclosed that I have been diagnosed with high blood pressure which had always been under control with meds and never a crisis. So BUPA sends me the disclaimer from the underwriter that states as follows:

Any treatment of high blood pressure and its complications such as heart vessel disease, cerebrovascular accident (CVA) include brain damage from CVA , renal failure, and any related condition will not be covered.

Now I read that as saying 90% of the things an average Joe might want covered into his later years are now excluded because of treatable and under control high blood pressure,. Now there are no doubt some guys who have uncontrolled high blood pressure and don't even know it..and sign up for the policy without the exclusions.

I am extremely frustrated and really don't want to pay 4837 baht a month for a policy that covers none of the major age related ailments a male might encounter.

Any others encounter this and how did you handle it ?

Of course the rep tried to sugar coat it and said that only if the doctor says your ailment is caused by high BP would it be not covered. "Doctor, what do you think caused his stroke ? (or heart disease or kidney issues...etc etc). It just seems like a great way to get out of paying claims to me.

Edited October 13, 2015 by tonray

[JLCrab]

The BUPA policy refers to a Pre-existing conditions as one "that would cause a prudent person to seek diagnosis, caring or treatment ... " such that someone who had high blood pressure even if they were unaware at the time they sent in the application could still be considered to have a pre--existing condition.

Every time one goes to a hospital for whatever reason they take your blood pressure so I don't think 'Gee I didn't know' will carry much weight.

[tonray]

The BUPA policy refers to a Pre-existing conditions as one "that would cause a prudent person to seek diagnosis, caring or treatment ... " such that someone who had high blood pressure even if they were unaware at the time they sent in the application could still be considered to have a pre--existing condition.

Every time one goes to a hospital for whatever reason they take your blood pressure so I don't think 'Gee I didn't know' will carry much weight.

That was not the point I was trying to get at. They have linked excluding any potential related condition so you are not covered for things you do not have now. For example...my recent blood work shows my kidneys and cholesterol are normal and always have been but since I disclosed high BP if I have a kidney problem 5 years from now...they can legally screw me. I think people should read their exclusion list...you may be paying premiums for something they don't cover. Just venting....too much BS in the insurance industry globally. Used to be about shared risk pools...now they only want profit certain contracts.

[DogNo1]

Maybe it's best to put those premiums into a medical savings account. In effect, you would be self-insuring but you would be covered for anything.

[JLCrab]

Well maybe OP can find a different insurer with less restrictive pre-existing condition policy terms. However, for persons at large, it is better to purchase health insurance before you have any existing conditions. BTW having a reserve and self-insuring are not the same thing.

[AlexRRR]

Maybe it's best to put those premiums into a medical savings account. In effect, you would be self-insuring but you would be covered for anything.

I agree and this is what i would do, all in all medical insurance has been getting watered down and costly.

Im also of the mind set that i won't get sick, i trust myself to be healthy with minor aliments, to get to my age and be free of anything more than some arthritis i think i have done well, shows me i have good internal working body, of course I'm not so stupid to think nothing can happen to me I'm not bullet proof, accidents can happen as well....as one poster here suggested what ever your premium would be for a year deposit it into a separate account for that rainy day.

[JLCrab]

Bob Hope's famous line: A bank is a place that will lend you money if you can prove to them that you don't need it.

... pretty much applies to health insurance as well.

[stevenl]

The BUPA policy refers to a Pre-existing conditions as one "that would cause a prudent person to seek diagnosis, caring or treatment ... " such that someone who had high blood pressure even if they were unaware at the time they sent in the application could still be considered to have a pre--existing condition.

Every time one goes to a hospital for whatever reason they take your blood pressure so I don't think 'Gee I didn't know' will carry much weight.

That was not the point I was trying to get at. They have linked excluding any potential related condition so you are not covered for things you do not have now. For example...my recent blood work shows my kidneys and cholesterol are normal and always have been but since I disclosed high BP if I have a kidney problem 5 years from now...they can legally screw me. I think people should read their exclusion list...you may be paying premiums for something they don't cover. Just venting....too much BS in the insurance industry globally. Used to be about shared risk pools...now they only want profit certain contracts.

You have high blood pressure, therefore a medical condition. So yes, it makes sense from an insurance perspective to exclude any illness stemming from that condition. So if your kidney problem in 5 years time is a result from your high blood pressure it will not be covered, if your kidney problem has another cause it will be covered. Does make sense to me.

As with all insurance contracts for profit based insurance companies, they want to accept risks that seem profitable, whereas the insured sometimes has the same goal: getting more out of it than they put in, in stead of the real goal: cover for risks that are too big to cover out of pocket. And therein lies the dilemma.

[tonray]

The BUPA policy refers to a Pre-existing conditions as one "that would cause a prudent person to seek diagnosis, caring or treatment ... " such that someone who had high blood pressure even if they were unaware at the time they sent in the application could still be considered to have a pre--existing condition.

Every time one goes to a hospital for whatever reason they take your blood pressure so I don't think 'Gee I didn't know' will carry much weight.

That was not the point I was trying to get at. They have linked excluding any potential related condition so you are not covered for things you do not have now. For example...my recent blood work shows my kidneys and cholesterol are normal and always have been but since I disclosed high BP if I have a kidney problem 5 years from now...they can legally screw me. I think people should read their exclusion list...you may be paying premiums for something they don't cover. Just venting....too much BS in the insurance industry globally. Used to be about shared risk pools...now they only want profit certain contracts.

You have high blood pressure, therefore a medical condition. So yes, it makes sense from an insurance perspective to exclude any illness stemming from that condition. So if your kidney problem in 5 years time is a result from your high blood pressure it will not be covered, if your kidney problem has another cause it will be covered. Does make sense to me.

As with all insurance contracts for profit based insurance companies, they want to accept risks that seem profitable, whereas the insured sometimes has the same goal: getting more out of it than they put in, in stead of the real goal: cover for risks that are too big to cover out of pocket. And therein lies the dilemma.

The problem lies in that outside of an autopsy there is really no way to determine for example whether a coronary bypass was needed due to high blood pressure or due to high cholesterol but the doctor of course can say that BP is a contributing factor in any heart disease. Since my BP is controlled daily with Meds, it would stand to reason that BP could not be the cause of any future ailments. But this gives the insurer a blanket way to refuse payment on ANY heart or circulatory ailment. Nothing one can do about it...just a fact. Someone who has never visited a doctor and lives with high BP everyday un-diagnosed gets a policy without exclusions and someone who takes care of their health issues with treatment gets shafted. The world we live in.

Edited October 14, 2015 by tonray

[JLCrab]

If the person who has high-blood pressure, but has never visited a doctor, answers 'No' on the policy application to the high blood pressure query, and then puts in a claim for a stubbed toe, the doctor who checks his blood pressure prior to the toe surgery might then notify the claims department that this person has high blood pressure that was not disclosed when the policy was issued and the entire policy might be cancelled.

[meatboy]

If the person who has high-blood pressure, but has never visited a doctor, answers 'No' on the policy application to the high blood pressure query, and then puts in a claim for a stubbed toe, the doctor who checks his blood pressure prior to the toe surgery might then notify the claims department that this person has high blood pressure that was not disclosed when the policy was issued and the entire policy might be cancelled.

and if they COUGH.

[SussexExpat]

Beware if you have to make a claim.

Two years after I started my BUPA cover I had gastric problems investigated at Bumrungrad hospital. Total bill was 35K, which BUPA paid in full with no problems.

When it came to renewing my insurance the next year my premium increased by 30%.