Hernia op

[Sutty]

Laying in hospital bed awaiting hernia op in khon kaen ram hospital.

Background to this I belive I did hernia in gym about 4 months ago it steadily got worse but I was too busy to get it sorted. Anyway when trying to walk became painful for long peiods decided it was time.

Called insurance to check all was in order ect ect guess what hernia isn't covered what a waste of space BUPA thailand are they said it could have been caused before I took out insurance so are excluded great!!!!. Went along to goverment hospital in khon kaen was diagnosed with hernia yes we can do it cost 20000bht as it's elective surgery there is a queue no problems I thought !!!! Then told wait for op 12 months. No way of getting that time reduced not even with an offer of tea money (all took in good humour). So priced up this hospital and bangkok price diffrence bangkok hospital KK 130,000bht all inclusive.

RAM 50,000bht (maybe less depends on tear inside surgeon thinks less but ceiling limit is 50,000bht) all inclusive not hard to see why I'm here. Came in this AM at 0900 to see doctor (first time no appointment) after all tests ultra sound/xray/normal health checks going down for op at 1330 can't beat that. Oh and final irony surgeon came to see me and is the same man as goverment hospital and he tells me he also does sat and Sunday at Bangkok KK. In for 2 nights a tad expensive but can you put a price on health

Edited January 4, 2016 by Sutty

[Sheryl]

How long have you had the BUPA policy? There is a 6 month waiting period for hernia repair with BUPA and also many other insurance policies. So if you have had the policy for 6 months or less, they are correct in not covering it. (see the section on "waiting period" in your policy document).

BUPA definitely will cover hernia repairs per se, just not within the first 6 months and also nto if it was pre-existing.

If you have had the policy for more than 6 months then the only grounds for denying coverage is suspicion it was pre-existing and you can appeal this. Appeal should be to the Office of Insurance Commission. http://www.oic.or.th/en

[Sutty]

How long have you had the BUPA policy? There is a 6 month waiting period for hernia repair with BUPA and also many other insurance policies. So if you have had the policy for 6 months or less, they are correct in not covering it. (see the section on "waiting period" in your policy document).

BUPA definitely will cover hernia repairs per se, just not within the first 6 months and also nto if it was pre-existing.

If you have had the policy for more than 6 months then the only grounds for denying coverage is suspicion it was pre-existing and you can appeal this. Appeal should be to the Office of Insurance Commission. http://www.oic.or.th/en

Had insurance for 6 months and a few weeks they showed me the relevant clauses as to why they don't cover hernia ops mainly as you said they say it could have been pre existing not my only gripe with BUPA but that's another story. Have details already to appeal will get it sorted first and then appeal.

[Sheryl]

The fact that it was just over 6 months may have triggered alarm bells with them since it looks like a pattern consistent with someone just waiting out the waiting period - not saying that was the case but I can see why it might seem so to them. If you had had the policy for several years, I doubt there would have been any issue.

BUPA does tend to very closely and suspiciously scrutinize claims in the first year of a policy.

In appealing, if you have any records that would support the claim that it was not pre-existing it would help -- for example, a physical check up report with no mention of it. Of course logically the burden of proving it was pre-exisitng should fall on BUPA and I suspect that, provided there are no medical records anywhere that indicate otherwise, if you appeal this and persist you will eventually win.