Pre existing medical conditions - I'm Confused

[Once Bitten]

 

I am going to upgrade my health insurance with BUPA ,  originally many years ago when I first completed the application form , I put down that some years before I had a problem with a tingling sensation in one of my hands , that eventually went away. I all so said that some times I suffered form stomach acid , but it went away and has not returned. I all so mentioned that from time to time my neck ached and was given pain killers , that to eventually went away by its self and has never returned . I have never made a claim on my BUPA insurance , so I asked if,  seeing as I had never claimed , could they now remove the pre existing conditions for the things I put on my original application form.

 

 

 

 

Now BUPA have sent me this ---

 

We need physician certificate to confirm free from hernia and no treatment, no follow up in 5 year

 

We need  orthopedic physician certificate to confirm free from Ankylosing spondylitis and no treatment, no follow up in 5 year

2. The present Lab x-ray result for abdominal pain and back pain.

 
We need report  abdominal x-ray, report spine x- ray this year for confirm physician certificate

 

I am a bit confused what exactly to ask for at the hospital ,  which type of doctor , tests needed  and what's involved to for fill the BUPA request shown above .

 

Any suggestions how to proceed , what to expect , ideas .

 

 

 

[Sheryl]

BUPA Thailand in my experience tends to misunderstand medical matters and conditions. It appears that they assumed, from your reported symptoms, that you suffer from both cervical spondylitis and hiatal hernia (good chance you have neither condition and never did...or at most, that you have very slight cervical spondylosis causing little problem.).

 

Now, based on these incorrect suppositions, they are demanding not just physician certificate but a set of Xrays you do not need. An abdominal Xray by itself will not, BTW, show a hiatal hernia, it would need a barium swallow.

 

If you want to go through those hoops, then you need to see either a good GP or else separately an orthopedist and GI specialist, and have at a minimum an Xray of the cervical spine (no big deal) and a c=barium swallow (more of a hassle).

 

You'll need a doctor(s) not afraid to provide certifications which many Thai doctors are (other than the standard medical certificate form which contains nothing but the date of visit and current diagnosis). One with training in the west will be better about this as a rule.

 

If you are in Bangkok, suggest you go to Dr. Nick Walters at Mission Hospital (an American GP licensed in Thailand).

 

Other option would be to change insurers. This sort of irrational behavior is not unusual with BUPA. They seem to use staff who either lack medical training ir are afraid to use their medical judgement, either way working off a set boilerplate without actually understanding a particular patient's condition.  European insurers are much more sophisticated/accurate in their interpretation of matters medical.

[tutsiwarrior]

it sounds like a simple way of sayin' that they don't want yer business...

 

I always thought that 'pre existing medical conditions' referred to chronic problems like diabetes and high BP...of which I have both and which I presume excludes me from any type of reasonably priced medical insurance coverage...

 

I figure better to accept imminent death and just get on with things...

 

not very helpful, I know and with apologies to sheryl...

 

 

Edited October 8, 2016 by tutsiwarrior

[Once Bitten]

3 hours ago, Sheryl said:

BUPA Thailand in my experience tends to misunderstand medical matters and conditions. It appears that they assumed, from your reported symptoms, that you suffer from both cervical spondylitis and hiatal hernia (good chance you have neither condition and never did...or at most, that you have very slight cervical spondylosis causing little problem.).

 

Now, based on these incorrect suppositions, they are demanding not just physician certificate but a set of Xrays you do not need. An abdominal Xray by itself will not, BTW, show a hiatal hernia, it would need a barium swallow.

 

If you want to go through those hoops, then you need to see either a good GP or else separately an orthopedist and GI specialist, and have at a minimum an Xray of the cervical spine (no big deal) and a c=barium swallow (more of a hassle).

 

You'll need a doctor(s) not afraid to provide certifications which many Thai doctors are (other than the standard medical certificate form which contains nothing but the date of visit and current diagnosis). One with training in the west will be better about this as a rule.

 

If you are in Bangkok, suggest you go to Dr. Nick Walters at Mission Hospital (an American GP licensed in Thailand).

 

Other option would be to change insurers. This sort of irrational behavior is not unusual with BUPA. They seem to use staff who either lack medical training ir are afraid to use their medical judgement, either way working off a set boilerplate without actually understanding a particular patient's condition.  European insurers are much more sophisticated/accurate in their interpretation of matters medical.

 

 

 

Thanks Sheryl

 

 

Looking back I think I made several mistakes when first applying for my BUPA health insurance , first mistake was not choosing a better plan with a much higher cover amount , second mistake was mentioning my past health problems that I had before I came to Thailand .

 

I have looked at my original BUPA application paperwork and now see that I used my past UK doctors description of my health problems and put them on my application form as follows ---

 

1. Tingling in hand / soar neck , so I put down my doctors description on the form which was .. mild spondylosis

 

2. For the stomach acid , I also put down my doctors description which was
Esophagitis

I have just gone over some of my BUPA paperwork and found this document ---

 

Exclusion to cover

 

Any treatment of hiatus hernia and its complications  , such as --

Reflux esophagitis
Ankylosing spondylitus

Treatment of Ankylosing spondylitus and its complications such as -

Back pain
Chronic arthritis
Difficulty breathing
Heart valve
Regurgitation
Inflammatory bowel disease
Anemia including complication of treatment and reconstruction .

 

As I have been with BUPA from day one in Thailand , I feel that may be staying with them , relating to past ( no claims  ) long history ,could be the way to go , but at the same time upgrade my current plan , to their Platinum Plan .

 

So I don’t want to be in the situation of upgrading to a better and more expensive plan , without first knowing exactly what I will be covered for .

 

I have only ever been to St Mary’s hospital in Korat , so my initial idea was to take the list BUPA sent me , but written in Thai and present it to the hospital reception desk and ask if I can get all the BUPA requested items done there ( at my expense ) and just see what they said .

 

 

Going to Bangkok for any thing is some thing I like to avoid if possible .

One thought is that , with the physician certificate how can they tell if I have had  / have not had any of the issue shown on the BUPA list within the last 5 years , ( which Ive not )

 

I'm still uncertain 

 

 

[Once Bitten]

2 hours ago, tutsiwarrior said:

it sounds like a simple way of sayin' that they don't want yer business...

 

I always thought that 'pre existing medical conditions' referred to chronic problems like diabetes and high BP...of which I have both and which I presume excludes me from any type of reasonably priced medical insurance coverage...

 

I figure better to accept imminent death and just get on with things...

 

not very helpful, I know and with apologies to sheryl...

 

 

 

I’m hoping that I can sort out the current BUPA  / health insurance problems , sadly I don’t have the nerve to not carry on

 

 

[Sheryl]

It is not that they don't want his business. It is just that they incorrectly interpreted the information on his application and thus created an exclusion for a condition (hiatal hernia) that he does not have and has never had. In addition, they misinterpreted a condition he may have had (mild spondylosis) with a condition he has never had (ankylosing spondylitis - arthritis of the spine causing fusion of the vertebra.

 

It also sounds like they are willing to lift the exclusions if he can produce a doctors' certificates stating that (1) he doesn't to have a hiatal hernia and has not required treatment for esophagitis anytime in the past 5 years (with report of a barium Xray to prove it) and (2) that he has no signs of ankylosing spondylosis and has not required treatment for it in the past 5 years.

 

OP, do not try to arrange any of this with a receptionist, they will not know the right thing to do and you will create much confusion and waste a lot of time and possibly money. Instead ask to separately see an ortho and a GI specialist and discuss the matter with each doctor as follows:

 

1. Orthopedic specialist: explain your prior history and that you are now fine but your insurance company wants you to undergo a spinal Xray and produce a doctor's certificate to that effect and specifically to rule out ankylosing spondylitis (which it does not remotely sound like you ever had). . Show him the part of the BUPA letter related to that (but not the GI part as ortho doc can do nothing on that). Where you may run into difficulty is that, if you really had mild  spondylosis  years ago (i.e. if the diagnosis was confirmed by Xray or scan) , you would still have it to some degree - the term simply means age-related degenerative changes to the intervertebral disks. Anyhow best you can ask for is a spinal film and medical certificate describing your condition with particular reference to whether, based on history, physical exam and Xray, there is any indication of ankylosing spondylitis (there almost certainly won't be). What you are looking for is a letter that says something like this:

 

History X years ago of mild spondylosis. Resolved spontaneously without treatment. No symptoms for past X years. Physical exam shows no sign of nerve impingmeent, no pain/tenderness, normal reflexes in both arms blah blah blah. Xray shows (whatever it shows - probably mild degenerative changes  in at least one disc), no signs of  anklysing spondylitis blah blah.

 

Be warned that even with this they may misunderstand what it says just as they misunderstood in he first instance. Sounds like the underwriter is  an untrained person working off a list of symptoms and all possible conditions associated with them, and  simply assumed you had the most serious of these.

 

2. GI specialist: explain you had mild esophagitis X years ago which did not require any treatment , have never had a hiatal hernia and have had no problems with heartburn etc o for X years but your insurance company is requiring an Xray and doctors certificate to  this effect and that you do not have a hiatal hernia. You will have to undergo a barium swallow study, which entails no food, perhaps laxatives the day before, swallowing some icky white stuff then being Xrayed in various positions, following which you'll need laxatives to pass the white stuff (barium) out. An unnecessary hassle but not terribly expensive. If they try to sell you on endoscopy refuse, costs more, unnecessary in an asymptomatic person and not what BUPA asked for.

 

On the hiatal hernia side your prospects, if you are willing to undergo all this, are good as odds are the Xray results will be perfectly normal.

 

Note that the exclusion for the ankylosing spondylitis (which you did not ever have) includes a broad range of conditions some of which  have very little to do with it. Heart valve disease, for example, is found more often in people with ankylosing spondylitis than those without it but is not caused by it. Knowing BUPA, if you develop any of the conditions on that list, even though unrelated to your prior brief neck issue, they will insist that it was due to this condition and thus pre-exisitng - all nonsense.

 

In filling out Thai insurance applications it is necessary to include any past conditions that were severe enough to require hospitalization or a prolonged course of treatment but it is not necessary or advisable to list every problem or symptom you've ever had even though the wording of the forms may suggest you should. If you do, admitting that you have ever had a common cold will be taken to mean you have a pre-existing chronic respiratory problem for example. Again, the people reviewing this information (and for that matter the ones who developed these forms) are not medically sophisticated to put it mildly. You would find the forms for a western based country far better, clearer and more reasonable.

 

The other big mistake made was accepting the initial policy exclusion for conditions you did not ever have - should have argued the point then and there and established with them that you never had either of the two conditions listed...and if unsuccessful, gotten a different policy.

 

Tutsi: the fact that you have diabetes and hypertension does not prevent you from getting insurance, though there may be some exclusions especially if these conditions are not well controlled, and you would have to get a policy issued out of the West, not a Thai based policy. Cigna tends to be quite reasonable especially for conditions that are well controlled. I got a Cigna policy a few years back despite being on meds for hypertension and no exclusions at all because my BP was well controlled on meds. In other cases they may exclude certain problems but often just for a few years into the policy then lift the exclusion if you remain stable during that time, or provide at least some limited cover for acute problems related to the pre-exisitng one but upo to a lower maximum than the rest if the policy. And unrelated things - like that car or moto accident waiting to happen - will of course be covered in full. So get off your you-know-what and get yourself insured, I have had to spend way too much time trying to advise people who got themselves into horrible messes for lack of insurance and do not fancy having to do so for you

[Once Bitten]

4 hours ago, Sheryl said:

It is not that they don't want his business. It is just that they incorrectly interpreted the information on his application and thus created an exclusion for a condition (hiatal hernia) that he does not have and has never had. In addition, they misinterpreted a condition he may have had (mild spondylosis) with a condition he has never had (ankylosing spondylitis - arthritis of the spine causing fusion of the vertebra.

 

It also sounds like they are willing to lift the exclusions if he can produce a doctors' certificates stating that (1) he doesn't to have a hiatal hernia and has not required treatment for esophagitis anytime in the past 5 years (with report of a barium Xray to prove it) and (2) that he has no signs of ankylosing spondylosis and has not required treatment for it in the past 5 years.

 

OP, do not try to arrange any of this with a receptionist, they will not know the right thing to do and you will create much confusion and waste a lot of time and possibly money. Instead ask to separately see an ortho and a GI specialist and discuss the matter with each doctor as follows:

 

1. Orthopedic specialist: explain your prior history and that you are now fine but your insurance company wants you to undergo a spinal Xray and produce a doctor's certificate to that effect and specifically to rule out ankylosing spondylitis (which it does not remotely sound like you ever had). . Show him the part of the BUPA letter related to that (but not the GI part as ortho doc can do nothing on that). Where you may run into difficulty is that, if you really had mild  spondylosis  years ago (i.e. if the diagnosis was confirmed by Xray or scan) , you would still have it to some degree - the term simply means age-related degenerative changes to the intervertebral disks. Anyhow best you can ask for is a spinal film and medical certificate describing your condition with particular reference to whether, based on history, physical exam and Xray, there is any indication of ankylosing spondylitis (there almost certainly won't be). What you are looking for is a letter that says something like this:

 

History X years ago of mild spondylosis. Resolved spontaneously without treatment. No symptoms for past X years. Physical exam shows no sign of nerve impingmeent, no pain/tenderness, normal reflexes in both arms blah blah blah. Xray shows (whatever it shows - probably mild degenerative changes  in at least one disc), no signs of  anklysing spondylitis blah blah.

 

Be warned that even with this they may misunderstand what it says just as they misunderstood in he first instance. Sounds like the underwriter is  an untrained person working off a list of symptoms and all possible conditions associated with them, and  simply assumed you had the most serious of these.

 

2. GI specialist: explain you had mild esophagitis X years ago which did not require any treatment , have never had a hiatal hernia and have had no problems with heartburn etc o for X years but your insurance company is requiring an Xray and doctors certificate to  this effect and that you do not have a hiatal hernia. You will have to undergo a barium swallow study, which entails no food, perhaps laxatives the day before, swallowing some icky white stuff then being Xrayed in various positions, following which you'll need laxatives to pass the white stuff (barium) out. An unnecessary hassle but not terribly expensive. If they try to sell you on endoscopy refuse, costs more, unnecessary in an asymptomatic person and not what BUPA asked for.

 

On the hiatal hernia side your prospects, if you are willing to undergo all this, are good as odds are the Xray results will be perfectly normal.

 

Note that the exclusion for the ankylosing spondylitis (which you did not ever have) includes a broad range of conditions some of which  have very little to do with it. Heart valve disease, for example, is found more often in people with ankylosing spondylitis than those without it but is not caused by it. Knowing BUPA, if you develop any of the conditions on that list, even though unrelated to your prior brief neck issue, they will insist that it was due to this condition and thus pre-exisitng - all nonsense.

 

In filling out Thai insurance applications it is necessary to include any past conditions that were severe enough to require hospitalization or a prolonged course of treatment but it is not necessary or advisable to list every problem or symptom you've ever had even though the wording of the forms may suggest you should. If you do, admitting that you have ever had a common cold will be taken to mean you have a pre-existing chronic respiratory problem for example. Again, the people reviewing this information (and for that matter the ones who developed these forms) are not medically sophisticated to put it mildly. You would find the forms for a western based country far better, clearer and more reasonable.

 

The other big mistake made was accepting the initial policy exclusion for conditions you did not ever have - should have argued the point then and there and established with them that you never had either of the two conditions listed...and if unsuccessful, gotten a different policy.

 

Tutsi: the fact that you have diabetes and hypertension does not prevent you from getting insurance, though there may be some exclusions especially if these conditions are not well controlled, and you would have to get a policy issued out of the West, not a Thai based policy. Cigna tends to be quite reasonable especially for conditions that are well controlled. I got a Cigna policy a few years back despite being on meds for hypertension and no exclusions at all because my BP was well controlled on meds. In other cases they may exclude certain problems but often just for a few years into the policy then lift the exclusion if you remain stable during that time, or provide at least some limited cover for acute problems related to the pre-exisitng one but upo to a lower maximum than the rest if the policy. And unrelated things - like that car or moto accident waiting to happen - will of course be covered in full. So get off your you-know-what and get yourself insured, I have had to spend way too much time trying to advise people who got themselves into horrible messes for lack of insurance and do not fancy having to do so for you

 

 

Thanks again Sheryl for the detailed advice

 

 

So basically its this

 

 

1. A physician certificate confirming that I do not have a hiatal hernia

 

2. GI specialist certificate  confirming that I do not have esophagitis ( + barium swallow study / x-ray ) or have been treated for it in the last 5 years

 

3. An Orthopedic specialist certificate confirming that I do not have ankylosing spondylitis ( including a spinal Xray ) and have not received any treatment for it in the last five years.

 

So have I got this right ---

 

There's a still a possibility that if I get the above certificates and the pre existing conditions are now removed from my new health plan , should I have a medical problem in the future relating to any of the past removed pre existing conditions , BUPA may still refuse to accept a claim .

 

 

One other point , in the original BUPA list of requirements ( outlined in blue ) , they do not ask for any certificate for esophagitis , but esophagitis is shown on my original pre existing conditions outline paper work at home  , strange the they have not added the esophagitis to their original list , so do I forget the esophagitis certificate or ask BUPA about this .

 

We need physician certificate to confirm free from hernia and no treatment, no follow up in 5 year

 

We need  orthopedic physician certificate to confirm free from Ankylosing spondylitis and no treatment, no follow up in 5 year

2. The present Lab x-ray result for abdominal pain and back pain.

 
We need report  abdominal x-ray, report spine x- ray this year for confirm physician certificate

 

 

It looks like I really messed up when I originally applied for this BUPA health plan

 

My only other option for my mistake and this current BUPA pre condition issue , would be to ditch BUPA and take a chance with another health insurance provider like cigna , where I can at least declare no pre existing conditions for over 10 years and start with a clean slate .

 

I still feel a bit nervous about leaving BUPA after all these years .

 

Oh hindsight is a wonderful thing

 

 

 

 

 

[Sheryl]

You need  certificate from a GI doctor stating you do not have a hiatal hernia(supported by a Barium swallow Xray report) and have not required any treatment for one  in past 5 years.

 

If the pre-existing conditions are lifted from the policy they cannot then refuse coverage (unless they claim/believe you withheld/misrepresented information).

 

What appears to have happened is that they assumed your esophagitis was due to a hiatal hernia. This would not have happened with a more skilled underwriter, they would have known the difference. Forget the esophagitis issue and just deal with what they have requested.

 

If you apply to Cigna you will see that their way of recording and dealing with prior conditions is much more rational and sophisticated.

 

You can always start the application process with both, see what they are offering you and make final decision after that.

 

 

[Once Bitten]

1 hour ago, Sheryl said:

You need  certificate from a GI doctor stating you do not have a hiatal hernia(supported by a Barium swallow Xray report) and have not required any treatment for one  in past 5 years.

 

If the pre-existing conditions are lifted from the policy they cannot then refuse coverage (unless they claim/believe you withheld/misrepresented information).

 

What appears to have happened is that they assumed your esophagitis was due to a hiatal hernia. This would not have happened with a more skilled underwriter, they would have known the difference. Forget the esophagitis issue and just deal with what they have requested.

 

If you apply to Cigna you will see that their way of recording and dealing with prior conditions is much more rational and sophisticated.

 

You can always start the application process with both, see what they are offering you and make final decision after that.

 

 

 

 

Thanks again Sheryl

I am first going to see if I can now get the pre existing conditions removed from BUPA , and if I can then start the application process to upgrade to their Platinum Plan.

And at the same time start the application process for the Silver Plan with cignaglobal and see / compare both plans.

When I upgrade from my current BUPA plan , I want to try and make sure that which ever health insurance provider I choose , I don’t make any mistakes like I did originally many years ago.

I have a few  health insurance related questions / thoughts / concerns , would it be best to post them here in the health , body , medicine  section or in the insurance section .

 

[Sheryl]

Probably the insurance section.

[al007]

I find it easier to carefully write the letter myself, if there is history confirm no new symptoms or recurrences for 5 yrs, check it very carefully, then give the draft on memory stick to doctor and say you know he is busy, maybe he can cut and paste onto his letterhead, you have done it this way to save his time

 

6 mths ago I needed a letter for my pension fund actuaries, I took it to the doctor, he immediately signed my draft, I was a little amazed, I did not want to rock the boat by putting it on letterhead, so I got the hospital to stamp each page, then I got the records dept to put a copy on my file, so if ever checked at a later date, the record is on file

 

Mission accomplished

 

Many years ago one of my wives suffered manic depression and was bipolar, she was on tagretol and lithium, I coaxed a letter out of her expensive psychiatrist , that said she had been stable and living a normal life for over three years and he saw no reason for that to change, the fact she was on medication was not mentioned

 

I got the exclusion removed and a couple of years later they paid for six months in patient care in the upmarket nut house, the secret is do not lie just be scare with what you provide