Problem with Bupa...

[pomozki]

Hi, I am into the 2nd year of a health insurance policy with Bupa Thailand. I got sick 2 months ago and lodged a claim.

 

Bupa wouldn't approve it immediately, said I needed to settle the bill myself when I left hospital and claim later. I did.

 

First, they sent me a letter saying the claim had been rejected because, after examining all my records, they believed it was a pre-existing condition (which is nonsense).

Then then sent me a follow-up, saying they couldn't decide on my claim because they still hadn't received the documents I was meant to send them!

 

Recently I submitted more documents, which I think prove beyond any doubt it was a new sickness. That was a few weeks ago. They indicated they still believed the claim had been rejected but would let me know.

 

If they continue to not bother following up or reject my claim without justification is there anything I can do?

I imagine that a farang challenging a Thai company over anything had stuff all chance of getting a fair hearing n this country.

 

[lopburi3]

Believe it has less to do with being farang than insurance being worth at least the price of the paper it is written on.  

[Sheryl]

Insurance of all types (jincluding health insurance) is regulated in Thailand by the Office of Insurance Commission, and consumers can seek assistance through them/file complaints

 

http://www.oic.or.th/en#

But the complaint form itself is all in Thai so you'll need a Thai speaker to help you with it

 

If nothing else,  this should prod BUPA into being more conmmunicative with you so that you can get to the bottom of why they think this was pre-existing. It may well have to do with information you gave on the  initial application form, or to the history you provided the doctor.

 

In my experience, BUPA staff have little medical knowledge and seem to work off charts which list symptoms and possible diseases without really understanding what they are doing. For example, there was a recent case in the Health Forum where they wrongly assumed that a man who acknowledged on his application form that he had in the past experienced indigestion/heartburn (who hasn't?), had a hiatal hernia. He did not have one, never had one, nor do the vast majority of people with heartburn...though  heartburn is a symptom that is associated with hiatal hernia. That sort of thing.

 

Read through your policy very closely as it should clearly list, under exclusions, any conditions that were believed by BUPA at the time they issued the policy, to be pre-exisitng. They will put such into policies without necessarily bringing it to the applicant's attention and many people never actually read their policies.

 

If there is no exclusion listed in the policy, your position is much stronger.

[pomozki]

thanks for the replies. Sorry for my late reply. I thought I'd be notified by email when someone replied and I haven't had any notificatons.
Sounds like I might be able to challenge Bupa but with a minimal chance of success. I'll keep on at them

 

re pre-existing conditions: I listed them all when I signed up but a blood test showed the hospital doctors I'd had an infection which damaged my liver (for just a few days). It showed abnormal levels of liver enzymes, which soon cleared up. An ultrasound also showed I had 2 nodules on the liver, which doctors aren't worried about but which need a follow-up ultrasound.
The infection caused something called myalgia, a weakness of muscles and a lot of pain in the shoulder. Now I can barely move the left shoulder. It seems to be something called "frozen shoulder", which I've never had before and which can't possibly be related to a previous condition.

anyway, I suspect the truth of the situation is irrelevant. I wouldn't trust these people as far as I can throw them. They rejected my claim and a few days later said they weren't in a position to rule on it cos they hadn't received my documents! Go figure.

that tells you all you need to know about their motivation to seek the truth here

[Sheryl]

Again, you need to check the wording in your policy to see what, if any, exclusions BUPA listed. As those would be the basis for denial now.

 

I would not be some pessimistic about your chances on this - provided there is no relevant exclusion listed in your policy. Check that.

[impulse]

I'd like to thank the OP for posting up his experience, and I hope he'll keep us informed as he works out a resolution.

 

So often, we read glowing reviews of insurance companies based only on the price of the policy, their user friendly website, and the ease of giving them our money.

 

It's very valuable to hear actual experiences of people when there's a claim to pay.  A significant claim.  That's about the only way to truly judge the value for money we're going to receive after we sign up and kiss the premium $$$ goodbye.  Especially when an unwelcome surprise can financially derail a lifelong retirement plan.

 

Thanks for the effort...

Edited October 22, 2016 by impulse

[Sheryl]

OP - myalgia is just the medical term for muscle aches. Not a diagnosis.

 

 Quite likely what set BUPA off was the liver nodules. They would leap to the assumption you have cancer of the liver, and cancer of the liver in someone only two years into a policy would immediately grab their attention. It usually exists for some time before it is diagnosed, so they may be taking the position (possibly backed by something on your enrollment info) that this condition - which you do not in fact have - was pre-existing. If you can get clear with them that you do not, in fact, have cancer if the liver things may go better.

[pomozki]

On 10/24/2016 at 0:40 PM, Sheryl said:

OP - myalgia is just the medical term for muscle aches. Not a diagnosis.

 

 Quite likely what set BUPA off was the liver nodules. They would leap to the assumption you have cancer of the liver, and cancer of the liver in someone only two years into a policy would immediately grab their attention. It usually exists for some time before it is diagnosed, so they may be taking the position (possibly backed by something on your enrollment info) that this condition - which you do not in fact have - was pre-existing. If you can get clear with them that you do not, in fact, have cancer if the liver things may go better.

wow, just to clarify - as far as the hospital doctors were concerned. I definitely don't have liver cancer. They did blood tests and confirmed that, although I should have a follow-up ultrasound, there was no evidence of cancer in the liver. In fact one doctor said what he'd seen on the ultrasound was a 90% chance of small, harmless nodules which apparently many people have.

meanwhile, I'm still fighting for them to cover me. They're now examining hospital records of an entirely different ailment I had 2 years ago - one which is also totally unrelated. Will update when this darn episode ends. Whatever happens, I'm so sick of fighting these people (who show every sign of doing everything necessary to find an excuse NOT to pay out) that I'll almost certainly not renew my Bupa policy when it ends anyway. A nightmare to deal with them.

Edited November 6, 2016 by pomozki

[Sheryl]

As mentioned, you can complain to the OIC.

I suspect that even though drs ruled out luver cancer this is not clear to BUPA. As I mentioned the people on their staff who do rhis often have no medical training and frequently misinterpret things. They ate working off a chart that says nodules = cancer and now they ate chasing down other things listed on this chart as early symptoms of liver cancer.

Since you have been unsucvessful in engaging them in dialogue a complaint to OIC may be in order.

[siam2007]

Another reason to avoid BUPA, me thinks

[pomozki]

Folks, BUPA have suddenly informed me that they've approved my claim - more than 3 months after I lodged it!

I had to chase them up constantly and only one guy kept helping - I think he was a middleman and kept having to pass on my complaints.They also seem to have approved a higher sum than I was expecting. I'll believe it when it's in my bank a/c. I don't know if 3+ months is normal but it was quite stressful have to constantly chase them up, knowing this was a new incident but not getting replies.

 

On the health front, I recently had a follow-up ultrasound, which the specialist says has confirmed I had harmless nodules, not cancer, but I'll have a 3rd ultrasound in a few months. Incidentally, no doctor ever gave me a clear diagnosis for the original illness and this contributed to the problem. I wish I'd insisted on a diagnosis before paying my hospital bill.

 

3+ months later, I still have reduced use of one shoulder (CT scan says no stroke - some Internet posts call it frozen shoulder) and numbness in the other, plus constipation/appetite loss and weight loss, which are very slowly returning to normal. All of this from some unknown infection, I think.

Moral of the story: keep chasing! The Thais can be slow and may not seem interested but keep trying. Thanks to all for their posts.

 

Edited December 13, 2016 by pomozki

[lopburi3]

Quote

I wish I'd insisted on a diagnosis before paying my hospital bill.

Always ask for a medical certificate for any treatment.  That will require they write down a diagnosis and is a routine request to make.

[pomozki]

On 12/14/2016 at 2:14 PM, lopburi3 said:

Always ask for a medical certificate for any treatment.  That will require they write down a diagnosis and is a routine request to make.

only just saw your reply - wish I'd known that at the time
I mentioned this to another doctor and she was shocked they hadn't given me even a diagnosis

 

[Sheryl]

Thai hospitals tend to be quite bad at paperwork and this can often cause problems with insurance claims. Ideal is to have hospital directly bill insurance then the burden falls on the hospital to provide what the Insurance co. requires or else they don't get paid. When you pay first the hospital has no incentive to provide the required documentation.

BUPA has direct billing arrangement with most hospitals but hospital must call them before (or in emergency, as soon as possible after) admission to get approval.

Wherever possible make it clear up front to the hospital that you will not self pay and that they must bill your insurance. Hospital billing office staff will sometimes try to pressure you to "pay first", that is to save themselves work. Try to resist this if you can. I have known a certain hosp in particular to resort to lies like "it will take days to get approval, you'll have to postpone your (surgery/procedure etc) if you want to wait for that." Last time they told me that it in fact took only 2 hours for insurance co to approve... but I had foolishly believed them and paid up front on assurrance that they'd return my money as soon as insurance co confirmed direct payment. You guessed it --- they did not and I was only able to get my money back by disputing the charge with credit card co.