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You probably know them, the glossy brochures full of beautiful marketing slogans from the powerful insurance companies. Complete coverage for almost all calamities at low premiums, the payment in the event of damage is a piece of cake, etc... In practice, it is often a lot more difficult than the brochures promise, this is such a practical story.
After 8 years of health insurance through April, I switched to Cigna, the same insurance at a considerably low premium, all on the advice and help of AA Insurance. Neatly completed questionnaire, stated past treatments, policy received no further questions and no exclusions.
September 2019, after 8 months of insurance with Cigna, I received complaints about my urination behavior and decided to visit the urologist at the Bangkok Hospital in Bangkok. At first nothing seemed out of the ordinary but there was a strong warning because after some testing and a superficial examination it turned out that my psa value had risen to a disturbing 9.1 while between 4.0 and 6.0 is normal for a man my age. So come back a week later for an MRI scan, an internal examination and further tests. Everything in one day. With a tight schedule, everything worked out on time, although it was a very long wait, but that was included in the research package.
At the end of the long day the results, I went to the urologist and from his gloomy face I could already see that it was wrong and indeed not to beat around the bush but diagnosis: advanced prostate cancer with metastases. Short-term intervention was necessary to prevent problems. The urologist discussed several options,
- I could do nothing in the hope that no further expansion would develop;
- undergoing chemotherapy;
- a classic operation through the abdominal wall;
- or a computer-controlled surgical procedure, the so-called DaVInci method.
Each option, of course, had its pros and cons. I had already studied this matter in advance via the website and some doctor friends and knew that an operative procedure using the so-called DaVinci method was often successful and had my preference.
Waiting or chemotherapy were not an option for my situation. A classic operation was also not an option for me given the risks that come with it. In the end I opted for the DaVinci method, which uses so-called robot technology, no incision is made in the abdomen, but one enters the abdominal cavity via a tube and a camera. However, this fairly new technology in Thailand was not available in the Bangkok hospital, but was available in the famous Siriraj hospital, where the late King Bhumibol, you know, lay.
In the Siriraj hospital I came into contact with Prof. Srinualnad a very experienced urologist and expert on DaVinci, a procedure was scheduled for early November. Everything seemed fine, just had Cigna notify my insurance company. Then came the shock from Cigna, the request for surgery reimbursement of 21.000 euros was rejected because my past PSA readings that I had sent in were 4.2 too high.
Now you should know that I switched to Cigna a year ago but in the questionnaire there was not a single question about psa values or anything so I thought it was all right. Cigna's defense was that the standard they use to make all PSAs 4.0 and above fall under lockout. But you never asked about my defense, so why exclusion now. The answer was, this is the global standard and we adhere to it, and you have withheld essential information in your registration. Even a letter to the CEO of Cigna could not change their mind.
In a short letter I received from Cigna I was informed that I had been disbarred as a customer for withholding vital information. The premium paid was refunded and that was the end of the story.
Part 2 tomorrow.
Submitted by Do
The first question that comes to mind after this story is what supporting role did AAinsurance play for you in this negative response from the Cigna, did they stand up for you or otherwise do anything for you?
Sad story hope for a good outcome for you, have been wondering for years whether AA insurances are aware of these practices, It would give me a terrible feeling to advise someone, which ultimately results in great disappointments.
Do not think that you are the only one who may experience this, at least give me the conclusion to insure or no insurance, it will not make you good, these practices.
Dear,
Please contact Donaat Vernieuwe of the Flemish Club Pattaya.
We are now in the process of group insurance with Pacific Cross(closing date 15/9)
[email protected]
Succes
Do they give a hundred percent guarantee that everything is well organized at Pacific cross?
In general, you cannot insure a burning house.
No, see conditions
No prostate and eye treatment after 70 years.
There must be no problems to report on a number of components after registration within a certain time frame, which will then still be included in the policy, but problems? Exclusion!
One part even 3 years!
Received an email today via nvtpattaya, it showed the conditions! A supposedly cheaper health insurance for expats, where? Yes AA Pattaya!
No Pacific Cross for me!
Truthfully filled out my application to Pacific cross and was denied! I was 68 and healthy they couldn't insure there, my father (74) died of an infarction, my sister had breast cancer and another sister had lung cancer, both at a young age. I've never seen the inside of a hospital, except that I've worked there for 41 years. My joints, female organs, bones, eyes, etc… were also excluded due to age.
But everything could be insured by paying a sky-high premium. Now have another one that I've had for 5 years and thankfully never had to use!
what other do you have , can you let me know please ?
Now I have Healthy Wealthy, Thai insurance and also approved for my visa.
Last year also made an attempt to go to Pacific Cross. I have stents in my heart so I know this is out of the question. Passed the full examination and the doctors had not much to say.
Then came the answer from Pacific Cross, they want to accept me but my vertebrae and everything around it is excluded (I had stated that I sometimes had a little pain in the lower back) My heart was of course excluded but also my kidneys and many other things matters based on my age (65 at the time) and possible flaws in the family. In addition, they had introduced a waiting period of 3 months to a year for many cases.
It came down to the fact that they accepted me to pay the premium but otherwise had little incentive to insure me for anything.
So Pacific Cross and probably many Thai insurances have been canceled.
Good morning, had the same problem with passific Cris. if they have to pay huh.
Only pay premium but do not expect a withdrawal fee.
TIT.success on.
A very unpleasant situation for you. I sympathize with you.
Some options if you don't have more than 20K lying around yourself.
— a legal expenses insurance that you could take out here;
— engage a lawyer in the US who wants to collect your compensation on a no cure basis. With an addition for moral damages you may break even;
— emigrate to an EU Member State where the desired treatment can take place and is reimbursed by the health insurance you can take out there.
At the AA insurances office in Pattaya I received no expert information about the various options at insurance companies.
I had thoroughly prepared myself about this matter with insurance companies and with thorough questioning
I had strong doubts about the knowledgeable answers, unfortunately.
I have now placed my insurance with a German insurance company.
APG Consulting, Office: +66 33 641 520 email: [email protected]
pattaya beach condo,
482 Moo 10 Soi 13 (Herr Rainier )
Challenge the verdict regarding the undisclosed PSA values and the so-called withheld essential information!
you must try Mattieu in hua hinn. In Pattaya, the office manager is ill.
Wonder you Dutch people don't have hospitalization insurance in your own country that you can fall back on?
Not if you have been deregistered from the Netherlands for years and have not paid a premium since deregistration.
Dear JM,
If you live here permanently, and therefore do not stay in NL for four consecutive months per year, you are no longer entitled to health insurance in NL. Easy.
It is not simple, on the contrary - it is very complicated, which is again apparent from the story of the contributor who does not disclose his name and surname. Anyone who lives elsewhere than in the Netherlands for longer than 8 months will be deregistered and will therefore no longer be insured for health costs in the Netherlands. That means that you already make a choice in it. If you live permanently in Thailand, you know that you are on your own, and that if you want to be insured you have to look hard. Because all health insurance providers are commercial companies - so doing business to make a profit - you have to study all the big and small print of the policies very carefully. Which also means that you can't just assume that everything is okay. Especially not if you are already of age, but also especially if considerably lower premiums are charged in the event of a switch.
Rianne, thank you for this incredibly important addition. Have you been a kindergarten teacher?
Dear Maryse,
If you are in the Netherlands for more than 4 months, you are entitled to health insurance. This is right. If you are homeless in the Netherlands and your status is RNI, you will not be accepted by the health insurer. And a postal address is only a temporary solution (3 or 6 months). If you leave for Turlje, you are entitled to free health insurance based on what Turks also receive. So if you become seriously ill in Thailand, move to Turkey. The bilateral agreement entitles you to this. And the costs will be borne by the Netherlands. Renting a house is 25% of what it costs in the Netherlands.
Regards Anthony
Jm if you have deregistered from your municipality and left for a country outside the EEC (Thailand) Then as a Dutch citizen you are no longer insured in the Netherlands and you must take out private health insurance somewhere
Sad but unfortunately true
Piet
A solution is to return to NL and register again. You can then immediately return to the compulsory insurance without testing and your costs will be covered. However, then you probably have to deal with waiting times, which all Dutch people are confronted with.
Not every health insurance company has an obligation to accept someone!
Yes, as soon as you have a home address and live in the Netherlands for more than 4 months in a year, you are therefore obliged to register in the Municipal Administration (GBA), and you also fall under the health care system with compulsory insurance. Please note that the term starts from the moment of registration in the GBA and that you do not wait 4 months first. And when you register at the town hall, you will be asked how long you think you will stay and you should report that you will be living in the Netherlands for more than a year and, above all, do not say that you will only be staying here for 4 months, because that may be the reason for not registering. writing by the officer. What you do later, including a minimum of 4 months in the Netherlands and a maximum of 8 months abroad, is then allowed to remain registered.
Quote from the Dutch government:
“Does a health insurer have to accept me for health insurance?
A health insurer is legally obliged to accept you for basic insurance, regardless of your age or health situation. The insurer may, however, refuse you for supplementary insurance. ”
.
Living in Thailand you pay the main price for a Dutch hospitalization insurance.
Count on €500 – €600 per month depending on age above 70 years!
I do not understand why the Belgian and Dutch embassies in Thailand do not look for a solution for their compatriots who need proper insurance!
For Thai translations and arranging visas, they do have addresses that they do give, why not reliable insurance?
That is because it is your own choice and your own decision to deregister from the Netherlands and settle in Rhailand. If you had stayed in the EU, there would have been several options available. In any case, if you decide to leave the Netherlands, that is your own responsibility. If you are going to live in Thailand and you cannot afford decent health insurance, you are consciously taking a number of risks. My husband and I also do not have health insurance because we are in different financial circumstances.
Best ?
Very sorry for you. What surprises me is the following: if Cigna didn't ask about the psa values, how can they now claim that your value was 4.2 when you created the contract.
But maybe you'll tell tomorrow.
Do you think AA should have informed you better? Or are they not to blame? I assume your contacts with Cigna are through AA, not direct?
Extremely frustrating, in retrospect you naturally think that you should never have switched to another insurer after 8 years. But yes, if you think that you can save considerably on the premium while the conditions appear to be the same, then the choice to switch is very tempting. You do not mention your age or the reason for having the PSA values measured at an earlier stage, which then came to 4,2. According to the Andros site, a specialized Dutch clinic, you are usually in good hands with a PSA of lower than 2,5 if your age is between 55 and 65 years and lower than 3,5 - 4 if you are 65-75. Between 4-10 one falls into a 'gray' area, as the level of the PSA is not only determined by the age of the man but also by the size of the prostate at the time of the measurement. That could possibly also explain the 4,2 you measured. In general, according to the doctors at Andros, a single elevated value is not an absolute indicator of prostate cancer. (And unfortunately a low value does not guarantee freedom from prostate cancer). That is why doctor Maarten from Thailandblog does not consider simply measuring the PSA to be advisable because, on the one hand, its predictive value is not sufficient and, on the other hand, prostate cancer may be found after further screening, but treatment is not necessary and there is a risk of unnecessary treatment and in any case unnecessary anxiety. In conclusion, the previous 4,2 does not actually mean anything to you, but convincing an unwilling insurer of this will not be easy, if not impossible. They assume a maximum value of 4,0 and should of course have told you this immediately when you sent the test result of 4,2 when applying for insurance. However, in their rejection of reimbursement for the operation, they also state that essential information was withheld at the time. You don't elaborate further on this, but is that perhaps the reason why you decided to have your PSA measured? You say that unfortunately metastases have now been detected. Assuming that these metastases also need to be controlled and treated, there will also be costs involved. While waiting for part 2 of your entry, I wish you the best of luck and recovery!
Previously I also had insurance with Cigna premium became more than € 300 more expensive every 3 months when I turned 65, then after a long search I switched to FWD despite negative comments by an expert, so far I am very satisfied with it, I only had to speak pay half of it myself after an Aneurysm treatment operation and 2 weeks aftercare in the hospital, I pay 20.000 baht per 3 months for 10 years then premium free but insured and when I die my wife will receive a benefit, it is a kind of savings insurance hence those personal contributions for large or expensive treatments
I've done the opposite.
Now I was insured with the city of Rotterdam.
And I had to be admitted urgently due to a bacterial infection.
I was as sick as a dog and was immediately admitted to the Bangkok hospital.
Then proof had to be sent of the insurance that they will be paid.
Was immediately done by the insurance using red cross.
Super arranged by them.
After 10 days in the hospital, payment had to be made.
At 9 o'clock they told me that I could leave if the insurance had paid, I had to wait.
The insurance company sent me proof that about 14.00 baht was paid at XNUMX:XNUMX PM.
So I was tired of waiting for the nurse and the administration to come and show me the evidence.
And have them talk to the insurance company.
I was still not allowed to leave the insurance lady didn't understand anything about it she had even emailed it three times.
At 17.00 I was completely done with it and went home, but in the parking lot I was surrounded by security.
And I was held hostage in a separate room I asked for the police but they were not called.
I was only allowed to call my insurance.
So I call red cross and the City of Rotterdam insurance, told them everything.
They didn't understand it, so I gave the phone to the employee of the Bangkok hospital.
After half an hour, the City of Rotterdam told them to transfer it a second time.
Otherwise I wouldn't be released, they did.
Well deserved getting paid twice for the same work.
I've seen the evidence.
Finally I was allowed to leave at 20.00 pm.
It's criminals at Bangkok hospital.
Neatly arranged by red cross and the City of Rotterdam.
Kind regards, Rob
I have had such an experience and can therefore confirm this story. Earlier I wrote about a dermatological treatment of a total of 5 years and 150.000 baht poorer because out patient so no insurance. The story was that they couldn't help me and they let me leave. (or rather, die of the infections.) I went to the city hospital a little later. After examination, I was immediately admitted and was treated several times a day and filled with anti-biotics. Consequences left the City hospital after 11 days of recovery. Costs, self-paid, that's how it works there, 58.000 Baht including everything. Costs later reimbursed by April because in-patient.
@Rob, absolutely correct. Something similar happened to me at Bangkok-Pattaya Hospital. This hospital even employs foreigners who do nothing but walk through the rooms every day and urge patients to pay as soon as possible… or else!! These are called “consultants”. They don't see me anymore.
Why don't they hand over the passport.
The hospital always wants to see the money it has received and rightly so.
Have experienced several times here in Changmai hospital sent my insurance bank guarantee.
But that the amount has not yet been received, or not enough.
Then get the proposal or wait, or hand over my passport, then get a proof that they have taken my passport.
Always hand over my passport.
Usually I get a phone call a few hours later or at the latest the next day, that I can pick up my passport.
I am insured with VGZ universally complete, with Thailand as wooomland.
Hans van Mourik
See PS
https://www.thailandblog.nl/lezers-inzending/hulde-aan-het-changmai-ram-ziekenhuis/
Hans van Mourik
Best!!!!!!
You have been insured before, when you take out Cigna policy (which I also have myself) you give permission to request information from the previous insurer if there is anything.
If you have been tested there for PSA value, Cigna can know that from previous insurer.
Do think that Cigna or the office should have informed you if it is not in the policy conditions. If they start from the general guideline of max 4, it will probably be hidden somewhere in the policy. General terms and conditions, but who reads that so thoroughly beforehand.
In any case, you had knowledge of a slightly elevated PSA of 4,2, which you may not have thought of when applying, but you have the option to add it as an addition to the application.
I've had Cigna for years, fortunately never had to use it, so no knowledge of payouts. But from experience I know if you have only been insured for a short time, there will always be suspicion and they will ask what their right is. At Cigna it is in any case the case that you are not insured for certain types of cancer for the first 6 months, the so-called waiting period. Incidentally, with almost all insurers.
Then just a comment about not being insured if you have been out of the Netherlands for more than 8 months or have been deregistered.
For people who have not yet been deregistered but still want to leave, I recommend that you arrange with an insurer in the Netherlands that you are going to make a world trip, so that you can still use Dutch health insurance for at least 2 years and longer with some insurers.
In any case, good luck and hope that Cigna will meet you in the costs.
I am 63 years old. I have had hospitalization insurance with DKV for about 40 years. No exclusion whatsoever and I am very confident about this for the future. Most people take out hospice insurance later in life if they think there is a chance of using it. If everyone does this at a late age, the premiums would still have to be x3 and the exclusions x2.
I am sorry to say that if you sent 2 invoices to DKV, they will only pay one for Thailand. That's exactly what we asked and it turns out to be true. So ..they pay the first invoice, not the second, because you only have coverage in Europe, OR you pay a very high premium.
I didn't want to respond to this article at first, but I will now. On the one hand because we receive a lot of questions about this message, on the other hand because - completely unintentionally by the writer, I'm sure - it has provoked quite a few reactions questioning the role of AA.
#Cigna
The quality of Cigna as a company can of course be called into question. Cigna is the largest expat insurance company in the world. The fact that in this case they took a position that we did not agree with does not mean that they are not recommended. The largest carrier automatically implies the greatest chance of misses. In every society there are sometimes discussions about whether something was pre-existing or not. Usually these kinds of things are resolved quickly. In this specific case, an incorrect doctor's report was at the root of the misunderstanding. However, Cigna is and remains simply the very best option for a certain category of people.
#Is AA knowingly offering insurance that they know is bad?
First of all, there is no ideal insurance policy. We cannot compare the situation here with the safe and comprehensive policies that we can take out in the Netherlands and Belgium without any problem. Every plan we can offer here simply has shortcomings.
Everyone at AA who deals with health insurance will always do their best to select the best possible option. The available budget, health situation, travel behavior, age, etc. are taken into account.
Today we see more and more internet brokers popping up. We are not an anonymous internet broker who can use the credo “sell and forget”. We have offices that can be visited and – more importantly – we live in the middle of our customers so we can't hide if something goes wrong. Therefore, a careful consideration is always made.
This is independent of the fact that we, as a service provider, are of course always dependent on the performance of third parties (the companies). We are therefore constantly working to iron out wrinkles and solve problems.
In addition, it is very common in the insurance world for staff to receive a salary that is largely based on commissions. However, at AA we have consciously opted for a fixed salary. Someone with a problem needs to be helped faster than someone who can make money at that moment.
I also read that someone had a bad experience with education at the Pattaya office.
This may have been in the period (about 4 years ago) when we had not yet taken over the office in Pattaya and it was still in other hands. It is a known fact that the previous owner was less concerned with health insurance.
If it happened in the last 4 years then I deeply regret this.
In the current situation, new staff must shadow and observe for 6 months before they are allowed to work completely independently. After all, there are enormous interests involved. A thorough knowledge can certainly be expected from the two Dutch people who work at the office in Pattaya. Of course also from the 2 Dutch people in Hua Hin and our Flemish college on Phuket.
#Has AA done anything to help with this issue?
The entire Ombudsman process went hand in hand and in very close consultation. Part 2 will make this clear.
#General:
This incident once again points to the importance of reading the general terms and conditions. There are hundreds of types of policies on the market. People sometimes ask us why we don't support such and such society. Well, a company based on a small island in the middle of the Pacific Ocean, somewhere where one can never get his or her justice and where the dispute settlement consists of “If you disagree with something, you can write a letter to our own director”, is potentially a life-threatening risk and the main purpose of health insurance is precisely to exclude financial risks.
This case shows once again how important a good dispute settlement with an impartial ombudsman can be.
#PacificCross
There have also been quite a few reactions about Pacific Cross. That has nothing to do with this case, but in general: The Pacific Cross policies - like all other companies - have shortcomings. In addition, Pacific Cross is a real Thai company. That means they're tough when they find out something wasn't reported on the medical questionnaire. Never conceal anything with a Thai company. Virtually all Thai airlines will conduct a medical history review if something occurs during the first 2 years that may be a pre-existing condition. Pacific Cross also has age-related exclusions and waiting times. So it is not ideal, but the ideal society simply does not exist. Everything always remains a trade-off between premiums and coverage.
However, the approach of the group plan to be set up now is to generate a discount for participants.
If everything has been stated honestly and people agree with Pacific Cross's proposal, then there is nothing wrong with this company. They always pay when they have to. For questions about this I would like to refer to my colleague Wim ([email protected]) from our Pattaya office as he is the driving force from AA.
For all non-Pacific Cross group plan related questions I can be reached via [email protected] or 08 – 1006 7008.
Pacific Cross, I used to have group insurance at expat club, now switched to ind. plan. Due to exploratory surgery on the left knee (was no longer insured in the event of problems with the left knee), now it comes from the winter of February to have tests done in Bangkok hospital. My contract expired at the end of June, switched mid-May (papers filled in) only got my papers around June 7 and premium paid (so if you read the fine print I was not insured for a week, got my insurance through Neng. After a month I got a message got that a few things are no longer insured, all after paying the premium, so started snooping in your papers from your tests, a bit of a mafia practice from Pacific Cross! Of course which is a good insurance? Do they exist?