An extremely unpleasant experience with Cigna health insurance (part 2 – conclusion)
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.
Continue part 1
What to do now, switching to another insurance was out of the question given my status as a cancer patient and my age (73), what remained was to remain uninsured. Other options to take out possible health insurance were;
- a marriage, so you can take out Thai insurance that is considerably cheaper
- NL insurance with a sky-high premium
- a possible different insurance but with the exclusion of all organs, a 5-year waiting period and then just wait and see and a premium surcharge of 30% or more
None of the alternatives appealed to me, so I decided to take the risk of being uninsured. In the meantime I had forwarded my case to CIFO, this is an independent professional committee to which Cigna is affiliated, the decision in conflicts is binding to avoid costly and lengthy litigation, there is no appeal other than a civil suit.
At CIFO it was important to summarize all relevant information about the medical history and send it to this organization, in addition to of course answering a large number of questions and forms in order to get a good picture of the situation. But the treatment time is land and can sometimes take up to a year. And then .. wait wait wait September, October November. More forms, more questions, more additions, etc. In the meantime, I did have the prostate operation that I paid for myself, after all, the medical situation had become urgent.
After a long, more than 5-hour procedure using the DaVinci technology, the prostate, including all metastases, was removed. After 5 days in a comfortable room at 11e floor I could go to my house in Chaam to further strengthen there. Incidentally, I had excellent care, the doctors and nurses were very friendly and knowledgeable, but also surprised that the long farang wanted to get out of bed after 2 days to go for a few short walks because people were not used to that. It was annoying that every 3 hours, day and night, a nice nurse comes to your bed to measure temperature and blood pressure. It is nice to mention that for many years King Bhumibol had been only 2 floors higher in the same wing and I was surprised that so many senior military personnel were still walking around.
Anyway, it was December and I went to inquire about the state of affairs with my file at Cigna. After some insistence I received the reassuring message that my file had been qualified as urgent and it would not be too long before I would receive any meaningful message. I received the same coverage in February, March, etc. Time for a tone change to put some more pressure on the matter. Shortly afterwards I received another request for additional information, after which I received the message in early April that the person who was responsible for my file was on annual leave for an indefinite period. Now I have worked for American companies almost my entire career and know the meaning of this communication, the file was just left, almost nothing was done about it and I got a new contact person who immediately accelerated it, including the apology for the long course of action. And yes, at the end of May I was asked to send all invoices again, and also to summarize what had happened in my experience. Then another few weeks of silence and at the beginning of July I was asked to go to a notary to have it recorded that all information submitted had been answered correctly. In Thailand, of course, this is a piece of cake.
It was now the beginning of August when I received the message that they were finalizing the procedure and that I could expect the result within a few weeks. And yes, August 14 on Friday evening a large email from CIFO. With almost trembling hands I opened the extensive appendix, read, read a lot of legal language and almost on the last page the redeeming announcement that I had been proven right on all points, Cigna had to reimburse all surgery costs and I was also eligible for punitive damages. But…..I wasn't there yet this was a recommendation, I had to agree with the result but so did Cigna. So another 2 exciting weeks passed when I finally got the redeeming email from Cigna accepting the full CIFO ruling and thus full rehabilitation. You can imagine that I had a very nice weekend, not only because I was completely right but also because I was no longer uninsured.
Final word
Fortunately, justice still exists and with the right arguments, perseverance, evidence, etc., this job succeeded. However, I would never have managed this without the fantastic help and support of AA Insurance, Matthieu Heijligenberg and his team. After all, it was Matthieu who drew my attention to CIFO, because he also believed that I had been wronged considerably.
Submitted by Do
Persevere. Congratulations!
Congratulations, quite a bit of work.
Can you.now.stay there too?.
Or have they now also ruled you out for cancer..
In this case I was not successful, all correspondence.in English.
TOP of.you.
Hans van Mourik
Hans,
yes I can just stay with Cigna again as it was before the procedure, so nothing is excluded. Legal English in particular was quite a job, but I lived in the USA for 3 years so I was able to handle this.
Furthermore, indeed had a lot of work with highs and lows, but I believed in success and giving up was not an option, please note that the help and advice of AA insurance have been of almost decisive importance.
Congratulations. Fortunately it ended well.
May I ask about the point of marrying a Thai? I thought you only qualify for Thai health insurance if she is in government service?
Hi Frits,
your thoughts are correct, thanks for your comment/addition.
Dear, I am also curious how I can qualify for Thai health insurance through my marriage to my Thai wife. Is it possible to get a website of such insurance, please. My email adress. [email protected]. Thanks in advance.
Dear also, I am quite curious if I can still take out insurance as a married person.
Thanks in advance!
[email protected]
Good and clear story.
Only I would like to hear some more information about taking out insurance that would be significantly cheaper if you are married to a Thai woman. Thank you in advance
Lung kees
Dear Lung Kees,
The Thai woman you are married to must work for the government. If that is the case, the premium to be paid can easily be 40-50% cheaper, please note that you will end up in a government hospital, which means that you can get an upgrade to a small room or a private room, if… ...this is available, which is often not the case and you end up in a large room with 40-50 people.
greeting
Dominic van Drunen
Maybe a stupid question: why did you switch at that age and with the background and other negative possibilities? I mean the difference in premiums is not about thousands of euros per year, is it? I remember when the Bupa was about 75 euros per month for very extensive.
Dear Peter,
Not a stupid question at all, I made a mistake here as I did not sufficiently realize what the possible negative consequences could be. However, I believe that AA insurance could have pointed this out to me and they are now going to do so.
Groet
Dominic van Drunen
Can I ask Mr Do what this treatment cost.
My PSA is 8.9 and I have no cancer, I had 1 MRI and 2 biopsies done, so I would like to know the cost.
Because I have too many exclusions, I am not insured and hope for a good outcome.
Dear Driekes
The complete operation with the DaVinci method including 5 days in hospital, nursing aftercare, etc. cost me 19.000 euros. Please note that this was an operation with a private room and 5 star care and 4 nights. This can of course be done cheaper with a classic procedure and a stay in a ward, then count on approximately 13.000 euros.
If you would like more details, please email me [email protected]
Incidentally, with a PSA of 8.9 and no cancer would be reason for me for a so-called 2nd opinion.
greeting
Dominic van Drunen
Congratulations on the verdict.
I would also like some more info about if you are married to a Thai. And as far as the costs for the operation are concerned: suppose you don't have 20.000 euros, then you can't do anything at all and you are at the mercy of the Temple
Also on my behalf, congratulations on your victory. I also had a complaint handled in NL regarding the woekerpolis issue via the KiFiD (Financial Services Complaints Institute), but that ended unsuccessfully for me. What interests me, and therefore blog reader Frits here, is your comment that a marriage with a Thai person automatically gives you the right to take out Thai health insurance. Can you explain that again?
Dear Haki,
I would like to do that, see my previous responses to this, In short Your Thai woman must be employed by the government, after that you can take out your insurance with a Thai health insurance policy with considerably lower premiums, but .... only for government hospitals.
Groet
Dominic van Drunen
Congratulations on your win, Do! Cheers for your perseverance and fighting spirit, and thank you for taking the trouble to share this with us so extensively. Your story was very clear!
Where can I learn more ocer CIFO and what does the abbreviation mean. I can't find it on the internet
CIFO stands for Channel Islands Financial Ombudsman,
website ; http://www.ci-fo.org,
email ;enquiries@ci-fo,org
address Jersey, Channel Islands JE4 9OG
good luck,
Dominic van Drunen
Magnificent!
What does CIFO stand for and where is it located? Might come in handy for me too.
Glad it all ended well. It took a lot of crumb, but eventually won the battle. Congratulations. Thank you also for complimenting AA Insurance and Matthieu Heijligenberg and his team for their help and support. In reactions to part 1, some of them already came off badly in advance. Turns out it was wrong now! Nevertheless, I would like to make 2 comments regarding the subject in general:
1- In discussions about health insurance for long-term/permanent residents in Thailand, the Netherlands often gets out of pocket. Thailand is then exempt from all blame. I think that is an incorrect position. The Netherlands is very clear in its position: if you are away from the Netherlands for more than 8 months, participation in the group health insurance schemes will lapse. The essence is in the collective. If you have left the Netherlands, you will no longer participate in the intended joint venture and you may not expect that your healthcare costs will have to be paid from the Netherlands. You must provide alternative means of insurance, or sufficient resources to cover medical costs yourself. My husband and I do according to this last principle. The fact that Thailand does not recognize participation in Thai collectivity for 'farang' cannot be addressed to the Netherlands. Even some groups of Thai are sometimes excluded from participation. It seems to me that they need attention first.
2- It is not always necessary to have expensive premium health insurance in Thailand. Read all the responses from part 1 again, and see how often you come across people who have been paying for years but have never had to make a claim on such an insurance policy. Also read how often people experience opposition. If you deposit all premium monies into a bank account every month, it is not inconceivable that a small amount of capital will be saved in the long run. You can consider this approach by taking the time to consider your own medical history, what has happened in the medical histories of your immediate family members, and by realizing that palliative care is often preferred as you get older. deserves. This means that if there are no hereditary diseases, ailments and/or degenerations in your own health history and that of your parents, brothers and sisters, uncles and aunts, expensive insurance is not necessary.
It's nice that AA has been a great support, but I didn't expect anything else, because they also make money from the polls they take out,
Congratulations on the achieved result!
Can you provide CIFO's website or email address?
I don't know where to find this on the internet.
My former insurance company does not want to pay for follow-up surgery.
I also want to file a complaint now.
Kind assistance.
My advice: don't work with health insurers that have established themselves outside Thailand.
Personally, I have had bad experiences with Pacific Cross.
They don't have their administration in order and communicate about it discourteously and downright rude.
The customer is certainly not king here and the internet (including Thai Visa) is also teeming with horror stories: unilateral cancellation due to high claims, insane interim premium increases without prior notice and all kinds of exclusions afterwards.
Other companies also cause problems and do not inspire much confidence.
In this forum the names of Cigna and AXA Assudia have already been mentioned.
Nowadays you no longer have to be married to a Thai person to take out Thai insurance.
I (unmarried) have been insured with Thai Life Insurance Medicare since last year.
One of the largest in Thailand.
A health insurance policy, combined with a life insurance policy.
Biggest advantages for me: you can't just be kicked out and the premiums are fixed.
The coverage is comparable in all respects with other insurers.
There is even a 'loss of income' paid out for each day you are in hospital.
Can go up to a few thousand Baht per day.
My sum insured is currently 1.000.000 Bht. (can be higher and can also be adjusted in the meantime).
I was 66 when I took out the insurance, no medical examination.
Until seventy, I thought, is still accepted.
My premium: Bht57.000 for the first five years. The next five years; Bht86.000.
Then 129.000 Baht for four years and then (I'm eighty years old) 6 Bht for 9.000 years.
Everything completed.
Outpatient: no reimbursement, except for (traffic) accidents.
Whatever I claim: the premium is fixed and in the event of death a substantial sum (increased according to the term of insurance) is paid out.
So that the next of kin are not left with unpaid bills.
Also a reassurance.
Dear Paul, I just had a look at the site. Can you tell me what the name of the policy is and/or what plan you have. I'm looking for something for my wife. She is 67 years old. When I look under her age category, I really only find accident insurance. In my opinion, payment is only made in the event of an accident, not in the event of illness. The 'sap mascote 90/15' is an exception in my opinion. So I'm curious what plan you have? Thanks in advance for the info!
It's true that their site doesn't provide much information about health insurance.
As far as I know they don't work with different names for their packages, no precious metals or gems.
But they do have excellent health insurance that covers everything and with which you can go to all Thai hospitals, including private ones such as Bangkok Hospital.
And you don't have to be married to a Thai, that's still a persistent misunderstanding.
My cover mentioned above and the fixed associated premiums give a good indication of the possibilities.
If you want more, it will of course cost more.
Thai Life Insurance Medicare have offices everywhere that can explain everything to you.
I arranged everything (quickly) through a very good English-speaking intermediary in Ban Chang.
Thanks for your info, Paul! I have approached them through their site and am waiting to see what the result will be. By the way, it generally looks good on their site. Gives confidence.
Any complaint should in the first instance be sent to us at:
Cigna Global Health Options Customer Care Team
1 Knowe Road
Greenock
Scotland PA15 4RJ
27.2
If the complaint is not resolved, the complaint may be referred to the Financial Ombudsman Service at:
The Channel Islands Financial Ombudsman (CIFO)
PO Box 114
Jersey Channel Islands
JE4 9QG
Telephone: +44 (0)1534 748610 Fax: +44 (0)1534 747629 Email: [email protected]
Do, first of all congratulations on your victory, what I just don't understand//understand is your next comment: "a marriage, this allows you to take out Thai insurance that is considerably cheaper". We are both farang (Dutch), but we have had Thai health insurance for a few years now.
Hi Will,
I am over 70 and then taking out health insurance is almost impossible, I have experienced,
also Thai
First of all, congratulations on the result achieved. However, a few things are unclear to me. I am also married to a Thai woman who has always worked for the government. I'm piggybacking on her health insurance in Thailand. We have applied for passes at various government hospitals where I can go. Now my experience has remained happy with check ups and some minor treatments. I don't have to pay for medicines. Only a small fee for the doctor in the order of 500 Bath. What is unclear to me is whether a separate health insurance policy must also be taken out as Do has with Cigna. I can imagine if you want to be treated in a private hospital you have to insure this separately but not for a government hospital.
Hi Jan,
you do not have to take out separate insurance unless you want to stay in a private hospital, which are not covered by the Thai policy.
Succes
Dominic van Drunen
I would take out additional insurance for this, with any Thai company whatsoever.
Many people are quite enthusiastic about the Thai state hospitals, but my experience and observation after many years is the opposite.
Crazy long waiting times, overcrowded waiting rooms, doctors who don't show up, poor hygiene, noisy dormitories, even private rooms are rickety, poorly trained staff, outdated equipment, bad food, nothing for me.
Complicated medical procedures can often not be performed and then you will still be referred to a private hospital (and you will pay for everything yourself…).
Dear Do,
Congratulations on your recovery and the result achieved at Cigna!
Regards,
Lodewijk
What a great story. So there is justice after all. But you almost have to be a lawyer to get that equality and justice. Bravo for your perseverance. Most of us couldn't have done this.
A big greeting
Stephan