Ajarn Forum - Living and Teaching In Thailand - View Single Post - Ask Tony Dabbs (Our Health Insurance Expert)

tonyd · 30th September 2006, 23:52

F.Y.I. Lying on your application for medical insurance gives the insurance company grounds for canceling or refusing to renew your insurance coverage, even if you really didn’t mean to lie.

We recently were contacted for help through our website by a man who was refused renewal of his insurance policy even though he had had it for 2 years.

During his second year of coverage he was admitted to the hospital for major surgery. The company paid the claim in full, no problem. But while he was in the hospital they discovered that he had once had major heart surgery he didn’t tell the insurance company about. The surgery was done 7 years before he applied for the insurance.

The English portion of the application appears to ask about health history going back only 5 years. It’s possible that the English translation was poorly worded. But, the agent who sold him the policy was Thai. The agent told him not to mention the heart surgery because it happened more than 5 years ago.

The insurance company paid the claim, but they refuse to renew his policy because he “lied” to them. Trying to convince them otherwise became an exercise in cross-cultural communication futility for us.

I’ve learned to understand how insurance companies think. That’s why we tell our applicants not to go back more than 5 years in providing health history “unless it relates to a pre-existing condition.”

The problem we have is getting people to understand just what a pre-existing condition really is. If you had cancer more than 7 or 8 years ago, it was fully removed and doctors have certified that you been cancer free for at least 7 years. It can’t be classed as a pre-existing condition. That’s because cancer can be cured.

But, if you have ever had heart disease, diabetes, hypertension, etc., no matter how long ago, it is still considered a pre-existing condition no matter how long it has been since you required any treatment for the condition. That is because these conditions can not (currently) be cured. They can only be controlled.

As for the man whose insurance had been canceled, we placed him with another insurance company.

30th September 2006, 23:52	#119 (permalink)
tonyd tonyd is..... The insurance guy Join Date: Dec 2005 Location: Nontaburi Posts: 126 vCash: 500 Rep Power: 29	Re: Ask Tony Dabbs (Our Health Insurance Expert) F.Y.I. Lying on your application for medical insurance gives the insurance company grounds for canceling or refusing to renew your insurance coverage, even if you really didn’t mean to lie. We recently were contacted for help through our website by a man who was refused renewal of his insurance policy even though he had had it for 2 years. During his second year of coverage he was admitted to the hospital for major surgery. The company paid the claim in full, no problem. But while he was in the hospital they discovered that he had once had major heart surgery he didn’t tell the insurance company about. The surgery was done 7 years before he applied for the insurance. The English portion of the application appears to ask about health history going back only 5 years. It’s possible that the English translation was poorly worded. But, the agent who sold him the policy was Thai. The agent told him not to mention the heart surgery because it happened more than 5 years ago. The insurance company paid the claim, but they refuse to renew his policy because he “lied” to them. Trying to convince them otherwise became an exercise in cross-cultural communication futility for us. I’ve learned to understand how insurance companies think. That’s why we tell our applicants not to go back more than 5 years in providing health history “unless it relates to a pre-existing condition.” The problem we have is getting people to understand just what a pre-existing condition really is. If you had cancer more than 7 or 8 years ago, it was fully removed and doctors have certified that you been cancer free for at least 7 years. It can’t be classed as a pre-existing condition. That’s because cancer can be cured. But, if you have ever had heart disease, diabetes, hypertension, etc., no matter how long ago, it is still considered a pre-existing condition no matter how long it has been since you required any treatment for the condition. That is because these conditions can not (currently) be cured. They can only be controlled. As for the man whose insurance had been canceled, we placed him with another insurance company. Last edited by tonyd; 1st October 2006 at 00:10.