Thaivisa exclusive: Hua Hin shark attack victim said insurance gave him the green light to go to expensive hospital

[Thaidream]

1 minute ago, mogandave said:

 

So how do we have any idea what the insurance company actually said?

 

Most insurance companies tape the conversations that a claims processor/adjuster discuss with a  customer making a claim or seeking information.

[FigaroLucowski]

It is no surprise to me that the insurance company didn't pay the bill, the same thing happened to me. I had a cancerous carcinoma removed from my nose, I was in Chiang Mai Ram 2 days. My bill was 100,000 Baht. When I went to the cashier they said AIA needed to check my medical history, I had no previous incidents of cancer. So I paid thinking AIA would give me the money back in a few weeks. Three months later they said they wouldn't pay because I was treated to remove a small blood clot logged in my lungs ..20 years ago in Hawaii. Of course insurance companies these days are only looking at the bottom line. AIA canceled my insurance and now I just go to cheaper hospitals, at 67 I would have to pay big money for insurance.  In the end, I guess you can't complain in that we pay a fraction of what you would pay in the USA. 

[redwhiteandblue]

45 minutes ago, Thaidream said:

In the past most insurance was purchased through an agent who specialized in that particular policy and gave their clients a full explanation of coverage and exclusions. 

This was not the case in the UK. 

[stevenl]

36 minutes ago, Thaidream said:

The burden is on the Insurance claims agent to ask all the questions necessary to determine coverage or delay a decision on coverage until an investigation determines whether there is coverage.   If  there is any doubt- the claims agent does not say you are covered- they say coverage is pending.

No, it is not as simple as that, the policy holder has to inform the company important information.

 

This quote of yours " In the past most insurance was purchased through an agent who specialized in that particular policy and gave their clients a full explanation of coverage and exclusions. Today, with internet and other methods of electronic purchase- the buyer has to beware. " is also not correct with regards to travel insurance. Before internet this was sold by the travel agent, who really had no clue.

 

Agree with you it is much more 'buyer beware' and with insurance that is quite often not a good idea, a good broker is IMO recommended for most people.

 

" Most insurance companies tape the conversations that a claims processor/adjuster discuss with a  customer making a claim or seeking information. "

Maybe in present times, but this was most certainly not the case 20 years ago.

 

 

[Here It Is]

5 minutes ago, redwhiteandblue said:

This was not the case in the UK. 

Indeed, how long would it take to explain every last point of the coverage and exclusions.  Far easier to read the policy at your leisure.

 

I know pretty much every last detail of my Bupa travel insurance policy, though hope that I don't have to call on it.  I purchase it direct from Bupa, by the way.

[Just Weird]

2 hours ago, monkfish said:

Sorry I am not going to post that Email here you either believe me or you don't up to you.
One thing you are right about is the insurance company wanted her to change to a less expensive hospital in the area but as she was already attached to a drip and in a great deal of pain we decided not to change hospitals and paid for treatment cash. She later when she returned home she was reimbursed for about 60% of the cost of treatment. The policy was purchased together with a direct Flight from London to BKK with BA and purchased from the a well know high street Travel Agency in the UK she chose the most expensive travel insurance policy offered.

I just want to warn other travelers they might not be covered for treatment at the most expensive hospitals that all.
We all assume we can go to every hospital but it's not true.

Why wouldn't you post it if it were true?  But that's ok, I can live with not believing that those were the words used.

 

"Same thing thing happened to my mother whilst on 2 week vacation the Insurance refused to pay for treatment at the hospital".

So that's not what actually happened, then?  The insurer asked her to go to a hospital whose costs they would cover but as she didn't do that they reimbursed her for the amount they were obligated to pay.  In other words the insurer did absolutely nothing wrong, which is not what your original post suggested.

 

"We all assume we can go to every hospital but it's not true".

You're wrong, we do not all believe that.  Some hope that's the case and try to get away with it.  All insurance policies point out the limitations of the cover provided, they have to or they would get sued constantly.

[mogandave]

Most insurance companies tape the conversations that a claims processor/adjuster discuss with a  customer making a claim or seeking information.

And of course you know what was said because they played the recording back for you.

[Thaidream]

Insurance companies do get sued constantly simply because they do not provide the coverage they promised; the  insurance staff states customers are covered and then try and  withhold coverage; and many other reasons.  When purchasing insurance- the policyholder answers a set of questions that establishes rates for the coverage.

 

When a claim is filed- the claims agent asks another series of questions to determine if coverage exists and  checks the policy for payment; dates; exclusions etc.   If the claims agent never asks the questions and says the incident is covered and then later tries to withdraw coverage- the agent has not done their job properly and the  insurance company should be liable for payment but the customer is going to have to push for an investigation; possibly file a complaint with the insurance commission or get a lawyer involved.  Most people give up and big insurance knows it.

 

I will tell you all once again most people who purchase insurance do not understand it - do not understand the exclusions and the coverage and how it is applicable to their situation.

 

Insurance companies are not benevolent protectors of their customers- they exist to make money- just as most hospitals exist to make money. Let the buyer beware...And that is one reason I left the employment of  Insurance.  I actually wanted to help people-  most insurance doesn't.

[NoshowJones]

16 hours ago, Just Weird said:

Maybe he didn't get the green light specifically, so far there's only his word for that.  You could be right about something rotten going on.

I would trust anyone before I would trust an insurance company, they are all quick to take your money, but when it comes to paying out, they try every trick in the book not to.

There are reports in the papers all the time in the UK about insurance companies not paying out.

[NoshowJones]

5 hours ago, HLover said:

what insurance do you recommend? 

None.

[Just Weird]

1 hour ago, Thaidream said:

 

 

In this case, if the insurance company failed to notice that the policy had lapsed or what was being claimed was not part of the policy but went ahead and authorized the payment but then later declined- this is probably in most countries not per the law which governs insurance.   Most people have no idea how intricate insurance coverage can be and sometimes it is very difficult to understand how the policy is written. 

 

Just an aside- most call centers for insurance tape all conversations so there should be taped proof of what was said and what was not said.

"In this case, if the insurance company failed to notice that the policy had lapsed or what was being claimed was not part of the policy but went ahead and authorized the payment but then later declined-..."

Well, that's only according to what the kindhearted Norwegian said is the case!   No one seems to have asked the insurer for it's side of the story.

 

"Most people have no idea how intricate insurance coverage can be and sometimes it is very difficult to understand how the policy is written".

These days policy conditions, exclusions, etc., have to be written in language that can be reasonably understood by the policyholder.   And insurers always instruct policyholders to read the conditions and exclusions.

[Just Weird]

7 minutes ago, possum1931 said:

I would trust anyone before I would trust an insurance company, they are all quick to take your money, but when it comes to paying out, they try every trick in the book not to.

There are reports in the papers all the time in the UK about insurance companies not paying out.

Really?  I think you read too many tabloid rags.

 

How many can you point to in, let's say, the past 12 months that have been proved to be the insurer not paying out when it should have, then? 

 

Indignant tabloid reports about claims not being approved by policyholders who have not read their policies and who have no legitimate claim do not count as insurers trying every trick in the book to avoid paying out.

[Thaidream]

I have no idea what was said or not said and nether do you- however, as a former insurance adjuster and investigator- I have heard hours and hours of taped recordings to determine who said what to whom.  I am simply giving my take based on what was presented by the injured party.

 

If I as a customer was told by my insurance company that -"you are covered for xxx amount "  and later I was then told  I am not covered-   I would raise holy hell..... and if the Company did not agree- I would go to the Insurance Commission and demand the recorded tapes and seek legal counsel

 

Insurance companies would love to have some of the posters here as customers- you have no idea what your rights as policy holders are nor even how insurance coverage works.

[Here It Is]

16 minutes ago, possum1931 said:

6 hours ago, HLover said:

what insurance do you recommend? 

None.

I wouldn't go anywhere without my annual policy, therefore you're a braver man than me.  

 

[sambum]

17 hours ago, GuiseppeD said:

Who knows? Clerical error, maybe.  But if you read the story, this guy's insurance was definitely invalid. 

 

Anyway, would it make much difference if the insurance company had not given the green light in the first place?

"He said that he was mindful that an expensive hospital in Hua Hin would cost him a lot of money and was prepared to go to a cheaper hospital if necessary.But after his insurance company assured him over the phone that everything was okay he decided to go to Hua Hin Bangkok Hospital".

 

So, if the insurance company had NOT given him the "green light" he would have gone to a cheaper hospital, so the difference is probably baht in the 6 figures bracket! 

 

[NoshowJones]

2 minutes ago, Here It Is said:

I wouldn't go anywhere without my annual policy, therefore you're a braver man than me.  

 

What I am saying is I would not trust any insurance company, every time I went to America I always took out insurance, and always for my cars, and motorbikes, and my house, but I would not be confident of them paying out although I know of people getting paid out.

It all comes down to the one thing, they all use small print, why do they do that? It is not hard to figure it out. Why can they not use all print the same size in their policy? Because they are crooks trying all they can to refuse to pay out claims if they can get away with it.

[Here It Is]

1 minute ago, sambum said:

"He said that he was mindful that an expensive hospital in Hua Hin would cost him a lot of money and was prepared to go to a cheaper hospital if necessary.But after his insurance company assured him over the phone that everything was okay he decided to go to Hua Hin Bangkok Hospital".

But it's still unknown as to what was specifically discussed in the phone call.  He may have phoned the call centre with a general query:

 

Mr Norway:  I've just been bitten by a shark.

Call centre:  Do you have a policy with us, Mr Norway?

Mr Norway:  Yes.

Call centre:  Then you are covered for a shark bite.  Please proceed to your nearest hospital.

 

It's not until the actual claim was processed was it discovered that Mr Norway had overstayed the maximum permissible stay, which is what I suspect is the underlying story.

[stevenl]

8 minutes ago, possum1931 said:

<snip>

It all comes down to the one thing, they all use small print, <snip>

In many countries: no, they don't use small print.

[Here It Is]

9 minutes ago, possum1931 said:

What I am saying is I would not trust any insurance company, every time I went to America I always took out insurance, and always for my cars, and motorbikes, and my house, but I would not be confident of them paying out although I know of people getting paid out.

It all comes down to the one thing, they all use small print, why do they do that? It is not hard to figure it out. Why can they not use all print the same size in their policy? Because they are crooks trying all they can to refuse to pay out claims if they can get away with it.

But surely if one has read the policy and stays within the contract then one will be paid out in the event of an accident. 

 

I'm baffled by the continuous stream of news stories of injured parties bemoaning insurance companies not paying out when they haven't kept to their side of the bargain.  How many involve motorcycle accidents when the policy clearly doesn't cover motorbikes?

[NoshowJones]

24 minutes ago, stevenl said:

In many countries: no, they don't use small print.

Maybe so, but most of my insurances have been in the UK, and they all use small print. Why? Isn't it obvious?

[sambum]

8 minutes ago, Here It Is said:

But it's still unknown as to what was specifically discussed in the phone call.  He may have phoned the call centre with a general query:

 

Mr Norway:  I've just been bitten by a shark.

Call centre:  Do you have a policy with us, Mr Norway?

Mr Norway:  Yes.

Call centre:  Then you are covered for a shark bite.  Please proceed to your nearest hospital.

 

It's not until the actual claim was processed was it discovered that Mr Norway had overstayed the maximum permissible stay, which is what I suspect is the underlying story.

No, I don't think he called the Call Centre with a "general query "  -  having been bitten by a shark you call the Claims Centre to see if you are covered. It is not a run of the mill occurrence, after all!

 

Mind, if he was inadvertently put through to a Call Centre, I can quite understand if there was some confusion as to what advice was given - especially if (for instance) the Call Centre was somewhere in Calcutta, or Delhi! Having had some prior experience with them, I now refuse to deal with them, and ask to be transferred to the appropriate Department.

 

However, I think you are spot on with your closing comment, and he should have checked his policy, but I think that understandably,  his main priority was getting treatment and hey, maybe the shark knew that he'd "outstayed his welcome"!

[NoshowJones]

24 minutes ago, Here It Is said:

But surely if one has read the policy and stays within the contract then one will be paid out in the event of an accident. 

 

I'm baffled by the continuous stream of news stories of injured parties bemoaning insurance companies not paying out when they haven't kept to their side of the bargain.  How many involve motorcycle accidents when the policy clearly doesn't cover motorbikes?

and your not baffled at the way insurance companies try not to pay out claims? I'm referring mainly to UK insurance companies.

[mogandave]

I doubt very much the term of the policy is in the “fine print”.

Anyone that expects coverage to continue on after the term is a bone-head.

I have insurance and I have always been treated fairly.

It’s been my experience that people think everyone is like them, so people that think everyone is out to cheat them....

[mogandave]

No, I don't think he called the Call Centre with a "general query " 

No, I’m sure he said: “Hey, I got bit by a shark, but my policy expired a month ago...am I still covered?

[JLCrab]

1 hour ago, Thaidream said:

<snip> If I as a customer was told by my insurance company that -"you are covered for xxx amount "  and later I was then told  I am not covered-   I would raise holy hell..... and if the Company did not agree- I would go to the Insurance Commission and demand the recorded tapes and seek legal counsel <snip2>

Well then I guess he could raise hell holy or otherwise when he gets back to Norway. But again, the tapes may reveal that the customer was told: As long as you are within x day time limit per excursion ex-Norway, you are covered for XXX amount" and that detail has been left out of the OP article.

 

The hospital might have proceeded without any hard copy guarantee of the coverage by the Norway insurer because, upon being admitted, the customer signed a release saying that -- insurance or not -- he was the one ultimately responsible for the charges incurred by the hospital for his treatment.

[BwindiBoy]

7 hours ago, mstevens said:

Surely the insurance company would have gone in to the computer, checked his policy and then given the green light, or not?  You would think their computer system would show immediately whether the policy was valid or not and even if it didn't, that they would make the requisite checks before giving him the green light to get treated.

Their system would show that the annual policy was valid, yes, but not that he had been on holiday for longer than the maximum holiday period within that annual policy period.

[cookieqw]

should of gone to the cheaper hospital in the first place,  might have been a better chance of the doctors realising they were shark bites instead of rock bites  555

[mogandave]

Their system would show that the annual policy was valid, yes, but not that he had been on holiday for longer than the maximum holiday period within that annual policy period.

I thought I read he had a 60 day travel policy, no?

[Bangel72]

Would the real sharks please stand up.

[Thaidream]

all hospitals will have the patient sign a statement indicating that they are responsible for charges whether insured or not.

 

A legitimate insurance company will get the policy number and pull up the policy and go thru the claim process which would include a complete desription of what ahppened- where it happened- how long the insured had been at the location- when he left home- when he arrived and  so forth.  The insurance company after the interview would have enough information to move forward.  Many companies will take the claim details and then state 'coverage pending' -if in an emergency situation -seek medical attention. We will contact you within 24 hours  to discuss coverage.

 

However, if this company gave the authorization by saying 'you are covered for xxx amount'  they have just committed their company to payment. 

 

Everyone should know that the devil is in the details and to read the policy carefully but most people do not.  Insurance companies are not out to cheat people and most common claims are paid correctly and quickly.  However, insurance companies are there to make a profit Travel claims are tricky becuase they have so many limits and exclusions

 

If the injured person in this scenario was told by the claims agent- 'you are covered for xx amount'  and then later rescinded the statement- he has grounds to file a formal complaint or sue. If that agent should not have said he was covered  and made a mistake- the company still pays and 'counsels' their employee on how to handle the claim process properly.  As a professional, licensed company you better have your agents properly trained on what is coverable and what is not. When your employee makes an error- a reputable company makes it good whether the insured had proper coverage or not.