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KSwr7UDHyn

What exactly constitutes a pre-existing condition?

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A few years ago, back in the US, I began to experience a feeling like my heart was thumping out of beat.  I looked up a bunch of stuff online and most of it said that this was quite common and, to a degree, normal.  Saw a cardiologist and he ran me through the paces, stress testing on a treadmill, ECG, sonicgram of the heat, etc.  Said everything appeared to be normal.  He called it a pre-arteirial contraction and said it was nothing to be concerned about.  Asked if I wanted to try some meds that might make the thumping less annoying by decreasing blood pressure, but mostly, cut caffeine, get more exercise, etc.  I took the meds for a couple of months and then quit taking them (doctor said I could quit if I wanted).  The thumping went away on it’s own and it’s been a year or so now since I last took the meds.  

 

When I applied for a health insurance policy, that was the only other thing I mentioned on my application and it was turned down.  No reason given.  

 

First, is a condition that was temporary and the doctor did not deem serious, a pre-existing condition?

 

Second, I know I could be denied coverage if the insurance company were to find out, but would an insurance company be able to get my US medical records?  Is that common?  

 

Mind you, I’m not trying to cross the line.  I just want to know where the line is.  Too many folks like to say, “report everything” but sometimes we see a doctor because it’s better safe than sorry, especially with something heart related.  If even seeing a doctor to rule out a serious condition could disqualify you from ever receiving health coverage, that seems pretty crazy.  

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17 hours ago, ThaiBunny said:

The basic premise of any insurance company is "Don't pay out - deny the claim". They'll find some way not to pay

As a purchaser to insurance, tell them nothing. Maybe they insist on a health check at a hospital, how will they detect all pre existing conditions?

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In the real world you have some right of appeal, barring that there is always a law suit

 

Afraid those remedies are not available here, unless you naively believe in the Office of Consumer Affairs, and is probably the number one reason, after cost, why I will never buy the insurance issued by any Thai Company

 

Not only are they corrupt but are clueless on how to write Health Insurance, the perfect example of Thainess, incompetence backed up by corruption  

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I have the same exact condition, tried to get insurance through LUMA, they said they would cover me but not for anything heart related. So a stroke I’m covered but a heart attack I’m not.  You willing never get heart coverage out here with your condition but you can get all else covered.   PAC is a type of arythmia, once you have it you always have it even if it’s dormant for a while.  The health insurance companies here don’t care if it’s a benign PAC, all they care about is your have an arythmia and so they lump you into a high risk group incorrectly.  It’s super frustrating but you will get nowhere trying to explain it to them.

Edited by Ajvat37

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18 hours ago, OneMoreFarang said:

You had a heart problem.

 

That’s sort of the point I’m making.  According to the doctor, I didn’t have a heart problem.  In fact, because of all of the testing that he did to confirm that there was no problem, I’m probably a lower risk than someone that has never had the tests done.  The doctor said that the pre-arterial contraction is actually normal but some people are more sensitive to feeling it than others.  In other words, you probably have the same thing happening and you may not even know it.  And the doctor doesn’t consider that a problem as there is no correlation to any sort of other heart condition.  

 

Now, an insurance company can say that because I was cautious, that this is now a pre-existing condition.  

 

Doesn’t this just incentivize people to not check out problems until they get to the point of being serious or life threatening? 

 

That’s why I was asking, what defines a pre-existing condition?  If you notice a lump and get freaked out that you have cancer and the doctor performs some tests and determines it’s just some sort of cyst, because you originally sought treatment for cancer is cancer now a pre-existing condition?    

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24 minutes ago, KSwr7UDHyn said:

 

That’s sort of the point I’m making.  According to the doctor, I didn’t have a heart problem.  In fact, because of all of the testing that he did to confirm that there was no problem, I’m probably a lower risk than someone that has never had the tests done.  The doctor said that the pre-arterial contraction is actually normal but some people are more sensitive to feeling it than others.  In other words, you probably have the same thing happening and you may not even know it.  And the doctor doesn’t consider that a problem as there is no correlation to any sort of other heart condition.  

 

Now, an insurance company can say that because I was cautious, that this is now a pre-existing condition.  

 

Doesn’t this just incentivize people to not check out problems until they get to the point of being serious or life threatening? 

 

That’s why I was asking, what defines a pre-existing condition?  If you notice a lump and get freaked out that you have cancer and the doctor performs some tests and determines it’s just some sort of cyst, because you originally sought treatment for cancer is cancer now a pre-existing condition?    

And insurance company will look at the facts. If condition A makes it likely that condition B will follow and B is expensive then they will be careful. If A is harmless then you have nothing to worry about.

I guess a big part is what the doctor actually wrote in his (internal) report. If he wrote something like: "Patient feels xzy but I checked it and all is fine." then fine. But if he wrote "condition A, I gave him medication" then maybe it's not so fine.

Like I wrote above: Get the records from your doctor. That is what counts.

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1 hour ago, legend49 said:

As a purchaser to insurance, tell them nothing. Maybe they insist on a health check at a hospital, how will they detect all pre existing conditions?

You sign that you answered all their questions truthfully. If you don't do that and if they discover it, then they won't pay and maybe they call your behavior fraud. And these days with computers everywhere it will be difficult to hide your records.

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I can only speak for what sometimes happens in the US and yes I know the question is about Thailand.

In the past ANY preexisting condition, i.e. a bad left knee, would disqualify someone for any coverage.  I have direct experience with my wife not being able to get insurance because she had osteoporosis.  I had a plan denied because of some minor issue which was not even one of their health questions but was discovered by some kind of medical records check.

It doesn't matter what your doctor says.  It is what their doctor says.  In the example given, having a stroke could easily lead to being an underlying heart issue and cause for a denial.

I would be surprised if they are more lenient in Thailand.

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From what you describe you did not and do not have heart disease.

 

You had  episodes  benign arrythmia (premature atrial contractions, which occurs to many people if they take too much caffeine).

 

What to put on an insurance form will depend on what exactly is asked.

 

You can truthfully put "no" to heart disease. Also "no" to taking any medications for a heart condition.

 

If asked to give details of any condition for which you saw a doctor (not hospitalized) within the time period that this occurred you should put down that you saw a cardiologist for what at the time felt like palpitations, but tests excluded any abnormal heart condition.  And offer to attach full medical report,  which you might do well to get a copy of.

 

It would be unusual for  a an insurance form to ask about doctor visits more than 2 years ago, but be guided by what exactly is asked.  Answer truthfully but do not volunteer more than is asked for.

 

Was this a Thai or international policy that you had applied for?  Unfortunately most Thai underwriters do not use medically trained people to scrutinize forms and staff tend to work robotically off of simplified charts. I have known many cases where people were given exclusions for pre-existing conditions that they never had. Some of the forms are so constructed that if answered literally, everyone would have to say yes to questions that would then lead them to be branded as having a chronic respiratory disease, for example (e.g. along the lines of "Have you ever had a sore throat or runny nose?").

 

No reasonable insurer would consider what you describe as a pre-existing condition, assuming you gave the full information in your post.  But Thai insurance company staff  in my experience would often miss the key elements and take away only "saw a doctor for  a heart condition".

 

 

 

 

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16 minutes ago, AAArdvark said:

I can only speak for what sometimes happens in the US and yes I know the question is about Thailand.

In the past ANY preexisting condition, i.e. a bad left knee, would disqualify someone for any coverage.  I have direct experience with my wife not being able to get insurance because she had osteoporosis.  I had a plan denied because of some minor issue which was not even one of their health questions but was discovered by some kind of medical records check.

It doesn't matter what your doctor says.  It is what their doctor says.  In the example given, having a stroke could easily lead to being an underlying heart issue and cause for a denial.

I would be surprised if they are more lenient in Thailand.

 

It is only a pre-existing condition if it (condition or risk factor)  exists at the time of application.

 

Osteoporosis is a chronic condition and does create an very increased risk of fractures and other problems.

 

OP describes having had some occasional PAC's, a very different matter, especially as a battery of tests rules out any underlying  cardiac disease.

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2 hours ago, Langsuan Man said:

In the real world you have some right of appeal, barring that there is always a law suit

 

Afraid those remedies are not available here, unless you naively believe in the Office of Consumer Affairs, and is probably the number one reason, after cost, why I will never buy the insurance issued by any Thai Company

 

Not only are they corrupt but are clueless on how to write Health Insurance, the perfect example of Thainess, incompetence backed up by corruption  

All depends if a Thai company or international . If international you can lodge complaints with ombudsman office usually in UK.

 

saying that.  Insurance is not obliged to offer anyone cover and are free to refuse cover during application without a reason 

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