Medical Insurance - how much do you understand?

Friday, 29 April 2011 From Issue Vol. XIX No. 17 By  Dr. Iain Corness

Came across an interesting situation the other day regarding Travel Insurance.  Most people take these out at the travel agency and the days included are enough to give you cover from the day you leave until the day your flight returns.  Simple and easy to understand - but is it enough?

Imagine you are in Singapore and on the day you are leaving you are hit by a taxi.  Head injury and a broken leg.  You are taken to ICU and then graduate to a ward after three days.  Your travel insurance expired three days ago.  Where do you stand?

It appears that most, but not all, travel insurance companies will continue to pay for your hospital treatment - but for a limited time only.  “Get well soon,” as the sympathy card says!

Now here is another part of the above scenario.  You have now graduated to walking on crutches, you are back at the hotel and will be fit to travel in the next three days, but unfortunately you contract Dengue Hemorrhagic Fever and need more hospitalization.  Your travel insurance period has already expired, and the insurance company is more than justified in rejecting this new claim.

On to another aspect of medical insurance - do you have out-patient cover as well as in-patient cover?  Most people do not, as out-patient treatment is generally very cheap in this country.  However, there is this thought in the collective sub-consciousness that if the out-patient bill is going to be high, then just stay as an in-patient for one night and then the insurance company will pick up the tab, because you are “insured”.  Do you honestly think the insurance companies are that naïve?  It has never occurred to them that this could happen?

Now put yourself in the role of the insurance company, are you just going to automatically pay up, when it is obvious even to Blind Freddie that “clinically” it was not necessary for you to be hospitalized.  You could have easily slept in your own bed and returned to the hospital the next day to get the results of the tests.  But you don’t want to because you do not have out-patient insurance!  With ‘cost containment’ being the new buzz words in the insurance industry, expect this so-called loop hole to be closed off.

Now anyone who reads this column regularly will know I promote the concept of having annual check-ups.  The guiding principle behind check-ups is to find deviations from normal health patterns at an early stage.  Early enough that the trend can be reversed, before damage has occurred.  Examples of this include blood pressure (BP) increase which is generally symptomless, and blood sugar.  It requires sky-high sugar levels before the person begins to feel that something might be wrong.  And by then the sugar levels have affected vision, the vascular system and many other systems, all of which can decrease your quality of life in the future.

However, Peter Smith from AA Insurance Brokers, brought out an interesting situation, which could be vitally important for someone finding they have a chronic problem.  If you have your check-up and find that you have high blood pressure, and then go and take out insurance, it is too late.  You “know” about your blood pressure problem at the time of applying for the insurance, so it becomes a ‘pre-existing condition’ and your insurer is within its rights to refuse to pay for the further treatment of your blood pressure, or for any other conditions caused by high blood pressure.  Including the stroke.

The simple answer, is to make sure your insurance policies are in place before having the annual check-up.  In fact, I strongly advise everyone to take out medical insurance.  You do not know what is round the next corner.  It could be a motorcycle coming the wrong way up a one way street.  Even I have insurance, and I work in the hospital, so I don’t really need it - but I can also be run over in Bangkok, Chiang Mai or Nakhon Nowhere!

Go to a reputable insurance broker and go from there.  You will thank me in 15 years time!

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