The utter minefield of health insurance.

xandreu · Post by **xandreu** » Fri Apr 28, 2023 1:24 pm

I've lived in Cambodia for several years now and I have never had health insurance. - Go on, do your worst... "How irresponsible of you.... Were you hoping to rely on Go Fund Me...? You deserved all you get if you fall ill..."

The honest reason why I have never got health insurance is because I neither understand it nor, to some degree, trust it. Every now and again, such as at the moment, I feel that I really should get it sorted.

I have spent the last few days trying to find something that I think fits my requirements, but this is made even more difficult given the fact that I don't even know what my requirements are. How does anyone know what they need to be covered for? How can anyone know what's ailments they are going to succumb to? So many policies seem to cover this, but don't cover that, or that covers this but only if that has been fulfilled and that has to have been within this requirement if you want to claim, but you can only claim for that if this has been met. Good God!

A lot of the time, I can't even see what certain policies cover and what they don't. I always have this feeling in the back of my mind that a policy may say they cover cancer for example, but if you ever get cancer, they'll turn around and say "oh yes, we do cover cancer but unfortunately not that kind of cancer. Sorry about that".

I have been in touch with an insurance broker recently who has recommended a policy to me. I asked him if I were to have a serious illness, I would be looking to get treatment in a neighbouring country, as Cambodian healthcare is not of a particularly high standard. He replied yes - if you're in a hospital that can't treat you, you will be repatriated to a hospital that can. This doesn't fill me with much confidence. Of course a hospital is going to say they can treat you - they want the fees. Whether they can treat you with any decent standard though is open to interpretation. And who's to say they won't just transfer you to another Cambodian hospital? - They aren't exactly in the business of spending money needlessly.

Most of us westerners, except the Americans I guess, come from countries with free health care and don't have to think about or deal with this sort of thing. When we do, or at least when I do, I really don't know what I'm doing. But I know that I do need to be covered.

Are there any members here who know a thing or two about this and can guide me in the right direction? I just want something that will cover me for emergencies and any long term serious illness, with the option to go to Thailand or Vietnam should the need arise.

If anyone can recommend any insurance companies or give me some advice, I'd be really grateful.

Tootsfriend · Post by **Tootsfriend** » Fri Apr 28, 2023 1:47 pm

xandreu wrote: ↑Fri Apr 28, 2023 1:24 pm I've lived in Cambodia for several years now and I have never had health insurance. - Go on, do your worst... "How irresponsible of you.... Were you hoping to rely on Go Fund Me...? You deserved all you get if you fall ill..."

The honest reason why I have never got health insurance is because I neither understand it nor, to some degree, trust it. Every now and again, such as at the moment, I feel that I really should get it sorted.

I have spent the last few days trying to find something that I think fits my requirements, but this is made even more difficult given the fact that I don't even know what my requirements are. How does anyone know what they need to be covered for? How can anyone know what's ailments they are going to succumb to? So many policies seem to cover this, but don't cover that, or that covers this but only if that has been fulfilled and that has to have been within this requirement if you want to claim, but you can only claim for that if this has been met. Good God!

A lot of the time, I can't even see what certain policies cover and what they don't. I always have this feeling in the back of my mind that a policy may say they cover cancer for example, but if you ever get cancer, they'll turn around and say "oh yes, we do cover cancer but unfortunately not that kind of cancer. Sorry about that".

I have been in touch with an insurance broker recently who has recommended a policy to me. I asked him if I were to have a serious illness, I would be looking to get treatment in a neighbouring country, as Cambodian healthcare is not of a particularly high standard. He replied yes - if you're in a hospital that can't treat you, you will be repatriated to a hospital that can. This doesn't fill me with much confidence. Of course a hospital is going to say they can treat you - they want the fees. Whether they can treat you with any decent standard though is open to interpretation. And who's to say they won't just transfer you to another Cambodian hospital? - They aren't exactly in the business of spending money needlessly.

Most of us westerners, except the Americans I guess, come from countries with free health care and don't have to think about or deal with this sort of thing. When we do, or at least when I do, I really don't know what I'm doing. But I know that I do need to be covered.

Are there any members here who know a thing or two about this and can guide me in the right direction? I just want something that will cover me for emergencies and any long term serious illness, with the option to go to Thailand or Vietnam should the need arise.

If anyone can recommend any insurance companies or give me some advice, I'd be really grateful.

I went through all that when I first came to Cambodia 19 years ago and decided that I would put the equivalent of a health insurance fee into a special account and not touch it. Presently stands around A $12k. Not a lot, but at least I know I''m not paying for all the expenses of sales agent fees, holidays, profits, and all those costs that make Insurance so high. Besides , what insurance company wants to insure old age pensioners when they turn 76 years of age.

Spoiler:

simon43 · Post by **simon43** » Fri Apr 28, 2023 2:10 pm

I'm not in Cambodia, but have been based in Thailand for 22 years and then mostly working in Myanmar. So I have always looked for a medical insurance policy that will medivac me back to Thailand for urgent treatment.

Some advice:
- Do not choose a local company because usually they can substantially increase their premium if they have to pay out on an insurance claim, or can simply cancel your insurance or can cut you off at some advanced age. In general, international (EU/UK) companies cannot increase premiums if you claim, but can only increase premiums across an age band. You can be insured for life, so long as so pay the premiums, which will obviously increase with age.

Having said that, I paid April International Insurance (France) for many years, and when an MRI scan last Autumn showed suspected prostate cancer, they cut me off and cancelled my insurance immediately(!!), forcing me to return to the UK for NHS diagnosis etc. Happily, no cancer was found, but it completely shook my confidence in insurance companies.

Don't opt for outpatient cover - it adds a lot to your premiums. Also, forget dental and optical (unless it is for cataracts etc). You need a policy that covers you for 'sudden' serious illnesses such as stroke, heart attack etc and accidents. Most policies also cover for all types of cancer, but for diseases like that you should be well enough to return to your home country for treatment.

In view of my recent experiences, I have now reinsured with a company called WRLife (Google them), who offer competitive premiums. This will allow me to also save funds in my bank account, in case they 'do the dirty' on me if I have to claim again.

Doc67 · Post by **Doc67** » Fri Apr 28, 2023 2:26 pm

The big print giveth and the small print taketh away.

You should read the entire policy document and in particular the exclusions. There will always be a moratorium for the first year or two, especially for pre-existing conditions that have not flared up for a while.

I have had a policy for 5 years, never claimed and it gives me peace of mind, but I know when push comes to shove, getting them to pay will not be easy. It is all smiles and plane sailing to get a policy - just fill in a form and pay them - but they will get very picky and fussy when it comes to claims time.

Stick with a European insurer that is at least regulated by an ombudsman scheme, and probably best to use a UK insurer so you at least have some idea how to exert pressure if the screw you around.

As for cancer, you will probably get a diagnosis quickly and cheaply here, of which the costs of those tests may be recoverable, but when it comes to treatment I would decamp to Bangkok and make a claim from there. There is NO WAY I would ever willingly accept medical treatment in a Cambodian hospital.

My policy is global and covers me anywhere in the world, including the UK which may well be my choice for serious treatment, for quality of care, the language and cultural aspect and convenience for the family to visit me (or probate reasons.)

The only country that is excluded is the US which is just fine with me.

I use the agent AG Cambodia who are excellent and based in the Himarawi complex, and my insurer in Globality, part of Munich Re.

The one thing the really troubles me is you have to pay first and claim later, and hope they don't refuse payments because they say they were excessive, unnecessary or other excuse. If you get out of Cambodia and perhaps back to the UK, they will accept a direct pay system.

xandreu · Post by **xandreu** » Fri Apr 28, 2023 2:26 pm

simon43 wrote: ↑Fri Apr 28, 2023 2:10 pm I'm not in Cambodia, but have been based in Thailand for 22 years and then mostly working in Myanmar. So I have always looked for a medical insurance policy that will medivac me back to Thailand for urgent treatment.

Some advice:
- Do not choose a local company because usually they can substantially increase their premium if they have to pay out on an insurance claim, or can simply cancel your insurance or can cut you off at some advanced age. In general, international (EU/UK) companies cannot increase premiums if you claim, but can only increase premiums across an age band. You can be insured for life, so long as so pay the premiums, which will obviously increase with age.

Having said that, I paid April International Insurance (France) for many years, and when an MRI scan last Autumn showed suspected prostate cancer, they cut me off and cancelled my insurance immediately(!!), forcing me to return to the UK for NHS diagnosis etc. Happily, no cancer was found, but it completely shook my confidence in insurance companies.

Don't opt for outpatient cover - it adds a lot to your premiums. Also, forget dental and optical (unless it is for cataracts etc). You need a policy that covers you for 'sudden' serious illnesses such as stroke, heart attack etc and accidents. Most policies also cover for all types of cancer, but for diseases like that you should be well enough to return to your home country for treatment.

In view of my recent experiences, I have now reinsured with a company called WRLife (Google them), who offer competitive premiums. This will allow me to also save funds in my bank account, in case they 'do the dirty' on me if I have to claim again.

Yes, the cost of non-emergency outpatient type of treatment, as well as dental work is cheap enough in Cambodia that I wouldn't pay a premium to have it added to my policy. It's mostly the unexpected emergencies (being hit by a bus kind of thing) and long-term health issues I'm mostly interested in being covered for. The latter having the option to go to Thailand, or at least Vietnam for any long-term treatment.

A lot of policies say they can repatriate you back to your home country if need be, but as far as the UK is concerned, citizens no longer have the right to free health care if they've lived outside of the country for a certain length of time. I'm well over that period so this is of no use to me.

Thanks for the recommendation of WRLife. I'll check them out.

Doc67 · Post by **Doc67** » Fri Apr 28, 2023 2:41 pm

xandreu wrote: ↑Fri Apr 28, 2023 2:26 pm
simon43 wrote: ↑Fri Apr 28, 2023 2:10 pm I'm not in Cambodia, but have been based in Thailand for 22 years and then mostly working in Myanmar. So I have always looked for a medical insurance policy that will medivac me back to Thailand for urgent treatment.

Some advice:
- Do not choose a local company because usually they can substantially increase their premium if they have to pay out on an insurance claim, or can simply cancel your insurance or can cut you off at some advanced age. In general, international (EU/UK) companies cannot increase premiums if you claim, but can only increase premiums across an age band. You can be insured for life, so long as so pay the premiums, which will obviously increase with age.

Having said that, I paid April International Insurance (France) for many years, and when an MRI scan last Autumn showed suspected prostate cancer, they cut me off and cancelled my insurance immediately(!!), forcing me to return to the UK for NHS diagnosis etc. Happily, no cancer was found, but it completely shook my confidence in insurance companies.

Don't opt for outpatient cover - it adds a lot to your premiums. Also, forget dental and optical (unless it is for cataracts etc). You need a policy that covers you for 'sudden' serious illnesses such as stroke, heart attack etc and accidents. Most policies also cover for all types of cancer, but for diseases like that you should be well enough to return to your home country for treatment.

In view of my recent experiences, I have now reinsured with a company called WRLife (Google them), who offer competitive premiums. This will allow me to also save funds in my bank account, in case they 'do the dirty' on me if I have to claim again.
Yes, the cost of non-emergency outpatient type of treatment, as well as dental work is cheap enough in Cambodia that I wouldn't pay a premium to have it added to my policy. It's mostly the unexpected emergencies (being hit by a bus kind of thing) and long-term health issues I'm mostly interested in being covered for. The latter having the option to go to Thailand, or at least Vietnam for any long-term treatment.

A lot of policies say they can repatriate you back to your home country if need be, but as far as the UK is concerned, citizens no longer have the right to free health care if they've lived outside of the country for a certain length of time. I'm well over that period so this is of no use to me.

Thanks for the recommendation of WRLife. I'll check them out.

Med evac is most likely for travel insurance. As soon as you are well enough to travel, they put you on a plane and send you home, then wash their hands.

I was on a BA flight in biz class, from BKK to LHR. An old guy was in a seat with a canula inserted and a monitor attached to him and was traveling with a young paramedic from Bangkok Hospital who had a box of tricks. He monitored this old man every hour and gave him some stuff that knocked him out. This is probably the most expensive medivac they would stump up for: 2 x Biz class (one way), and one economy seat to bring their paramedic home on the next flight - Maybe $5000. All this nonsense about $25,000,000,000,000 coverage is just bullshit. I'm sure they would have you killed if you looked like getting anywhere near $1m

simon43 · Post by **simon43** » Fri Apr 28, 2023 3:18 pm

xandreu wrote: ↑Fri Apr 28, 2023 2:26 pm ...
A lot of policies say they can repatriate you back to your home country if need be, but as far as the UK is concerned, citizens no longer have the right to free health care if they've lived outside of the country for a certain length of time. I'm well over that period so this is of no use to me.

You misunderstand the UK situation. Expats can receive free treatment under the NHS as soon as they step foot on UK soil and state that it is their intention to return permanently to the UK (whether or not this is indeed the case).

After my French insurer refused to cover the costs to diagnose my prostate cancer/no prostate cancer, I returned to the UK and registered with a GP in a couple of days, then explained to him my situation and that I had returned to the UK for NHS treatment after 21 years living in south-east Asia. He immediately referred me to the local hospital for cancer diagnosis investigation and I had my first consultation a week later, with my doctor fully aware of my expat situation. After about 2 months of various tests, I was given the all-clear for prostate cancer (the problem is actually prostatitis/prostate stones, which gives similar symptoms to prostate cancer - raised PSA and shadows on the MRI scan).

At no time was my expat situation ever questioned by my GP or the hospital. Had it actually been prostate cancer, then my plan was indeed to remain in the UK. Since it was actually something of no great concern, I returned to Thailand

Post by **Freightdog** » Fri Apr 28, 2023 3:20 pm

The large value policy coverage appears to satisfy the initial concern, geographically, that if you get admitted as an emergency or urgent case, you are covered until stabilised. And while they get you stabilised, there’s moves afoot to get you relocated. Being relocated is probably not well be done with little reference to you, the patient.

Some of it is practical- people do recover better when not isolated from everything and everyone that they know. Some of it is logical. Why hang about in the US any longer than necessary? The medical insurance cost for short term (under 6 months for one outfit) to cover just the USA was more expensive by a huge amount than all of the rest of the world cover. Including our potential forays into near war zones.
Some of it is saving their arse- no one in their right mind would want to pay significant money for below normal standard care unless the risk of moving is greater than the risk of staying.

But I don’t trust insurance companies at all. Any type. They’re often incompetent, falling into that ‘most of the time we get it right’, and failing miserable in the 5% that they get wrong.
We’ve just recently discovered that a company insurance is borderline worthless above 55years old, which is about when most insurances of the type would normally expect to provide cover. It’s not entirely clear how that snuck in.

I’m sure I wrote the number down in a previous thread, but for guidance- I spent 3 days in Royal Phnom Penh when I was diagnosed with cancer, and the bill to the insurance company was about $12k. I heard about a former colleague a while back, similar circumstances, over $100k in a U.S. hospital.

Kammekor · Post by **Kammekor** » Fri Apr 28, 2023 3:26 pm

Tootsfriend wrote: ↑Fri Apr 28, 2023 1:47 pm
I went through all that when I first came to Cambodia 19 years ago and decided that I would put the equivalent of a health insurance fee into a special account and not touch it. Presently stands around A $12k. Not a lot, but at least I know I''m not paying for all the expenses of sales agent fees, holidays, profits, and all those costs that make Insurance so high. Besides , what insurance company wants to insure old age pensioners when they turn 76 years of age.
Spoiler:
yep, it's my birthday today, and its so so exciting cause I've never been 76 before.

I don't think 19 years of (real) health insurance equals $12k in the age band 57-76. My 11 years old' costs me 800$ per year already.

Happy birthday.

truffledog · Post by **truffledog** » Fri Apr 28, 2023 3:30 pm

Quite a few gofundme campaigns result from motorbike accidents. Insurance companies tend to exclude those on the base that you had no local driving licence and/or drunk/intoxicated while driving.

The utter minefield of health insurance.

The utter minefield of health insurance.

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