What issues have others faced with Pacific Cross regarding hospital bill payments, and what advice can you offer?

Oct 12, 2024
2 months ago
Danny *******
ORIGINAL POSTER
Anybody had problems with Pacific Cross not paying hospital bills? Any advice? We are in the hospital and having problems with them paying the bill.

P.S. Please, I'm looking ONLY for opinions/advice from those who have or have had Pacific Cross insurance, not opinions of insurance or other companies to consider. So, no rants and opinions about the pros and cons of insurance. Thanks.
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TLDR : Answer Summary
The conversation revolves around the challenges faced by expats using Pacific Cross insurance in Thailand, particularly regarding claim payments for hospital bills. Users shared their personal experiences, noting difficulties in claims processing, often linked to pre-existing conditions and vague coverage terms. Many emphasized the importance of understanding policy exclusions and advised potential users to be cautious. There is also a strong sentiment towards self-insurance due to perceived inadequacies in standard insurance offerings in Thailand.
Danny *******
ORIGINAL POSTER
Thanks for all the revenant advice and suggestions. I will turn off comments now.
Anita ********
After reading all these comments, it appears that most will self ensure. What happens if you go to the emergency room and you can’t pre-pay?
Pranom **********
Not sure about the term, if emergency they will ask to paid it in advance.

You may want to contact Pacific Cross directly to clarify any discrepancies or delays with payment. In some cases, hospitals might require you to pay upfront and seek reimbursement later from the insurance company. It’s also helpful to check the specific terms of your policy to ensure the bill falls within their coverage guidelines. Others have had mixed experiences, with some delays in claims processing, but persistence with follow-up calls and emails usually resolves the issue. You could also ask the hospital to contact Pacific Cross on your behalf, as they often have direct lines to insurance providers.
Harris ******
Virtually all insurance companies that write insurance here will try hard to deny claims on the basis of preexisting situations or less than candid disclosures on the application. Its very sad
Joe ******
I'm with Pacific Cross. Am I happy with them? I would say
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I have never been sick my entire life apart from having Non-Hodgkin's Lymphoma back in 1980.

Then four years ago I got diagnosed with cancer on the back of my throat and COPD. Pacific Cross refused to pay for COPD treatment as they claim it was a pre-existing condition which was complete rubbish. So I contacted the Insurance Ombut Man and Pacific Cross agreed to pay for some of it.

As for the cancer treatment, as long as I was in hospital, Pacific Cross paid but Radiotherapy is done as an outpatient and so only got 2'500THB per day for a maximum of 30 days. Each of the 75 Radiation treatments cost 5'500THB.

At the time, the entire medical bill for COPD and cancer treatment, including medication and renting a small room in a homestead for three months close to the Cancer hospital was over 2.5 million THB. Insurance paid around 40% of it, the rest I had to pay myself.
Hakan ************
PC will go off what your doctor has written.. its as simple as that.

Depending on what cover you have will determine if u get paid out or not..

In Thailand I'm guessing the doctor has said 1 thing to you and has put something else in the report.... At the end the insurance company will go of the doctors report rather than you jumping up and down trying to explain it to them...

Hope all works out mate
Danny *******
ORIGINAL POSTER
@Hakan ***********
I think PC read what they wanted to read and not what the doctor actually wrote, so they could claim it was not covered.
Hakan ************
@Danny ******
the only other advice would be put pen to paper to the compliance department..

🤘
Danny *******
ORIGINAL POSTER
@Hakan ***********
We will file an appeal with SC and if that fails then to the ombudsman office.
Danny *******
ORIGINAL POSTER
@Hakan ***********
The doctor wrote the correct thing but apparently the insurance company can’t read. 🙄
Barry *******
Pretty sure it was these guys that refused to pay for friends chemo.
Danny *******
ORIGINAL POSTER
@Barry ******
Do you know why?
Barry *******
@Danny ******
it was in the small print that they would not cover a ‘throat condition’

My friend was diagnosed with throat cancer.
Danny *******
ORIGINAL POSTER
@Barry ******
Typical from what I’m seeing.
Barry *******
@Danny ******
I wouldn’t class cancer as a ‘condition’!
Martin ********
I don't have Pacific Cross, however I have had dealings with them in the past when processing bills. They are extremely difficult to deal with , and appear to like to delay, ask for additional paperwork etc , their model appears to be based on make it so difficult that the claiment will give up. Cigna are by far the easiest and most professional to deal with . This is my experience as a healthcare provider in Thailand. Good luck
Peter *******
Don't forget Thai insurers will exclude pre-existing conditions, things you are likely to claim on, so you'll need to self insure anyway
Kool *******
@Danny ******
what exactly are they not covering, and why? Most every insurance, including Pacific Cross, do not cover accidents when alcohol was involved, when a high risk activity was involved, like involving a motorcycle, or when the law was being broken. What did they refuse to cover exactly? No one can help you without specific details.
Danny *******
ORIGINAL POSTER
@Kool ******
They are confusing two very technical but also very different medical conditions with similar names. One is covered the other not. They refused to acknowledge the error on their part.. face saving?
Kool *******
@Danny ******
still not providing exact details so can not help you. Insurance companies have no concern with saving face. Exact details please
Danny *******
ORIGINAL POSTER
@Kool ******
That’s personal medical information that I don’t put on social media. Unless you have personally dealt with Pacific Cross I don’t think you can help me.
Kool *******
@Danny ******
Pacific Cross goes strictly by what your doctor wrote, not by what you say at all. You should know that.
Danny *******
ORIGINAL POSTER
@Kool ******
Like I said I don't think you can help me.
Kool *******
@Danny ******
without exact details, no I can not help you, and no one else can either. Like I said before, everything is based on what your attending doctor wrote, not what you say.
Danny *******
ORIGINAL POSTER
@Kool ******
Give it a rest.
David ********
They are like casinos. They always win in the long run.
Mario ************
I don’t use insurance. Cheaper to pay out of pocket.
Danny *******
ORIGINAL POSTER
@Mario ***********
That's not what I asked.
Mario ************
Sorry Charlie
Bart **************
They've once offered that they called covid insurance, when this was required for entry by the Thai government. But then they excluded, you already guessed it ... exactly that! Like a motorcycle insurance not covering liability if you're at fault.

Ever since then I've decided I'll never do business with them, and recommended the same to anyone else.
Danny *******
ORIGINAL POSTER
@Bart *************
That's not what I asked about.
Gregory ********
@Danny ******
you need to elaborate why they are not paying—everybody is underwritten individually —its not a medical aid—so you need be specific about why they are not paying—too many different reasons they might have to settle the claims
Danny *******
ORIGINAL POSTER
@Gregory *******
Without getting into specifics, they don't seem to understand different medical terms that sound similar what are miles apart. I've tried to educate them but they only seem to know how to repeat the same thing, .i.e. "we no pay".
Gregory ********
@Danny ******
The Office of the Ombudsman in Thailand is responsible for supporting and promoting health insurance systems. They can be contacted by:

Hotline: Call 1676, a toll-free number that is available nationwide

Post: Send a complaint letter to the Office of the Ombudsman, located at The Government Complex Building B, 5th Floor, Chaengwattana Road, Laksi District, Bangkok
*****


Online: Submit a complaint through the official website or th
Gregory ********
Online: Submit a complaint through the official website or the complaint program at the ICT Learning Center in your community

Email: Send an email to
***********************
or
********************


Phone: Call 02-
*****
00

Fax: Send a fax to 02-
*****
41

The Ombudsman's duties include:

Recommending that relevant state agencies revise laws, rules, and regulations that are unfair, cause grievance, or impose an unnecessary burden on the people

Conducting fact-finding when there is a person affected by grievance or unfairness

Notifying the Council of Ministers if a relevant state agency has not implemented the Ombudsman's recommendations

Referring matters to the Constitutional Court or the Administrative Court when appropriate
Gregory ********
Only way to resolve it if they not listening to you—dont phone—put everything in writing—so they cannot dispute at a later stage—hope this helps💪💪💪
Danny *******
ORIGINAL POSTER
@Gregory *******
Thanks, this is one of the few relevant and helpful comments. 🙏👍
Gregory ********
@Danny ******
i was a qualified financial advisor for 35 years in South Africa and k ow how underwriters and claims work—my best advice without getting into specifics is to lodge a complaint with the ombudsman who will intervene and make a decision
Gregory ********
Full disclosure is required at signing time —not at claim stage—Insurance is run as a business—they would all be out of business if they we paying out for non disclosed illnesses or conditions—ask for a copy of the terms and conditions from the company including ALL the exclusions you will be subjected too—BEFORE you sign
Danny *******
ORIGINAL POSTER
@Gregory *******
That's not what I asked?
Gregory ********
@Danny ******
well you not disclosing what the true issues are—so i am playing the guessing game from 35 years experience—anyway sent you the ombudsman’s details in a separate message—submit the complaint online or via email in writing—good luck💪💪
SJ *******
I had a claim paid for $10,000 when i got a kidney stone in Singapore.
Paul ********
Used them for 5 years, needed to claim once for serious illness with hospital stay and they paid out as per contract,
Andy **********
Generally speaking, you could just take out a good accident and critical illness cover, and self insure for everything else, it's not expensive to treat minor illnesses, a bad accident or a critical illness are the two things that could potentially cost you a lot of money, I get messages everyday from AXA and AIA saying polices start from ฿9 a day.
Detlef ***********
@Andy *********
great idea Andy ! Cheers for that !
Mark *********
@Andy *********
do you have any links so I can take a look?
Andy **********
@Mark ********
I use an insurance broker that has an office in Pattaya, I purchased accident and critical illness cover, I think they were two separate policies, at a cost of between ฿6000 and ฿7000 each for a 12 month policy, I don't have any links from the messages I mentioned, because I always just delete them, but if you want the link to the insurance broker I use, I could DM the link to there website in a message, it is run by a British expat, you could e-mail them for a quote, or even better depending on your location, just go to there office for a chat so you know who your dealing with.
Mark *********
@Andy *********
just D/M you thank you
Mark *********
@Andy *********
that’s not a bad idea
Frank ******
If you have resources self insured, most insurance companies here just take in premiums and run happily to bank
Andrew *********
@Frank *****
well said . Ex insurance broker here ... insurance is a rip off . Use your savings or investments if hospital bills are needed.
SJ *******
@Andrew ********
what about a fight home with critical or chronic injuries.

Travel insurance is cheap.
Andrew *********
@SJ ******
it's a gamble always but i would not say it is cheap. If your popping over for a few weeks fine but my comments were for Ex pats .
SJ *******
@Andrew ********
cheap compared to the unlikely but devastating consequence if all goes wrong. Plenty of Farangs going off buildings.
Nigel **************
Wear a Buddhist Amulet
Patrick ********
@Nigel *************
maybe you should
Werner ************
Most Thai based insurance has many loopholes and just take your money premiums

The best is Cigna Global a western insurer, more expensive but legitimate insurance for overseas and pays hospitals directly

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mailto:
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Steven *********
@Werner ***********
it certainly is expensive.. it looks like insurance costs are shooting up so much. The hospitals taking advantage of insurance policy holders will certainly be a driving force.
Werner ************
@Steven ********
it is but it’s legitimate insurance without the loopholes - no sense paying premiums for years with no or undercoverage when you actually need it
Tony **********
@Werner ***********
and remember the AIA is American company AIG traded on the HK exchange. Same AIG that caused the financial crisis in 2008!
Frank ********
@Tony *********
yea, got bailed out by US tax payers. Threw a party and layer sued the government for the oversight rules.
Gregory *******
Waste of time insurance companies
Leon ********
@Gregory ******
that is really not a wise or intelligent approach. You ever needed cancer treatment? Had a heart attack? Had a stroke? I can assure you that if you are not part of a baby to grave system like AUS, NZ, UK etc. where the population is cotton woolled with state provided medical care and schooling , you are doomed without med insurance in most countries.
Gregory *******
@Leon *******
rather die then have treatment thanks
Andrew *********
@Leon *******
Ex insurance broker here ... insurance is a rip off . Use your savings or investments if hospital bills are needed.
Leon ********
@Andrew ********
Andrew i dont agree. Im an Insurance Broker now for 43 years. In the last 22 months i have had 3 MAJOR surgeries that would have set back the average person for a while to come. Living in South Africa with a 3rd world black government it might have had very negative outcomes if i had to be treated in any government hospital etc. For us its imperitave to have private medical care which is FAR more expensive than Thailand. Your approach might be feasible if you have years of saving behind you to back up medical costs. Most people dont. Lets say you self fund and in the 1st month you have a car prang and you need back surgery? Risk is too high and could change your life from financial comfort to one of utter financial misery. You guys are priviledged to still have your SUPER to provide for retirement but of course we dont.
Frank ********
@Leon *******
but most insurance companies will not pay.
Andrew *********
@Leon *******
That is your entitled opinion but if you ask me your of course going to say that if your currently a broker its like asking a used car salesmen if the car is fine . i am just giving my advice as an ex broker . Insurance has and always been a gamble and in my opinion better to use investments or savings to cover costs if in the unlikely event it is needed .
Leon ********
@Andrew ********
well if you state what you do; would you regard household insurance, vehicle insurance, disability insurance, super annuiation etc as a scam ? Like you said ; you are an Ex Broker. Figures.
Andrew *********
@Leon *******
omg you dont stop do you ... have a glass of water Lesley
Tony **********
@Leon *******
cancer coverage maybe covered but any cardiac, liver or kidney issues are many times excluded. Not many males over 50 that are not receiving blood pressure medication. That then can exclude any number of maladies. Insurance here is highly individualized and the actuary is mostly Thais who never do preventative medicine.
Leon ********
@Tony *********
i heard of this before. Which med insurer would you recommend ?
Andrew *********
@Leon *******
none ... Leon Fourie Ex insurance broker here ... insurance is a rip off . Use your savings or investments if hospital bills are needed.
Tony **********
@Leon *******
I don't recommend any. I've chosen to tuck money away every month and have chosen to self insure. The majority of my risk scenarios would be excluded so don't see a need to donate to large corporations.
Paul ********
@Tony *********
I'm the same. I can't get insurance as I have so many joint issues but my internal body is perfect. I just don't do anything crazy when I'm on holiday
Tony **********
@Paul *******
I'm living here. Easy to get travel insurance from home country that will cover you for 1-3 months of holiday. That's not heath insurance though. The key with travel insurance is the medical evacuation coverage to get you back to home country where your normal health insurance will cover you.
Anita ********
@Tony *********
great point. I wonder if three months is the most coverage you can get? What if you live in Thailand six months and the US the other six months?
Tony **********
@Anita *******
depending on your age, you could keep Medicare and fly to Guam if extensive hospitalization is needed. If you privately insure in USA, you might be able to suspend while in Thailand. Sone companies also offer international coverage but if purchased outside of USA, will exclude USA since healthcare in USA it exorbitantly expensive compared to the rest of the world
Andrew *********
@Tony *********
A wise man .
Galenus ******
@Gregory ******
Depends on how much you'll like to save on your account. At least 2 million Baht. Good that you did it 👍
Marion ***********
Galenus ******
Most bad insurance imo.
Peter ****************
@Galenus *****
That's the case with a lot of insurances; many times you hope you do not need them for a long long time indeed 💪🤞
Michael ***********
@Galenus *****
So who is the best in your opinion?
Galenus ******
@Michael **********
I got a quotation from them with almost 100 exclusions. So I signed with WRLIFE. However, at the end it depends on your own health status and age. Maybe get a quotation from WRLIFE and compare.
Peter ****************
@Galenus *****
I am with WRLife for 2,5 year now. Happy I did not need them so far. In the beginning many positive stories, even from acquainted people but lately alas more negative stories with the 'pre-existing' story. Last month I got an update where they exclude a lot in the first FIVE years of paying. I THINK I would go to AIA, Cigna or April, but don't want to switch after 2,5 of paying premium. The only story of Paciffic Cross I heard is, that IF they pay, the premium goes up a lot.
Melissa *********
@Peter ***************
that is the case for almost all insurance companies. I would love to know one who does not do this to customers.
Galenus ******
@Peter ***************
yes, so fingers crossed, we wouldn't need them the first 5 years
Michael ***********
@Galenus *****
Thank you
Peter *******
Usually undisclosed pre-existing condition?
Sue **********
What was the reason they didn‘t want to pay?
Danny *******
ORIGINAL POSTER
@Sue *********
Claiming services are uncovered when they are clearly not. It's like the claims people don't understand medical terms.
Will **********
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Danny *******
ORIGINAL POSTER
@Will *********
Sorry I don't read Thai and there is very little English.
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