Cozumel chamber and DAN

[zinmaker]

Hello,
Just curious about an article I read. DAN insurance (American) not being accepted, in Cozumel, does this apply to both of the chambers or just one? Thanks

http://www.sssnetwork.com/

 

[Christi]

Hello,
Just curious about an article I read. DAN insurance (American) not being accepted, in Cozumel, does this apply to both of the chambers or just one? Thanks

http://www.sssnetwork.com/

This topic has come up several times in the last few months. This just applies to the chamber on Calle 5. Dr. Piccolo at the Clinica San Miguel on Calle 6 Nte. between Av. 5 and Av. 10 accepts DAN. In fact I just spoke to them about this last week.

 

[Gdog]

wow...very disturbing...wonder where this is heading...??!

 

[HammerNoMore]

It's not disturbing at all. It's one guy spamming the world because he want's to overcharge for services. I've been on this mailing list from the get go and I'm not even sure how, but the deal is that he's charging 3-4 times normal rates for services and is getting upset becaus an insurance company will only pay "reasonable and customary expenses".

DAN has responded to this trash in the past. Rest assured that you will be covered by DAN as per your policy (please read your policy). I.E. The looser in the debate between what is reasonable or not will not be you as long as you would be covered normally.

This spammer is causing a lot of fuss over the fact that he wants to charge more than any other chamber and it is at the discredit of a Major diving benifactor....don't buy into the spam...

 

[DandyDon]

So do we need a new forum just for "Is DAN any good" threads...?

 

[HammerNoMore]

So do we need a new forum just for "Is DAN any good" threads...?

Do you even need to ask?

 

[Christi]

It's not disturbing at all. It's one guy spamming the world because he want's to overcharge for services. I've been on this mailing list from the get go and I'm not even sure how, but the deal is that he's charging 3-4 times normal rates for services and is getting upset becaus an insurance company will only pay "reasonable and customary expenses".

DAN has responded to this trash in the past. Rest assured that you will be covered by DAN as per your policy (please read your policy). I.E. The looser in the debate between what is reasonable or not will not be you as long as you would be covered normally.

This spammer is causing a lot of fuss over the fact that he wants to charge more than any other chamber and it is at the discredit of a Major diving benifactor....don't buy into the spam...

Actually James, it is not just one Dr. and it is not because he or anyone else is charging 3 to 4 times more. They have lowered their fees once to appease DAN.

Chambers in ALL of these locations (not ALL chambers in these locations) have followed suit...and many others are on the verge of following...and these are not all owned by the same Dr.

Bahamas
Baja California
Belize
Cancun
Cozumel
Galapagos
Phuket, Thailand
Playa del Carmen
Samui, Thailand
Yucatan, Mexico

For example, Dr. Piccolo had a case recently where a DAN Dr. "supervised" treatment...authorized treatment, and they are STILL having difficulties getting DAN to cover the claim.

DAN basically wants these Dr.'s to provide the services and facilities for next to nothing.

My opinion of DAN has waivered back and forth over the past couple of years...with good arguments on both sides...but I think they have taken this too far and they are going to need to be reasonable or they are going to find themselves with nothing.

Why is it that the other diving insurance providers (ie: PADI and Dive Assure) are not having the same problems with these same facilities?

 

[HammerNoMore]

Actually James, it is not just one Dr. and it is not because he or anyone else is charging 3 to 4 times more. They have lowered their fees once to appease DAN.

This is after the last time Mr. Moreno sent out his spam mail. It was full of lies the first time and I have no reason to believe the second spam any more. The first time he claimed a buch of chambers were not accepting it and it was actually just his 2. He's spammed me 3 times and I believe his spam just about as much as I do all of the spams with pills making wild promices.

I've emailed the tourism boards of each of the countries he has listed letting them know that his spam is likely hurting their tourism.

DAN Responds to Press Release SSS USA Corporate Offices to Accept DAN Insurance in Nine Chambers
See "SSS USA CORPORATE OFFICE WILL ACCEPT DAN INSURANCE" below.
Note: If you have questions regarding the availability of any chambers in the SSS network, please contact insuranceqt@sssnetwork.com.
This is the SSS USA corporate offices, which, as indicated below have nine chambers that DO support DAN insurance.
If you have questions on the availability of any other chambers, please contact the DAN Medical department at medic@DiversAlertNetwork.org.
The DAN Diver Accident Insurance Program has provided coverage for hundreds of thousands of divers and their families, and DAN America’s insurers have paid out more than $20 million dollars in claims to members and treatment facilities around the globe.
During this time, DAN has collected and exhaustively studied a wealth of information on treatment charges. From this, DAN has identified “reasonable and customary” charges for treatment of decompression illness. This information is an important component to any insurance program to assure treatment of injuries at a fair price. This benefits both the insurer and the insured.
Unfortunately there is currently a dispute between DAN and Mr. Mauricio Moreno, the owner of a few chambers in our region. Specifically the dispute involves what constitutes reasonable and customary charges for hyperbaric chamber treatment. It is DAN's view that reasonable and customary means the usual charges of similar chambers. It is the view of Mr. Moreno that reasonable and customary means what the chamber charges, even if the charges are significantly higher than charges of other similar chambers. One major international insurance company previously withdrew coverage altogether due to these high charges. Having been sued by Mr. Moreno, DAN is now forced to address this situation legally.
There is no dispute, however, that DAN's insurers have agreed to pay Mr. Moreno's chambers at what they consider reasonable and customary rates. Therefore, if Mr. Moreno requires divers to pay in full for services when rendered, even for the portion of charges in excess of what is reasonable and customary, Mr. Moreno is needlessly overreaching and inconveniencing divers.
Despite these issues, DAN is committed to providing coverage to our members regardless of where they live and dive. Therefore, we have attempted to negotiate with Mr. Moreno over several years, including DAN’s attempt to identify costs unique to his chambers, but without success. The good news is that the vast majority of chamber operators in the USA and around the world provide excellent treatments and services at fair rates.
Despite this dispute, DAN will continue to take care of divers in need. DAN encourages members to ALWAYS contact DAN directly if there is any question about treatment issues or payment of services. DAN, as we always have, will address such inquiries immediately, 24/7/365. No DAN member who purchases dive accident insurance through DAN should be at risk of not being covered.
On Jan. 11, DAN received the following announcement from the SSS USA Corporate Offices:
SSS USA CORPORATE OFFICE WILL ACCEPT DAN INSURANCE
DATE: January 10, 2006
TO: SSS Recompression Chamber Network Affiliates & General Public
FROM: Quantum Processing Services Co, Ltd. SSS USA Corporate Office.
RE: DIVER ALERT NETWORK DIVE INSURANCE
We would like to inform all that the facilities as listed below will continue to accept Divers Alert Network (DAN) America Insurance. Our facilities are open and ready to treat any dive medical illness. These facilities are under new ownership; however, we are still dedicated to provide the best service possible. For any inquiries, please contact insuranceqt@sssnetwork.com.
Buceo Medico Mexicano
COZUMEL
Cozumel, Q. Roo, Mexico
Ph: 52.987.872.1430
Fax: 52.987.872.1848
PLAYA DEL CARMEN
Playa Del Carmen
Q. Roo, Mexico
Ph: 52.984.873.1365
Fax: 52.984.873.1755
Protesub, S.A.
GALAPAGOS
Galapagos, Ecuador
Ph/Fax: 593.52.526.911
Subaquatic Services of Belize, Ltd.
Ambergris Caye, Belize
Ph: 501.226.2851
Fax: 501-226.2852
Hyperbaric Services of Thailand, Ltd.
PHUKET
Phuket, Thailand
Ph: 66.76.342.518
Fax: 66.76.345.051
KOH SAMUI
Koh Samui, Thailand
Ph: 66.77.427.427
Fax: 66.77.427.377
KRABI
Krabi, Thailand
Ph: 66.75.695.275
KOH TAO
Koh, Tao, Thailand
Ph/Fax: 66.77.456.572
KHAO LAK
Khaolak, Thailand
Ph: 66.76.423.812
Fax: 66.76.423.813

And another:

On Tuesday, Jan. 31, DAN issued the following statement, addressing concerns among members about insurance coverage:

"DAN strongly emphasizes that we support our members. In the unlikely event of a diving injury, be assured that if any DAN member were to be referred to a chamber, their DAN diving accident insurance and membership will apply.

"If the chamber is one of the nine (9) facilities referred to in the press release from SSS Corporate Headquarters, SSS has stated, categorically, they DO accept the DAN diving accident insurance.

"If a DAN member were to be referred to one of the three (3) facilities that have stated they do not support DAN and will not accept insurance purchased with DAN membership (the SSS chambers in Nassau, Cabo San Lucas or Cancun), DAN will nevertheless work to assure that the DAN members are covered.

"Although DAN maintains that the charges at these three facilities are in excess of reasonable and customary charges, divers should not be caught in the middle of this dispute.

"To ensure that the divers are not caught in the middle, effective immediately, DAN's insurer will coordinate with the SSS chambers in Nassau, Cabo San Lucas or Cancun to cover all treatment charges.

"When the injured DAN Member or their representative contacts DAN using the 24-Hour Diving Emergency Hotline, DAN will liaise with the chamber to arrange immediate payment. DAN will continue to do so until there has been a resolution to this dispute. Rest assured, DAN continues to seek an amicable resolution."

If you'd like more information (for example, to see the names of the nine pro-DAN SSS facilities see the announcement entitled "DAN Responds to SSS Press Release," in the News & Events section of the website or go to http://www.diversalertnetwork.org/news/article.asp?newsid=709.

If you have questions about chamber availability, please call DAN Headquarters at 1-800-446-2671 and speak to a DAN medic; or email DAN at medic@DiversAlertNetwork.org.

[/EMAIL]Why is it that the other diving insurance providers (ie: PADI and Dive Assure) are not having the same problems with these same facilities?

Because compaired to DAN their number are small and Mr Moreno wants to target this big dog first...

 

[Christi]

Actually James, it is not just one Dr. and it is not because he or anyone else is charging 3 to 4 times more. They have lowered their fees once to appease DAN.

This is after the last time Mr. Moreno sent out his spam mail. It was full of lies the first time and I have no reason to believe the second spam any more. The first time he claimed a buch of chambers were not accepting it and it was actually just his 2. He's spammed me 3 times and I believe his spam just about as much as I do all of the spams with pills making wild promices.

I've emailed the tourism boards of each of the countries he has listed letting them know that his spam is likely hurting their tourism.

James,

Dive Assure and PADI for example, are paying claims with no problems.

Remember my friend Chuck's problem last year? DAN was refusing treatment until Chuck told DAN they would be hearing from his attorney. There was another case just like this shared on the D2D board not too long ago.

A very recent case (within last two weeks) actually had a DAN Dr. IN Cozumel monitoring and "supervising" treatment for a patient, yet DAN is still fighting full coverage of the treatment...and theis is NOT with Dr. Moreno's facility.

The other chambers listed as not accepting DAN as of March 9 are NOT all Dr. Moreno's facilities.

Although the other two Cozumel chambers have not stopped accepting DAN yet, they are not far behind the SSI chamber.

DAN is basically expecting these Dr.'s to provide their services and facilities for next to nothing. The Dr'.s have already made concessions, but DAN has not made any...and I think it's time for them to meet the Dr.'s somewhere in the middle.

Yes, DAN will still cover the claims once you've paid for them out of pocket...but how many people really have an extra $15 to $20K lying around while they wait for DAN to reimburse them?

However, also remember that if you have primary insurance converage, check your policy. You may be covered and then whatever diving insurance you have actually picks up the balance as a secondary.

No need for mass hysteria over this...but I DO thnk that DAN needs to start playing more fairly.

This is definitley not a good situation and not good for tourism in the effected areas...I agree.

But agian, remember in Cozumel, there are other options...Dr. Piccolo for example!

 

[scubapro50]

DAN is like any other insurance company ... they try to get by with paying the lowest possible for any treatment. Take State Farm insurance ..... there has been quite a few lawsuits due to RITA because State Farm is paying claims based on the "normal" rate charged for the repair to a home not what it is costing to really get the repair done in this area.