DAN gets attacked by commercial spammer

[SDAnderson]

Interstingly enough, when you search the DAN website, you'll find this note that the Cozumel chamber has been the recipient of some matching grant money from DAN to help upgrade the facility.

It kind of sounds like DAN isn't willing to pay the rates that Moreno is looking for without a satisfactory explanation about why they are higher than normal and Moreno isn't willing to accept less money. It's an awful thing but I don't have a problem imagining a medical provider trying to put the screws to an insurance company - nor do I have a problem imagining an insurance company trying to diddle a medical provider out of a few pesos.

Too bad it's the divers that get stuck in the middle of this dog fight.

 

[detroit diver]

I don't want to have to wait to be medivac'd to another chamber. If I'm in trouble, time is of the essence and I want to be treated immediately if the service is available. Either DAN is going to have to figure something out with the SSS group, or people diving in those places posted below are up the creek if they have DAN insurance. The out of pocket expenses, whether reasonable or not, can be a boatload of money.

I'm going back to the Bahamas in a couple of weeks and just bought DiveAssure, which is accepted by SSS. I'm looking into cancelling my DAN insurance that I just purchased late last month.

Got the same e-mail from MedicalHyperbarics.com <cdammert@medicalhyperbarics.com>

Supposedly Subaquatic Safety Services operates chambers in Cozumel, Mexico, *Playa Del Carmen, Mexico, Cabo San Lucas, Mexico, Ambergris Caye, Belize, *Nassau, Bahamas, Florida Keys & Phuket, Thailand?

Spoke to a DAN rep today after reading their press release response on DAN's website. I was told that if you need a chamber that DAN will work with the chamber operator or Medivac the patient to a chamber that will work with DAN insurance without any out of pocket expenses. For the cost of Medivacing a patient I think they would rather pay the chamber fees even if they are a higher price then what is reasonable & customary. A bent diver should get the quickest medical care available.

Just a quick follow-up from a dive operation in the Galapago's

"For all our divers, we are asking for a voluntary contribution of $35, as we are very fortunate to have a new Hyperbaric Chamber installated in Galapagos operated by SSS (Subaquatic Safety Services) that provides top quality medical assistance with their Recompression Chamber Network around the globe and will contribute to the proper maintenance and operation of this recompression center."

How much support do you think the diving community will now give to a private company for the chamber in the Galapagos Islands?

 

[Doc Intrepid]

FWIW, I also don't find enough details available to make any educated assumptions regarding which side is more at fault.

There may plausibly be some reason why Moreno's costs are higher than average.

In the absence of any analysis, my vote is to avoid apportioning blame until more facts are known.

 

[detroit diver]

I really don't care who's to blame. It's not really relevant. I care whether the insurance that I've paid for will cover me if I get into trouble.

I'm sure there's a lot of background info that both sides aren't revealing.

 

[ScottZeagle]

I don't know if you guys have seen this or not - if so, my apologies...

http://www.diversalertnetwork.org/n....asp?newsid=709

News & Events
DAN Responds to Press Release

The DAN Diver Accident Insurance Program has provided coverage for hundreds of thousands of divers and their families, and DAN America&#8217;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 &#8220;reasonable and customary&#8221; 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&#8217;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.

 

[BigJetDriver]

Okay folks, before everyone gets all charged up over this, I will tell you that I spoke directly to Mr. Dan Orr, President and CEO of Divers Alert Network this morning.
--------------------------------------------------------------------

NOTE: I just spoke to Dan Orr, President and CEO of DAN, personally. (10Jan06-0810CST) The following is a condensed version of our conversation posted with his permission.

(1) The dispute is with the owner/operator of several (not a dozen) chambers concerning the charging of fees that are in excess of normal for services.

(2) DAN has never NOT paid a member's legitimate claim.

(2) DAN will never allow a member to remain "out-of-pocket" for charges due to a legitimate claim.

(3) DAN will issue a press release addressing this entire issue specifically later today. Mr. Orr assured me I will receive it immediately, and I will post it on this Board as soon as I receive it.
---------------------------------------------

Okay, as promised, here is the text of the DAN statement:

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.
-------------------------------------------------------------------------

In a further message to me, reprinted by permission, Mr. Orr had this to say:

Hi Rob!

Thanks for the help. I have received further information regarding this
issue. We have received information that many of the SSS facilities are
going to be issuing a press release that they are not involved in this
and do, in deed, honor DAN insurance. As soon as we get confirmation of
this, it will be posted on our website.

Dan Orr
--------------------------------

Just as a note, and in the interest of full-disclosure, I am a DAN professional member, and also have DAN insurance. I have never heard any serious professional criticism of DAN, and plan to remain a member.

Rob

 

[Wayward Son]

Any comments?

Yeah. You missed the lengthy discussion of this earlier today. Look down a few threads.

 

[DiverG]

Yeah. You missed the lengthy discussion of this earlier today. Look down a few threads.

Well I did do a quick search for DAN, but I only scanned the titles and didn't see anything that resembled a discussion on this topic. My Bad.

edited to add: No wonder why I didn't find this discussion before posting my thread which looks like it's been merged into this thread talking about spammers.

 

[ItsBruce]

Here is my take: First, my qualifications: I have been an attorney representing insurance companies for over 20 years. Until my recent semi-retirement, I was one of the ones many of big insurance companies would go to when they had questions about what was or wasn't covered under their policies or when they were sued over their claims handling. Second: my observations: Insurance companies are largely interchangable. With only minor exceptions (and you know who you are), claims represntatives are equally qualified, dedicated, interested, motivated, etc. With only minor exceptions (and you know who you are), corporate philosophies and cultures are the same. With only minor exceptions (ditto), claims are handled equally well/poorly. With only minor exceptions (ditto), carriers only pay "usual and customary" charges. With only minor exceptions (ditto), what one carrier considers "usual and customary" charges is what other carriers consider "usual and cuatomary." Third, my conclusion: If DAN is having issues with charges by a particular chamber operator, all insurance carriers are probably having issues with that operator. However, the smaller carriers do not present as good a target as DAN.

Therefore, I remain comfortable with my DAN insurance.

And, I'd like to hear from someone with other insurance who has had to use one of the chambers that is the subject of the dispute.

 

[Tom Smedley]

The same article was included in today's DiveNewsWire.