DAN vs. Dive Assure for dive and travel insurance?

[jonhall]

DAN did not act as my advocate. I had a DCS incident in Cozumel, several years ago. My doctor (Dr Piccolo) recommended an 8th chamber treatment. His wife, Heidi (who does his administrative work) told me that DAN wouldn't pay for it because they have a strict limit on the number of chamber treatments, regardless of medical necessity. Sure enough, DAN denied my claim for the last treatment.

I haven't had to experience any diving insurance claims myself, but as you described your process, is it possible you were given incomplete or incorrect information? My policy (2019) states that eligible charges include charges for up to 7 chamber treatments. If more than 7 are recommended by the treating physician, YOU MUST contact DAN for pre-certification. It seems the door is open for further treatments being covered if they are pre-certified.

 

[jonhall]

Dan picked up $11,000 after our primary paid $44,000

Meant to attach this to my previous post. Just so people, like me, have an understanding of how the insurance works (if it's not to personal):

1. Did you have to pay for any of the treatments up front before being admitted to the hospital?

2. When did you have to pay the $11,000 - were you held hostage in Coz until you paid or were you billed when you got back home?

3. Did you pay for the extra treatments out of your own pocket and then send in a claim to DAN to get reimbursed?

 

[krbailey]

I haven't had to experience any diving insurance claims myself, but as you described your process, is it possible you were given incomplete or incorrect information? My policy (2019) states that eligible charges include charges for up to 7 chamber treatments. If more than 7 are recommended by the treating physician, YOU MUST contact DAN for pre-certification. It seems the door is open for further treatments being covered if they are pre-certified.

They warned me before calling DAN. Dr and Mrs Piccolo are very familiar with DAN since they are one of the main (if not the top) dive medical professionals on Cozumel. They said this was typical of DAN denying coverage for the treatment, regardless of a doctor's recommendation.

 

[Hoyden]

They warned me before calling DAN. Dr and Mrs Piccolo are very familiar with DAN since they are one of the main (if not the top) dive medical professionals on Cozumel. They said this was typical of DAN denying coverage for the treatment, regardless of a doctor's recommendation.

There is a history a problematic relations between DAN and some Mexico chamber operators.

 

[jonhall]

Thanks for the reply @krbailey

Since I'm probably like many - unsure of the fine and not so fine print - when it comes to different insurances, hope you don't mind if I ask a few more questions of you or anyone with the same experience of chamber treatments beyond the covered number. It's when I explore, after reading/hearing stories, that I actually find out a lot about what I, myself, actually have and best practices (never thought I'd use that term again after retiring from teaching) that can be used if in a particular situation. Also like many, I doubt I'll ever use the insurance, but I'm booked for Coz later in the year and you never know, so best to be prepared.

1. To clarify, you didn't actually call DAN before the 8th treatment (based on what you were told by the Dr./wife?)

2. Did you or the hospital staff contact DAN before the first 7 chamber treatments?

3. Rephrasing a question I asked of a different poster: When did you have to pay for the extra treatment - were you held hostage in Coz until you paid or were you billed when you got back home?

4. For any dive related treatment, but especially a more costly one such as a chamber ride, does one, like me - limited medical insurance (a little from Medicare and a little from a travel insurance plan) with dive insurance - have to put down a large sum of money on the spot before getting treated or is it all billed?

5. Does one need to verify that the covered treatments will actually be covered before getting the first treatment or does one just send claim forms in?

Dan would not approve over 7 unless I went to see Dr Gomez.

6. After seeing Dr. Gomez, who verified you needed the extra treatment, did you make the call to DAN or did Dr. Gomez make the call on your behalf, to make sure DAN would cover the treatment?

Thanks for any replies.

 

[krbailey]

Thanks for the reply @krbailey

Since I'm probably like many - unsure of the fine and not so fine print - when it comes to different insurances, hope you don't mind if I ask a few more questions of you or anyone with the same experience of chamber treatments beyond the covered number. It's when I explore, after reading/hearing stories, that I actually find out a lot about what I, myself, actually have and best practices (never thought I'd use that term again after retiring from teaching) that can be used if in a particular situation. Also like many, I doubt I'll ever use the insurance, but I'm booked for Coz later in the year and you never know, so best to be prepared.

1. To clarify, you didn't actually call DAN before the 8th treatment (based on what you were told by the Dr./wife?)

2. Did you or the hospital staff contact DAN before the first 7 chamber treatments?

3. Rephrasing a question I asked of a different poster: When did you have to pay for the extra treatment - were you held hostage in Coz until you paid or were you billed when you got back home?

4. For any dive related treatment, but especially a more costly one such as a chamber ride, does one, like me - limited medical insurance (a little from Medicare and a little from a travel insurance plan) with dive insurance - have to put down a large sum of money on the spot before getting treated or is it all billed?

5. Does one need to verify that the covered treatments will actually be covered before getting the first treatment or does one just send claim forms in?



6. After seeing Dr. Gomez, who verified you needed the extra treatment, did you make the call to DAN or did Dr. Gomez make the call on your behalf, to make sure DAN would cover the treatment?

Thanks for any replies.

1. The hospital staff contacted DAN before the 8th treatment. Ms Piccolo has dealt with this issue with them before. She knew that I would be denied but hoped they would change their decision after an appeal (They did not).

2. The staff contacted them immediately upon my arrival at the hospital. It's my understanding that this is their standard procedure.

3. I was able to leave before payment. I had Allianz as my secondary provider and it took over a year of fighting with them to get them to pay my claim for the last treatment. I'm not sure if my case was handled any differently because of this or some other reason or if it is standard procedure.

4. I can't answer this based on my experience. That was never expressed as a concern by the hospital staff. I have heard anecdotal accounts where the bill must be settled prior to leaving.

5. I wouldn't think they would hold up treatment while waiting for an approval. Especially in a life-threatening situation where a chamber treatment is necessary.

6. I only dealt with Dr Piccolo and his wife (who handles all of the paperwork, insurance etc). I don't remember if I initially spoke to DAN - I was pretty out of it for the first day or so. I do know that the staff was in constant contact with DAN.

I must say that the treatment I received was better than any hospital I've been to in the States.

 

[jbjclj]

Dr Gomez contacted DAN. The only thing I paid for upfront was $800 for an MRI. We have Medicare part F ( I don't know if that is still an available option) that covers injuries out of the country. Our primary covered most and DAN paid the rest. Very satisfied with the outcome. Excellent care at the International Hospital. When we returned 6 months later, Dr Garcia evaluated me and certified me to dive. I have a different schedule, every other day, Nitrox, stay above 80 feet.

 

[tursiops]

I have a different schedule, every other day, Nitrox, stay above 80 feet.

Restrictions like that are disallowed on the RSTC medical statement. Sure, it might be a good idea, but if it were on the RSTC form, you would not be allow to dive in a class requiring a medical release, nor on a liveaboard requiring one, etc.

 

[jbjclj]

I am not quite sure what you are saying. The doctor issued a release for the dive shop and sent to the appropriate agency. The changes I made were just precautions for safer diving

 

[tursiops]

I am not quite sure what you are saying. The doctor issued a release for the dive shop and sent to the appropriate agency. The changes I made were just precautions for safer diving

Did the release have those restrictions written on it? Your post implied it did.