DCS Treatment and Obama-Care

[Akimbo]

I’m not a proponent of government involvement in much of anything, including health care. However, we are stuck with this now so do any of these new mandates include coverage for DCS treatment? Also, are there any mandates for coverage outside of the US?

Correct me if I am wrong, but isn’t hyperbaric treatment for DCS the “standard of care”?

[Edit] I doubt that DCS is specifically addressed, but perhaps it falls under provisions that make it hard to prohibit coverage uncommon maladies???

 

[Hatul]

Not sure about hyperbaric treatment, but I know the plans cover your perinatal care.

 

[Akimbo]

I wish a condom or a pill would prevent DCS! I'd even pay for a vaccine.

 

[Duke Dive Medicine]

I can't imagine that the ACA will change the standard of care for any disease. It will effect Medicare reimbursement as CMS rolls out some more quality assurance measures by which to gauge a hospital's performance.

 

[Akimbo]

So does that mean that DCS treatment will be covered by “compliant” policies?

 

[Duke Dive Medicine]

I wouldn't see why not but I don't speak for the insurance companies. For hyperbaric treatment, Medicare for the most part follows the UHMS-approved indications ( Indications for Hyperbaric Oxygen Therapy - Undersea and Hyperbaric Medical Society ) when reimbursing, e.g. Medicare reimburses for soft tissue radiation injury but not for treatment of autism or TBI. Most insurance companies follow suit. Some are easier to work with than others, and some get weird about indications they dispute. Since treatment for DCI is considered an emergent treatment, the insurance companies are typically very fair in my experience. I can't imagine them refusing to reimburse for something that, like you said, is standard of care.

 

[Aguablanco1]

Do most policies cover us while we are out of the country? That should be the real question since that is where most DCS incidents would probably occur.
RichH

 

[Altamira]

From the SSA.gov website outlining Medicare medical coverage overseas:
Medicare generally does not cover health care while you are outside the United States. Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands are considered part of the United States.
In rare cases, however, Medicare may pay for inpatient hospital services provided in Canada or Mexico if:

• You live in the United States and a foreign hospital is closer or easier to get to from your home than the nearest United States hospital that can provide the care you need; or
  
• You are in the United States when you have a medical emergency and a foreign hospital is closer or easier to get to than the nearest United States hospital that can treat your emergency; or
  
• You are crossing through Canada without delay between Alaska and another state and have a medical emergency and a Canadian hospital is closer or easier to get to than the nearest United States hospital that can treat your emergency.

Some Medicare Advantage and Medigap plans provide worldwide or emergency coverage when you travel outside the United States. You should check with your plan before traveling outside of the country.

 

[Aguablanco1]

Not all insurance offered under the ACA is Medicare or Medicaid. I was specifically addressing private insurance.
RichH

 

[DocVikingo]

Do most policies cover us while we are out of the country? That should be the real question since that is where most DCS incidents would probably occur.

Not all insurance offered under the ACA is Medicare or Medicaid. I was specifically addressing private insurance.

Hi Aguablanco1,

That depends on the specified coverage of the private health insurance policy in question. However, the larger insurers (e.g., Aetna, Cigna) do tend to cover medical services obtained in foreign countries provided that they are for bona fide emergencies, and treatment for DCI should be considered emergent. But be aware that these insurers require that you pay up front for all services received and submit the records & receipts required for reimbursement to the company afterwards. So, you’d want to make sure that your credit card(s) has a limit adequate to cover many 10s of 1,000s of dollars’ worth of services. And if you need air evacuation from a remote location, basically we’re talking an AMEX card with no preset limits held by a very highly credit-worthy individual. No many of us reach this level.

Given the above considerations, no matter what coverage your medical policy provides, IMHO a DAN plan, especially their Preferred Plan, is well, well worth the peace of mind & benefits it provides, such as worldwide medical dive & non-dive accident coverage (including evacuation to another treatment venue, if medically necessary) and trip cancellation & interruption benefits. Additionaly, DAN will monitor your status & treatment. And, with the required membership you support a very worthy organization & get a subscription to the new & quite slick Alert Diver magazine.

Regards,

DocVikingo