Diving Insurance/Local Emergency Question

[scubadobadoo]

"If you have a dive related injury within a 50 mile radius from your home your evac to a hospital or a chamber WILL NOT be covered in any way shape or form." Period. That's a direct quote from the insurance company that handles DAN's policies. Ofcourse this is assuming this person understood my question and was capable of answering it.

Basically, if most of your diving takes place within 50 miles of your home you should consider DAN insurance almost useless if you have to ride in an ambulance or go by air to any hospital or chamber. Once you get to the hospital or chamber DAN has you covered. Your primary coverage (work insurance for example) may protect you during the evac, but in most cases won't cover dive related injuries as mentioned above.

Now, wether or not DAN will cover your broken leg (happened on a dive boat) bills once you get to the hospital depends on what level of coverage you purchase from DAN and that's another topic. However, if the Captain of the boat decides you need evac by air or other methods and the boat is 51 or more miles away from your home then your evac due to your broken leg will be covered regardless of where they take you. Once you are more than 50 miles away from home then what is called Travel Assist comes into play.

Any TRAVEL ASSISTANCE that you may require due to a diving accident may be covered by "Travel Assist" if you are more than 50 miles away from home. Again, Travel Assist comes into play wether you are in Cozumel or on the Channel Islands, assuming the Channel Islands are more than 50 miles away from your home. I was very confused about this whole Travel Assist thing as well. Travel Assist may take MANY FORMS from an evacuation to another plane ticket to get home after treatment in a chamber regardless of wether you are in Hong Kong or a Channel Island that is MORE than 50 miles away from your home. It's all "TRAVEL ASSISTANCE." Make sense?

Again, Travel Assist does nothing for you if you are less than 50 miles away from your home at the time of the accident. This is a huge problem for local divers and diving professionals working close to home. My guess is that this unclear policy has many divers thinking they will be covered for an evacuation when they WON'T be. Sad.

I had Padi's insurance last year and don't recall this same exclusion. Padi's also doesn't require one to be a member to get insurance through them if I recall correctly.

Sorry if my post makes me seem like a know it all. Not my intention, it's just that this exclusion just doesn't make sense to me at all coming from such a good organization like DAN. I guess having a dive accident is a numbers game and if one dives locally then one may be diving MORE than the average "vacation" diver and that equals a higher chance of the insurance company having to pay out and that equals a 50 mile radius exclusion on evacuations. Too bad really.

So, if you live in OC and go dive Point Dume (I believe that's more than 50 miles in most cases) then your evacuation will be covered. Do you think I could stage a fake "dive accident" and convince DAN to evacuate me to Bonaire? Only if the dive accident takes place more than....yeah yeah yeah!

"Longest Post Ever!"--Comic Book Guy

 

[pasley]

.... In one place, I see transportation to nearest acceptable facility, and in another, an exclusion on evacuation close to home.

Frankly, I do not see any contradiction.

The problem is there are TWO different policies: DAN's Dive Accident Insurance which is provided by United States Life Insurance Co, and Travel Assist which is provided by Medaire and are two very different things. Travel Assist does not kick in until you are over 50 miles from home. DAN Dive Accident Insurance covers you anyplace you are diving. A ride from the site of dive injury to the hospital is not evacuation and is covered (see below for the black and white on it.)

Evacuation occurs after the emergency is over and the medical situation is stabilized and would involve transportation from the hospital to the home. If that is less than 50 miles then it would not be covered.

I have scaned in and present below a quote from the DAN Membership Handbook. It is very clear that the amublance or air amublance is covered to get you from accident to hospital if medically necessary.

"If you have a dive related injury within a 50 mile radius from your home your evac to a hospital or a chamber WILL NOT be covered in any way shape or form." Period. That's a direct quote from the insurance company that handles DAN's policies.

Basically, if most of your diving takes place within 50 miles of your home you should consider DAN insurance almost useless if you have to ride in an ambulance or go by air to any hospital or chamber. ...

Not to contradict, but I will wager the quote scubadobadoo references comes from the Travel Assist insurance provider and does not apply to DAN's Dive Accident Insurance. See the DAN Member Handbook Page 25-26 item #3 under Covered Items (emphasis added) which reads (and I quote, actually I scanned it in):

DIVING ACCIDENT MEDICAL INSURANCE
Preferred, Master and Standard Covered Medical Charges
United States Life will pay the benefits described below, subject to the terms and limitations. Covered charges means eligible charges that are for Medically Necessary services, supplies, care or treatment for a Covered Diving Accident. The accident must occur while Insurance is in force. The expenses incurred as a result of the accident must be incurred within 36S days of the accident.
Such services, supplies, care or treatment must be prescribed, performed or ordered by a Physician. Charges for such services, supplies, care or treatment must be Reasonable and Customary. United States Life will not pay for charges in excess of the maximum shown in the Schedule for the plan of insurance selected.

Eligible charges include:
1. Reasonable and Customary Hyperbaric Chamber Treatment Charges for up to seven treatments per Covered Diving Accident.
Any treatment after the seventh must be precertified by National Baromedical Services Inc. at 1-800-292-8381 or+1-803-434-7101;
2. Reasonable and customary Physician's charges for Hyperbaric Chamber Treatment, medical care and surgical operations;
3. Ambulance charges for transportation by a professional ground, air or marine ambulance service to the nearest Hospital or Hyperbaric Chamber where appropriate care or treatment can be given. Eligible charges do not include charges covered under the DAN TravelAsist benefit through MedAire,lnc.
All transportation involving air or marine ambulance service must be arranged in advance by DAN...
______________________________________________
Someone on the phone may say one thing, but this is in their book and very clear. You also have to be sure you have called the right company "handling DANS insurance" as there are two. DAN's travel assist would not cover the ambulance as the basic Dive Accident Policy does this and travel assist (a different policy from a seperate company) does not come into effect until after you are more than 50 miles from home.

I hope that helps clarify the issue.

 

[scubadobadoo]

"Ofcourse this is assuming this person understood my question and was capable of answering it.

I believe, according to what Melvin has pointed out in the Handbook, that he is correct. I still wouldn't call it "very clear." Heck, even Dan couldn't explain it. I certainly hope you are right Melvin. Makes me feel better anyway about having DAN insurance.

 

[Robert Phillips]

And don't forget that your primary insurance may also cover any ambulance rides.

 

[Scottkl]

Ok well I saw many answers as to DAN as for the 911 system which I happen to work for. I cover from Ventura county line down to Orange county. You normaly would be air lifted by coast gaurd to the Chamber in catalina. If you are stable enough for the trip. Other wise they would Air lift you to the clostes hospital to get stable and then send you in a unit to the closest chamber. There are many privately owned and a few hospital owned chambers but the only true Dive related chamber is on Catalina. Most of the others are mainly used for wound care and are set up diffrently. If you have any other questions in reguards to this please feel free to PM me or ask here.

Scott

 

[jeffinhburg]

At this point, I don't really care what the handbook says. I hope that didn't sound rude, and am sorry if it did, but to but to put it in context, I remember being in the hospital and having to fight my health insurance company over whether one of the chemo components was an uncovered "medication" or a covered "treatment." I am very schooled in the medical and legal aspects of this type of problem, but it was the last thing I wanted to do while hungry, fatigued, hurting from surgeries, and attached to an IV pole for nearly a week at a time.

Whether it is covered or not according to the handbook - and I think it should be, the fact is that the people running the show either don't know that it's covered or half-heartedly deny that it is (speaking now of the accident evacs 50 miles or less from home). I received a less definitively negative answer than the previous poster but also a less-than-assuredly-postive answer when I called, too. I felt like I received a different and conflicting answer from each person I spoke with. The lack of a straight negative answer probably had something to do with my quoting word for word from the booklet the same portions you referenced. To me, that means they are likely to deny coverage to that extent (even if only out of ignorance, and not any bad intent), and I'll be darned if I'm going to be sick (or in this hypo, injured) in the hospital worrying about that type of thing again. Been there, done that.

My own interpretation is that the basic coverage that comes with DAN membership does not cover it, even for DCS, but that the other policies should. If they don't know that, however, I don't want to be put in the position of having to fight over it if the fight is avoidable by obtaining insurance through a company that tells me straight-up when I ask them that they cover it.

In addition to having to appeal lots of denials from my previous health insurers (amazing how my $1000 deductible became $25,000 until I appealed), I work with a lot of workers' comp insurers in my job, and one thing I know about insurance company employees is that if they don't know for certain that something is covered and must be paid, they deny it first and sort it out later if the injured person or that person's lawyer or health care provider cares enough to resubmit the bill several times and fight the point.

Frankly, I do not see any contradiction.

The problem is there are TWO different policies: DAN's Dive Accident Insurance which is provided by United States Life Insurance Co, and Travel Assist which is provided by Medaire and are two very different things. Travel Assist does not kick in until you are over 50 miles from home. DAN Dive Accident Insurance covers you anyplace you are diving. A ride from the site of dive injury to the hospital is not evacuation and is covered (see below for the black and white on it.)

Evacuation occurs after the emergency is over and the medical situation is stabilized and would involve transportation from the hospital to the home. If that is less than 50 miles then it would not be covered.

I have scaned in and present below a quote from the DAN Membership Handbook. It is very clear that the amublance or air amublance is covered to get you from accident to hospital if medically necessary.

Not to contradict, but I will wager the quote scubadobadoo references comes from the Travel Assist insurance provider and does not apply to DAN's Dive Accident Insurance. See the DAN Member Handbook Page 25-26 item #3 under Covered Items (emphasis added) which reads (and I quote, actually I scanned it in):

DIVING ACCIDENT MEDICAL INSURANCE
Preferred, Master and Standard Covered Medical Charges
United States Life will pay the benefits described below, subject to the terms and limitations. Covered charges means eligible charges that are for Medically Necessary services, supplies, care or treatment for a Covered Diving Accident. The accident must occur while Insurance is in force. The expenses incurred as a result of the accident must be incurred within 36S days of the accident.
Such services, supplies, care or treatment must be prescribed, performed or ordered by a Physician. Charges for such services, supplies, care or treatment must be Reasonable and Customary. United States Life will not pay for charges in excess of the maximum shown in the Schedule for the plan of insurance selected.

Eligible charges include:
1. Reasonable and Customary Hyperbaric Chamber Treatment Charges for up to seven treatments per Covered Diving Accident.
Any treatment after the seventh must be precertified by National Baromedical Services Inc. at 1-800-292-8381 or+1-803-434-7101;
2. Reasonable and customary Physician's charges for Hyperbaric Chamber Treatment, medical care and surgical operations;
3. Ambulance charges for transportation by a professional ground, air or marine ambulance service to the nearest Hospital or Hyperbaric Chamber where appropriate care or treatment can be given. Eligible charges do not include charges covered under the DAN TravelAsist benefit through MedAire,lnc.
All transportation involving air or marine ambulance service must be arranged in advance by DAN...
______________________________________________
Someone on the phone may say one thing, but this is in their book and very clear. You also have to be sure you have called the right company "handling DANS insurance" as there are two. DAN's travel assist would not cover the ambulance as the basic Dive Accident Policy does this and travel assist (a different policy from a seperate company) does not come into effect until after you are more than 50 miles from home.

I hope that helps clarify the issue.

 

[scubadobadoo]

I believe that DAN is a good company but I also believe that the insurance companies working with DAN are insurance companies like most Jeffinhburg described above. My correspondance by email from DAN never had the words "yes" or "no" in them, only quotes from the handbook as Pasley pointed out. "Please refer to page 26..." They could never simply say, "Yes, you would normally be covered in that situation." However, two dif. people did say, "No, you will not be covered" on the phone. The conflicting responses didn't make me feel any better, regardless of who (what branch of DAN) they are coming from.

I am going to Beneath the Sea tomorrow in NJ. I believe it's the largest dive expo in the US. I will be stopping by the DAN booth and will politely address the fact that many divers have been confused about the coverage. Yes, the handbook does explain everything but perhaps it could be a bit more clear or maybe they should know that some employees need to know the answer. I'm pretty sure at this point that they will confirm pasley's post above. DSAO! Hope I didn't confuse the situation here more. That's what I get for calling DAN.

 

[jeffinhburg]

Thank you - I would really appreciate a report back on that issue if you get a good (as in definitive) answer.

I hope it doesn't sound like I'm trying to harp on this or cause anything negative for DAN. Really, I like DAN, and I'm pushing the point because I want to get their insurance, but I also want to be assured that it would cover me in the most likely injury scenarios without a lot of the insurance company hassles I've spent far too much of my life staightening out.

The order of injury scenarios that I think are most likely given my dive locations and parameters are:

(1) DCS close to home;
(2) DCS far from home;
(3) Other pressure related injury (if my docs turned out to be wrong releasing me to dive);
(4) Physical injury other than DCS (break, strain, sprain, etc); and
(5) Some type of critter injury far from home (sting, bite, etc.) while snorkeling.

My main concerns about coverage are with regard to DCS close to home and snorkeling injuries. I think the snorkeling injuries are definitely covered now as skin diving injuries, but can you confirm this with them if you read this in time and have a chance?

 

[scubadobadoo]

I hope it doesn't sound like I'm trying to harp on this or cause anything negative for DAN. Really, I like DAN, and I'm pushing the point because I want to get their insurance, but I also want to be assured that it would cover me in the most likely injury scenarios without a lot of the insurance company hassles I've spent far too much of my life staightening out.

I spoke with DAN today at the dive show in person. They were very nice and confirmed EXACTLY what Pasley pointed out above. No worries. Let this thread fade into SB history for future confused divers!

 

[jeffinhburg]

Thanks, that's great news. Just wondering - Did the people you spoke with have any insight into or concern about why the people on the phone with either of us could not give the same definitive answer?

I spoke with DAN today at the dive show in person. They were very nice and confirmed EXACTLY what Pasley pointed out above. No worries. Let this thread fade into SB history for future confused divers!