United Health Care / DAN coverage

[jduncan]

I have a PPO with UHC. I called them today and got a customer service rep to whom I asked "Does UHC cover SCUBA related injuries such as DCI, and related treatments in a hyperbaric chamber?" She put me on hold, and shortly returned saying "If you have a medical condition, we cover it".

I'm curious to know the relation between my normal health insurance, and the DAN coverage I have - over the fact that DAN is "Secondary". How does that work?

I'm interested in hearing from anyone with real life events where they had to deal with both insurance companies after a diving related injury and/or recompression, etc.

j

 

[robbcayman]

I have a PPO with UHC. I called them today and got a customer service rep to whom I asked "Does UHC cover SCUBA related injuries such as DCI, and related treatments in a hyperbaric chamber?" She put me on hold, and shortly returned saying "If you have a medical condition, we cover it".

I'm curious to know the relation between my normal health insurance, and the DAN coverage I have - over the fact that DAN is "Secondary". How does that work?

I'm interested in hearing from anyone with real life events where they had to deal with both insurance companies after a diving related injury and/or recompression, etc.

j

My guess is they would cover a part of it but not all of it. This is where it would be beneficial to have additional insurance i.e DAN. Just my guess though.

 

[Tengai]

I posed a similiar question to my health care provider, Harvard Pilgrim Health Care.

Here is their response.

'In a case of transportation via air ambulance due to a medical emergency then transportation to the nearest hospital to render appropriate emergency care would be covered, or if the hospital where the Member has been taken cannot treat the Member and it is necessary to transfer the Member to another facility with the necessary equipment and expertise then this would be covered as well. If this were an elective service then the member would be responsible for the cost.

SCUBA accidents would fall under emergency care also and if utilizing a hyper baric chamber is needed and medically necessary for you then this will covered as long as it remains so. If for some reason this was being used for a more elective reason after any initial emergency care then this would be member responsibility and not a covered service'.

I 'assume' (I hate that word that supplemental insurance is NOT needed.

My best advice would be to get it in writing from the provider.

Good Luck

Greg

 

[jduncan]

Right. The general cliche presented by suplimental dive insurance is that most helath care plans don't cover dive related accidents. Here we have two major HC providers stating that they do cover it.

So why do we need supplimental coverage for diving? Don't get me wrong, I have DAN and plan to keep it because I don't take chances. But I don't totally see where it will benefit me - Unless it's more useful out of the country? That is likely the case.

 

[herman]

The key words here are "medically necessary". If the nondiving, nonhyperbaric med trained "doctor" at your HMO does not think it was necessary, it's was not necessary and you pay. The fact that your bent like a pretzel does not matter. Also, many health care providers outside the US will not accept payment from a US insurance company. They take cash, credit card or DAN and you have to fight with the HMO doctors to justify it was necessary. Get DAN, it's cheap and respected worldwide.

 

[jduncan]

I have DAN, as I stated a few times. I was just looking for some examples and reasons for having it - some of which you provided. Thanks.

 

[jduncan]

Okay, so DAN states that it's insurance is "supplemental" to a persons personal health care insurance.

"DAN coverage is secondary coverage. After any other coverage you may have, DAN pays up to 100 percent of reasonable and customary costs of all remaining eligible expenses."

So, does DAN require me to first submit a claim to my insurance company before they pay? How do they know what is covered with my PPO? I don't understand the relationship here.

I'd like to hear some real world examples of what happened when any of you used DAN for a dive related incident.

 

[cowjazz]

Okay, so DAN states that it's insurance is "supplemental" to a persons personal health care insurance.

"DAN coverage is secondary coverage. After any other coverage you may have, DAN pays up to 100 percent of reasonable and customary costs of all remaining eligible expenses."

So, does DAN require me to first submit a claim to my insurance company before they pay? How do they know what is covered with my PPO? I don't understand the relationship here.

That is the way I understood it.

I have Blue Cross/Blue Shield of Texas Health Select Plus. They told me medical condition related to a dive accident would be covered.

I still obtained DAN as secondary coverage for the reasons already stated, and because it goes beyond my BCBS group coverage in many ways. In addition (from what I think I figuered out), if you do get injured the doctor in whatever country you are in can get medical treatment advice from DAN physicians. DAN also provides coverage for medical evacuation back home (could easily run you 10K), lost/damage gear, and trip coverage, etc. for losses suffered from the result of a dive related accident.

 

[Diver Lori]

I can't answer your "real world" question. But I do know that a diver would be nuts not to have a secondary insurance for diving. ESPECIALLY if you are exceeding the limits of recreational diving. (hence the higher level of DAN insurance) Which I do at times as a cave diver.

Plus, going out of the country is a nightmare with regards to medical care. I fell on a dive boat and broke my ankle in 2001 on the Nautilus Explorer out of BC. I went to a Canadian hospital and they informed me right quick that I need to produce a credit card for treatment. It was up to me to get my money back from my healthcare company or DAN.

Moral? I have one credit card, with a high limit and no balance, that I take on all vacations. That and my limitless American Express should be enough if bad luck strikes. This I learned early in my diving career while on a trip on Blackbeards. A female diver shot to the surface from around 80 feet according to her story and her boyfriends. They were new divers and did not have DAN. The captain of the boat, while radioing for help, informed boyfriend to cough up a credit card with lots of room on it if he wanted her airlifted off the boat via a nearby uninhabited island. He said no one would come get her without DAN or a hefty credit card authorization. Nuf said.....

 

[pasley]

What your medical insurance does NOT cover that DAN does (if medically required):
1. Hotel that you have to stay in for several days or weeks because you can't fly home yet. A dive buddies husband had to hotel it for 2 weeks because he lives at 3,000 feet and could not go home.
2. The cost of the plane ticket at full fare because you lost you super cheap non-transferable, non-changeable ticket because you were bent and could not fly on the appointed day.
3. Air ambulance to fly you home at tree top level if reqyuired
4. Cost of flying a loved one to be with you if medically required (recommended)
5. Cost of shipping you home if the worst happens and you do not survive.
In short, your medical insurance may or may not cover the medical cost (doctor, hospital) of getting bent or other dive related injury, but DAN will pick up the slack and very importantly cover the related cost caused by the dive injury but not directly medical in nature (hotel, air travel, etc).

In short it is cheap and good peace of mind IMHO. I have used DAN in the past and they paid without problem. I have no other insurance, and it was easy dealing with DAN. they paid all the bills without a penny out of my pocket.