Climbing and Health Insurance

Hi I am from the UK and so do not have any experience with the US healthcare system other than the fact my wife had to pay a couple hundred dollars just for a GP appointment. Hopefully I will be granted a spousal visa sometime in the next year and will be able to move over. I have hear the insurance companies will often try to weasel out of paying and one of the things that worries me is having an accident climbing and the insurance not paying out. So I was wondering what the general situation with climbing and health insurance is and if you need to take out extra coverage as a climber.

Worst thing you could do is tell them.
You were Hiking...HIKING.

Yes Doc, I was lifting weights, that's why I have chalk on my hands when some idiot came and pushed me off cliff. At least he had the decency to stick a helmet and harness on me, that's why I'm not dead but do have 2 broken legs... ;)

If you have a preexisting condition in your medical history, yes it seems they find every reason from denying you health care coverage in the first place but they do not assess your lifestyle otherwise. If after you've succeeded in getting coverage, you have a climbing related injury, I have not had trouble with climbing related claims (I've only ever sprained an ankle).
With Obama's bill that passed, even if you are denied the plan you want, there are other option available where they do not underwrite or investigate your past medical history, but the coverage available isn't very good and it is very expensive.

Life insurance on the other hand is a different thing where they do assess your lifestyle to determine risk in more depth. In my experience I had to complete an addendum/climbing resume with the application stating experience, training, etc. There are similar supplemental forms to complete if you are a participant skydiver, pilot, etc. I've heard of situations where they may simply grant you the coverage but exclude climbing related claims. In my case they did opt to cover me for climbing related death, but I have to pay more. If I climbed in a gym 6 times a year I probably wouldn't have filled this out but at the time I made my livelihood in the climbing industry and was about to go on a climbing road trip across the country and there was really no honest way around it, so I sacked up and just pay the extra coverage with no regret as I am probably more likely to die climbing than any other way at this point in my life.

Hope this helps and good luck!
Safe climbing-
Dan

Dan Allard wrote:I am probably more likely to die climbing than any other way at this point in my life.

Actually you are probably more likely to get killed in a car accident with an insurance agent driving his fast new BMW.

+1 for the preexisting condition issue. When you first sign up for a health insurance plan, there will be a period of time (about a year or two) where if you file a claim for something that could be a preexisting condition, they will come after you for more info (medical history, or proof of prior health insurance coverage usually 60 days or less from the start date of your new insurance plan).

Personally, I took a bad fall bouldering. Landed flat on my back from about 10 ft. (best insurance=better spotters, btw). Within a couple weeks, I was having tingling down my legs and pain in my low back. Went to a chiropractor (covered under my plan), got xrays, adjusted the sublaxation, and have been feeling better since. But in the insurance claims process "back pain" is considered something that could be a preexisting condition, so I had to file paperwork from my previous insurance company (still being worked through by the new insurance company).

A couple months later, I took a fall and hurt my heel. I went to get it examined and xrayed. All was well and insurance covered it without question because "possibly broken foot" doesn't set off those preexisting condition alarm bells.

So climbing in itself really isn't the problem for health insurance, but having the insurance slap a preexisting condition clause on a claim could be.

Almost all of the Affordable Care Act will come in effect in 2014, which, in theory, should eliminate coverage denial based on pre-existing conditions and activity related injuries such as climbing.

People in other forums here have mentioned that Kaiser Permanente treats climbing accidents like skiing accidents, meaning that it's covered. Assurant is one of the companies that specifically excludes anything climbing related (as well as motor racing), and I'm sure there are other companies that exclude it as well- perhaps some other MP users can help add to the list.

I used to work in insurance and in my experience, health insurance companies do not care if you're a climber, a sky diver, a scuba diver, a fire juggler, whatever... as long as you don't have preexisting conditions.

Life insurance is another story. For every "hazardous" hobby or occupation you engage in, your premium will sky rocket accordingly.

Edit: Didn't realize that there were health insurance companies rating-up and excluding hazardous activity related injuries. Kind of screwed up in my opinion, but perhaps, statistically justifiable.

Just goes to show that you need to read your contract with your insurance company. Ask questions if something in the paperwork doesn't make sense. Then call another rep from the same company and ask the same question. You'd be surprised how many different answers you'll get (depending on the company of course). But you'll start to get a good idea of what you might be covered for. Unfortunately, in some cases, you might not know exactly, until it happens.

Insurance can be a pretty grey place.

I didn't have major medical for a few months last year, so got an accident expense policy from American General. It cost me $42 a month for 15K of coverage with a $100 deductible. Thankfully, I didn't have to use it, so I can't really tell you how good that particular company is, but it made me feel better to have it and the agent assured me it didn't matter if I had the accident climbing, skiing, or in a car. I figured the American Alpine Club would cover the rescue to the road ($75 a year), and this policy would take care of the rest (provided it wasn't very serious; it doesn't take very long to run up a 15K bill).

Few people realize that many health insurance plans offer reduced or no coverage outside of their network. Well, if you deck trying to onsight your project, do you really think the ambulance is going to let you select your own hospital? You are going to go to the nearest hospital, and upon doing so you may find you have yourself a $250,000 bill with an insurance company that will only cover 40% of it because it was out of network.

Fortunately, Obama Care makes that act illegal in 2014, so we wont have to worry about it next year. But in reality, health insurance in America is a very black, complex, and evil topic. I could write a library worth of books about how healthcare in America is a joke, and even with so called "insurance" you can still end up with massive out-of-pocket expenses if you suffer from an emergent climbing injury. My only advice is to READ AND UNDERSTAND your policy. I know it is 90 pages of wordy bullshit. But understanding what your insurance will and will not cover can save you a lifetime worth of debt if you get injured. Dont forget, the number one cause of bankruptcy in America is medical debt, and many of those were insured at the time of the debt accumulation.

richardd wrote:I didn't have major medical for a few months last year, so got an accident expense policy from American General. It cost me $42 a month for 15K of coverage with a $100 deductible. Thankfully, I didn't have to use it, so I can't really tell you how good that particular company is, but it made me feel better to have it and the agent assured me it didn't matter if I had the accident climbing, skiing, or in a car. I figured the American Alpine Club would cover the rescue to the road ($75 a year), and this policy would take care of the rest (provided it wasn't very serious; it doesn't take very long to run up a 15K bill).

Be carefully, as you mentioned $15k is pocket change. You can exceed that with a broken hand. If you deck and break something, you are going over that limit, it is an almost certainty.

Your wife had to pay for a visit to a professional doctor? That's ludicrous. Everything should be free in merica.

Stay on your side of the pond if you want freebees or go to Canada where they already figured out that system doesn't work. It will take us a decade or more to figure it out here.

Jon Zucco wrote:I used to work in insurance..Edit: Didn't realize that there were health insurance companies rating-up and excluding hazardous activity related injuries. Kind of screwed up in my opinion, but perhaps, statistically justifiable.

Are you suggesting that health-insurance companies are losing money because of people that engage in "hazardous activities?" Are you suggesting that health-insurance companies aren't profitable as a whole?

I think that people have lost sight of the reason that insurance exists.
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Greg D wrote:...go to Canada where they already figured out that system doesn't work....

Canada's health-care system isn't perfect. But let me ask you this: in fifteen years, do you think that the US healthcare system is going to look more like Canada's? Or is Canada's system going to look more like the US's?

Which one do you think is more sustainable in its current form?

Not sure if your wife works for a company that provides health insurance as a job benefit, but if so the insurance company can't deny coverage. (And starting in 2014 all companies that employ 50 or more people will be required to provide health insurance to employees, spouses and dependents.)

20 kN wrote:Few people realize that many health insurance plans offer reduced or no coverage outside of their network. Well, if you deck trying to onsight your project, do you really think the ambulance is going to let you select your own hospital? You are going to go to the nearest hospital, and upon doing so you may find you have yourself a $250,000 bill with an insurance company that will only cover 40% of it because it was out of network.

Actually most insurance companies provide out-of-network coverage for medical emergencies at the same level as in-network coverage.

Okay, so that was the good news. The bad news is that your visa status may cause complications. Even though you're legally in the US, you probably won't have a social security number at first. You'll have to jump through some bureaucratic hoops to get one and this may take a couple of months. Until your SSN arrives, you'll have to resign yourself to being be treated as a non-person by most US government agencies, banks, insurance companies, etc.

Martin le Roux wrote:Even though you're legally in the US, you probably won't have a social security number at first. You'll have to jump through some bureaucratic hoops to get one and this may take a couple of months. Until your SSN arrives, you'll have to resign yourself to being be treated as a non-person by most US government agencies, banks, insurance companies, etc.

So what do you do in the meantime, just hope that you don't get a burst appendix or get hit by a car?

Good to know climbing wouldn't affect the health insurance though.

richardd wrote:I didn't have major medical for a few months last year, so got an accident expense policy from American General. It cost me $42 a month for 15K of coverage with a $100 deductible. Thankfully, I didn't have to use it, so I can't really tell you how good that particular company is, but it made me feel better to have it and the agent assured me it didn't matter if I had the accident climbing, skiing, or in a car. I figured the American Alpine Club would cover the rescue to the road ($75 a year), and this policy would take care of the rest (provided it wasn't very serious; it doesn't take very long to run up a 15K bill).

So insurance is needed for search and rescue in the USA too?

Some ins. companies cover climbing, others do not. When I was in grad school, my student health plan specifically stated that it did not cover "risky activities such as sky diving, scuba diving, or climbing where a guide and a rope were used." (dumbest wording ever) I wound up buying insurance from another carrier so that I'd be covered climbing, only to get screwed over when I needed regular medical procedures.

My current insurance (through my wife's grad school) has been awesome for covering a recent foot fracture that I got climbing. The biggest thing they have been concerned with was finding out if anyone else was responsible: they keep sending me questionnaires wondering if there was negligence, if I was climbing as part of an official group activity, and asking whose land the accident occurred on (fortunately, it was National Forest). You always hear about ridiculous lawsuits, and landowners who are afraid of being sued, and you think "I would never sue someone like that if I got injured!" Then you realize that it's the ins. companies, and you have no say in it.

Dan Halperin wrote: So insurance is needed for search and rescue in the USA too?

In the vast majority of rescues involving MRA rescue teams, everything leading up to the moment flights or the ambulance picks you up is FREE. tell your friends.

Rescue may be free in most of the US, but not everywhere. I read a number of articles when I lived in NH about folks being billed for rescue in the White Mountains which I remember mostly because they seemed to have a funny sort of way of determining if you should pay...If you're clueless, you don't; if you should have known better, you do. In CO, you can pay a $5 fee (for 3 years?) at the Division of Wildlife for a kind of rescue insurance. It's included in the cost of hunting licenses. Volunteer organizations and volunteers are truly awesome. I would like to think they have some way to recover some of their expenses through insurance or fees.

All im saying is that any self-respecting mountain rescue team does not charge for rescue. It is objective and the circumstances don't matter ... unless you are obviously a stupid idiot and never deserved to be rescued in the first place ... wait, we dont charge those people either.

Having said that, buy the CORSAR card, which does kick back some much-needed funds to local teams.

Health insurance is odd sometimes. Every contract/group is different. Most insurances aren't, can't, judge you because you're a climber. If you got hurt, they'll pay the contracted amount (minus patient responsibilty). The only reason they'd care how you got hurt is if other party liability may be involved (auto insurance, workers comp, etc) because they don't want to pay what they legally don't have to. No problem as a climbe

HOWEVER you mentioned your wife. Are you going onto her employer`s group plan? If so, if they are a self-insured group they then have the right (it'd be in the contract) to deny for climbing or suicide or whatever they want. Its a self insured groups choice.

I still don't think you'll have a single problem. Blue Cross and Blue Shield doesn't care if you're a climber. The individual groups might (doubt it but possible) but not the insurance companies as a "usual and customary" way (not to deny for climbing, hockey, because you were drunk, etc). I work for a very large BC BS company and I deal with this kind of stuff daily.