SkiNurse & I were recently talking about situations in which medical insurance does not/did not cover ski related injuries because the insurance company deemed skiing as an "extreme sport".

I know that during my whole frostbite/sepsis saga my insurance company put up a bit of a protest. Fortunately for me a couple of my loved ones fought it out with my insurance provider and everything was resolved.

Have any of you had problems with your insurance company covering ski related injuries? My advice is to check your policy so that you know what to expect!

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Life is not measured by the number of breaths you take
But by the number of moments that take your breath away~

It's true!! Make sure you know what your insurance covers. Especially before you come out to Colorado and play!

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I'm not a native, but I got here as fast as I could

I'm an Adventure Advocates member, and their accident coverage has served me very well in dealing with my ACL reconstruction. They have varying levels of coverage, from $2,500 of coverage with a $100 deductible up to $25,000 of coverage with a $500 deductible, so it works well as a supplement to your health insurance or on its own to provide accident coverage to make things like skiing carry less financial risk for those without health insurance.

There's a bunch of other benefits to being a member, but the accident insurance protection is priceless, especially with the gaping holes in coverage of many health insurance plans.

Luckily, I've been covered! ....so far!

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Kelly


Vail is Open!

"The secret of life is enjoying the passage of time." ~James Taylor

"Wrinkles will only go where the smiles have been." ~ Jimmy Buffett

Personally I've had a lot of experience fighting with a major insurer about covering the things that are clearly covered. They regularly through either intent or incompetence misprocessed things and would have left us holding the bills. Luckily though I clued into this early so I have probably spent many hours fighting with them to get things covered properly. Only one case I have not won.

So in my experience it doesn't really matter what is supposed to be covered in an insurer trying to deny coverage. You just have to be vigilant and fight. I'm sure they make out because a lot of people don't or won't fight because they think they can't.

This is one of the things I checked before I signed for the insurance company I'm using now. I've seen how they handle skiing accidents when they happen, and I'm very impressed. It cost a bit more, but it is worth it when accidents happen.

Seems to be getting worse every year....

Ah yes, Adventure Advocates. If ONLY I'd known about this a couple of years prior --- would have saved my son a total of $10k in deductibles!! Hindsight.... Good to hear, num, that they are reputable when it comes to actual claims. Obviously, my son has the gold level coverage now, so his monthly insurance premiums are in excess of $300...and rising...

In re: what persee said: fight the good fight. It can be miles of red tape but is worth the time and effort. Ditto her situation for me last year, although mine was not sports injury-related. Plainly covered expense was routinely lost, ignored, never applied to deductible, etc, ad nauseam. 8 months of battle, which eventually required the help of an outside advocate to resolve --- all for something that was legitimately covered and should never have been an issue.

In view of num's post, I strongly advise Adventure Advocates:
Adventure Advocates :: Accident Protection
There is coverage provided out of country, for rescue -- all kinds of things that your primary coverage might not touch. For those of you who do a lot of traveling, especially out of country -- but even here -- this is worth considering.

I'm in an HMO. Do you remember the story on SD of the woman who broke her leg skiing and drove herself home to get to her HMO hospital? Well, I would have to do the same.

Great point to bring up. This came up last year when my cousin & his gf from England were visiting. He wanted to learn to snowboard, the insurance he had purchased did not cover that activity. Being a 20 something he of course did it anyhow. They are returning this year & I'll bet he'll have the insurance this time.

I do remember the Diva w/the broken leg. We have the same HMO. This was a choice made by her. That insurer happens to send ambulances to Tahoe hospitals regularly for inter-hospital transport when they so deem they prefer treatment/surgery occur at their Sacramento or NorCal facilities vs the Tahoe ERs, and when appropriate to patient's condition. If not transfered, they cover the out of town E.R. visit/treatment. IIRC the patient sounded like she wanted to chose which facility she would receive treatment near her home. Transporting self is the only way to maintain that control. I got the impression she felt it far easier to just go home & get it treated there than to have to deal with being out of town & treated or ambulance transport to a facility that would still be out of town for her.

num/MSL~ Thanks for the information on Adventure Advocates. It sounds like a sound preventative investment!

Persee~ I think you are probably right. BUT, some insurance companies are MUCH more difficult to fight than others. When I was living in California I was insured by a HMO (Kaiser Permanente) and I returned home from a trip to India extremely sick. It was a huge fight to get them to pay for it since they deemed my trip an unnecessary risk!

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Life is not measured by the number of breaths you take
But by the number of moments that take your breath away~

The recent unfortunate trends mean that more and more of us are going to have to look to "gap"-type insurance - not unlike what many Medicare recipients have to buy (as I recall w/my mom). I'm guessing that there will be an increasingly large market for this, given the cutbacks in most of our insurance coverage (and ever increasing premiums...). Therefore, hopefully more insurers will get on this bandwagon.

In the meantime, for those of you who do a LOT of traveling, this Adventure Advocates is probably your best bet. Costs my son $360/yr for the gold level coverage----but good grief, look at the benefits. His health insurance has a $5k deductible () but kicks in w/o question afterward. Keep in mind that this "gap" coverage is a reimbursement plan, not immediate coverage, so bills do have to be paid by subscriber. I'm not sure how the red tape situation is, perhaps num can fill us in. DS has (HAPPILY, KNOCK ON ALL WOOD) NOT had to implement his.

Really?!! Oh that is a relief! Thank you so much for that info! I, too, have the same HMO as the Diva. When I read she drove herself home with a broken leg, I thought it was because she had to. Sooo relieved now! That story really worried me! I really should check the HMO's fine print on out of town accidents...

Glad DS hasn't had to utilize his accident protection, MSL. He's had enough of that already.

I've been an Adventure Advocates member for quite a while, and am very happy with the Gold level of coverage. While we're on the insurance topic, it's worth mentioning that in addition to the accident protection plan that is included in membership, they also offer voluntary health insurance plans with good coverage (worldwide coverage while traveling) for competitive rates. It's great for anyone unemployed, self employed, retired or who's insurance offered at work has high premiums. There are a million other perks to being a member, if anyone's interested feel free to ask me about em.

As far as red tape with the accident protection plan goes, I'd say that Adventure Advocates themselves are very easy to deal with. They haven't given me a hard time about anything. Anything prescribed for the condition or deemed medically necessary is covered, and there's no hassle about second opinions and the like. The actual accident insurance comes from another company that Adventure Advocates has a group policy with. I only deal with that company in sending them my claim forms and receiving checks from them. The customer service angle is handled through Adventure Advocates.

The limit of coverage is firm, and it's up to you to be smart about how you're spending it to stretch it as far as possible (i.e. being proactive about self pay discounts and the like). One thing that you need to keep in mind, however, is time. It takes them 4-8 weeks to process your claim and send a check, and it's important to also consider how long it takes to get the necessary itemized bills from hospitals, doctors etc in order to send in the claim. If you're looking to get reimbursed for a major expense like surgery, see about putting the balance on a zero apr for 6 months credit card or something similar and getting it all set up through reimbursements before that time is up. I'm still dealing with reimbursements from my surgery 3 months ago. Definitely not a complaint though.

Thanks MSL & Num for all the info. Sounds like it is worth checking into for any needed supplement if traveling abroad.

Sounds absolutely crazy. I can't imagine considering how many of the plan Dr's. travel abroad etc. But, there is a huge difference in how the So.Cal admin & NorCal admin & plan function. Dunno why, but N.Cal Kaiser is just a customer satisfaction machine in comparison.

Good idea though to re-chk or update plan info. cause I don't really know what type of outside E.R. visit needs they may consider non-E.R. If I broke my arm, I think I can just get in with the urgent care/treatment vs. ER. But not sure. DH has been trans by ambulance from our home to a local E.R. & subsequently transfered to a plan facility via ambulance transport for the remainder of his treatment/hospital stays. No charge to us for any of it.