Basejumper.com - archive

Had a base accident last August. Blue Cross just denied me bc base jumping is considered "parachuting" which is excluded from coverage. Has anyone successfully appealed/fought on this?
The bill is very big :(

insurance is a sham to begin with

I have Tonik formally from BC. I have never used it [knocking on wood] for anything, but I directly asked about all the "what ifs" I could think of including hooking up a parachute backwards and jumping off a buidling. Its all coverd, or so they say and I believe in. Thats all I have.

http://www.tonik.com

I work in e.r. Can check with reps in a.m. when I go to work..never heard of this...no. Just a sport, like skiing, fishing, whatnot. I would think they would even cover a failed suicide attempt....don't know.
386

insurance companies "control costs" by denying claims.
it is what they do. since health care costs keep rising faster than inflation, a whole lot of scrambling to cut possible expenses is occurring.

for me, I had a job that knew I skydived. as soon as they could, they modified the plan to exclude hazardous sports. they included several examples. one was skydiving. that was back in the '90s.

I recommend everyone read their plans. my current plan has a clause against paying if the injury occurred while committing a crime (or similar wording).

also, filling out forms IS a legal exercise (like talking to cops). there is NO need to go into excessive detail. be careful what you say. the emergency room is no place to be bragging about BASE!

knowing a site in detail will affect your choices.
knowing your insurance plan in detail can also affect your choices.

So far they have covered all my bills from an accident last July. Maybe just because the bills aren't that high.

Is it standard BC or Blue Cross underwritten travel insurance? What state?

Thanks for all the info so far. I am going to check on that other policy because it's really scary to realize I actually have no insurance right now, as well as all the other bad stuff associated with this. Yes, I guess I missed the part in the base course about lying. In the ER, I was just trying to be honest and specific about what happened, to make sure I got the best care. Bragging was pretty far from my mind. Smashing yourself in a base accident is actually quite humiliating, from my point of view.

The policy I have is Blue Cross Blue Shield of Utah. It specifically excludes the "high risk activity of parachuting." Unfortunately for me, my brother had a base accident last winter and was totally covered by his policy from the same company (blue cross). So it never even occurred to me to double check mine, or lie at the hospital and on the forms. Which I could have. So I screwed up big on that, by thinking blue cross covered base accidents. I'm still not sure why his was covered.

Even worse, the billing departments tell me that they cut the bills by 40% for people who don't have insurance. Since I HAVE insurance, even though they won't pay, they won't reduce my bills. Nice. I'm hoping to fight blue cross on the technicality that parachuting is another term for skydiving. And the uspa doesn't even recognize base. Seems like a real longshot.

So yeah, the lesson learned, is honesty doesn't pay :( Lying does. This makes me sad, but I guess that's just how it is.

But thanks a lot for the good suggestions so far. I will try to appeal it, and definitely check into that other rider policy.

United Healthcare is one of the best...I had two options with the law firm I was working for...asked the appropriate questions regarding "parachuting" and went with United Healthcare, even though it was an additional premium (like $45/mo) but when I needed to use it, my ACL reconstruction only cost me $400 with rehab & physical therapy. Any time I have the ability to choose, I will always go with United Healthcare. A lot of people aren't aware they may have more than one option with a company benefit package. Look into it for future options.

Kaye

Your policy sucks. My wife had $115K in bills from femuring in a couple of years ago.

Blue Cross covered everything except about $2000...including Air Ambulance.

And apparently my premium increases over the years and your tax dollars covered Karnowski since insurance is a scam and he's a fuckin soup kitchen douchenozzle.

I am with you dude, I know it
is true but it still really sucks!!

I had a job where they told me I'd be
better lying about why I wanted time off

People at this company took time off
all the time for supposed sick children,
hangovers, fishing trips, and my good
friend Jack for motorcycle trips...

Of course while working there I never
got hurt jumping but I did get hit on
my motorcycle and Jack was killed
on his bike.

However, they hated hearing that I
wanted time off to skydive, WTF!?

In Tallahassee there is a big insurance
company that covers all state workers
and many private companies called
Capital Health Plan (CHP) which had
this clause:

You are immediately NOT covered if you
volunatarily eject yourself from a moving
plane, train, boat, or automobile.

Of course the running joke around the
DZ was I did not jump they threw me

We did have one jumper, who was a lawyer
for the state of Florida, get a minor injury
but on the ER report they got hurt from
falling off of their mountain bike.

Again, we built a society that rewards liars!

No need to lie, just be careful what you say. I told the ER I jumped of a bridge...they never asked which one and nothing was mentioned about base. My Blue Shield has accepted my claim.

I was asked about my accident and told them, "I fell down a cliff".

There are a lot of things my insurance won't cover, such as physical therapy, my brace and "self injectable" medications, which were a necessary blood thinner after my surgery.

I'm keeping my fingers crossed about the big stuff, though. My claims have not been fully processed yet.

if anyone wants a medium phoenix fly tracking suit or a 220 dagger, i'm listing those in classifieds.

get it written off.

here's the trick. claim poverty and that you will pay $100 per week (or whatever), and never never never ever (and I mean NEVER) be late on these payments. your credit won't be blown if you do this. when your account comes up for audit in a year or two by the internal accounting agency of the hospital, they will just write it off because it's more trouble than it's worth.

thank you :)
good idea. and it's not even a lie! ;)

 

Thanks Adam! Do you know what those plans are? So far I am finding nothing that covers it. Also, hospitals refuse self-pay discounts to people who have insurance, even when the insurance won't cover them. Any suggestions about that problem?

Do exactly what 460 said to do.

I'm paying like $50 a month for the rest of my life on a shitload of psychiatric bills my ex-wife racked up behind my back. The crazy worthless bitch gargoyle...anyway...

I got stuck with 1/2 of them in the divorce when they suddenly appeared in discovery. As long as you're paying something, your credit will be ok.

 

Hi Adam,
Thanks for the links. Though I have been paying premiums to Blue Cross for fifteen years, it does seem like it's time to find a policy that will fit my activities better. Though I've spent the last two days searching the internet and making phone calls, it definitely helps to be pointed in the right direction by more experienced community members such as yourself.

We haven't met, but your suggestions are great. Thanks too, for your nice remarks. In a small community, it's great to feel the good energy. Hope to see you at an exit somewhere, and let me know if I can ever help you out with anything too.
Thanks! Steph

Again, WHICH Blue Cross? Policy exclusions vary by State.

Utah. What I'm learning now, a little late, is that companies are allowed to make exclusions for individual insurance policies. So they do. If it is group insurance (done through a company), they are not allowed to make exclusions.

That's why my brother's Blue Cross policy covered his base accident, and my Blue Cross policy didn't, though I just assumed since we were both Blue Cross we would have the same coverage. So far, everyone I've called has told me that all individual plans exclude "parachuting" and non-commercial aviation (i.e., jump planes and small planes), because they can. I checked on the IHI that was recommended, and if you live in the US or Canada, they need to make a special exception to give you a policy. I haven't heard back from them yet about how to do that, they are in Denmark.

Each company has umpteen gajillion different plans which vary from each other, between individual versus group plans, and between states.

Against my better judgement, here goes:

1) Yes you should read the policy that comes with your health insurance because it says what's excluded. If you don't read it you don't know. And yes I know its perfectly legal for an insuror to exclude certain things (generally things that don't have a politically powerful lobbying group associated with them, try excluding pregnancy which is likely the most statically dangerous thing you can do).

2) However...I have a huge problem with insurors excluding activities from coverage. The whole idea of insurance is to pool risk throughout large groups of people. While one could argue that the exclusions are there to avoid passing on high costs because of high risk activities to the rest of society, I would instead assert that the exclusions are very selected for activities with low participation and therefore low political clout. Sure exclude skdiving and BASE and perhaps some other such things like scuba diving and ultimate fighting and etc. But from my work experience I can tell you what really costs tons of money for the health care system are not these activities, instead - smoking, drinking and driving, riding motorcylces without helmets and being obese and not exercising. Granted many of those habits may apply to some of the BASE community, but never the less these things aren't excluded because lots of people choose to do them no matter how dangerous. There's actually legisllation pending prohibiting insurances from excluding motorcycling and snowmobiling - why - political clout. On the other hand someone who might choose to not drink and drive, not smoke tobacco, wear a helmet (including while base jumping), hike up stuff instead of taking helicopters, eat well still gets excluded. Why- because they can get away with it. Its about time we saw better regulation of the health insurance industry to prohibit the excluding both activities and pre-existing conditions. And also better regulation of all of us to require everyone has insurance. Thus spread the risk and spread the cost and keep everyone covered. Sounds like Hilary's plan...and this all from a free-market capitalist and libertarian...oh well that's what working in the medical profession does to you. :)

 

Harvey.... I think we married the same cum dumpster....bummer dude! I hope you weren't the sperm donor she was copulating with before she came home to me!

In a free market we'd be allowed to form groups without an employer that existed for the sole purpose of negotiating group health insurance plans.

The 2,000 BASE jumpers, 30,000 skydivers, 400,000 general aviation pilots, and 5,000,000 motorcyclists could all band together to get insurance which didn't exclude other "high risk" sports that we might like to try.

But we don't have free-market capitalism.

When you can't get government to undo the work of corporations who aren't content to compete on level ground without legislative kickbacks you need to work within the system to get your own unfair advantage.

That might mean dovetailing on the Boomers' work to get national health care as they retire, loose their group plans, and find themselves not eligible for private coverage.

it's hard to see how the US health care system even remotely resembles free-market capitalism.

most health care is paid for by insurance, so who really is the consumer? frequently, it is the insurance company, not the patient.

most insurance is paid for by the employer, so who really is the insurance consumer? it rarely is the patient.

then, after a BASE accident, who will shop around and make a rational choice regarding the best care? I bet most will go wherever is closest.

it's a muddled mess that robs the patient of virtually all ability to negotiate price. to get back to free-market principles, that ability MUST be restored. I don't see it happening.

This is a good idea. I had a skydive accident years back and a friend of mine gave me similar advice (she was a social worker who worked in a hospital and helped people in no insurance/emergency situations) I'd offer more like $25 a month though
This woman told me that hospitals have a certain quota of accounts that they write off every year for various reasons. Also, all of the bills you receive are priced SUPER-high because the insurance companies pay. As soon as you cry poor you can request to pay essentially just the cost of your stay with no markup. It's all a SCAM and i'm not an insurance lawyer so you should call the hospital you were at and see if you can talk to someone about your dilemma.

or you can do what I did: Shine it all and move off the grid to some tropical island for a while
I asked a woman at the bank once if unpaid medical emergency bills negatively affected credit and she told me "No, they are a seperate part of the credit report." again... im no expert...

SUCKS!!!

When I was selling cars earlier this year I had a few people come in that we had to turn down because they had unpaid medical bills. They did hurt some peoples credit pretty bad. That is exactly why i got health insurance.

this has nothing to do with health insurance, but as far as property / home owner's insurance, Allstate and State Farm, among others, periodically hire outside consultants to educate their adjusters on how to "interpret policies in the interest of minimizing the company's exposure" in other words, how not to pay. insurance is a complete scam.

They are super high because if the insurance company sees a bill for $100 and their contract with the preferred provider is for $50, they will pay $50. If they see a bill for $25 and the contract is for $50, they will only pay $25....

The self-pay discounts are not offered to people with insurance if the insurance is paying anything because the hospital counts on:

Discounted insurance payments + full price billing for non-insured items to person = total.

If you don't have any insurance then the total $ is the same, they just discount everything 40% across the board instead of some items 60% and some items 20%.

Lots of people are asking me what I found out. I found out I'm pretty much SOL on the current deal, but I am looking to get new insurance. If you are a jumper or pilot who believes that honesty is the best policy, blue cross in utah is not the best policy.

The IHI will not cover Americans, they just emailed me on that. The Tonik insurance suggested is great, but only services about six states, not including Utah. It seems really good if you are in California, Colorado or the other states.

Good news, for Utahns, I think Altius insurance seems very good. They have good ratings, and they do not exclude aviation or any air sports, or climbing or mountaineering, or any athletics or high risk activities. They do exclude injuries sustained while doing illegal activites, so for urban folks or people living in national parks, keep that in mind. I am applying for that insurance now.

Thanks to everyone for all the suggestions, they have been super helpful.

If that is the case, thats probably good information for everyone on here. I'm digging out my policy to see what it excludes.

Hospitals will often give you the same discount as they give the insurance company if you pay the entire amount up front. I have successfully gotten $100,000 worth of medical bills for one of the partners in my company turned into $40,000 by offering to send a cashier's check that day. You might have to take out a loan to do it, but it reduces your overall out of pocket significantly.

Good luck.

I have Blue Cross in Utah and supplement with IHI when traveling overseas. BC does suck, no doubt about it. I had surgery a few months ago and they denied the claim until I completed a very detailed report on what necessitated the surgery irrespective of the fact that I had been 'pre-approved’ by BC for surgery and the doctor's notes all reflected the cause of injury. BC then rejected the doctor required post-op physical therapy until I fought them on it.

When overseas, I do get IHI because it is relatively cheap (i.e. 3 month climbing trip was $300US and euro-base trip was ~$100). Also, IHI will take care of the bills directly with the overseas hospital as opposed to BC sometimes requiring you to pay the hospital and then reimbursing you.

When I practiced law years ago and would settle a personal injury case for a client, I would negotiate the medical bills directly with the hospital for the client. I had a good relationship with the most of the hospital's business offices and knew who to talk to and what the pressure points were to get the bills lowered. Steph, it might be worth getting a local lawyer who handles PI in the area where your hospital is located to help. I know it is hard to think about spending more money but he/she would probably do it for free or nominal cost and I would think it might really help.

Good luck.

Baxter.

Steph,
Your plight prompted me to call my insurance company, BCBS of Oregon, and verify what exclusions were on my individual policy, specifically "sport parachuting" and "non-commercial aviation". The rep was very courteous, sent my request to her legal dept. and got a reply which she told me was recorded on her end. According to the legal dept of Blue Cross Blue Shield of Oregon, there are "no lifestyle exclusions" on my policy, nothing denying coverage as long as it is not work-related or involving illegal activity. She specifically stated that sport parachuting and aviation injuries would be covered under my individual policy. I also explained the reason I was prompted to call, and after explaining your situation briefly, she strongly recommended appealing, stating that "sounds like there may be other extenuating circumstances to deny coverage in her case".
I wish you a full and speedy recovery, that's the most important part... besides that, fight the bastards as hard as you can.

Richard

All this talk about insurance companies being charged more is crazy. Health Insurers get pre-negotiated discounted rates...its called volume buying...

No...

I went in for a routine test that required a doctor + hospital and their equipment + some nice sleepy drugs.

The hospital called me the day before:

"Dear sir, if you pay cash prior to the procedure, we offer a discount - $2,500 flat fee, plus whatever your doctor charges."

I said, "No thanks, I have insurance."

(My insurance: I have to pay the first $2000 PLUS 20% of everything else up to $4000...)

I got the bills post procedure: The insurance company offered to pay $4,800 for the same procedure to the hospital, leaving me $2400 for deductible plus copay, and the doctors fees I had to pay the hospital direct... Out of pocket I was out almost $3,000 for a procedure I could have paid $2,500 cash without insurance.

I called the insurance company, "why did you pay $4,800 for a procedure they offered me $2,500 cash discount?"

"That is our contract price."

"Why do you have worse pricing than I could negotiate?"

"I don't Know"

"Next time, can I pay cash and bill you, the insurance company, because I can get these services cheaper and save us both money?"

"No sir, that is not how insurance works."

Just another example of How and Why
health insurance and health care in our
country is totally fucked up!!!!

I am going to get around to posting a
long rant soon about how we got to
this place in a separate thread.

 

can you post it in GREEN and RED since it is the Xmas season....

BREAK


Scam... they are in bed with each other...

we dont have socialist medicine, but when the govt controls 50% of it... might as well be..

Merry Christmas
Happy Hanukkah
Kickin' Kwanzaa

I am going to post a rant in the Hang Out
forum that explains the origins of how
the process of paying for health care
got so fu(ked up in our young country.

young?
the US is one of the oldest countries in existence!
wars, revolutions, independence from colonialism, etc. have redrawn maps numerous times since 1776.

Sure, most contemporary civilizations
have had some name changes...

Plenty of past societies had the same
name for longer than 300 years.

And really the age of our country had
nothing to do with my rant rendition
of our health care problems.

as countries evolve, they get saddled with their "traditions."

when a country is reborn, they frequently discard some of these "traditions." for example, while China is a proud and ancient society, the current country is relatively young and threw out many policies it felt were stale, ineffective, or outdated. (that is NOT a personal endorsement, more of an observation.)

you provided history on how the US system came to be, whether good or bad. most people wish to improve the health care system. the trick to making many happy will be to revolutionize the system, not the country.

the age of the country results in a certain political inertia favoring entrenched powers. failing to acknowledge this may blind people to the challenges of changing the system.

certain political inertia favors entrenched powers

In economics there is a term called
"rent seeking behavior"... and yes,
the powers that be have a vested
interest in keeping the status quo.

Any paradigm shift allows for some
new people, groups, and/or political
parties to benefit, hence the existing
peeps are usually reluctant to change.

makes sense to me.

that creates problems for anyone trying to change the system. to get enough votes to overcome the status quo, they need to enlist fringe folks, obtained by padding the bill with excesses.

I never heard of Blue Cross denying health insurance coverage, but make sure the policy actually excludes "parachuting" by name. If not, let them look at a website for the University of Warwick in England who did some comparisons about skiing and other sports. It's at http://www.skydivewarwick.co.uk/safety.php. They had an article called "How safe is skydiving? from the British Parachuting Association bpa.org.uk. We had to use this with Randy's injuries and medical bills since his self funded electrical union's health plan excluded "Extaordinary Risks" and they decided parachuting was one. The British site shows that skiing injuries requiring medical attention happen more frequently than skydiving injuries. However, be careful on BASE since some jumps are illegal and there are some companies who will try ot latch on the fact that they may exclude injuries gained from illegal acts. Good Luck but first read your policy carefully and if it doesn't actually say "parachuting" or something similar, try to use the statistics in the British site.
Rick Harrison
#38


editted to create clicky. it looks like sound advice! -- wwarped

I spent 5 days in a hospital via ER admission with some CT scans, endoscopy etc.

The total bill was $22k. The Blue Cross negotiated rate was $13K. I paid $2K and that was my maximum out of pocket for the year so I wouldnt have paid a cent more if the bill had been $200k or $300k

Are these public or private hospitals offering the breaks?

I have a hernia I need fixed and am not insured as of this moment, so I'd love to play lets make a deal...just not with the anesthesiologist

Read your contract. If it's not in there that parachuting is a non-covered activity, than call up the insurance company, ask to talk to a senior level claims adjustment manager, and threaten to call your state insurance commissioner.

http://www.insurance.utah.gov/

For the record I didn't lie. I admitted that I fell off a rock.