Jumping WITH Insurance

[Inigo_Montoya 0]

Upon reading the 'jump withOUT insurance' thread, I had this thought.....

It seems that many insurance companies would not cover your injuries related to extreme sports (very broad statement, I realize but irrelevant for the question at hand)

Let's say you injure yourself skydiving..... would you just say you fell down stairs or off a ladder? Any experience with this situation? It seems you would almost be 'shooting yourself in the foot' if you actually told your doctor it was skydiving related.... he writes that down.... then you get denied your claim....


Thoughts?

"I'm not young enough to know everything." O.W.

[NWFlyer 2]

I wouldn't jump in the first place without insurance that covered skydiving. My health insurance does. I also made a point of seeking out a travel accident insurance policy for my trip to Belize that covered skydiving.

Lying about how you received an injury is what's called insurance fraud. You might be able to get away with it if it's a minor break and you get driven in by a friend ... but when the ambulance (ground or air) takes you in, rest assured that the information about how you got injured will be readily available to the folks who are treating you at the hospital as well. Once your claim gets up into the high dollar amounts you'd better believe your insurance company will do it's homework to ensure that they only have to pay for what the policy says they'll pay for. (Also note that a lot of DZs have a standard policy - if you can't walk off the field under your own power, they're calling 911, so thinking "Oh I'll just get my friend to load me into their car for this little femur break" ... think again!)

If it's excluded in your policy, it won't be covered if you don't lie. If you do lie and they find out, not only won't it be covered, you stand a good chance of losing your coverage altogether (or worse).

"There is only one basic human right, the right to do as you damn well please. And with it comes the only basic human duty, the duty to take the consequences." -P.J. O'Rourke

[Glitch 0]

Don't volunteer any information you don't absolutely have to.... describe your injuries in a manner that doesn't include any words even closely associated with skydiving or extreme sports. Admit nothing, except 'it hurts like hell' and 'it STILL hurts like hell'.

Randomly f'n thingies up since before I was born...

[Inigo_Montoya 0]

Thanks. Both of my parents are in the medical industry, so the fraud point is valid.

I have also been screwed over by insurance companies in the past, so sticking it to them in minor situations is not a moral issue for me.

Obviously in the case of needing ambulance, and something that extreme, lying wouldn't be the way to go. I was more thinking out loud for cases such as broken and sprained ankles, minor injuries, etc.

And admittedly, I have not done my research for health insurance that covers skydiving. Sometimes, I like to think out loud via a thread. :)

"I'm not young enough to know everything." O.W.

[NWFlyer 2]

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And admittedly, I have not done my research for health insurance that covers skydiving. Sometimes, I like to think out loud via a thread. :)

Since I started jumping, I've worked for 4 different employers, been covered under 5 different health plans, with the health plans (based on the company HQ location) in 4 different states. NONE of them has excluded skydiving. All of my coverage has been "group" coverage, through my employers, not individual coverage.

I've actually sought treatment under 3 of those health plans for injuries related to skydiving (all relatively minor - a concussion, and two separate shoulder injuries). I've been straight up every time and had no problems whatsoever.

I dunno - maybe others are better at this, but I suck at lying. The idea of having to keep up a web of lies throughout a complex recovery and insurance navigation process just sounds like something I'd fuck up pretty quickly. I've been through that process for a fairly major injury (total cost $100K+) that wasn't skydiving related, and just keeping the TRUE facts straight through dealing with three insurance companies and a personal injury attorney was exhausting enough. I'd hate to add lies on top of that.

"There is only one basic human right, the right to do as you damn well please. And with it comes the only basic human duty, the duty to take the consequences." -P.J. O'Rourke

[Remster 24]

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NONE of them has excluded skydiving.

My understanding, after asking the question to our HR reps, and our corporate insurance agent, is that group health policies cannot discriminate in any way like this, so, unless someone can educate me otherwise, cannot exclude any activities. Individual insurance plans are a whole other issue of course.

Remster

[jdathome 0]

Thanks for the reminder! I have always wanted to check my insurance. I am on Blue Cross/Blue Shield. My policy is through work. I am covered, even while skydiving! That's a relief

[PiLFy 0]

Hi Inigo,
Let me tell you a couple of stories, OK? A fellow student I met in the ground class had been hurt the prior year. He panicked on landing in windy conditions, & flared too early. Result? He went up to about 35', & stalled right over a runway... Ouch. It could have been worse. He only broke a bone in his foot, plus a few toes. Treatment only involved X-rays & taping his toes together. He drove himself to the ER. The bill was for over $7K, & his insurer denied coverage for skydiving injuries. The next time he gets hurt? He's falling off the roof while cleaning gutters...

There was a lawsuit lost by a California BC/BS. They were structuring their bonuses on how many people their employees managed to throw into the abyss. Briefly, insured people would get a catastrophic diagnosis, such as cancer. The BC/BS employees would trump up some bogus excuse, & revoke coverage. They would then do everything in their power to NOT straighten it out. Stress will kill someone much faster when fighting such a disease. The Insurers know this. When the patients die while still trying to get their coverage reinstated? The carrier saves money. It's all they care about. The woman who won that suit was in the vast minority. She had been diagnosed w/breast cancer. After two rounds of chemo, they cut her off. She was lucky enough to survive the stresses of the illness & the rest of her treatments. She lost her marriage, her house...everything. She had also accrued something like $300K in medical debts. I'm not making this up, or embellishing it in any way. It's a matter of public record. That's just one example. The insurance industry is a dirty industry, make no mistake. I believe the amount awarded was around $42 million.

I'll not have anyone tell me what perfectly legal recreational activities I can & cannot participate in. They've absolutely no right to even attempt to circumvent my liberties. You can't defraud a bunch of amoral & repugnant thieves. Some here have told the truth about their skydiving injuries w/o any problems? I'm glad. Their skydiving is now a matter of record. Should their providers one day decide to try what other providers across the street are already doing? They'll have a problem next time. You decide what you're comfortable with, my friend.

[NWFlyer 2]

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I'll not have anyone tell me what perfectly legal recreational activities I can & cannot participate in. They've absolutely no right to even attempt to circumvent my liberties

No one's telling you that you can't participate. They're being very up-front about what the consequences are if you do choose to participate and get hurt.

Listen, I get the "insurance companies are evil" mentality. Insurance companies have done some shitty stuff to people. But trying to say that they're infringing on your personal liberties ... nope. No one's telling you what to do.

It's like when Dr. Laura said she quit her radio show so she could "take her First Amendment rights back." News flash, sweetie, just because advertisers didn't like your particular exercise of your first amendment rights and chose not to do business with your network doesn't mean you lost those rights. It just means you didn't like the consequences of exercising those rights. Big difference.

"There is only one basic human right, the right to do as you damn well please. And with it comes the only basic human duty, the duty to take the consequences." -P.J. O'Rourke

[DrewEckhardt 0]

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NONE of them has excluded skydiving.

My understanding, after asking the question to our HR reps, and our corporate insurance agent, is that group health policies cannot discriminate in any way like this, so, unless someone can educate me otherwise, cannot exclude any activities. Individual insurance plans are a whole other issue of course.

Wrong.

HIPAA requires group plans to cover participants in hazardous activities but allows source of injury exclusions so skydivers can join such plans but are only covered when falling off ladders but not jumping.

Organizations for millions of horseback riders and motorcyclists (versus 30,000 skydivers) have fought this.

As of 2009, the best they were able to do is require the insurers to spell out the limitations before you join a group plan.

That said I've never had a policy with a skydiving exclusion.

[NewGuy2005 51]

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I'll not have anyone tell me what perfectly legal recreational activities I can & cannot participate in.

They are not trying to tell you what you can and cannot do. They are just telling you what they will and will not cover.

[Remster 24]

Thanks for the clarification Drew.

Same here tho since we moved to the US: 3 different plans in 5 years (gawd I love the US insurance system lol) and none of them excluded skydiving.

Remster

[theonlyski 3]

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Let's say you injure yourself skydiving..... would you just say you fell down stairs or off a ladder?

How are you going to explain a ladder in the middle of a DZ landing area, while wearing an inflated parachute that the EMTs have to cut off of you?

"I may be a dirty pirate hooker...but I'm not about to go stand on the corner." iluvtofly
DPH -7, TDS 578, Muff 5153, SCR 14890
I'm an asshole, and I approve this message

[pmags88 0]

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Let's say you injure yourself skydiving..... would you just say you fell down stairs or off a ladder?

How are you going to explain a ladder in the middle of a DZ landing area, while wearing an inflated parachute that the EMTs have to cut off of you?

the parachute was a safety precaution in case you did fall off

[PiLFy 0]

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I'll not have anyone tell me what perfectly legal recreational activities I can & cannot participate in. They've absolutely no right to even attempt to circumvent my liberties

No one's telling you that you can't participate. They're being very up-front about what the consequences are if you do choose to participate and get hurt.

Listen, I get the "insurance companies are evil" mentality. Insurance companies have done some shitty stuff to people. But trying to say that they're infringing on your personal liberties ... nope. No one's telling you what to do.

It's like when Dr. Laura said she quit her radio show so she could "take her First Amendment rights back." News flash, sweetie, just because advertisers didn't like your particular exercise of your first amendment rights and chose not to do business with your network doesn't mean you lost those rights. It just means you didn't like the consequences of exercising those rights. Big difference.

A simple femur fracture can easily run about $60K w/o any major complications. Throw in a nosocomial infection, & it will go north of $100K real quick. By your logic. You're saying that holding a $100K anvil over someone's head isn't a form of coercion. You have extra bundles of $100K sitting around the attic, do you? Most of us don't. Someone else already mentioned the motorcycling lobby regarding similar discrimination. I've been riding for almost thirty years. I remember employers/insurers who discriminated against people who legally chose to ride a motorcycle. USPA doesn't have as much clout, but it's the exact same principle. Do we not agree on that much? I can't even tell you who Dr.Laura is. I don't watch TV.

[PiLFy 0]

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Let's say you injure yourself skydiving..... would you just say you fell down stairs or off a ladder?

How are you going to explain a ladder in the middle of a DZ landing area, while wearing an inflated parachute that the EMTs have to cut off of you?

"Obviously in the case of needing ambulance, and something that extreme, lying wouldn't be the way to go. I was more thinking out loud for cases such as broken and sprained ankles, minor injuries, etc."

[ghost47 18]

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I'll not have anyone tell me what perfectly legal recreational activities I can & cannot participate in. They've absolutely no right to even attempt to circumvent my liberties.

So, say you have a car you want to rent out to people. If they want to drive it around town, you charge them $20 a day. If they want to drive it out of town, you charge them $30 a day. If they want to drive it out of state, you charge them $40 a day. If they want to drive to Mexico, you tell them, no deal, you can't rent my car.

Because if something goes wrong with the car in town, it's easier to deal with. Out of town, a little harder. Out of state, a little harder still. Out of the country, a nightmare. So you want to be compensated extra for the extra risks, or in some cases, don't want to incur the risk at all.

That okay?

If so, why are you restricting your renters' perfectly legal activities?

Some company has a health insurance plan. They make you a deal: pay us $100 a month, and if you get hurt doing anything except for X, Y, and Z, we'll pay for your medical bills up to $100,000. You can say, that's ridiculous, I refuse to give you $100 if you won't let me do X, Y, and Z. In which case maybe they say, okay, give me $250 a month, and you can do X, Y, and Z.

Or maybe they say, okay, well, thanks for looking, but looks like we don't agree on terms, so don't pay me, and I won't cover you.

But why is it right to say okay, I agree to your terms, and then lie about doing X, Y, or Z?

[billvon 2,396]

>A simple femur fracture can easily run about $60K w/o any major
> complications. Throw in a nosocomial infection, & it will go north of $100K
>real quick.

Afraid of that $100K bill? Then don't take the risks associated with skydiving.

Want to have a really rad, fun time skydiving? Then man up and accept the potential consequences of your actions.

[pirana 0]

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NONE of them has excluded skydiving.

My understanding, after asking the question to our HR reps, and our corporate insurance agent, is that group health policies cannot discriminate in any way like this, so, unless someone can educate me otherwise, cannot exclude any activities. Individual insurance plans are a whole other issue of course.

Never seen a health plan that excluded care for skydiving related injuries - and if you have heard of one from a friend of a friend it is probably an insuraphobic hyperbolic whiner stirring the pot.

And you have it backwards as far as the likelihood of restrictions on coverage. Large employers, self-insuring their employees, have far more latitude (nearly unlimited) to exclude for special situations, conditions, or just cuz they want to. Individual plans, which can not get around mandates, actually have far fewer restrictions.

" . . . the lust for power can be just as completely satisfied by suggesting people into loving their servitude as by flogging them and kicking them into obedience." -- Aldous Huxley

[pirana 0]

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Hi Inigo,
Let me tell you a couple of stories, OK? A fellow student I met in the ground class had been hurt the prior year. He panicked on landing in windy conditions, & flared too early. Result? He went up to about 35', & stalled right over a runway... Ouch. It could have been worse. He only broke a bone in his foot, plus a few toes. Treatment only involved X-rays & taping his toes together. He drove himself to the ER. The bill was for over $7K, & his insurer denied coverage for skydiving injuries. The next time he gets hurt? He's falling off the roof while cleaning gutters...

There was a lawsuit lost by a California BC/BS. They were structuring their bonuses on how many people their employees managed to throw into the abyss. Briefly, insured people would get a catastrophic diagnosis, such as cancer. The BC/BS employees would trump up some bogus excuse, & revoke coverage. They would then do everything in their power to NOT straighten it out. Stress will kill someone much faster when fighting such a disease. The Insurers know this. When the patients die while still trying to get their coverage reinstated? The carrier saves money. It's all they care about. The woman who won that suit was in the vast minority. She had been diagnosed w/breast cancer. After two rounds of chemo, they cut her off. She was lucky enough to survive the stresses of the illness & the rest of her treatments. She lost her marriage, her house...everything. She had also accrued something like $300K in medical debts. I'm not making this up, or embellishing it in any way. It's a matter of public record. That's just one example. The insurance industry is a dirty industry, make no mistake. I believe the amount awarded was around $42 million.

I'll not have anyone tell me what perfectly legal recreational activities I can & cannot participate in. They've absolutely no right to even attempt to circumvent my liberties. You can't defraud a bunch of amoral & repugnant thieves. Some here have told the truth about their skydiving injuries w/o any problems? I'm glad. Their skydiving is now a matter of record. Should their providers one day decide to try what other providers across the street are already doing? They'll have a problem next time. You decide what you're comfortable with, my friend.

Got a link to this story? Understood that there are unscrupulous people in all businesses; but this sounds a bit over the top. Did they really prove (or have solid evidence) that a number of employees were in a conspiracy to fabricate denial reasons; or is that the accusation generated by you based on one anecdotal occurence?

" . . . the lust for power can be just as completely satisfied by suggesting people into loving their servitude as by flogging them and kicking them into obedience." -- Aldous Huxley

[Southern_Man 0]

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Thanks for the reminder! I have always wanted to check my insurance. I am on Blue Cross/Blue Shield. My policy is through work. I am covered, even while skydiving! That's a relief

Health insurance is generally regulated by states (at least at this point in time) so just because it was true at the one guys work doesn't necessarily mean it is true at yours.

Although, I've never heard of a group health insurance plan that has excluded activities.

"What if there were no hypothetical questions?"

[jdathome 0]

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Thanks for the reminder! I have always wanted to check my insurance. I am on Blue Cross/Blue Shield. My policy is through work. I am covered, even while skydiving! That's a relief

Health insurance is generally regulated by states (at least at this point in time) so just because it was true at the one guys work doesn't necessarily mean it is true at yours.

Although, I've never heard of a group health insurance plan that has excluded activities.

Sorry, I should have been more clear. I was trying to say, "I checked with my agent. My group plan has no exclusions for skydiving. I am on South Dakota Blue Cross/Blue Shield" Just wanted to share my findings.

It's funny, but I've avoided checking my policy for two years. I didn't want to find out I was going to be broke if I got hurt skydiving. Now I feel better!

[PiLFy 0]

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I'll not have anyone tell me what perfectly legal recreational activities I can & cannot participate in. They've absolutely no right to even attempt to circumvent my liberties.

So, say you have a car you want to rent out to people. If they want to drive it around town, you charge them $20 a day. If they want to drive it out of town, you charge them $30 a day. If they want to drive it out of state, you charge them $40 a day. If they want to drive to Mexico, you tell them, no deal, you can't rent my car.

Because if something goes wrong with the car in town, it's easier to deal with. Out of town, a little harder. Out of state, a little harder still. Out of the country, a nightmare. So you want to be compensated extra for the extra risks, or in some cases, don't want to incur the risk at all.

That okay?
___________________________________________________

**That's a poor analogy. I can go to several places in just about any town around here, & rent a car. If I don't like one rental place's pricing structures for whatever reason? I can simply walk down the street a bit. The reputable rental places are all closely matched in pricing. In a pinch. The cheaper ( = older cars) rentals are always there, as well. If I don't like any of their prices? I can simply lease a car by the month. It'll be cheaper, & I can do whatever I please within the mileage restriction. When working for companies. One is typically offered two to three choices for health coverage. You pick your best fit. The freedom to simply buy elsewhere is far more restricted. Simply walking down the street to another health insurer will increase my premiums about 10X. That's substantially more than a 10-20% difference.

___________________________________________________

If so, why are you restricting your renters' perfectly legal activities?

Some company has a health insurance plan. They make you a deal: pay us $100 a month, and if you get hurt doing anything except for X, Y, and Z, we'll pay for your medical bills up to $100,000. You can say, that's ridiculous, I refuse to give you $100 if you won't let me do X, Y, and Z. In which case maybe they say, okay, give me $250 a month, and you can do X, Y, and Z.

Or maybe they say, okay, well, thanks for looking, but looks like we don't agree on terms, so don't pay me, and I won't cover you.

But why is it right to say okay, I agree to your terms, and then lie about doing X, Y, or Z?

"...your renters' perfectly legal activities?"

**Perfectly legal activities? There is much that can be said about the law. A good part of which is neither ethical, nor just. Just because their buddies in the capital passed a law for them. That doesn't make it right. I remember a time around twenty five years ago. A lot of big companies were starting to exclude any employees who rode a motorcycle from their health plans. The trend was beginning to take hold. The backlash from the tens of thousands of riders in each state forced the powers that be to back down. Today, that type of discrimination is virtually unheard of in motorcycling. USPA only has about 32K members. Insurers are guilty of doing far worse to people than discriminating against 32K out of 300+ million Americans. The arguments could go on ad-nauseum from both sides of this. Over forty thousand people die every year on American roads. How many thousands of ER visits occur each year from weekend warrior' injuries (softball/volleyball/frisbee/etc...)? The insurers can't discriminate against those claims, but they are trying to do that against our infinitely smaller minority. The legal dept.s for the insurers would argue all day, hiding behind such convenient legalities. Like the man said: "I know it when I see it." You can be seriously injured or killed any number of ways w/o even leaving your home. The playing field is far from level on this. The insurers have too great of a financial advantage. Just because some dweebs in a board room are ignorant of, &/or afraid of skydiving. That doesn't give them the right to discriminate.

I could have brought this exchange into the political realm. However, I learned a long time ago to never discuss politics or religion w/strangers. They're far too polarizing. We all want to be friends here, right? I'm suuure you wouldn't want to argue about it...

[PiLFy 0]

"Then man up and accept the potential consequences of your actions."

This is a Smart_Butt comment that doesn't deserve a decent reply. As a student jumper who is keenly aware of his lack of knowledge/experience. Not to mention the fact that I started skydiving being VERY afraid of heights. I "Man Up" every time I pop out @14K'. You don't know me, sir. You've no idea how responsibly I live my life. Not too many people in this country wouldn't fear being hit w/$100K in debt. I pay my insurance premiums on time, every time. If I break a leg or two one day skydiving, or bicycling/jogging/doing the laundry @home/WHATEVER...? They can honor their part of the deal, & pay my medical bills (@their ridiculously discounted insurance company rates. Not the much higher rates for the Uninsured).

I've got a story for you, billy. There's an instructor @my home DZ. He's a nasty, surly pr*ck. He saunters around like he's a true Sky_God. He has >30 years of experience. He's been nasty to me from day one. It's a large DZ, & we don't have two words for each other. It was pointed out to me that he has a wealth of experience. It doesn't matter. W/his 'tude? I don't want a thing from him. There are other equally experienced instructors there who have the right motivations for teaching. That jackwagon does not.

This begs the question, billy. What are your motivations in posting an inflammatory quip like that? Are you trying to give back to the sport by teaching the newer jumpers? Is your concern to try your darnedest to help keep us from getting hurt? Or, do you enjoy posting surly comments while thumping your Sky_God chest?

[PiLFy 0]

"Got a link to this story? Understood that there are unscrupulous people in all businesses; but this sounds a bit over the top. Did they really prove (or have solid evidence) that a number of employees were in a conspiracy to fabricate denial reasons; or is that the accusation generated by you based on one anecdotal occurence?"


Hi Pirana,
I'm pretty wasted from work tonight, but I'll try to find it for you. I assure you this story, despite being quite over the top, is completely true. The carrier was allowed to deny any wrong doing. While simultaneously agreeing to pay about 42 mill, plus instituting policy measures to blah, blah, blah. There is nothing anecdotal about it. They were caught. They were fined. I think it was about seven years ago. I hope I find it tonight for you.

Edit: Here's other evidence of those policies:
http://attorneypages.com/hot/health-net-insurance-cancellation.htm

http://attorneypages.com/hot/la-city-attorney-sues-blue-cross.htm


http://attorneypages.com/hot/blue-cross-pays-fine-offers-new-coverage.htm

http://attorneypages.com/hot/health-net-lawsuit.htm


I'm still looking for that specific case. I'm finding all sorts of other carnage along the way. I'm running out of gas, fast. Do we have any paralegals here? I'm having a hard time trying to find that specific case.