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  1. #1
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    Insurance - Hospitals $$

    just wondering how you guys in the USA get on in the event of an injury that requires a hospital visit.

    Does your health insurance cover you for what could be considered a dangerous sport - mountain biking?

    Or could you be bankrupted by a serious injury?

  2. #2
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    Quote Originally Posted by mtb101 View Post
    Does your health insurance cover you for what could be considered a dangerous sport - mountain biking?
    Health/Medical insurance does not need to know anything about the fact that you are a mountain biker. This is even more true with Obama Care and the fact that insurance companies can't deny you coverage for pre-existing conditions.

    If you have insurance you are covered. That's what it's for. Hopfeully you'll never need it, but if/when you do there's nothing to worry about. At most, you'll have to pay a deductible for the hospital visit.

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    Quote Originally Posted by dharel1705 View Post
    Health/Medical insurance does not need to know anything about the fact that you are a mountain biker. This is even more true with Obama Care and the fact that insurance companies can't deny you coverage for pre-existing conditions.

    If you have insurance you are covered. That's what it's for. Hopfeully you'll never need it, but if/when you do there's nothing to worry about. At most, you'll have to pay a deductible for the hospital visit.
    so wouldn't they work out you are an mtber if you were injured and required emergency medical attention on an mtb trail with your mtb gear on. Would your insurance then cover you or would they be saying ha ha (read the fine print!!) doing a dangerious sport you aren't covered - well maybe not fully.

  4. #4
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    No. Not an issue with health insurance here.
    Some disability insurance policies do exclude "dangerous sports", but thankfully I have never seen MTB or cycling listed. Skydiving, hang-gliding, para-gliding are always there, and sometimes scuba diving. I think cycling is too popular and prevalent to be included.. plus the average person has no idea how fast we go and how knarly some of the things we ride are so they may actually underestimate the risk involved, IMHO.



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    Yea, not an issue. The paramedics had to put me in a basket and carry me out from a well known riding park, in gear. ER doc asked how I fvcked myself up so good, so I told him.

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    Quote Originally Posted by knoob View Post
    Yea, not an issue. The paramedics had to put me in a basket and carry me out from a well known riding park, in gear. ER doc asked how I fvcked myself up so good, so I told him.

    Sent using BOTH my thumbs
    The insurance company will send you a form to fill out asking if there are any 3rd parties you can think of who they can sue to recoup some of their expenses from paying your claim, though.

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    As a follow-up example. I'm a facial surgeon and have taken care of people that wrecked on their MOTORCYCLES, while riding without a helmet, while under the influence of alcohol or drugs...even one that was uninsured got financial aid from the hospital, got on Medicaid and has had multiple reconstructive surgeries paid for. Risky behavior is not punished in the medical system....

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  8. #8
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    Quote Originally Posted by mtb101 View Post
    just wondering how you guys in the USA get on in the event of an injury that requires a hospital visit.

    Does your health insurance cover you for what could be considered a dangerous sport - mountain biking?

    Or could you be bankrupted by a serious injury?
    Your financial liability in an emergency will depend on the "quality" of insurance you have and the type of policy you purchased.

    There is a lot of small print in policies that concern "out of network costs/non system provider costs" etc etc.

    You will generally receive quality care if you have insurance, but whether or not you will be bankrupted depends on your personal financial situation.

    Even with a quality insurer, the type of policy you purchase doesn't mean you always avoid paying massive out of pocket expenses.

    You need to meet your deductable, out of pocket expenses, etc. If you're insurer doesn't settle with a care provider at an amount that provider finds acceptable, that provider will likely come after you for the balance.

  9. #9
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    Well I'm about to find out with a recent visit to Emergency after hard fall, Ribs,Clavicle broken. I have no Insurance and received great care as far as I could tell. I have not been billed yet so am a bit worried of cost. We spoke with hospital and they said we can set up a payment plan and would get 20% discount if paid all at once.

  10. #10
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    It still amazes me the amount you guys in the States have to pay for medical insurance and how worried you are if you don't have it.

    Even without private insurance, in Australia you will pay nothing if you get hurt and need to be air lifted or ambulanced to hospital, regardless of the injury, or whether surgery is required. The only real expense is medication which costs nothing anyway.

    Even privately my chest x-ray when I busted my ribs only cost me $50 out of pocket.

    Hopefully one day the insurance companies will not have such a hold over your politicians and you can get a better more fair health care system for all.
    Last edited by brad72; 09-08-2012 at 02:36 AM.

  11. #11
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    Insurance is not all its cracked up to be

    I sustained a head injury in a collegiate mountain bike race a few years ago. I had insurance through the university (as a grad student), and the insurance company denied my claim since I was involved in a sport. 38,000 dollars later I have finally paid it off. thankfully USAC insurance covered the first 25k, but it still cost me 13000 out of pocket.
    Now if I get hurt for anything, I say that I "fell off the couch eating cheetos". There is no clause in insurance policy against that.
    I have also lived in New Zealand, and lost a finger in a farm accident. The care was phenomenal, and did not cost me a cent. Nationalized healthcare was great, IMO.

  12. #12
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    I went 150 feet down a steep mountainside last November while mtn biking. I have an HMO (no deductible). My ER visit totaled over 8K. All I had to pay for was a $100 ER fee for the trauma center I was airlifted to. I think my policy does have a cap of either 35K or 50K per year though.

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    Highmark, a health insurer in Pittsburgh, PA ran an ad campaign a few years back that was essentially: "Go ahead and bomb that downhill. If something happens, you're covered." I think it was actually about skiing not mtb, but the gist is the same.

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    Quote Originally Posted by agriholic View Post
    I sustained a head injury in a collegiate mountain bike race a few years ago. I had insurance through the university (as a grad student), and the insurance company denied my claim since I was involved in a sport. 38,000 dollars later I have finally paid it off. thankfully USAC insurance covered the first 25k, but it still cost me 13000 out of pocket.
    Now if I get hurt for anything, I say that I "fell off the couch eating cheetos". There is no clause in insurance policy against that.
    I have also lived in New Zealand, and lost a finger in a farm accident. The care was phenomenal, and did not cost me a cent. Nationalized healthcare was great, IMO.
    You should have got a lawyer asap in this case. I'm not one for suing but that's just wrong.

  15. #15
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    Quote Originally Posted by bloodninja View Post
    Highmark, a health insurer in Pittsburgh, PA ran an ad campaign a few years back that was essentially: "Go ahead and bomb that downhill. If something happens, you're covered." I think it was actually about skiing not mtb, but the gist is the same.
    Yeah Highmark around here is generally really good. I just had my first problem after fifteen years of being insured by them. A quick argument over the phone and they caved and paid the bill.

  16. #16
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    Quote Originally Posted by Norman Clydesdale View Post
    Your financial liability in an emergency will depend on the "quality" of insurance you have and the type of policy you purchased.

    There is a lot of small print in policies that concern "out of network costs/non system provider costs" etc etc.

    You will generally receive quality care if you have insurance, but whether or not you will be bankrupted depends on your personal financial situation.

    Even with a quality insurer, the type of policy you purchase doesn't mean you always avoid paying massive out of pocket expenses.

    You need to meet your deductable, out of pocket expenses, etc. If you're insurer doesn't settle with a care provider at an amount that provider finds acceptable, that provider will likely come after you for the balance.
    ^^^^^This.

    It all depends on what carrier and what policy, etc. etc. you have. There is no easy answer, because every case is different depending on the plan one chooses. And, the plan chosen usually has a strong correlation to income. I try to choose the plans that actually limit how easily I can be bankrupted. There is a point where I know the cost would be a point of no return for me, where I would lose everything. So I try to choose a plan where that point is only reached in a catastrophic scenario. I figure if I am in a coma or fighting for my life, I really won't give a **** about my money anymore and just let the banks take it all as long as I can get my life saved in return. *shrugs*.

    When it comes to basic care, I just only go to the doctors when I can't figure it out myself. The copays, cost of drugs, specialists, tests, etc. add up really fast. I almost got myself in a bunch of trouble last year when a well meaning doctor ran a bunch of tests trying to sniff out a long-time problem I had been having. She couldn't figure it out, and I ended up with a bill of over $600 for all the special tests she ran. I applied for a reduced payment thing for low income patients through the insurance company, and they accepted a much smaller payment from me. I will ask about the cost of all tests before I let someone do that again.

    I avoid the ER and hospitals like the plague, the cost is ASININE up front if it is only something minor. It is only worth it for major injuries, then it evens out. If I hurt myself while riding, and couldn't take care of it myself, I would try to make an appointment with my doctor and wait out the appointment date before going to the hospital. I slammed my finger in the car door one time, saw bone when I got it out and dragged my oozing, swollen digit to the ER. $365 and 6 hours later, with no sleep before my classes, I had a gauze bandage and a prescription for tylenol. I was NOT a happy camper, and have not been to an ER since. Protip: the dollar store carries that liquid stitches glue the docs use for cuts that only need a few stitches. It was what they used on my car-door finger, and it only costs a dollar! Pick up some generic tylenol for a dollar while you are there, as well as a pack of gauze and a roll of medical tape. I could have saved myself $361, 5 1/2 hours, and had leftover supplies! >.<

    I had major surgery when I was a teenager, and should have had followups for something like 15 years. I stopped doing them after I was no longer covered under my parent's insurance because I wasn't having any problems. Seeing a specialist really wasn't worth the money.

    It's the American way. Trust us, is is the only way that doesn't lead to socialism and nazis

  17. #17
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    I know that us Americans get bad publicity in countries with universal health care, but if you know the ins and outs of the various sytems there are quality health care institutions in place. Cutting my knee open riding in Fruita, Colorado required an ER visit which was paid for by the college-sponsored health insurance, and due to my volunteering for various active duty military tours I qualified for treatment at the federal government owned VA health facilities. When the federal government owned and operated health insurance program TriCare denied my hip surgeries as experimental, but would pay for much more expensive hip replacements, I went to the VA and they performed the less invasive hip surgeries without charging me.

    True, that these avenues aren't open to the general public that aren't affiliated with any institution, but for those who play their cards right there are some options.

  18. #18
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    Outside of the deductible (the MRI's wipe that one out fast) and copays for PT/Dr visits/Px, I'm covered 100%. As long as I stay "in-network" that is...

    But step outside for a moment my insurance company slaps you silly. For example- I had an ambulance trip courtesy of massive kidney stone attack last August. Month later I got slapped with a $600 bill for a 3 mile ride in the back of the bus because the ambulance company 911 sent was "Out of Network" (last i checked, i didn't get a choice in who responded) Next time I'll just drag myself in somehow...

    Had a friend require an ambulance trip out of Baxter State Park last July, a good 10 hours from where she lives and works, thanks to a nasty spill in camp. Somehow the Millinockett rescue squad was "in-network" for her insurance and the ride was covered
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  19. #19
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    Quote Originally Posted by brad72 View Post
    It still amazes me the amount you guys in the States have to pay for medical insurance and how worried you are if you don't have it.

    Even without private insurance, in Australia you will pay nothing if you get hurt and need to be air lifted or ambulanced to hospital, regardless of the injury, or whether surgery is required. The only real expense is medication which costs nothing anyway.

    Even privately my chest x-ray when I busted my ribs only cost me $50 out of pocket.

    Hopefully one day the insurance companies will not have such a hold over your politicians and you can get a better more fair health care system for all.
    Your medical care is not free. Everyone is paying for it through taxes.

    I now get a rebate on my premiums if I 'maintain a healthy lifestyle', which includes not smoking, body weight, BP, etc, and engage in regular exercise. Mountain biking is on the list of approved healthy activities.

  20. #20
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    Insurance in the US is a joke. Luckily I have top tier coverage with my job. I make sure to use more than I have to for checkups and what not. I have seen people be totally devastated financially from medical bills.

  21. #21
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    Stepson went to emergency room for suspected appendicitis... 6 hours later, turned out to be gas and a desire to stay out of school... bill = $8,000.

    Mother went to hospital with agonizing back pain, turned out to be cancer, tumor pressing on nerve... spent 6 days in hospital... very tiny room with a tv, no special equipment, visit from nurse every few hours... bill for the room (not treatment) = $80,000.00

    Guy I work with, his wife was diagnosed with cancer, died in 6 months, total bill for treatment was around $1.4 million

    Yep... medical bills will swallow whatever you've been able to squirrel away in pretty short order.

  22. #22
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    It's sad we are such a wealthy country (I am speaking for us United Statesians) and our health care is so awful. Not blaming any party, I think all parties can share a bit of it.

  23. #23
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    Broke the left collerbone which punctured my lung on the road bike last year. After ER, multiple follow-up Dr visits, 3 nights in the hospital for partial collapsing lung, surgery(s)..... I fulfilled my $3000 deductible...(ouch, could have built a decent Mtb with that). My only tip and even though my accident was not on a Mtb, you need know you limitations on what you can and can't do on the bike. It's risk / reward, some may need to ask themselves 'is it worth it to go that fast or bomb this technical descent' ???

    By the end of all of my Dr visits, I received a stack of bills from all of the doctors that I saw which was quite a few considering the injury. I started a spreadsheet just to keep track of them... I believe that all of them totaled up to over $30,000...
    "Don't ride faster than your guardian angel can fly"

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