Accident and Rescue Insurance – Part 2


This post by WildSnow.com blogger  
Will your accident insurance pay enough?

Will your accident insurance pay enough?

Accident insurance in the United States of America is as much a black water swamp as any other category of health insurance. Attractive (sometimes) websites and carefully worded PR copy make you think you’ve found the Valhalla of covering your backcountry skiing behind, but read the fine print before you dump your piggy bank. Oh, and what’s NOT in the fine print will chomp your wallet as well. (See Part 1, Rescue Insurance.)

Due to their advertising, Aflac is well known for accident insurance. Like any insurance company you’ll spend hours figuring out if they’ll provide anything useful in return for your coin. You can download a huge 36 megabyte PDF “brochure” on their website, then after thinking you’re getting an idea of what they offer (as well as using up a large chunk of your monthly bandwidth) you’ll notice text that reads “Refer to the policy and rider for COMPLETE DEFINITIONS, details, limitations, and exclusions.” So what you’ve just read is mere PR copy. Shucks.

After research worthy of a Bible scholar, we determined that Aflac does cover skiing, but we were never clear about their coverage of what they call a “hazardous Activity Accident.” For example, the agent we spoke with couldn’t tell us if “mountain climbing” applied to doing a hike-up peak, or was defined by the use of ropes or what. That kind of vagueness is a red flag warning when it comes to insurance because when you do make a claim you’ll likely encounter a skyscraper full of individuals who’s job it is to figure out ways to deny paying you. Thus, let’s say you’re out hiking up a mountain one day and lightning takes you out. Aflac will pay their death benefit to your loved ones? Will it pay if you survive and end up with fourteen different injuries? Unknown.

People who like Aflac say it pays quickly, and making a claim is easy (at least when they do cover you).

Indeed, unlike Aflac, other types of supplemental insurance may require you to first apply for coverage with your “primary” insurance, usually your main health insurance policy. Once you receive an “Explanation of Benefits” (EOB) from your primary, you send it along with your application for payment to your supplemental insurance. The process can be confusing and times consuming — especially if you’re incapacitated and have limited help.

(What is more, Aflac and all other accident insurance always require a physician to fill out some part or portion of the claim form. So you’ll go through a process of mailing or hand delivering the claim form to the doctor, getting it filled out, then retrieving it. Again, it’s a hidden cost in terms of time and effort.)

Despite the (relative) simplicity of how they pay, the problem with Aflac accident insurance is despite what we determined were significant monthly payments, the benefits were so meager compared to common medical care costs as to be a Las Vegas lounge joke. For example, the emergency room benefit is $120 and the MRI/CAT benefit is $200 per year. It’s been my experience that when you end up in a hospital emergency room, they’ll stick you in the MRI and the CAT at the slightest indication, and might even throw in a quick x-ray just to be sure they didn’t miss anything. That $200 will buy one of the MRI tech’s shoes. The other $3,000 for the procedures will be up to you and your insurance deductible, not Aflac.

In other words, Aflac is not really “gap” insurance that helps make up for a huge health insurance deductible. Instead, it is a pricey way to receive a bit of cash if you get hurt. Instead, “real” accident insurance might be a better option if you’re taking care to cover yourself financially.

“Real” medical accident insurance

One choice is the insurance offered through the American Alpine Club, associated with Adventure Advocates, selling accident insurance underwritten by United States Fire Insurance Company.

At least you know their insurance covers climbing! More, the “Plus Plan” covers skiing/snowboarding as well as helicopter rescue. What you’d want is the “Gold” version of the “Plus Plan” as it is the only level with a useful payout per accident of $10,000 ($50,000 for permanent consequences such as dismemberment). Still low, but if viewed as “gap” insurance to work with your health plan, those are useful sums. But wait, sit on a snowmobile and you’re not covered. Likewise, better make sure you’re a “fare paying passenger” in any aircraft, or you’re not covered.

More, the cost of AAC/Adventure-Advocates accident insurance is significant. Try $268 a month, or $3,216 a year for your family. If we applied that $268 a month to our Blue Cross bottomless cash hole, we could possibly drop our deductible down to where we could self insure for the “gap” by simply placing some of what we’d spend on accident insurance into savings.

Another option for accident insurance that covers backcountry skiing is American General Life’s accident policy. This is the accident insurance we ended up with, primarily because it doesn’t exclude mountain sports or snowmobiling (though parachuting is not covered). Maximum benefit per insured per year is $15,000. Again not huge, but significant if you have high-deductible “major medical” health insurance. Cost for our family of three is $358.35 a year. Sound affordable? Yes, with huge caveats.

First, American General really is supplemental insurance. It only covers your initial treatment (has to be obtained within 72 hours of incident), plus a limited amount of “three follow-up visits” per accident. All visits to occur within 30 days of the accident. Maximum benefit per person per year is $15,000.

The policy declaration is more confusing than a used car salesman about what they mean by “follow-up.” For example, say you broke your femur and ended up in the emergency room, then needed a $200,000 open reduction surgery. Would the operation be a “follow-up” visit? We got our medical billing consultant to research this as we didn’t even know how to ask the question.

Consultant determined that yes, a surgery would count as a follow-up and obviously take you up to the maximum benefit (after which, hopefully your major medical policy would kick in.) BUT, the surgery would have to happen within 30 days of the accident and would count as one of your “three followup visits.” Also, it has to be outpatient!

In other words, you’d have to be careful not to use up your “follow-up” visits with doctor’s office visits while you’re trying to determine your course of treatment — and if you do need surgery, better not spend a night in the hospital! If that game sounds a bit ridiculous, rest assured it indeed is somewhat strange (and appears to be a disguised way for this policy to not pay out for major surgery).

In the heat of a severe injury, while you’re trying to juggle family life, job, and healing, you’re trying to remember you can only see the doctor a total of four times on your accident policy? Perhaps American General should pay to have their fine-print tattooed on the back of your hands, or perhaps imprinted on your spouse’s forehead so when they’re visiting you in the hospital you can review the details.

(Also in the fine print of your accident insurance: Do they cover prescription drugs? Chiropractic? Probably not.)

Another problem with American General (and probably any accident insurance) is that the claims process is complicated and time consuming. For example, they’ll want a “Completed Accident and Health Insurance Claims form.” Easier said than done. This form has to be completed by the “attending physician,” meaning you’ll have to bring it to where you received care and get it filled out. Adding to the process, if you have primary health insurance that claim has to be made first, then the “explanation of benefits” (EOB) forms you receive from your primary have to be sent along with the American General claim. If you’re trying to hold a job as well as heal, add all the paperwork and you’ll feel like you’re rebuilding a NASCAR engine with nothing more than a pocket knife.

Moreover, say you get hurt in Nepal and the doctor that treats you doesn’t even speak English, let alone file insurance claims for you. That means when you get home, before collecting from your supplemental accident insurance you’ll have to somehow create or obtain the proper forms from the Nepalese doctor, which you will then have to file yourself with your primary health insurance company. Only when you get the EOB form back from your primary will you be able to apply to the supplemental. Time for that medical billing consultant we mentioned in Part 1? You bet. Learning to speak Nepalese might be a good idea as well, along with being sure your phone is enabled for international dialing.

In the end, while accident insurance looks good on the surface we’d recommend taking care with what you end up paying for. It may look better on paper than it performs in real life.

Commenters, please let everyone know your experiences with accident insurance. Above is base on my limited experience — am always willing to learn more.

Comments

13 Responses to “Accident and Rescue Insurance – Part 2”

  1. etto July 1st, 2013 10:54 am

    Sometimes being Norwegian is just great. OK, taxes might be higher than in the US (but surprisingly not by much!). But you do get free SAR service, and free health care. That doesn’t mean you shouldn’t have an insurance for travelling, (dental, gear etch are not covered), particularly if going abroad, but still. And surprisingly quite a few of those normal travel insurances cover very much.

  2. Lou Dawson July 1st, 2013 11:05 am

    Yeah, one thing you realize when traveling much is it’s all relative. Wonderful to have “free” health care, but factor in taxes and the price of petrol and beer, and you realize it’s probably just as hard to keep your money in the bank when you’re Norwegian as it is for us Americans.

    On the other hand, the worst part of our insurance in the end is not the cost, but the incredible time suck of doing the paperwork if you actually do need your insurance.

    http://www.thisismoney.co.uk/money/cars/article-2127644/Worlds-expensive-petrol-hotspots-revealed-Norway-tops-charts–does-Britain-make-ten.html

  3. Lou Dawson July 1st, 2013 11:06 am

    Forgot to mention, we have free SAR here in America as well. Hah!

    Also, with a nod to European exceptionalism I added “United States of America” to the beginning of my rant!

    Lou

  4. Mac July 1st, 2013 5:59 pm

    There are a lot of great things about the US, but I’m afraid that the healthsystem & insurance (of any sort) certainly isn’t one of them!

    Personally I am very happy to have ‘free’ universal government funded medical/health insurance, along with a “no fault” accident compensation scheme. New Zealand’s health outcomes are better than those in the US and despite being entirely funded by taxes, cost less than the rather miserly US system!

    Still, I’d probably be tempted to swap NZ’s ACC sytem for American western US snow pack!

  5. Mac July 1st, 2013 6:09 pm
  6. Lou Dawson July 1st, 2013 6:15 pm

    As you can read from my posts, I’m not exactly a fan of our U.S. health care system as it stands, though I do think we’ve got a bunch of exceptional doctors, nurses, etc. No country or region is going to be the perfect society, pluses and minuses. I’d still rather live here, works for me. My hope is we’ll gradually improve our system. I’ll be amazed if Obama Care is any improvement, but I’m prepared to be amazed and I’ll be delighted if it is a step forward.

  7. Lou Dawson July 1st, 2013 6:34 pm

    Mac, good stuff but any thinking person has to wonder how they measure “health.” Pretty ambiguous if you ask me. For example, let’s take suicide rates, a pretty good measure of one of the most important kinds of “health.” See where U.S. is on that list… http://en.wikipedia.org/wiki/List_of_countries_by_suicide_rate

  8. Jernej July 2nd, 2013 4:14 am

    I’ll continue the cheeky commentary and say that in some countries we take care of death and killing on our own, in others the task is outsourced. The end result is the same.

    How did the conversation end up in suicides?!

    As far as health and insurance institutions go I don’t have a particularly good or bad opinion about any country but for purely practical reasons I prefer the universal, mostly free healthcare systems. In the end it often depends on the particular person you’re dealing with, not the institution.

  9. Lou Dawson July 2nd, 2013 5:32 am

    Good example of a “summer” comment thread on WildSnow (grin)!

  10. John S July 2nd, 2013 8:04 am

    From a nation building perspective, I think the lack of single payer universal access health care is holding the US back. The US private system has come to the point where people consider health insurance one of the most important things in their lives. This means there are risks with changing jobs, or more importantly, becoming entrepreneurs. The high cost of non-group insurance inhibits small business growth.

  11. Rob July 2nd, 2013 9:13 am

    Lucky for us in Canada we don’t worry too much about insurance within Canada but travel insurance when we leave can be an issue. That being said when I lived in the UK I used a company called DogTag Insurance.

    The list of sports they covered (and did not cover) was clear and extensive and they offered a variety of levels of sports coverage. It was expensive (5x the price) compared to regular travel insurance but I guess thats the price you pay for thoughtful clarity in the world of “Exteme” sports and travel insurance.

    Would be nice if the North American insurers could do the same.

  12. Lou Dawson July 2nd, 2013 9:20 am

    Rob, fire in a link for Dog Tag please. Thanks, Lou

  13. jim July 2nd, 2013 2:13 pm

    Got hazardous activity medical evacuation insurance for Antarctica with medex insurance, but it doesn’t cover trip interruption due to mechanical failure or revolution. Given the situation in Argentina and prior trip cancellations when the Russian ship broke, I need to buy an additional policy. Can anyone recommend someone with trip cancellation, without the medical, which I already bought? Thanks.

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Welcome to Louis (Lou) Dawson's backcountry skiing information opinion website and e magazine. Lou's passion for the past 45 years has been alpinism, climbing, mountaineering and skiing -- along with all manner of outdoor recreation. He has authored numerous books and articles about backcountry skiing and is well known as the first person to ski down all 54 of Colorado's 14,000-foot peaks, otherwise known as the Fourteeners! Books and free back country news and information here, and tons of Randonnee rando telemark info.

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