MTB Riding and Insurance

[ghixon]

I was wondering, with all the risks that are inherent to mountain bike riding, what will or won't regular health insurance cover? I only ask this in a general sense. I know everyone's insurance is a bit different, but what do insurance co's generally take care of?

I was reading an IMBA article and associated call to action for changes to current legislation (H.R.1076, S 616) to include coverage for injury related to "risky forms of recreation".

Any of the folks on the DL have any insight?

Greg

[BrewMaster]

I haven't had anything too major, but my insurance (Kaiser) has never refused care because I was biking. In fact, they don't seem to care how I hurt myself.

Why would insurance refuse to pay for care if you were biking as opposed to playing football or something?

[soul rider]

the only issue that comes up is "did you get hurt at work? well did you?"
they have a hard on for work injuries.
i actually had a form of insurance that would pay me if i got hurt, for example getting knocked out= 100.00, broken arm 250.00 ,but in the fine print all the claims and paperwork you had to file it wasn't worth the hassle, God would have to tear open the sky and vouch for me..
if your insurance only covers head colds, time for new insurance.
ride free

[J_Sims]

Originally Posted by soul rider

the only issue that comes up is "did you get hurt at work? well did you?"
they have a hard on for work injuries.
i actually had a form of insurance that would pay me if i got hurt, for example getting knocked out= 100.00, broken arm 250.00 ,but in the fine print all the claims and paperwork you had to file it wasn't worth the hassle, God would have to tear open the sky and vouch for me..
if your insurance only covers head colds, time for new insurance.
ride free

This is the only question that I get as well.... This happened at work?? I even after the "repairs" I get a phone call from Aetna asking again just to make sure....

[Sprockethead]

I have United Health and they've never denied a claim when I went down with a MTB injury. Like the previous poster, all they asked me was, did you get injured at work?

[Flat Broke]

The reason your health insurance company wants to know if the injury occured at work is because they're looking to dodge out on paying. If it happened at work, then they can drag in your employer's insurance and spend less money themselves. We have "good" insurance (Blue Shield PPO, no co pay etc.) and we still have to watch every bill that comes in the mail because the insurance company will find any excuse not to pay on an item. When I was taken by ambulance to the hospital for my ankle, the insurance company denied payment for the ambulance ride because the EMT put Chris instead of Christopher. Nevermind my SSN was accurate, DOB was accurate, address was accurate, etc, etc. The insurance companies will do anything they can within the scope of legal behavior to deny a claim. The reason being is because the service provider/hospital/ambulance company ultimately holds YOU financially responsible. The insurance company has nothing to lose by denying a claim if they have any conceiveable reason to do so. The worst case scenario for them is that you catch it when the bill comes, and then they have to pay. Guess what, they held onto the money an extra month and made a little more interest on it. Multiply that behavior by every active claim and you can see why they exercise the practice.

Sorry for getting off on a tangent. If you're worried about whether your policy covers biking related injuries, simply call your insurance provider and ask for a statement of benefits and a copy of your policy. If they exclude coverage for any reason, it will be stated in there.

Chris

[2wheel_lee]

Although my accident a year and a half ago was on a dirt bike (85-mph get-off after being hit by another racer), it's basically the same.

My insurance covered everything, except a few minor co-pays! Two ambulance rides (one was an off-road ambulance to get me to the second ambulance), a helicopter ride, a visit to the ER where they took many full-body X-rays along with a bunch of other scans of my head (I had some facial injuries where they thought that my cheek bones may have been broken), two wrist surgeries (which included many X-rays over the course of about 5 months), multiple casts for the 5 months followed by physical therapy (which I thought was worthless). I don't know the total costs, because I didn't see most of the bills, but I'd bet it was near $100k.

My wrist still hasn't recovered, and it probably won't. I'm stil considering a third surgury to improve my range of motion. So, being that this was only a year and a half ago, understand why I may not have the balls to go big on stuff anymore.

As some else posted, my insurance company only asked if it was work related or not. That's all.

[spookydave]

here is one to look into. Will your life insurance pay if you die in a bike race? I know they will if you kick the bucket out on a group ride. But what about a sanctioned race?

They asked me if I flew planes or raced any type of motorsports. So I told him the truth and got the boohoo for you if you die boat racing. But they would pay if I flipped it while drunk out in front of the Roadrunner. lol

[0gravity]

I'm new to the area (LA) and need to switch to a California-based insurance company. What are the main providers? And what have your experiences been? Which is "better"? I strongly lean towards a PPO plan. Probably Blue Cross or Blue Shield. Has one been better than than the other? Thx

[~ Pakiha ~]

From what I recall from when I got my health and life insurance License (Avoid this cert at all cost OR DIE OF BOREDUM)

- If the injuries were self inflicted you may not be covered
- If you knew there was a high possibility of bodily harm they could cancel coverage afterwards
- If you continue to perform the activity companies will deny you and/or refuse to cover "Pre-Existing Conditions"

For example in San Diego there were a couple of brothers who LOVED BMX dirt jumping, but injured themselves continually and repetitiously, often ignoring Dr's orders and not finishing PT. They Lost there coverage, and have been denied coverage by anyone else, EVEN their parents work coverage will not accept them.

[papisimo11]

my blue shield ppo covered my whole hospital and pt bill.
34000 grand worth of work.
paz afuera

[Fired Yo Momma]

I hate insurance companys they are worse than lawyers. At least if you pay a lawyer you can get something back/service from them. I have Blue cross and they suck azz. They make me jump through all kinds of hoops "go here go their or we did not get the fax" thats a good one. I feel so bad for the old people that Blue cross makes jump through the hoops. If anybody works for blue cross your hearing it from me...they are horrible.

[ODB]

My Aetna HMO plan has covered two surgeries for me in the past two and a half years:
Busted femur: surgery and four-day hospital stay. Out of pocket: $250
Busted collarbone: outpatient surgery. Also $250.

I honestly don't know if i'd continue riding if i didn't have good insurance.

[JoeTruth]

Originally Posted by papisimo11

my blue shield ppo covered my whole hospital and pt bill.
34000 grand worth of work.
paz afuera

[SIZE=3]Between your $34K and my $90K, we could've scored a boat load of mota.
Damn hospitals and doctors!
[/SIZE]

[ghixon]

My wife and I have Blue Cross/Shield PPO and so far, I haven't had to take any "unscheduled" trips to see a doctor type (knock, knock). I have requested a complete statement of coverage from the insurance company. Our in-house HR folks aren't sure what would be considered risky for recreation, but I thought I would ask about to get any first hand knowledge.

Thanks to all for the info....

Greg

For example in San Diego there were a couple of brothers who LOVED BMX dirt jumping, but injured themselves continually and repetitiously, often ignoring Dr's orders and not finishing PT. They Lost there coverage, and have been denied coverage by anyone else, EVEN their parents work coverage will not accept them.

I'm curious to know if someone were to repeatedly injury themselves riding recreationally, if the insurance company would cancel your policy or just raise your rates. I suppose you could just call it bad luck.

[sladnas]

There is a fine line (sometimes) that insurance walks when denying coverage. If it happens to you, I just hope you have good lawyer and tons of money. The amount of "risk" of a given activity is really a function of several things of which age and health are fairly large factors. In other words, risk is a subjective tool insurers will use to deny claims. There is no common definition either...so you can just hope that when the time comes, you aren't denied.

If you are concerned about it, make an anonymous call to a representative and ask about specifics of their policies.

As for getting your policy canceled for repetition...again, subjective. If you are ignoring doctors orders (which are written in your chart), of course they have grounds to dump you...

[queenwilhelmina]

Almost all insurance co's I've used have pissed me off in one way or another and it gets worse every year. But usually if you are insured through your employer, that group plan is generally a bit better than trying to get insurance on your own. And I've found that even though the process can be frustrating, they generally won't just flat out deny a claim for no good reason. At worst, you'll have a high deductible and have to pay that.

[soul rider]

My doctor has a big chuckle looking at my chart. 90% of the chart is all mountain bike related. never had a problem with the frequency of visits due to biking.