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Denial of insurance for "dangerous" recreation

post #1 of 25
Thread Starter 
Did you see this article in the January issue of Skiing (pg. 30)?

Evidently (to quote the article) last spring, the government said it would permit health insurers to deny coverage for "dangerous" recreation, a policy that was previously prohibited by the National Insurance Portability and Accoutablity Act. And that means skiing (and mountain biking and snowmobiling and horseback riding.....).

The article goes on to say:

There is no need to panic - yet. No one has been denied coverage, and the new rule will only apply to furture plans, not current ones. But when renewals come up, it could all change. Key pointer: Make sure to read the fine print when your policy is up for renewal.

So, what do you think?
post #2 of 25
Sugar,

Oh man, this would be terrible!

I don't think it'll happen though. Too much money involved with skiing -- it's a billion dollar a year business.
post #3 of 25
I think there was a thread on this topic last spring. I don't think it would make much economic sense for plans to deny coverage for skiing mishaps (presumably skiers are a more healthy population than the average American, and would be able to switch to a plan that didn't exclude skiing accidents). But you never know - as Sugar Snack said, read the fine print!
post #4 of 25
Yes there was definitely a post here last spring. We were supposed to write our congressmen. Guess it didn't help!

Considering the amount of sedentary individuals who have heart attacks while watching TV, why don't we deny coverage for television viewers? Or how about the number of people who either sprain their ankles or break bones while walking on icy sidewalks. If they had been skiers, they may have had better balance. Should we deny coverage for having a sedentary lifestyle? {perhaps we should!}

Many people have Seasonal Affected Disorder in the winter, and run up their health care bills with psychological care. Skiing is the best antidote for SID. Why don't we deny coverage to people who were not smart enough to take up a winter sport?

Recent studies have shown that prevention of osteoporosis is accomplished LESS by using weight training machines, and MORE by unpredictable weight bearing activities, such as skiing.
Lets just deny coverage to anyone who never read that study, and ends osteoporsis despite hours on the leg extension machine!
post #5 of 25
Most non-skiers will think "Not a bad idea if it will lower rates...."
Of course there will be no lower rates. And don't think that the insurance companies didn't gang together to lobby for this. So there will be no major insurance company that will offer coverage for no additional charge. And since most people get health insurance through their employer, it probably won't be possible to get the optional coverage. Which means that you will have to go to a specialist insurer. Which means $$$$$.
What a pisser! :
post #6 of 25
This is another fine exsample of congress giving the public the shaft and favoring one industry over others.How much "soft" money do You think the insurance lobby pumped into congressional campaigns?
In my opinion The most at risk activity is unactivity.I bet that the guy who spends his day at a desk all day then spends his weekends drinking beer eating junk food and watching sports.will cost the insurance companies a lot more money in long term heath cost then someone who gets out and does some "at risk sport."Just sitting here reading this is putting me at risk.It's raising my blood pressure to dangerous levels.So if I have a heart attack can I sue the insurance lobby?
post #7 of 25
Well Said, Utah!
post #8 of 25
There's always the V.A. I suppose...
post #9 of 25
Was wondering how long it might take for insurance companies to tune out skiers. I'm a recreational scuba diver, and have been denied insurance since I was certified. I always have to smirk at how insurers think their doing you the biggest favour in the world by "allowing" you to pay ridiculous premiums for coverage. Of course when you do have to make a claim, they do everything they can to figure out an excuse not to make a payout.

You can't win with insurance. If you collect on a claim, it's because something bad happened. Best insurance is a healthy lifestyle, being cautious with calculated risk, and watching out for the other guy.
post #10 of 25
Come and live in Europe, my friends, where most health care is free (though in Britain is sometimes lacking in consistent quality).
Surely free health care, with no questions asked, is something we should ask of all governments?
And don't call me Shirley.
post #11 of 25
That and free education too.
post #12 of 25
This can't bode well for my motorcyle road racing affliction. (actually there were already companies wouldn't cover it but this seems to codify it.)

I hate insurance companies! :
post #13 of 25
I'm an avid skier but thought I'd provide another perspective.

Perhaps the premise behind this clause is that those who engage in behaviors or activities with higher risk should pay higher premiums. For example, those who smoke have higher risks of having health problems and should incur higher health insurance premiums. Most would agree that this is not unreasonable. I, as a non-smoker, should not have to (and do not want to) pay for the health costs of those who smoke. If you have many traffic violations on your record you, not I, should have to pay a higher auto insurance premium due to your increased risk of having or causing an accident.

I think insurance companies are just taking that principle and applying it to other activities. Yes, certain athletic endeavors are considered higher risk and have higher injury rates. Insurance companies, for the most part, have low profit margins and are looking to make insurance more affordable for the average person. Should those who do not engage in these high risk activities have to pick up the extra cost for those of us who do? Because ultimately, as medical bills from injuries rack up, everyone will have to pay more.

It is not that insurance companies will not cover these activities. Those who choose (that's the key word here) to participate in these activities may have to pay a higher premium to cover their additional risk. Just as I don't want to pay higher premiums to cover those who engage in high risk behaviors which I choose not to do, I don't think the average Smoe should have to pay for the higher risk I choose to incur. We should take responsibility for our actions. Remember, insurance is an option, not a right or requirement. You don't have to buy it if you don't like it.

Let the nastyness begin.
post #14 of 25
Well Prosper, that would be fine if it worked the other way. I work out 6 to 7 days a week, don't smoke, have a safe driving record and lead a reasonably healthy life style. Are the insurance companys going to give me a decent discount for being a good boy? Fat chance. This is just another way for them to cut their losses. Most of us pay healthy premiums every year to protect ourselves and rarely collect. But if you do make a claim, especially with autos, there is a chance you may be cancelled. Talk about house odds.
post #15 of 25
Exactly, Lucky! Some time last year, on another ski forum, I posted something about Kenneth Cooper being considered for Surgeon General. One of his plans was to give a 1,000 tax rebate to anyone who had a healthy lifestyle. You would not believe this , but on a ski forum, people were horrified at the idea!

Another odd thing: You know how some insurance companies send out these "healthy lifestyle" newsletters? They will recommend certain activities, usually ones that they consider "gentle". One that comes up all the time is Yoga.

Not to say anything negative about Yoga, but
IF
Someone has extreme joint laxity or hyperflexibility, Yoga can overstretch the body, making you more susceptible to serious injury. Many of the postures, such as the full lotus, are horrible for the knee joints, as well as totally non functional for a western lifestyle. The shoulder stand or plough can cause herniated disks in SOME people.
IF
Someone has low blood pressure, the constant head up head down can cause fainting spells.
IF
Someone has a low metabolic rate, certain forms of Yoga will make that rate even lower, promoting, you guessed it, weight gain, which is a health risk.

Yoga classrooms are often kept at ridiculously high temperatures! For some people, this in itself can cause a health risk. For others, if there is someone in the room in the early stages of a virus, the high temperatures will make everyone else susceptible to it.

My point was NOT to do a rant against Yoga, because for some people, its a highly effective form of fitness. But by insurance companies pushing this as a one size fits all sort of fitness plan, they are inadvertantly setting SOME people up for injuries or other medical problems.

So my point is, you cannot arbitrarily assign the tag "dangerous" to certain activities, without seeing the big picture.
A hyperflexible overweight person, needs to be active in activities that promote JOINT STABILITY, such as skiing. They need to be in the cold, to promote thermogenisis.
Also, with today's emphasis on families, should'nt insurance companies be promoting more family friendly activities?
post #16 of 25
Yeah, like lucky said...

this isn't about people with dangerous hobbies paying more. This is an excuse for the insurance companies to get more money.
If it was REALLY about fairness then other people would be getting discounts and the net income to the insurance companies would stay the same.

There's an old saying and I think it applies to the insurance companies here...

Your actiona are speaking so loud I can't hear a word you're saying.
post #17 of 25
This is the dumbest thing that I have ever heard. Well, one of the dumbest... Everybody in America lives a high risk lifestyle, so everybody should deal with similar insurance costs. I drove home the other night around 2 am, sober. Should I have to pay higher rates because I am on the roads at a higher risk time of being hit by a drunk, no. I pay around $110 a month for my health insurance, over a few years, that adds up. I have not been to the hostipal in a long time, I went a few months ago. So to get that peice of glass out of my foot cost me around $3000! Now, I'm a skier, should it cost me $5000, NO! I'm in good shape, leave me alone!

Of course, like a trend that bugs me lately, I could sue Volkl for making my skis that got me hurt like smokers going after Phillip Morris. Forget insurance, you can just sue. :
post #18 of 25
Snack,

This topic was discussed in the forums at MTBR.com (a mtn bike web site) about a year ago. I think it's all panic and no substance. How in the world would it be enforced? The distinctions of difficulty and danger among the types of alpine ski runs (and mountain bike terrain) make it impossible to determine that simply riding a bike or being on skis renders you uninsurable.

Coverage of this nature is determined by the individual insurance carrier and its underwriters, and by the availability of reinsurance for that carrier's risks. It depends on the market, not on some hokum scare about "deniability" on certain types of activity.

The strongest indicator that this story is hokum is the fact that NOBODY has released any details on what insurers have filed policies, riders or endorsements that exclude such coverage. Insurance carriers must file their policy forms with state regulatory entities, and in many states, the regulators must approve the filed policy before the carrier may use the policy in the market.

NOBODY has provided detail of the status of the filing and/or approval.

Sounds to me like an urban legend.
post #19 of 25
Thread Starter 
<BLOCKQUOTE>quote:</font><HR>Originally posted by gonzostrike:
Snack,

This topic was discussed in the forums at MTBR.com (a mtn bike web site) about a year ago. I think it's all panic and no substance. How in the world would it be enforced? The distinctions of difficulty and danger among the types of alpine ski runs (and mountain bike terrain) make it impossible to determine that simply riding a bike or being on skis renders you uninsurable.
<HR></BLOCKQUOTE>

First off let me apologize for bringing up a subject that has already been discussed. I just saw the article in the January 2002 issue of Skiing so it was new to me.

Secondly Gonzo you obviously know little about denial of insurance benefits. That's what I do for a living. It's enforced when you get injured skiing and try to collect benefits and your insurer denies payment. You sue (this is where I come in) and you get your entire claim, medical history, life investigated. We determine that you were indeed engaging in a dangerous activity and we stamp a giant "DENY" on your case. This will last for about a year racking up attorney fees while your medical bills go unpaid. Eventually we may settle with you but not before you're totally insane and mad as Hell.

Although it's not in full force and effect right now I would not go so far as to call it an "Urban Legend." Keep your eyes and ears open and watch what the government is doing.
post #20 of 25
<BLOCKQUOTE>quote:</font><HR>Originally posted by Sugar Snack:
Secondly Gonzo you obviously know little about denial of insurance benefits. That's what I do for a living. * * * Although it's not in full force and effect right now I would not go so far as to call it an "Urban Legend." Keep your eyes and ears open and watch what the government is doing.<HR></BLOCKQUOTE>

ooohhh, so testy... is it because I've not been slavering over your photo and your "cute" posts in here? :

FYI, I am in-house counsel for an insurance company and have worked in insurance law and regulation since 1989... not that there's anything wrong with that.
post #21 of 25
Thread Starter 
<BLOCKQUOTE>quote:</font><HR>Originally posted by gonzostrike:


ooohhh, so testy... is it because I've not been slavering over your photo and your "cute" posts in here? :

FYI, I am in-house counsel for an insurance company and have worked in insurance law and regulation since 1989... not that there's anything wrong with that.
<HR></BLOCKQUOTE>

Boo hiss! Well then you know if you are in-house counsel. What's up with your post? I can tell you have some knowledge - since when have regulations stopped an insurer from "trying" to deny benefits?

P.S. My picture is there as an option (at least I know how to post one. Nice red "x" you've got there). If I really wanted to be saucy I have better ones than that - like you can really see much from that anyway. It's a better shot of the tortoise than me.

Better cute posts than contrary all the time. Bet you're fun in a deposition.

<FONT COLOR="#800080" SIZE="1">[ December 17, 2001 11:55 AM: Message edited 1 time, by Sugar Snack ]</font>
post #22 of 25
<BLOCKQUOTE>quote:</font><HR>If I really wanted to be saucy I have better ones than that <HR></BLOCKQUOTE>

Wow. Lets see the nekkid ones! And more of the turtle too, please. [img]smile.gif[/img]

Anyway… My thoughts on the insurance thing --- Urban Legend

I haven't seen the article… But if this were to actually happen, It would most definitely CLOSE every emergency medical center located in or near a ski town. In California, ER's are required by law to provide services for any acute injury or illness, regardless of a person's ability to pay. Resort-based medical clinics and hospitals whose primary income is from broken skiers would take a HUGE loss from this. No hospital would allow that kind of loss to continue, and thier only solution would to no longer maintain those services. How many people would be up for a drive into the nearest major city to find an ER? That might be kind of a bitch with a broken leg [img]smile.gif[/img]

Whaddya think?
post #23 of 25
<BLOCKQUOTE>quote:</font><HR>Originally posted by Sugar Snack:
It's enforced when you get injured skiing and try to collect benefits and your insurer denies payment. You sue (this is where I come in) and you get your entire claim, medical history, life investigated. We determine that you were indeed engaging in a dangerous activity and we stamp a giant "DENY" on your case. This will last for about a year racking up attorney fees while your medical bills go unpaid. Eventually we may settle with you but not before you're totally insane and mad as Hell<HR></BLOCKQUOTE>

I guess "guilty until proven otherwise" is one of the "Freedoms" the coalition is now fighting for. What gets me mad is sooner or later the whole "only for the rich" insurance, health & education scenario finds its way downunder.

Build the missile shield ASAP and keep all this "free enterprise" "economy at any cost" rip off wayward law based way of doing business to yourselves.

Oz :

<FONT COLOR="#800080" SIZE="1">[ December 18, 2001 07:43 AM: Message edited 2 times, by man from oz ]</font>
post #24 of 25
Lucky, in an ideal world, those who do live a healthy lifestyle should get a reduction in their insurance premiums. You do pay lower insurance rates than someone who is a smoker with known high cholesterol or coronary artery disease and is morbidly obese. So, in a sense you do get some fianacial benefit from living a healthy lifestyle. There are no health insurace companies which will cancel your policy if you file claims, no mater how many claims you file. You may be denied benefits for certain treatments which are considered experimental or non-traditional, but you will not get dropped. Health insurance is vastly different from auto insurance.

Altaskier, much of the underwriting and actuarial industries are based on the premise that people do not have similar risks. In reality, people have very different risks. Health, life, auto, disability, home, virtually all insurance pricing is based on this fact. Where you live, your age, your career choice, your gender, what kind of car you drive, etc. all factor into what each individual is at risk for. You can't possibly tell me that someone who works in a manufacturing factory with heavy machinery has the same occupational risk as an accountant who works in some office building. Or that a 90 year old has the same risks as a 10 year old. Those who live in rural communities have much different risks than those who live in big cities. That's an absurd notion that everyone in America has similar risks.

I'm not saying that skiing is a high risk activity and that people who ski should pay higher insurance premiums. What I am saying is that people with different risks should pay different amounts for their insurance. I don't think this is an inconceivable notion. The insurance industry is a business just like all other businesses. They exist to provide a service in exchage for money. Nakona, you're right, they are trying to make more money, just as any good business would try to do so. You may not think so, but fortunately most of us who are healthy do not have to take advantage of the service that is offered in exchange for your insurance premium. Isn't it better to not be sick and have to go to the doctor all the time? The trade off is that you buy insurance and don't have to use it. Say you developed cancer or had some life threatening accident that required extensive and expensive treatment. So, you've duped the insurance industry. You've only paid a few thousand dollars in premiums but the insurance company is not responsible for paying your hundreds of thousands of dollars in medical bills. What a deal, huh? No thanks. I'd rather pay for my insurance and not have to use it.

If only sick people had insurance, there would be no more insurance industry. There has to be a vast majority of healthy people who are insured and don't need to use it to offset those who do need to use it. Insurance companies are not doing charity work.

If certain activities are proven to be higher risk, people who choose to participate in those activities should have to pay higher insurance premiums. If I am one of those people I can choose to pay the higher insurance, not participate in the activity or take the risk myself and go uncovered. I may not be happy about it, but I have the choice. No one is holding the gun to my head. If you think you're getting a raw deal, you don't have to buy insurance. The key here is that the insurance industry needs to prove that those certain activities pose higher risk. No one would argue that sky diving or extreme anything are high risk activities. But are skiing, mountain biking, horseback riding also high risk? That remains to be seen. I'm sure there are many statistical types working on that as we speak.

Enough of my ranting and raving. Do you guys really think I'm that off base with this?
post #25 of 25
Prosper, you are not really off base here. But consider that health care is (or should be) a necessity. It's just not good for our society to have people not be healthy or disabled because they cannot afford health care. Even if they are that way because of their own actions. And because of the way our health care system works, it is unaffordable without insurance. Thus, if a significant minority of our population is denied coverage, they may have to remain disabled if they get injured. And that's when they get on the government dole. In my opinion, the insurers would be taking a great risk here in reviving the call for nationalized health care.

<FONT COLOR="#800080" SIZE="1">[ December 18, 2001 10:19 AM: Message edited 1 time, by milesb ]</font>
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