View Full Version : Injury and Health Insurance
I put this in the SF forum, so we would not get the usual, "Insurance is a rip off", "Insurance companies are crooks", type of post.
Recently a young lady posted she had been diagnosed with bursitis. After 4 weeks of rest it still hurt. She was asking, "is my hike over". Over Memorial weekend I hiked 50 miles, 20 in one day, and was worried, I might have done real damage to my foot. ( I'm OK, a couple of days rest and I'm 100%).
Anyway, for a person to hike when injured, to the point that they need surgery to get better, could be very costly. Once you have had surgery, some of the better health insurance companies, here in Georgia, will not cover that area, should you re-injure it. (This only applies to individual policies, not group health plans. It also only applies when you are purchasing a new policy. If you have an individual policy when you injure yourself the first time, they can not exclude future injuries.)
Hiking your way to the operating table might jeopardized future plans. It might prevent you from ever becoming self-employed, unless you are willing to be under-insured.
I just mentioned in another forum, that in 05, I had two medical situations that required going to the hospital. I was very glad to have good insurance!
HoosierHiker
06-12-2008, 00:32
I believe you are referring to a pre-existing condition clause that is a fairly standard provision in most individual and group health insurance policies. An older provision of the federal HIPAA law provides protection for pre-existing condition clauses. For example, if a policy doesn't cover pre-existing conditions for one year and you had coverage under another policy for a year prior to the effective date of the new policy, the insurer cannot impose the pre-existing clause provied you supply them with a certificae of credible coverage that the old insurer must give you. The exception to the law is if you had no medical insurance coverage for 63 or more days prior to obtaining the new policy. Then the new company can deny coverage for the pre-existing condition. At my company an employee transferred to the United States from the Netherlands and his insurance from the Netherlands satisfied the credible coverage provision. Good insurance companies will write coverage based on an honest application. If you have expensive claims they will increse your premiums dramatically the second year, but I've rarely ran into issues where they wouldn't honor their policy. State insurance commissions prtoect consummers as well.
fiddlehead
06-12-2008, 01:24
So what's the point of this thread? Are you an insurance salesman?
Folks can always come over here to Thailand and get health care at aprox 1/10th of the cost of the US instead of jeopardizing their " prevent you from ever becoming self-employed" syndrome.
That would suck for sure.
Seems to me you are starting a thread where you don't want people to say that insurance is not necessary and pro-insurance answers only. There are other ways to go through life. (see the above mention on "out of country" health care.
I just don't understand how people who hike a lot (more than one thru for example) can afford it.
I just don't understand how people who hike a lot (more than one thru for example) can afford it.
Afford what, FH? To be insured, or not to?
fiddlehead
06-12-2008, 03:28
Afford what, FH? To be insured, or not to?
to buy insurance. i know, i haven't had it in the past 19 years and would've spent aprox $68,000 buying it all those years.
I did 6 or 7 thrus plus traveled around the world and hiked in many places in that time and would've had to be working instead, just to pay that bill.
(had one hospital bill for $500 in that time period plus a few smaller clinic fees here and there)
Look it's been debated many times here on WB. I just try to keep some minds open that otherwise would turn sheepish.
You are right it can be expensive... My husband and I are both retired. We both worked in jobs that provided insurance for employees. Fortunately, my husband's continued after retirement for us both, while mine required continued payments. We are fortunate. But I would pay for some type of insurance if I didn't have his.
4eyedbuzzard
06-12-2008, 11:14
So what's the point of this thread? Are you an insurance salesman?
Folks can always come over here to Thailand and get health care at aprox 1/10th of the cost of the US instead of jeopardizing their " prevent you from ever becoming self-employed" syndrome.
That would suck for sure.
Seems to me you are starting a thread where you don't want people to say that insurance is not necessary and pro-insurance answers only. There are other ways to go through life. (see the above mention on "out of country" health care.
I just don't understand how people who hike a lot (more than one thru for example) can afford it.
Well, if you choose to hike that much that you choose not to either make enough while self-employed to afford health insurance or choose not to pursue a job or career path that provides subsidized insurance, then you choose to live with the consequences - like massive medical debt. Too bad. Hike less and work more or don't complain. For most people life isn't a string of 6 month vacations punctuated by occaisional work.
Do you absolutely need insurance? No. Do you absolutely need to hike? No.
FWIW, my wife just had to have emergency surgery for an appendix/peritoneal problem. Scope type surgery. In the hospital less than 23 hours. $28,000. Little more to add. People should make their own choices and live with the consequences.
So what's the point of this thread?
Yes I am an agent in GA. And I talk to lots of people about this everyday, and it is amazing the amount of ignorance there is out there. The point of the thread is to inform people about the hidden penalties associated with having surgery. All to often people who have insurance coverage will overuse it, totally unaware that the procedure will haunt them down the line.
Good example" Gastric Bypass. Had a client who worked for IBM for many years had this procedure. Hey I got insurance. Only cost me $500. Thats easier than diet and exercise. Later they quit IBM and opened up a small retail store. They set an appointment with me 17 months after they left IBM, (1 month remaining on COBRA). needing to buy health insurance. There was only one company who would take this case, and the premium was sky high. This person had no idea when they had that operation, that it would have consequences.
I was thinking about all the serious hiker injuries out there, that could be avoided by not pushing yourself.
The same is true for taking medications. Best way to keep blood pressure and cholesterol low is diet and exercise. Too many people find it easy to just take the pill. Hey it only cost $4 on their group health plan. Then they go to get private insurance and it cost 40% more.
I just thought people should be informed.
Hoosierhiker,
the insurer cannot impose the pre-existing clause provied you supply them with a certificae of credible coverage that the old insurer must give you.Companies issuing individual policies can exclude pre-existing conditions forever.
I don't mind negative comments, just want them to be informative.
OregonHiker
06-13-2008, 23:07
to buy insurance. i know, i haven't had it in the past 19 years and would've spent aprox $68,000 buying it all those years.
I did 6 or 7 thrus plus traveled around the world and hiked in many places in that time and would've had to be working instead, just to pay that bill.
(had one hospital bill for $500 in that time period plus a few smaller clinic fees here and there)
Look it's been debated many times here on WB. I just try to keep some minds open that otherwise would turn sheepish.
And if you had a major medical expense in the last 19 years,, would you hav been able to pay it?
I put this in the SF forum, so we would not get the usual, "Insurance is a rip off", "Insurance companies are crooks", type of post. AFAIK, Straight Forward means that you must stay on topic, not flame, not hijack the thread, stuff like that. Keep it civil and on topic, But it is still a discussion topic. Straight Forward doesn't mean you have to have the same belief as the orignal poster.
Insurance companies ARE basically crooks. That is straight forward and on topic. Some are less crooked than others, but all of them love to collect premiums and none of them like to pay out claims.
If you can afford it, insurance is better than not having it, but you do the best you can with what you have to work with. Just go into it with the idea that given a chance, insurance companies will screw you over. That's why they have so many lawyers on sataff.
And if you had a major medical expense in the last 19 years,, would you hav been able to pay it?It's called self-insuring. He would pay it and would still be in the black because he had $68,000 "in hte bank" from not paying premiums.
I do the same thing with those extended warranties on appliances and electronics that salesmen are always pushing. I never take them. Only twice would I ever have benefitted from an extended warranty. Those two times were would have nice, but the amount I would have received would have been a drop in the bucket compared to all the warranties I didn't buy and pocketed the $$$. Overall I have saved many times as much by not paying as I would have got from those two.
The difference with insurance, of course, is that we are talking about our bodies, not a DVD player, and the consequences of being wrong are higher.
I have health insurance from my former employer (I'm retired). I have to pay for it, but at the rate for the "group," which is a zillion times lower than it would be if I had to purchase it outright.
If I did not have this insurance, I would consider catastrophic type coverage. Something that would pay but only after a five or ten thousand dollar "deductible." I would pay for all the normal stuff, but would be covered if I had a serious injury/health issue.
OregonHiker
06-14-2008, 01:12
He would pay it and would still be in the black because he had $68,000 "in hte bank" from not paying premiums.
You really think that is the case?
fiddlehead
06-14-2008, 02:24
And if you had a major medical expense in the last 19 years,, would you hav been able to pay it?
Had one last year. Fat tissue in my gut wrapped itself around my large intestine and totally choked it off. Had surgery. I now have a foot long scar and was in the hospital for 6 days. Total cost here in Thailand $3,000.00 Paid it out of pocket and continue to not carry insurance as that is the first major problem i've had in my life.
Worrying about it happening again is not in my nature and I'm thankful for that. If it was, you're right, I'd probably have to work 40-50 hours a week to pay all of those people with their scare tactics and such.
And it seems to me that this thread is just and advertisement for one of them.
Had one last year. Fat tissue in my gut wrapped itself around my large intestine and totally choked it off. Had surgery. I now have a foot long scar and was in the hospital for 6 days. Total cost here in Thailand $3,000.00 Paid it out of pocket and continue to not carry insurance as that is the first major problem i've had in my life.
I fail to see the relevance of this scenario to those of us living in the USA. (Aside from the simple lesson that US health care is seriously effed up.)
fiddlehead
06-14-2008, 07:08
Flight to Thailand takes 17 hours and costs aprox $1700 RT.
Sure it would suck if you are very sick. But surgery for a foot problem, knees, ankles, wrists (they are very experienced at motorcycle accidents here so wrists, arms, legs are right up their alley)
Anyway, it's an option in many cases and many are doing it. I agree it wouldn't work for all cases and there are times (like emergency appendectomy) when you need help fast and yes, it would cost.
I did save some of that money (Hiker from Oregon) but hiked with a lot of it too. If I would've been forced into using it for insurance, i imagine I would have hiked less than half of my hikes that i did. Hey the decision is yours. Hike or pay someone to have more peace of mind. Up to you!
Flight to Thailand takes 17 hours and costs aprox $1700 RT.
Umm... right... gotcha. :rolleyes: