Where ever we turn, we see stories about the high cost of medical treatment and the skyrocketing cost of insurance. Now that we are divers, the topic of dive insurance is thrown at us.
Is this just another way for insurance companies to become rich? The reported cases of Decompression Illness (DCI) which covers both Decompression Sickness (DCS) and Air Gas Embolism (AGE) are low and slowly getting lower.
Due to a better understanding of the causes, better training and advancements in technology to help us avoid DCI, an occurrence rate is said to be 1 in 10,000 dives. If you are an open water diver staying within your training, the rate will be even less while rebreather divers are estimated to have a rate of 1 in 1,000.
These advancements might lead us to believe there is little risk, I am a safe diver and dive insurance is not needed. Good points, however, while the rate of DCI has gone down, the number of unexplained DCI is as high as 75%. Unexplained DCI is a case where the diver seemed to follow all the rules but got hit anyway.
I do not need dive insurance because I have health insurance
Not all health insurance is created equal, and many still treat diving as a high-risk activity which limits the coverage. Many insurance companies will not cover you out of your home country, and those that do will do so on a reimbursement basis and often have a large co-pay since you are “out of network”.
Let’s relate this to your wallet using an example of an international vacation and believing you may have symptoms of DCS
When you arrive at the hospital, they will verify if you have insurance that will pay directly. If you do, no problem and you will be evaluated by a doctor immediately. If not, you will be asked to pay the doctor’s evaluation fee upfront by cash or credit card.
At many hyperbaric chambers, an examination will set you back as much as $500. If the doctor believes you need treatment, then into the chamber you go, after a detour to the cashier to pay for the first treatment, average for table 6 first treatment about $5500.
They will also want to do an advanced approval on your credit card for other costs, so figure another $1,000. If you do not have the cash or credit limit, you can always call your family to wire you the money. Just remember that treatment within the first 4 hours has the highest rate of full recovery.
The majority of hyperbaric chambers uses the U.S. Navy decompression procedures
These procedures are normally referred to as table 5 or table 6. Table 5 is only used for minor cases and a treatment last 2 hours. If the symptoms are not resolved within 10 minutes, the treatment is upgraded to table 6.
According to studies from DAN (Diver Alert Network) most cases with neurological symptoms generally require less than seven treatments. An Italian study showed that 21% of table 6 treatments took longer than a week. The number of times you will be treated will, of course, depend on how difficult your case is.
The $5,500 example is just the treatment cost, this does not include the hospital stay for observation and follow on treatment.
Rough numbers, you will need to layout about $50,000 for treatment. If your insurance covers it, it likely will be with a 20% co-pay (you are responsible for paying the co-pay) for “out of network”. That leaves you with $10,000 out of pocket.Planning a scuba trip? Then you should download the ultimate scuba dive checklist just like 5000+ other divers already so you will not forget to bring anything.## Dive insurance, as a rule, works in a different manner then your regular health insurance
First we need to define two terms that we will expand on later: Primary coverage and secondary coverage.
When an insurance policy is called primary coverage, it means it is the first one to pay on a claim within their terms of coverage.
Secondary coverage is like a backup coverage, what the first insurance does not pay, the second policy will within their scope of coverage. If you have a covered accident and your primary pays minus a co-pay, using the example above, the dive insurance as a secondary will pay the $10,000. Depending on where you buy your dive insurance, it could be primary or secondary.
Your normal health insurance provider and your dive insurance provider will often work in a fundamentally different way. When you call your health provider in an emergency you get a call center agent, they will check your policy coverage, how life threatening your condition is, the location of the nearest in-network facility and the closest emergency center.
Depending on your condition they will direct you to the most appropriate facility and give you an approval number. When you get the bills, you fill out a claim and send it in.
When you call your dive insurance company in an emergency, it is handled differently. Medical emergencies in the recreational dive industry need specialized care and should be treated by specialists in the field of Dive Medicine or an alternate name Undersea and Hyperbaric Medicine.
Most doctors are not trained to understand some the more subtle points within this field. When you believe you have encountered a dive emergency, you can call your dive insurance company and talk to a dive physician.
They will give you emergency advise, and if necessary direct you to the proper place for treatment. If you went to to a medical facility immediately, the doctors at the facility can coordinate with the dive physician to ensure you get the best care.
The dive physician will also assist the local doctor by being the expert and will explaining some of the symptoms to evaluate. Your case will be assigned to a trained coordinator who will follow up on your progress and arrange evacuation if local care is not available or if special care is needed.
While many, in fact, most, health and travel insurances will cover evacuations cost, diver evacuation can also have special concerns that most companies do not have a standard procedure for but specialized dive insurance companies do.
Besides primary or secondary coverage these insurance companies provide is a payment guarantee.
Most of the dive insurance companies seem to have a managed care approach. They are there when you need them, and they make sure you and your treatment do not become just another case.
While it does not often happen, these insurance companies cannot only help get you the treatment you need but also to avoid less than honest facilities, which go overboard with “precautionary” treatments.
Besides primary or secondary coverage, another vital function these insurance companies provide is a payment guarantee.
They will have agreements in place in many locations that have the facilities to treat dive injuries. A quick call to verify your insurance and you will be connected to a doctor.
If the doctor advises treatment, as you are being prepared the doctor and dive physician discuss the treatment and it is approved. For DCI, the faster the treatment starts after the on set of symptoms, the higher the possibility of a full recovery.
The insurance will directly pay the hospital, treatment bills, relocation bills. Other incidental charges are recovered by filing a claim.
There are different options offered by different companies so it will help to look at a few choices to see which is best for you. Primary or secondary coverage is one option. Primary is an asset if you do not have other insurance or if it has a low lifetime limit. Secondary may be slightly lower in cost.
The term of coverage is also varied. You can get short term or annual policies. If you do all your diving on one vacation, then a short term policy may be all. If you need more than one short-term policy a year than an annual policy is best.
Do you need dive insurance? Yes you do!
If you still not sure if need the dive insurance, consider this. If you buy a $30,000 car would you not insure it against damage or theft? Of course you will, the amount you pay for insurance is low compared to the loss. Would you buy a 200,000 dollar house and not take a fire insurance? Of course, the house is worth the insurance cost.
Then consider this, if you dive without dive insurance, you are placing your life at risk. Is your life worth less than your car? Even if you recover, without insurance, you might have to sell that car and house to pay the medical bills.
Do you have dive insurance?
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This article is published by The Scuba Page, the online magazine for Scuba Dive lovers around the world. The Scuba Page is part of RUSHKULT : the online booking platform for adventure sports. Visit the RUSHKULT platform to book your next Scuba Dive training, guided trip and accommodation.