Uncovered

Uncovered

Orem, Tina
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Insurance can be a totally boring topic until you're looking at a thousand-dollar bill to fix the lung you punctured with your buddy's ice axe. That's when you realize that gear isn't the only expense thrillseekers have to consider.

It's an important concern, that thousand-dollar bill, because few people know that health insurance policies don't always cover injuries sustained during sports, organized outdoor events, or "high-risk recreational activities." And that means that if you break a leg skiing, bash your head in after you taco a wheel, or fall while ice climbing, your health insurance policy may leave you on the hook for 100% of your medical expenses.

"Read the fine print," says Rob Stehlin, a local insurance agent. "Every policy has fine print, and everyone has the time to read it—before and after the purchase." He's right; in our unscientific survey of insurance policies, we found no consistency in what was and was not covered when it came to so-called high-risk recreational activities. (And for that matter, the definitions of high-risk, organized sport, or similar terms were infrequent and inconsistent.)

For example, one policy we reviewed wouldn't cover injuries sustained from parachuting or hang-gliding, but it seemed to have no problem with hunting, mountain biking, or skiing. Another policy excluded rodeos, parachuting, bungee jumping, and, our favorite, "injury sustained… by flight in a space craft or any craft designed for navigation above or beyond the earth's atmosphere." (Sorry, Richard Branson.)

One of the policies excludes coverage for injuries any adult sustains while participating in "any professional or organized sport," which left us wondering if things like tweaking a knee during the Lewis & Clark marathon were covered. Most of the plans also didn't cover injuries sustained during riots, while you're high or drunk, or while you're committing a crime, proving that there is at least some threshold to the jackass behavior insurance companies will accept.

Some good news is that your penchant for risk doesn't necessarily mean you're totally uninsurable. According to The Health Insurance Portability and Accountability Act (HIPAA) of 1996: Overview and Guidance on Frequently Asked Questions, you cannot be denied enrollment in a group health plan if you engage in high-risk recreational activities. So, if your employer has a health plan, you probably can get coverage. However, there is no federal requirement to cover treatments for injuries associated with high-risk activities, even if the treatments are otherwise covered under the plan. Stehlin also advises insurance seekers to provide their insurance brokers with detailed medical histories and lifestyle information and to ask questions that are specific to their specific lifestyle choices. "You can always cancel a policy if you feel the coverage does not meet your needs," says Stehlin.

This all leads to an interesting philosophical debate: should insurance companies and the people they insure bear the expenses of helping someone who took unnecessary risks, or should insurance companies encourage "high-risk" recreational activities as part of a healthy, active lifestyle?

Regardless, if you've fallen down a trail, skied into a tree, or gotten bucked off a horse, the ensuing financial headaches could be much larger than the physical ones if you aren't covered, so read your policy. That's probably what 60-year-old David Pfahler wishes he had done. He was skiing in Vail last year when a seven-year-old kid skied into him. Pfahler claimed the blow dislocated his shoulder and tore his rotator cuff. When it was all said and done, Pfahler said he had $75,000 in unreimbursed expenses. It's unclear whether Pfahler's insurance, which he obtained through his employer, is refusing to pay the $75,000, but according to a January L.A. Times article, the insurance company urged Pfahler to get the money from the boy's family. So Pfahler is suing the seven-year-old and his family. The case is pending.





God Save the Spleen

Breaking your neck on the side of a mountain can break the bank, but it can also… well, break your neck. Knowing what to do until help arrives can make the difference between life and death. That's why we think taking a Wilderness First Responder Course from the Wilderness Medicine Institute (WMI) at the National Outdoor Leadership School (NOLS) is a good way to get more confident about your upcoming adventures. After all, somebody's gotta rescue you first so the hospitals and insurance companies have somebody to bill, right?

FIRST AID COURSE
March 22-23 (Saturday and Sunday)
Price: $200 per person. Two days of intense training; WMI will teach you the skills needed to care for an injured friend until the pros arrive. No previous experience needed.

WILDERNESS RESPONDER RECERTIFICATION COURSE
April 4-6 (Friday, Saturday, and Sunday)
Price: $250 per person. For those who have taken the 80-hour long Wilderness First Responder Course. This scenario-based course is a review and practice of evacuation and decision-making guidelines. Also provides practitioners with current updates in the wilderness medicine field. May be used to recertify Wilderness First Responder and Wilderness EMT (wilderness portion only) certifications.

Call 800-572-8747 or e-mail [email protected] for more information or to register.

-Tina Orem
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