Health insurance for moto

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11/13/2018 9:00 AM

I currently have medical mutual through my employer. Recently i was denied coverage for an accident i had in september that resulted in a broken leg and collarbone. They said even though i wasnt racing its still a hazardous activity and isnt covered. Unfortunately im stuck with a $70,000 bill for inpatient at the hospital. Although im trying to appeal the claim, i want to start looking for insurance thats applicable to a 25 year old who doesnt get sick. Something that covers things young people do that cause injuries.

Anyone have experience with a good company? Im in ohio

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11/13/2018 9:37 AM

Private market sucks for the young and the old, at least here in Texas. I rely heavily on my job for insurance. Also hospital usually will take a significant reduction if you negotiate. Best of luck, I am interested in others' responses.

Get well soon

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11/13/2018 9:42 AM
Edited Date/Time: 11/13/2018 9:42 AM

Depending on who you have for your employer's insurance, you should be able to get supplementary accident insurance. For example, I have Blue Cross Blue Shield as my PPO, and then I have MetLife voluntary accident for an additional cost. If your employer does not offer that, you should be able to get it on your own. In that case, I would reach out to MetLife directly.

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11/13/2018 9:42 AM

Aflac

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11/13/2018 9:52 AM

langhammx wrote:

Aflac

I looked into aflac, it sounds like they just write a check for 10k or so for a broken leg for example. I dont know if they have something that covers a 70k bill

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11/13/2018 9:55 AM

Our insurance is thru my wife because she works for the state so its very cheap for us, but its not great insurance ( although most insurance sucks now anyway ).

But I have been injured pretty bad twice in the 12ish years or so we have been on it and its never been an issue at all, both times I had to take an ambulance as well.

We have Anthem.

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11/13/2018 9:56 AM

I think I would lawyer up if I were you

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11/13/2018 10:04 AM

Kasier works well for me. They had no problem covering my ACL and various other moto related injuries. I've only ever paid the copay.

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Billy Wight
Luxon MX
@LuxonMX
https://luxonmx.com
Motocross Components Engineered for Performance

11/13/2018 10:19 AM

I would be appealing the claim. I know when I broke my wrist in July I went to the hospital and for the doctor to see me (for a maximum of 5 minutes and tell me it was broke) was $6,000. After appealing, I paid only $100.

Hospitals will work with you. As for insurance, I’m in the same boat. My work insurance kind of blows but it’s better than nothing. Looking for suggestions as well!

Here’s some pictures of my wrist that cost me $28,000. 2 hour surgery, titanium plate and 8 screws.


Photo
Photo



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11/13/2018 11:43 AM

Jbulz wrote:

I think I would lawyer up if I were you

Agreed

Driving a car is dangerous
Walking on stairs is dangerous
Riding a bicycle is dangerous - more so if you commute than recreational - cars are big
Football, soccer, basketball, dangerous
The gym is dangerous
Hiking is dangerous

While their point is valid mx is dangerous - you can get seriously injured doing just about anthing

Over 90 percent of spinal chord injuries come from car wrecks

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11/13/2018 11:49 AM

Its a federal law that everyone in the usa pay for health insurance or get a tax penalty. A "good" plan is $180 per month per person premium with a $5,000 per person annual deductible. Unless you lie they will not cover motocross racing accidents as they should since they are self inflicted. If they do cover it most have a cap of $10,000/yr. More importantly they can charge any amount they want since their are no regulations. I am making payments on a $1,700 ACE wrap bandage lol. That is the state of health care in the usa.

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11/13/2018 11:51 AM

Jbulz wrote:

I think I would lawyer up if I were you

Derek Harris wrote:

Agreed

Driving a car is dangerous
Walking on stairs is dangerous
Riding a bicycle is dangerous - more so if you commute than recreational - cars are big
Football, soccer, basketball, dangerous
The gym is dangerous
Hiking is dangerous

While their point is valid mx is dangerous - you can get seriously injured doing just about anthing

Over 90 percent of spinal chord injuries come from car wrecks

This is my logic. Wheres the line between falling on soft tilled dirt at 20-35mph and falling on a road at 60mph with cars and semis? Im sure anyone who rides both can agree they have more close calls on the street than off road from being hit by a car.

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11/13/2018 11:52 AM

Frank wrote:

Its a federal law that everyone in the usa pay for health insurance or get a tax penalty. A "good" plan is $180 per month per person premium with a $5,000 per person annual deductible. Unless you lie they will not cover motocross racing accidents as they should since they are self inflicted. If they do cover it most have a cap of $10,000/yr. More importantly they can charge any amount they want since their are no regulations. I am making payments on a $1,700 ACE wrap bandage lol. That is the state of health care in the usa.

I agree. Only problem is i wasnt racing and was still denied.

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11/13/2018 12:54 PM

Frank wrote:

Its a federal law that everyone in the usa pay for health insurance or get a tax penalty. A "good" plan is $180 per month per person premium with a $5,000 per person annual deductible. Unless you lie they will not cover motocross racing accidents as they should since they are self inflicted. If they do cover it most have a cap of $10,000/yr. More importantly they can charge any amount they want since their are no regulations. I am making payments on a $1,700 ACE wrap bandage lol. That is the state of health care in the usa.

$180 a month is cheap lol even for one person.

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11/13/2018 1:03 PM

Man that sucks to hear! I broke my leg when i was in College from riding and it required surgery. I go through with the surgery and all the physical therapy that was included by my insurance to then later receive a bill saying that they would not be covering it because i was injured on a motorcycle. They said that if i had been on an ATV they would cover it but not for a motorcycle. Such a joke! I learned that pretty much you should always say you just fell down the stairs so that they cant come back and find an excuse to deny you!

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11/13/2018 2:25 PM

Your best bet is to never mention motorcyclcle....Does your state have some kind of regulation requarding road motorcycles? In NYS no fault medical does not apply to road bikes..... Make sure they know it was a sporting event, not a road bike accident. I had to battle a bit this past summer for my ACL repair as it was mistakenly reported as a Motor vehicle accident, as in Road bike... My medical coverage started denying my bills, After several phone calls to explain off road= dirt bike, they agreed to pay the bills...I worked in the Insurance field for 25 years, I still had a hard time explaining to the Reps the difference between road bike & dirt bike.... From now on when I get hurt, it will be " in my backyard playing basketball" if you know what I mean....

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11/13/2018 2:35 PM

Derek Harris wrote:

Agreed

Driving a car is dangerous
Walking on stairs is dangerous
Riding a bicycle is dangerous - more so if you commute than recreational - cars are big
Football, soccer, basketball, dangerous
The gym is dangerous
Hiking is dangerous

While their point is valid mx is dangerous - you can get seriously injured doing just about anthing

Over 90 percent of spinal chord injuries come from car wrecks

Sure, but the injury rate for riding mx is much higher than those other activities.

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11/13/2018 3:29 PM

Little advice to everyone if they ask you what happened DO NOT mention anything to do with motorcycles or motocross. Just say you fell, and nothing else. Isn't any of their business. If you're regular health insurance hears anything with motorcycles, they will push it to auto insurance....and then they will fight, while you're stuck with the bill.

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11/13/2018 3:36 PM

Lying to insurance is fraud.. and its hard to say you fell down stairs when youre in an ambulance in your dirty riding gear lmao

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11/13/2018 4:24 PM

langhammx wrote:

Aflac

x2 on Aflac bros

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11/13/2018 4:55 PM

My god, what is wrong with the US? It’s called universal health care, pretty well every 1st world country has it. I don’t mind paying a little extra on the taxes so when guys get hurt doing something they like (mx,mtn biking,etc) they don’t have to worry about financial ruin. What’s so hard to understand??

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11/13/2018 4:57 PM
Edited Date/Time: 11/13/2018 5:04 PM

jjavaman wrote:

My god, what is wrong with the US? It’s called universal health care, pretty well every 1st world country has it. I don’t mind paying a little extra on the taxes so when guys get hurt doing something they like (mx,mtn biking,etc) they don’t have to worry about financial ruin. What’s so hard to understand??

There are far too many reasons for why we don’t have universal/single-payer to write out on Vital.

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11/13/2018 5:15 PM

I would first try re submitting your claim. I've heard that they automatically deny a certain percentage of claims right off the bat just to be dicks. They should pay it.

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11/13/2018 5:23 PM

langhammx wrote:

Aflac

Aflac is more like lost wages, better than nothing but not meant to cover medical expenses, unless the policy specifically covers medical expense.

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11/13/2018 5:32 PM

Again, this is state specific, but get online and see if your state has an Insurance Dept. likely you do & you can file a formal Insurance dept. complaint for your claim being denied. Once that is in motion, the Insurance company has to repsond to the Insurance dept. and you. Your Insurance company has a time limit once they are put on notice from the complaint, to repsond. Insurance company claim depts. donot like Formal complaints from their state Insurance dept"s & they will fast track your claim for payment or better have a dam good reason to deny you. I was an Insurance adjuster for 25 years, when a state dept. complaint comes in, shit happens. You don't need an attorney....yet.

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11/13/2018 5:44 PM

kb228 wrote:

Lying to insurance is fraud.. and its hard to say you fell down stairs when youre in an ambulance in your dirty riding gear lmao

You are correct, misrepresentation of facts is fraud. Unfortunetly we are not playing on a level field. If you are a " clean hands" policy holder...I.E. Premiums paid, not under the influence of drugs or alcohol and not participating in an unlawful or criminal act, a good insurance company adjuster, Should look for ways to PAY your claim not look for ways to DENY your claim.

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11/13/2018 6:15 PM

Healthcare is so F’d in this US. The ACA only compounded the un-affordability for most people. The individual mandate goes away next year which is good because it will make the insurance companies have to create semi-attractive products. Unfortunately, getting hurt on a motorcycle will still be excluded by health insurance for many people and most people don’t even know it because they don’t read their policies.

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11/13/2018 6:22 PM

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11/13/2018 6:35 PM
Edited Date/Time: 11/13/2018 6:36 PM

About 10 yrs ago my wife was between jobs thus waiting for our insurance to kick in and she goes into cardiac arrest while driving. Fortunately she safely pulled over. Long story short she ended up with light heart surgery (ablation) and a pacemaker and we were stuck with a $165,000.00 bill, no kidding!

We ended up getting an attorney and she looked into the billing and actual cost and told us the hospital only had $9,500.00 total into it. We were finally able to negotiate the hospital from 165,000.00 down to 12,000.00 so there quite a bit of leeway for negotiation on your billing.

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11/13/2018 7:04 PM

In Ohio? Start here for medical:

Ohio Department of Insurance- Health Benefit Review and Appeals

Has your provider submitted to you the policy language that states the exclusion they are denying? I’m curious as to how this reads.

If all else fails and you get stuck, negotiate the shit out of those bills.

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