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Do not feel bad lying your ass off.
It's no more fraudulent than the what the medical industry in the usa does.
That person is your enemy or your friend. If your adjuster is a tree hugger and you break you leg on a dirt bike, you a F'ed.
Look for "Extreme sports" "Exhibition of Speed" "Racing or Competition" "Including, but not limited to..."
They do NOT have to list a specific activity.
Social Medicine doesn't really have this problem, neither do those on Welfare in the USA. That is a zero deductable 100 % free for them, paid by the taxpayers healthplan. In other words, Social Medicine.
Thats why most doctors, and outpatient places in the US do NOT accept medicaid. They can NOT over bill, Triple bill, quadruple bill the govt. They wont pay. So the doctors don't take it. Period.
The Shop
It may depend on the tier plan your on (i.e. how much it cost you/your employer). Im on the highest level PPO my company offers (and the most costly to me of the four plans). The lower level plans have more exclusions, not just in terms of whats covered, but in terms of doctors, coinsurance, max out of pocket, etc.
Anyways, thankfully for a couple of my Canadian co-workers they live close to the US border, so when they need treatment without waiting a year they can cross the border into the US..
As soon as you mention dirt bike you're toast.
On the other hand, my brother broke 2 ankles and collar bone in one hit, ambulance delivered him to the hospital still geared up and that was covered by insurance.
My heath care and hospital bills would be covered. That’s just standard health care in Canada.
I finally just found coverage that will take care of me in the long term if I can’t do two or the six daily function of a regular person. This is coverage for literally the worst situation, but I have nothing to cover me in any other situation.
Be interested to hear what you have and your experiences with claims.
My company handles the claims work for those employers, sets up the reinsurance policies, sets the plan up with utilization review companies, and we offer them help creating the Plan Document...the booklet that details what is and isn't covered, defines terms, talks about when you're eligible, what happens when you leave the employer, all the HIPAA & ACA regs, etc. Sounds complicated, but self-insured plans are an extremely common way for employers to handle the health care plans for their employees. I'm in Illinois and that stupid "Hazardous Hobbies" exclusion is gaining in popularity in the midwest. I DESPISE it. A lot of our employer groups are in rural areas and yet they've found themselves with policies that exclude "hazardous hobbies" which can be defined by the policy in a number of ways, but one i read yesterday said "excluding injuries from 'riding or racing trail bikes, falling from an elevated hunting stand..." It's the exclusion de jour in the industry. Thing is...with these self-insured plans the employer has a LOT of say about what goes into the policy. Required stuff aside, they can choose to skip this exclusion...and often do when it's actually explained to them. (An company that sells and services farm machinery has rural guys working for them, and they know those guys hunt, ride ATVs and dirtbikes. No way in hell they're going to exclude coverage for common man activities.) We are not talking about being drunk and driving (meaning...doing something illegal.) Crashing your dirtbike isn't a 'self inflicted' injury either...that IS commonly excluded...because self inflicted means you intended to injure yourself. I ride and race (I'm pretty terrible but i'm 53 and have no intention of stopping)my employer knows I ride, and ya...i've gotten some sideways looks and the CFO, when I had to take a couple days off for knee surgery, DID ask if i fell off my ladder again.
kb228 - you were right to appeal. but talk to your employer too. If your insurance plan is self-funded the employer CAN choose to overturn even a denied appeal and have the claim paid. It's not uncommon.
For me, I'm going to continue to talk to my employer and the account managers (the ones who work with new groups to design the Plan Document) to help them understand how ludicrous this exclusion is. And just my personal opinion here: I really think it's another slam on 'guy' stuff. No one is excluding coverage for infected toes from a bad pedicure.
Pit Row
What a shitload of money people have to pay. That's not normal.
In holland you pay around 120 euro a month for standard medical care. If you want extra like dentist etc etc it cost a little bit more.
"Own risk" is 385 euro. That means if you need a surgery or medecins or a ambulance then your have to pay your own risk when the treament is over. If you can't pay it at once you can pay it like 49 euro a month.
People are complaining here that now days a lot people almost can't pay the monthly 120 basic health care. But if i'm reading what you guys are telling and the amount of cash you have to pay for the bills. Then we are lucky and shouldn't complaining.
HR is trying to tell me “motocross racing” means no dirtbike accidents whatsoever.
My appeal was denied.
End of the day, the policy is a legal document and it says motocross racing. I was riding an open ride day. Wasnt racing or even practice. I should be covered. Ive already hired a lawyer.
The reason healthcare costs is inflated is because there are so many un-insured that never pay a cent....so hospitals gotta jack their cost up by double or triple hoping that one well off (poor bastard) pays the $3,000 mri bill. The poor bastard just bought his mri and 2 others that didn’t pay.
1. I wasn’t riding a motorcycle
2. It explains why I have gear on
3. It’s not relevant how you broke the bone it’s broken and needs to be fixed
I have been riding/racing for my entire life (5yo to 40yo) and have a pretty unique perspective to most people having been from the track to the desert to racing overseas to the hospital and back. To the OP: Good luck with your claim.
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