Heli evacs and HMO/POS insurance ???

**comish** · 03-13-2007, 12:32 PM

Question for those that may have either experienced a Heli evac (US or Int'l), have US health insurance experience, or just know something about this.

If you are evac'ed and are covered in the US under a HMO or POS/PPO type plan and it says you are covered for ambulance service and also medically necesary emergency care, does this include Heli Evacs?

In Yurp you are pretty much guaranteed a Heli Ride if you mess yourself up, would this be covered by US health insurance? In the case of Mrs. 666's evac, would that be covered by US health insurance?

I have always bought the rescue card or Carte Niege in Yurp, but there isn't anything as obviously available in the US for rescues.

**gamma** · 03-13-2007, 12:40 PM

I would think not. urgent care and/or emergency care is not usually covered.

I think there is a decent market for ski insurance like this.

**powder11** · 03-13-2007, 12:46 PM

Im not sure what specific HMO plans do or dont cover. I can say that if your travelling to abroad, its wise to look into a travel ryder on your policy that works in the country your visiting. beware Canadian hospitals dont recognize private insurrance and require upfront payment at the time of service thats next to impossible to get reimbursed from your private policy. Ive been through this and it gets expensive real quick. I know at Cham, you can purchase insurance with your lift ticket that covers heli evacs and emergency medical.

**Tye 1on** · 03-13-2007, 12:56 PM

Originally Posted by gamma

I would think not. urgent care and/or emergency care is not usually covered.

Maybe read the post next time? Just a thought...

"Question for those that may have either experienced a Heli evac (US or Int'l), have US health insurance experience, or just know something about this.

If you are evac'ed and are covered in the US under a HMO or POS/PPO type plan and it says you are covered for ambulance service and also medically necesary emergency care, does this include Heli Evacs?"

**jfost** · 03-13-2007, 01:05 PM

HMO = you need to use their "in-network" Heli for 100% coverage...

**Sinecure** · 03-13-2007, 01:14 PM

I haven't experienced a Heli evac personally. However, I've known of plenty of people getting evaced from the Mcycle race track. I actually have Heli insurance through an org called Enloe Flight Care. Their site doesn't provide enough detail, but basically it costs me $25/yr for my whole family to be covered. They have reciprocal agreements with heli outfits in the Tahoe area, plus lots of places in PNW. Its not foolproof, but its a great start. If you get rescued by them (or transfered from place to place) you pay zip. Either they pick up the whole tab, or cover what your insurance doesn't. I haven't looked at my insurance closely, but I know I'd be on the hook for a big bill if I relied on them to heli rescue me. Without insurance, a heli rescue costs around $10,000-$15,000.

Here's the link to Enloe Flight Care: Link Here for Info
Here's the link to the application form: You can use the Group name "Thunderhill Raceway" to get the $25 rate. I believe its no problem to use that group name/discount even if you have no idea where Thunderhill Raceway is no have any intention of ever visiting.

If you ski in France, BUY A CARTE NEIGE. No two ways about it. I'm not sure about the rest of Europe, but in France you have to pay the Pisteurs (ski patrol) to take you off the mountain, pay the ambulance, pay the hospital, pay the helicopter, etc. if you need rescue. Pisteurs will literally ask you for your credit card before they'll turn you over to the ambulance. Show them your Carte Neige (you buy it at the same time you buy your lift pass and its really cheap) and its all covered.

The year I lived there a friend made a mistaken descent to a different town after lunch one day. He screwed up and ended up atop a 500' cliff and had to hike back up to the summit (would have been a 5-6 hour hike, postholing all the way and he'd have been lucky to make it). He saw a helicopter, waved them down with his snowboard and with his Carte Neige they gave him a free ride back to town. At the time they told him it would have cost him $3000 for that ride (this was in 1987). When the Pisteurs took me off the hill they said it would have cost $250 had I not had the Carte Neige. Carte Neige also covered my ambulance and hospital stay that trip and a free ambulance ride to Geneva airport on another trip where I got injured.

Calstar is another firm that does helo insurance.

**avacadotoast** · 03-13-2007, 01:15 PM

It'll vary by insurer and probably from State to State too. Check your EOC (Explanation of Coverage...or is it Evidence of Coverage).

We (Saint Marys in Reno) cover 100% w/ our HMO & POS. With our PPO it's merely subject to deductible and coinsurance. We pay EVERYTHING though and have trouble being competitive because of it...but we're one of the good guys I think.

Looking at some competitor info I've got, Anthem's Nevada advantage plan (PPO) covers up to $2500, member pays the rest - and that's only if they deem a ground ambulance could not possibly have been used. If they deem that you wouldn't have died if you waited for ground transport then they'll only cover up to their ground ambulance cap of $450. These caps will usually be different for HMO & POS plans and are typically more generous...again, read your EOC.

**4matic** · 03-13-2007, 02:39 PM

Originally Posted by Walter Sobchak

A coworker just got a $19,000 bill for having her kid flown from a ski resort base area to a hospital about two hours away for a minor concussion -- I think it was 9 grand base fee plus the rest for mileage. Kind of a BS use of a flight. We have a good PPO and her husband has good secondary insurance so she'll be an interesting test case.

The keyword is "she had her kid flown". My understanding is if the emergnecy tech/nurse/dr at the resort or site of the injury recomends a heli it is covered as emergency care. I don't know what the rules would be if you were BC and called in your own heli even if you had seperate insurance.

**comish** · 03-13-2007, 03:20 PM

Originally Posted by Corky

It'll vary by insurer and probably from State to State too. Check your EOC (Explanation of Coverage...or is it Evidence of Coverage).

We (Saint Marys in Reno) cover 100% w/ our HMO & POS. With our PPO it's merely subject to deductible and coinsurance. We pay EVERYTHING though and have trouble being competitive because of it...but we're one of the good guys I think.

Looking at some competitor info I've got, Anthem's Nevada advantage plan (PPO) covers up to $2500, member pays the rest - and that's only if they deem a ground ambulance could not possibly have been used. If they deem that you wouldn't have died if you waited for ground transport then they'll only cover up to their ground ambulance cap of $450. These caps will usually be different for HMO & POS plans and are typically more generous...again, read your EOC.

^^^This is kinda info I was looking for.

Jfrost

Sinecure, Agree on Carte Niege, as I mentioned in the original post. Anyone else have experience on either side of the pond, but with US insurance.

**huck4bucks** · 03-13-2007, 03:54 PM

I heard once that everytime you purchase a fishing license, a couple bucks gets tacked on for some sort of helivac fund. If you carry your fishing license (regardless if you're actually wetting your line or not) and you need helivav assistance, you are covered by the F&G helivac fund. Anyone know anything about this? I've heard it from multiple sources. Might be the best $40 ever spent.

**Arty50** · 03-13-2007, 04:03 PM

Comish, the Mrs. 666 thread just reminded me to renew my Calstar membership. It's only $40 for the year and covers a good portion of NorCal. My $40 membership covers any fees that my insurance company won't pony up for. So if my insurance pays $3k of a $15k bill, the rest is waived. Not bad for $40.

They also have reciprocal agreements with other flight ops.

I'm not sure who covers the Eastern Sierra, but you might want to look into it. Hopefully they have a similar deal.

www.calstar.org

Edit:
The site's being renovated, but here you go...
www.sierraaviation.com

Also, others should check out the Association of Air Medical Services member listing for ops in your area.

**Sinecure** · 03-13-2007, 04:07 PM

Originally Posted by comish

^^^This is kinda info I was looking for.

Jfrost

Sinecure, Agree on Carte Niege, as I mentioned in the original post. Anyone else have experience on either side of the pond, but with US insurance.

I've also had my US Insurance cover me for injury in France. I had to self-submit, but it worked. This was years ago so the insurance rules have no doubt changed. I actually got compensated twice on one injury (Carte Neige and my insurance). The funny part was I told my insurance that I was covered by Carte Neige and they still cut me the check. I did make one call to try to explain it, but they couldn't figure out how to deal with the problem and at that point I figured I'd upheld my end of the bargain so I cashed the check.

My insurance claims that they'll cover me outside the country for medical. I should check on the evac and repatriation stuff, but I just buy the Carte Neige because its so much easier.

For the helo insurance above, I figure the $25 is money well spent if I ever need it. I need to track down who they're associated with in the Sierra in case I ever need to make the cell phone call from the BC.

**rvski** · 03-13-2007, 04:35 PM

you should also check out adventure advocates. Its a secondary insurance type that cover any for of accident injury. I think im paying $8 a month for it. And it pick up anything your regular insurance wont. They also specifically used heli evacs as an example of how it saves your ass.

~Rickey

**Arty50** · 03-13-2007, 04:59 PM

Originally Posted by Sinecure

For the helo insurance above, I figure the $25 is money well spent if I ever need it. I need to track down who they're associated with in the Sierra in case I ever need to make the cell phone call from the BC.

Sinecure, on the back of my Calstar card it lists several reciprocal partners including Enloe and Careflight (Reno).

**coolstine** · 03-13-2007, 06:54 PM

this is why its important to have accident insurance. its cheap, its straightfoward, and it will cover anything that incurs cost due to an accident, including heli-evacs, ambulance rides, ER visits, surgery fees, and even follow up visits until the issue is resolved. I pay 25 bones a month to adventure advocates, for 25K dollars coverage of accident insurance per separate incident, which DOES COVER inherently dangerous activities like skiing, climbing, mountaineering. they paid out 13K to me when i fractured my L1 verterbrae skiing and i didn't have any other health insurance so it saved my ass, as I only had to pay a 100 dollar deductible. accident insurance will cover your deductibles for your full health insurance as well. so worth it!

just saw another mang reccomended adventure advocates earlier, right on!

**snowrider** · 03-13-2007, 08:02 PM

I am also interested in this as I was just heli evac-ed in Jackson. (http://www.tetongravity.com/forums/s...hlight=central) It was only from the base of Cody to the base of the mountain. Patrol called it, I was out of it due to a concussion and had no choice in the matter.

I'll be sure to post when I get a bill and if insurance covers it as "emergency care."

**Astar** · 03-13-2007, 08:24 PM

I'm the Director of EMS for Enloe Medical Center and one of the pilots for FlightCare. It is exceptionally rare that an insurance company or HMO refuses to pay for a transport by an approved air medical helicopter that was dispatched through the EMS system. But even if you have good insurance, you should still consider getting a membership through your local provider. Your copay and deductible can add up to a pretty penny. If you ride motorcycles, boat whitewater, ski, ride mountain/road bikes, climb, whatever... the chances are you will be flown out if seriously injured. $25-60 a year is way cheap for the peace of mind you get with the coverage.

**skimoore** · 03-13-2007, 08:33 PM

Originally Posted by Astar

I'm the Director of EMS for Enloe Medical Center and one of the pilots for FlightCare. It is exceptionally rare that an insurance company or HMO refuses to pay for a transport by an approved air medical helicopter that was dispatched through the EMS system. But even if you have good insurance, you should still consider getting a membership through your local provider. Your copay and deductible can add up to a pretty penny. If you ride motorcycles, boat whitewater, ski, ride mountain/road bikes, climb, whatever... the chances are you will be flown out if seriously injured. $25-60 a year is way cheap for the peace of mind you get with the coverage.

Thanks for that, Astar. I will get the insurance because Blue Cross PPO is for sure going to try to ream me on charges if it were to happen...I road bike, mountain bike when I can, wakeboard and ski....all of which could need a heli in case things go totally awry.

**TeleAl** · 03-14-2007, 12:52 AM

Originally Posted by Astar

I'm the Director of EMS for Enloe Medical Center and one of the pilots for FlightCare....$25-60 a year is way cheap for the peace of mind you get with the coverage.

It's worth it.

**Mountainsurf** · 03-14-2007, 12:55 AM

I got flight-for-lifed when I wa 19 and on my Dad's sweet corporate health insurance policy. All I remember is my Mom bitching about the fact that she paid $5000.00 for me to get airlifted and she beat the heli to the hospital by car.

**Adventure Advocates** · 03-21-2007, 11:59 PM

Originally Posted by rvski

you should also check out adventure advocates. Its a secondary insurance type that cover any for of accident injury. I think im paying $8 a month for it. And it pick up anything your regular insurance wont. They also specifically used heli evacs as an example of how it saves your ass.

~Rickey

To clarify a couple of things, Adventure Advocates is a not-for-profit association with a mission to promore responsible outdoor recreation and environmental conservation. Accident Medical Insurance is one of many benefits members enjoy with their membership. The cost is currently $25/month for individuals or $32/month for families. The accident insurance benefit reimburses members for accident related medical expenses, up to $25,000 per accident. Membership includes a seperate air evacuation benefit, but it is only while traveling and must be [U]pre-approved[U] by contacting a third party prior to being transported, which is not always possible. As other posts have mentioned, the accident medical coverage is excellent, but the benefit is not designed as a true air evacuation service. There are programs that specialize in air evacuation, which can be found by doing an internet search. So, with this said, Adventure Advocates membership serves as an incredible benefit to many people, but it has it's limits.

**cj001f** · 03-22-2007, 12:40 AM

$25 a month? Ouch.

Membership in one of the European Alpine clubs (OeAV, DAV, CAF) is <$100/year and covers pretty much the same stuff, with similar valuations. It also gets you the hut discount (the American Alpine Club has practically worthless insurance and no hut discount)

Check out the details at:
http://www.aacuk.org.uk/

**keksie** · 03-22-2007, 06:58 AM

yeah, for those too lazy here's what the ÖAV membership covers for about 55USD per year.. rescue cover includes helicopter costs as long as heli deployment was ordered by the regional rescue centre.:

Search and Rescue Cover up to €22,000
following a leisure activity accident or resulting from mountain or aquatic activity distress (injured or uninjured) following accident, hypothermia, getting lost, illness etc.

Repatriation and Transfer Cover unlimited
following an accident or illness or transportation of a body in the case of death following a rescue. Cover is dependent on prior approval being gained from Tyrol Air Ambulance or the insurance company UNIQA Personenversicherung AG (contact details are provided on the 2007 membership card and in the AWS leaflet).

Medical and Accommodation Cover up to €7,500
for non-deferable medically necessary treatment as an in-patient in a foreign hospital, of which up to €1,500 is available for out-patient medical treatment, inclusive of prescribed medication, at a foreign hospital or with a foreign doctor (excludes first €70 of any claim).

Public Liability Cover up to €2,180,000 and Legal Cover up to €32,700
covers any activity organised by OeAV Sections and the pursuit (including private pursuit) of hiking tours, mountaineering, climbing, skiing, ski touring, snowboarding, white-water canoeing, canyoning, and mountain bike tours. Cover is restricted to Europe and does not include the islands in the
Atlantic, Iceland , Greenland, Spitzbergen, Asian Turkey and the CIS..

edit: so it basically covers your way from the mountain to the hospital/doctor. for the rest you need something else. i'm not sure about DAV, i think their insurance covers a bit more