DAN America insurance -- problems?
Posted 10 January 2006 - 03:35 PM
FOR IMMEDIATE RELEASE
Dallas, Texas, January 9, 2006: The Recompression chamber network branded SSS (Sub-aquatic Safety Services), in service in a dozen popular dive destinations worldwide (and in most cases the only chamber in a several hundred mile radius), has been forced to notify the public that certain facilities in some destinations effective immediately, and others progressively so, will NO longer accept the Divers Alert Network (DAN) AMERICA insurance as a payment method for hyperbaric chamber and medical services.
It is hard enough to maintain the facilities available 24/7 with optimal technical, administrative and operational readiness, but with the underpayment and non-payment of bills, some over a year old by DAN America; the chambers feel obligated to the diving public to remain open. To that end the chambers can no longer tolerate unpaid services, and since the only insurer in the world who has refused to settle our bills is DAN America, thus some SSS chambers have no other choice but to ask DAN America patients to pay for services when rendered and file the claims themselves with DAN America for any possible reimbursement. Please note that this action applies only to DAN AMERICA. It does not apply to DAN Europe, DAN Southern Africa, DAN Southeast Asia-Pacific or DAN Japan.
Divers are advised to check with their insurance carrier prior to travel to secure verification of coverage.
Posted 10 January 2006 - 03:50 PM
The DAN Diver Accident Insurance Program has provided coverage for hundreds of thousands of divers and their families, and DAN America’s insurers have paid out more than $20 million dollars in claims to members and treatment facilities around the globe. During this time, DAN has collected and exhaustively studied a wealth of information on treatment charges. From this, DAN has identified ‘reasonable and customary’ charges for treatment of decompression illness. This information is an important component to any insurance program to assure treatment of injuries at a fair price. This benefits both the insurer and the insured.
Unfortunately there is currently a dispute between DAN and Mr. Mauricio Moreno, the owner of a few chambers in our region. Specifically the dispute involves what constitutes reasonable and customary charges for hyperbaric chamber treatment. It is DAN's view that reasonable and customary means the usual charges of similar chambers. It is the view of Mr. Moreno that reasonable and customary means what the chamber charges, even if the charges are significantly higher than charges of other similar chambers. One major international insurance company previously withdrew coverage altogether due to these high charges. Having been sued by Mr. Moreno, DAN is now forced to address this situation legally.
There is no dispute, however, that DAN's insurers have agreed to pay Mr. Moreno's chambers at what they consider reasonable and customary rates. Therefore, if Mr. Moreno requires divers to pay in full for services when rendered, even for the portion of charges in excess of what is reasonable and customary, Mr. Moreno is needlessly overreaching and inconveniencing divers.
Despite these issues, DAN is committed to providing coverage to our members regardless of where they live and dive. Therefore, we have attempted to negotiate with Mr. Moreno over several years, including DAN’s attempt to identify costs unique to his chambers, but without success. The good news is that the vast majority of chamber operators in the USA and around the world provide excellent treatments and services at fair rates.
Despite this dispute, DAN will continue to take care of divers in need. DAN encourages members to ALWAYS contact DAN directly if there is any question about treatment issues or payment of services. DAN, as we always have, will address such inquiries immediately, 24/7/365. No DAN member who purchases dive accident insurance through DAN should be at risk of not being covered.
Posted 11 January 2006 - 02:00 PM
The short version is that this is a pissing match between SSS and D.A.N. with injured divers caught in the middle. Perosnally, I lay the blame at the feet of SSS.
When we got to the Cozumel Chamber (her symptoms were fairly mild) they did the eval, decide she needed to be put in and asked about insurance. We dutifully produced her D.A.N. card and they immediately said they'd need to charge a $2500 "deposit" to her credit card. (Bear in mind, this was almost one year ago.)They explained that they were having problems with D.A.N. and they were sorry, etc., etc.
In the course of all of this, they also said they had contacted D.A.N. about our specific case and that D.A.N. wouldn't give them assurances about payment. We checked later and D.A.N. has no record of any such call and, in fact, Dan Orr personally told me that had they been aware of what was going on, they would have immediately wired money down directly to SSS to get the treatment going, and then deal with the fallout later.
SSS charged her card down in Cozumel and, once we were back in the states, D.A.N. pretty quickly (within a week) reimbursed her, with apologies, explaining the billing problems.
Interestingly, I asked the chamber tech we were dealing with what they would do if she couldn't have produced a credit card for the depsoit. He hemmed and hawed for a minute and said that, in an emergency, they would treat the diver anyhow. I aksed him if my conscious, breathing diver, whose symptoms were tingling and numbness in her arm, qualified as an emergency. He hemmed and hawed again and said, "Yes."
So the bottom line seems to be that they would have treated her regardless but they're trying to strongarm the diver first &/or we would have to have raised a stink. On the other hand, if they're not "guaranteed" payment, you have to wonder if that might affect their diagnosis in milder cases.
And while we were there at the end of her treatment, there was a guy coming in (a local) for what they told us was something like his 50th treatment in 6 months. I'm not a Hyperbaric tech, but I think the common wisdom is that after 6 or 7 treatments, you've pretty much gotten all the benefit you will. Now whether that reflects their profit motive at work or not, I have no direct knowledge. But it causes you to wonder.
I have discussed this somewhat extensively with Dan Orr at D.A.N. (my injured diver has had similar conversations - she's fine BTW), both on the phone and at DEMA. As an instructor and store owner, as well as someone who works very closely with the Catalina Hyperbaric Chamber here in L.A., the last thing we want as a diving community is for divers to put off or avoid treatment because they don't think they can afford it.
As I understand it from D.A.N., the fees that SSS charges seem higher than what would be "standard and customary" (but I don't have secific numbers). On top of that, after D.A.N. felt they had agreed upon a rate, that rate went up &/or there were other charges tacked on. So I think the D.A.N. position is that they feel SSS is sort of flim-flamming divers and the insuance companies with the rates.
I have no knowledge as to how others insurance compnaies are dealing with this or why it should only be D.A.N. that has this problem with SSS. I also got a copy of the e-mail and it seemed to me to be more aimed at smearing D.A.N. than it really was an attempt to alert the dive community to a problem. Seem to me th eintent of the e-mail is to get divers to call D.A.N. in a rage and demand that they pass SSS. Ironically, SSS still lists D.A.N. America on their website.
No matter how cut it, it stinks. Divers health should not become a political football. Shame on those who would play with that issue for their own gain.
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Posted 11 January 2006 - 02:08 PM
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Posted 16 January 2006 - 03:50 PM
"We actually had a very good experience at the chamber noted in the forum discussion. Dr. Moreno as very professional, we did not pay anything at the time, gave them info on both our primary provider, XXXX as well as DAN. The whole financial side of the picture was transparent to us. In November, SSS contacted us to let us know that XXXX (!) was sending us a check for $4500, which we would further need to send on to SSS. That was the sum of our effort.
"It is an interesting thread and there is probably some truth on both sides. The SSS facility and staff were to US professional doctor's office standards. There is likely a premium for this. Arguably with the anxiety of a bent diver as a counterproductive issue, perhpas the premium environs make a helpful impact."
It could be that with DAN as secondary insurer there wasn't the same issue as might have occured if DAN were the only one. I guess a lesson is that those diving and buying insurance should also check what their existing coverage offers as well as going through DAN (or other specialized insurance providers).
Posted 18 January 2006 - 10:49 AM
On Jan. 11, DAN received the following announcement from the SSS USA Corporate Offices:
SSS USA CORPORATE OFFICE WILL ACCEPT DAN INSURANCE
DATE: January 10, 2006
TO: SSS Recompression Chamber Network Affiliates & General Public
FROM: Quantum Processing Services Co, Ltd. SSS USA Corporate Office.
RE: DIVER ALERT NETWORK DIVE INSURANCE
We would like to inform all that the facilities as listed below will continue to accept Divers Alert Network (DAN) America Insurance. Our facilities are open and ready to treat any dive medical illness. These facilities are under new ownership; however, we are still dedicated to provide the best service possible. For any inquiries, please contact email@example.com.
Buceo Medico Mexicano
Cozumel, Q. Roo, Mexico
PLAYA DEL CARMEN
Playa Del Carmen
Q. Roo, Mexico
Subaquatic Services of Belize, Ltd.
Ambergris Caye, Belize
Hyperbaric Services of Thailand, Ltd.
Koh Samui, Thailand
Koh, Tao, Thailand
So it looks like things are worked out and us DAN members shouldn't have to worry if we need treatment!
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DAN Research Intern 2004