DAN Insurance: Rejected by Some

Dr. Michael Rosenberg, an Undercurrent subscriber from Providence, RI, recently toured the Galapagos hyperbaric chamber on Puerto Ayora. He told us he was “upset when I showed them my DAN Card and asked if it would cover a series of chamber treatments. They said the reimbursement didn’t come close to covering their expense.” Rosenberg e-mailed Divers Alert Network (DAN) for an explanation and when he got no response, he contacted Undercurrent.

National Baromedical Services manages claims for DAN. We spoke with NBS president Dick Clark, who says they process about 200 claims a month stemming from about 70 inwater cases, which include multiple claims such as evacuation to a major medical center for additional therapies and diagnosis. A typical patient undergoes 2.25 hyperbaric treatments before being released. DAN America says its insurers have paid out more than $20 million in claims to members and treatment facilities.

Based on the average costs of chamber treatments in remote nonhospital facilities like the one in the Galapagos, NBS has created a reimbursement schedule for “reasonable and customary” charges. This is the amount they offer the facility. Laurie Painter of Vicencia & Buckley, PADI’s agent for dive accident insurance, says that usual and customary rate schedules are common among health and travel insurance policies. She said she has never seen an insurance company deny a decompression bill because it was more than the reasonable and customary amount.

In response, Dr. Rosenberg told us that “as a medical provider, it doesn’t much matter what I charge. The insurer pays what they want!”

One concern is that if usual and customary reimbursements don’t cover a particular chamber operator’s costs, the operator may be unable to remain open. Chambers must always have personnel available for an emergency, and they have fixed monthly expenses, whether they are treating injured divers or not. Some even treat local divers who collect fish or lobsters, most of whom are poor and uninsured, for no cost.

The Dallas-based (Sub-aquatic Safety Services), which has chambers in Nassau, Thailand, Cozumel, and – you guessed it – the Galapagos, has stopped accepting DAN insurance. In a press release dated January 9, they said that “certain facilities will no longer accept the DAN America insurance as a payment method for hyperbaric chamber and medical services. . . . .It is hard enough to maintain the facilities available 24/7 . . . .but with the underpayment and nonpayment of bills, some over a year old by DAN America, the chambers feel obligated to the diving public to remain open. To that end, 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, . . . .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.” In fact, Mauricio Moreno, owner of SSS, told Undercurrent that they have sued DAN over alleged pay issues. However, he pointed out that the network is still “duty bound to render services despite a patient’s ability to pay.”

NBS’s Clark told Undercurrent that SSS may charge three to five times DAN’s reasonable and customary rates. But, two competitors, Painter and Peter Meyer, broker for DiveSafe (which insures industry professionals and divers certified by some agencies), told Undercurrent that they, in fact, find charges from the SSS network to be in line with other chambers.

Many chambers that charge more than DAN’s reimbursement have an “affiliation fee,” which they offer local operators. They may give preferred treatment to paid-up divers from an affiliated operation by waiving their dive policy’s deductible (if they have one) no questions asked. Dive operators assess the chamber affiliation fee on traveling divers. For example, this month’s Galapagos travel reviewer on the Star Dancer was assessed $35 for chamber fees. Many resorts tack on a dollar or two per tank.

DAN CEO Dan Orr confirmed they have been in court with SSS for months, but are still trying to work out a solution that’s right for DAN members as well as the industry. DAN has issued a statement saying “that reasonable and customary means the usual charges of similar chambers” and argues that Moreno’s fees are significantly higher than similar chambers. As to the allegations of slow pay, Orr told Undercurrent, “Questions are asked in any billing, and this does slow down the process. We think we’re doing the best job we can.” DAN says that they “will continue to take care of divers in need. . . . No DAN member who purchases dive accident insurance through DAN should be at risk of not being covered.”

It’s against medical ethics for a medical facility such as a hyperbaric chamber to refuse emergency treatment before they can ascertain the ability of a diver to pay. Clark advises that if a DAN-insured diver is presented with a bill after treatment, he or she should submit it to DAN for reimbursement. NBS then adjudicates the shortfall with the facility.

Rarely, a patient may have to advance payment out of his own pocket. Clark told us of one diver who was not allowed to leave a chamber facility without paying the $15,000 shortfall. The diver put it on his credit card and contacted DAN as soon as he got home. They wired full reimbursement to him the next day.

And then there’s the case reported in the January Undercurrent, when Lloyds TSB turned down a claim from a bent English diver because he had exceeded the 30-meter limit stipulated in the policy’s small print. Egyptian authorities wouldn’t let him leave the country until they secured payment. So, before traveling to a remote location, make sure your credit card limit is high enough to cover emergency medical expenses, regardless of what insurance you carry.

Larry Clinton