Uniforms, AFAMS, and Health Insurance, Oh My!

[billford1]

The thing that I think about is what has an impact on how we can do our ES missions. I wear the BBDU and like it just fine. The concern is what may happen if I get hurt on an actual USAF assigned mission. One of our Wing members was injured on a mission and needed to be hospitalized. He had no insurance coverage of his own. His treatment was delayed for hours because it was difficult to establish his relationship to the USAF and what if any treatment he was eligible for. It took great effort to finally get him treated. Something that may or may not have been debated by the USAF is how to handle cases like this where a CAP mission participant can be identified by the USAF for eligibility for treatment and other support when on USAF Auxiliary business. Has anyone heard discussion about how the USAF considers the operational status of CAP mission members who do not wear a USAF uniform when on USAF business when emergency care for an injured CAP member must be administered?
Edit: Topic after split from Uniform Cmte thread -TA

[mikeylikey]

^ Emergency care should be given no matter if the person has personal insurance or not. 

As far as the insurance issue of whether a member is wearing a CAP corporate or a CAP AF -style is null.  Any member on an AF assigned mission is covered .I don't know where the "have to be in AF-style uniform" came from.

I do believe the member has to send in the hospital bill along with the CAP forms and safety officer's report of investigation to the State Director through the Wing Commander.  The State Director then sends it up channels on the AF side.  I would imagine the AF either pays the hospital directly, or sends the total due back down channels to the member.

[billford1]

Correct that no AF Uniform required to be considered a legitimate mission participant. When you go to the hospital injured on a USAF mission are you recognized as covered by the USAF. The injured member from our wing had no hospitalization insurance and was unprepared for having to get treated when it was explained that he was on a USAF Mission. No member in such circumstances should have to assume part of the financial responsibility for treatment with the requirement that the bills to that individual should then be forwarded to the USAF where the bill would hopefully be paid.  As for the uniform is there a provision for denial of payment for treatment if the CAP member has made a mistake with the composition of their uniform? Just asking

[mikeylikey]

  As for the uniform is there a provision for denial of payment for treatment if the CAP member has made a mistake with the composition of their uniform? Just asking

I do not believe so.  Are they going to deny the member because he wore a white undershirt when he was to be wearing a black undershirt, probably not.  Are they going to deny it if the member was in a AC/DC T-shirt and cutoff's.....I don't know that answer, but logic would dictate that if he was on the mision and signed in, he is covered. 

This would better be answered by the legal beagles here.

[JohnKachenmeister]

If a member is in an authorized CAP uniform, he should be covered.  There is NO provision that persons on AF-funded missions only wear AF uniforms.  The AF allows for both CAP and AF uniforms.

Cutoffs and an AC/DC t-shirt is not a uniform.

How many and how serious do the uniform violations need to be before the person is considered "Out of uniform?" I don't have a definitive answer on that.  I would expect common sense to prevail, and trivial violations would be overlooked.

I know of ONE case where coverage was denied based on a person not being in uniform.  A CAP plane crashed in Indiana, and the CAP-member pilot was wearing jeans and a flannel shirt.  There was also some evidence that he was using the CAP plane in furtherance of his farming business.

[FW]

The only issue about uniforms and insurance coverage I'm aware of is during an AFAM. This regards  FICA, FUTA  coverage.  If you are NOT in a proper CAP uniform, which includes your membership card, the Air Force has been known to decertify the sortie.  This means the member would be denied the above coverage.  I've known about members serving as aircrew who were wearing jeans instead of gray slacks getting no coverage.  However, the member would still be covered by CAP's insurance.

[mikeylikey]

I know of ONE case where coverage was denied based on a person not being in uniform.  A CAP plane crashed in Indiana, and the CAP-member pilot was wearing jeans and a flannel shirt.  There was also some evidence that he was using the CAP plane in furtherance of his farming business.

I can only surmise that his his claim was denied because he was using the Aircraft for some personal use.  I really don't know how the AF would react to the actual clothing being worn by a member if he or she were to get hurt or die on an AFAM.

[Hawk200]

If you are NOT in a proper CAP uniform, which includes your membership card, the Air Force has been known to decertify the sortie.  This means the member would be denied the above coverage.  I've known about members serving as aircrew who were wearing jeans instead of gray slacks getting no coverage.  

A number of us have heard of these occurances, myself included, but noone seems to know any of these people that got denied coverage personally. Anyone actually know someone that this happened to?

BTW, I'm not saying that just because noone has been identified as such that it's OK to wear a uniform improperly. Common sense still applies.

I know of ONE case where coverage was denied based on a person not being in uniform.  A CAP plane crashed in Indiana, and the CAP-member pilot was wearing jeans and a flannel shirt.  There was also some evidence that he was using the CAP plane in furtherance of his farming business.

I can only surmise that his his claim was denied because he was using the Aircraft for some personal use.  I really don't know how the AF would react to the actual clothing being worn by a member if he or she were to get hurt or die on an AFAM.

Doesn't sound like this member was on an actual mission, does it? Wonder how someone would have called that an AFAM? 

On another note, the only missions I've heard of where civvies were allowed were CD, and then only if the agency we were working with requested that uniforms not be worn.

[JohnKachenmeister]

I am not sure of the status of the mission.  I don't know if it was an "Unfunded" proficiency flight, a funded corporate mission, or an AFAM.

CAP's insurance carrier also has a provision that the member must be in CAP uniform and all other regs. complied with, or coverage can be denied.

I suspect that the coverage was questioned due to evidence of the improper use of the CAP plane, but was denied based on the more easily-proved issue of the lack of a uniform.

[MIKE]

Drift.

[pixelwonk]

split

[RiverAux]

I think the more important part of the discussion is an apparent need for some sort of documentation that the AF or CAP should provide for members to prove that they are covered in this sort of situation.  Every other insurance program I've heard of issues some specific card and I imagine that military members get something similar for use in civilian hospitals in emergency situations.  Shouldn't we have something similar?

[Smokey]

This was put out by the CAWG State Director in 2004....note the bold especially....
To All,

    Several incidents have highlighted the need for comments on CAP uniforms.  Appropriate wear of CAP uniforms has received increased emphasis from both CAP and the Air Force recently, and one reason for this email is that State Directors have been directed to become more involved in ensuring compliance with Air Force and CAP guidance than we were in the past.  Normally, if we saw problems in the past, we brought them to the attention of the CAP leadership for resolution.  Now the CAP-USAF Commander has directed increased involvement by the liaison staff.  Here are some areas I would like to emphasize:



    1.    If you meet the grooming and weight standards specified in CAPM 39-1, you may wear Air Force style uniforms.

    2.    If you don't meet those standards, you may not wear a military style uniform, whether or not it has any insignia or rank on it.  This may especially concern those who don't meet grooming and/or weight standards who desire the protection provided by NOMEX.  I believe that wearing NOMEX while flying definitely enhances safety, and was concerned that some people would no longer be afforded the opportunity to wear it.  However, I have since discovered (most of you probably already knew) that a blue NOMEX flight suit, that does not have the weight and grooming requirements attached, is available from CAPMART. 
   
    3.    It is important for members of the CAWG to police themselves so those from outside the organization don't need to.  Here are some examples of problems that have been pointed out by Air Force and CAP visitors:
        a.    Flight suits worn with the zipper open more than 1/4 of the way open from the top.
        b.    Flight suits worn with street clothing exposed from the collar and/or the legs
        c.    People wearing the uniform who don't meet CAPM 39-1 weight and/or grooming standards

    4.    Proper wear of Air Force style uniforms is important for several reasons, including the fact that it conveys an image to the public of both CAP and the Air Force.  Most people who are not knowledgeable about the organization assume that CAP members they see in uniform are actually in the military.  If uniform wear is improper, it reflects unfavorably on the Air Force and CAP, while proper wear enhances the image of both organizations and increases the confidence of the people we serve.

    5.      Another important reason for proper wear of the uniform is insurance coverage.   In fact, if you are not in compliance with Paragraph 7-5 of CAPM 39-1 when you fly, you may be denied accident and death benefits by both the Air Force and CAP.  If this happens to you, rest assured that you won't be the first because it has happened in the past.  In order to help ensure nobody gets into this situation, I will deny Air Force mission status to people I see who wear Air Force style uniforms not in compliance with CAP and Air Force directives.  As you know, this will not completely solve the problem because there are many times I will not be in a position to see an aircrew depart on a mission, so it is up to you to ensure you are in compliance for your own protection.  

[isuhawkeye]

During his visit to the Iowa wing last fall Col.  Hodgkins informed the group that the Air Force has NEVER refused mission support, status, or benefits to a CAP member who was not in a proper uniform.

[RiverAux]

I've heard straight from a CAP Regional Commander that denial of coverage has happened before due to uniform issues. 

[FW]

Col. Hodgkins is right.  But, I was told it took a fight to get that "support" back after initial decertification.
Bottom line, as I see it, I won't go out and risk all just to wear what I feel like.  Before I get into an aircraft, I make sure my crew and I are in proper uniform and we have our current membership cards with us.  That is especially so when flying cadet O'flights.

[isuhawkeye]

dont get me wrong I certainly advocate the wear of proper uniforms.

On the topic check this out.

http://isuhawkeye.typepad.com/halbrook_associatescom/2008/01/america-relies.html

[DNall]

Federal coverage is provided by law for CAP members on AFAM. The law says nothing about uniforms. It says must be in compliance with all applicable rules & regulations. That means if you fail to follow rules for flight ops & pile up the airframe, then you aren't covered. But, it also means if you do everything else right but do so w/o a 39-1 required uniform then you'll likewise be denied coverage. It's kind of a no-brainer. Follow the rules & you're good to go, don't & you're screwed.

CAP insurance is paid by AF, and functions in exactly the same way. The only dif is the source of funds/oversight paid in case of an injury, and some very minor differences in coverage. The biggest difference is if it's CAP or AF that could be sued by a third party for the incident. For the actual member, there is no functional difference in AFAM or not.

[RiverAux]

CAP insurance is paid by AF, and functions in exactly the same way. The only dif is the source of funds/oversight paid in case of an injury, and some very minor differences in coverage. The biggest difference is if it's CAP or AF that could be sued by a third party for the incident. For the actual member, there is no functional difference in AFAM or not.

There is a HUGE HUGe HUGE difference between AF and Corp coverage for injuries. 

On an AFAM mission senior members and cadets are fully covered for any medical injury by the feds (CAPR 900-5(D)14(a)) 

On corporate missions or for cadets under 18 on an AFAM, you only get up to $8000 for medical benefits, and you only get that if your own private insurance doesn't fully cover the cost of the injury or you don't have any insurance at all.  (CAPR900-5(E).  In other words, don't count on CAP to help you on corporate missions or if you're a cadet.   

[ddelaney103]

Look, if the only mistake you made was wearing your Spinal Tap t-shirt under your flight suit, you're probably not going to have coverage denied in the event of an accident.  The "applicable rules & regulations" usually pertains to rulebreaking that might have contributed to the accident, such as "are you current?" or "were you flying out of regulations?"

The big word here is "usually."  The gov't has jacked over people before for little reason, such as the "since you're wounded, we'd like your reenlistment bonus back" flap from a month ago.

I think people are blowing this up into urban legend status, but wearing the right uniform can head this thing off at the pass.

[RiverAux]

Actually, we're getting a bit off track (to which I contributed and apologize)....

More on point, has anyone heard of other situations where CAP members have had difficulty getting medical treatment due to the unfamiliarity of hospitals with our status?   

[DNall]

Dang, wrote a reply that I guess didn't post last night. Oh well.

River, I'm not all that familiar with the coverage levels. My point was more the process at the member level.

i agree that the original intent of "applicable rules/regs" was about things that contributed to the accident & make it negligence on the part of the member versus the responsibility of the org. However, it is VERY common, in fact the industry standard, to deny coverage due to violations of completely unrelated rules.

Let me give you an example I worked on a few years ago. A member of a fraternity fell down the stairs & broke a leg during a party. The rules of the org required them to conduct the event with a solid guest list 48hrs prior that included members & no more than 2 guests per attending member. They did that, but they also let girls in the door that weren't on it. That had absolutely nothing to do with the accident, yet coverage was completely denied. That's completely unfair, but it's the absolute standard in public or private insurance.

You can get a policy that doesn't have those sorts of restrictions - outs for the insurance company to avoid paying - but, it costs a lot more. Most orgs choose to accept the risk to members/employees/etc so that they can afford a higher coverage/bond level on paper, even though it'll almost never pay out like it's supposed to. That's a risk based decision on their part. CAP is no different.

Far as difficulties w/ hospitals. If you show up at a base hospital, I'm pretty sure they'll sort it out rather quickly. A facility well away from the mil is going to have trouble figuring out something they never deal with. Of course emergency care is always given. After that comes your own health insurance. Neither the AF nor CAP provide health coverage to our folks. They provide accident coverage that reimburses well after the fact.

[chiles]

At least in Maryland, hospitals have a legal obligation to treat regardless of insurance coverage. So, whether you're sporting the top of the line healthcare, are being covered by the AF on a AFAM, or have no healthcare coverage whatsoever, they still must treat you. They just bill you afterward and then come after you when you fail to pay. However, the same isn't true with private healthcare entities (which mostly include urgent care centers as almost every hospital bills medicare and thus must follow federal "no dumping" rules or risk losing Joint Commission accreditation). They can deny service of care beyond life stabilization and transfer.

[wingnut]

I had an interesting conversation with one of our well respected CAWG staff, he told me that when we are involved in an AFAM we always have the CA State Office of emergency services (OES) mission number available just in case someone gets hurt. It seems the California State workers Comp is far superior to the Federal Workers Comp. My understanding is the Federal Covers you as a GS 9 federal employee (for pay).  I can attest to the Federal Workers Comp for injury back in the 80s, it was nightmare for guys injured with the DOJ, really sucked. I know guys who  had to waite 3 months for the pay to start. . .

Any input?

[RiverAux]

Well, hospitals have to treat emergency situations so I'm fairly sure that if a prop cuts my arm off the hospital will take care of me right away.  However, I could see some relatively minor injuries that don't warrant ER care causing a hassle.  Also, I could see hassles after the initial treatment for follow-up care or long-term hospitilization.  Just how long are hospitals going to take somebody's word for it that the federal government will pay for the care without being provided specific paperwork?  

[DNall]

Again, workers comp is not health insurance, accident insurance is not health insurance. You are not provided health coverage of any kind. That is 100% your responsibility. The coverage that is provided may after the fact compensate you for medical expenses, as in reimburse you or your insurance ocmpany, or possibly the hospital diretly if you hadn't paid them yet. Does this make sense? You get in a car wreck 7 show the hospital your car insurance. They're going to say okay that doesn't mean anything to us.

[flyerthom]

At least in Maryland, hospitals have a legal obligation to treat regardless of insurance coverage. So, whether you're sporting the top of the line healthcare, are being covered by the AF on a AFAM, or have no healthcare coverage whatsoever, they still must treat you. They just bill you afterward and then come after you when you fail to pay. However, the same isn't true with private healthcare entities (which mostly include urgent care centers as almost every hospital bills medicare and thus must follow federal "no dumping" rules or risk losing Joint Commission accreditation). They can deny service of care beyond life stabilization and transfer.

EMTALA FAQ

Bottom line, since most all ER's bill medicare etc. they are covered onter EMTALA / COBRA. Even some (not all) Military hospitals are. So any presentation after an injury must be given initial care even if the insurance question is not clear. In addition treatment must not be delayed. If the initial post had an initial emergent treatment delayed because of insurance that is not good. 

[chiles]

Well, hospitals have to treat emergency situations so I'm fairly sure that if a prop cuts my arm off the hospital will take care of me right away.  However, I could see some relatively minor injuries that don't warrant ER care causing a hassle.  Also, I could see hassles after the initial treatment for follow-up care or long-term hospitalization.  Just how long are hospitals going to take somebody's word for it that the federal government will pay for the care without being provided specific paperwork?  

Hospitals are not allowed to refuse treatment based off of mechanism of injury in the ER based on insurance status if they bill medicare per Joint Commission accreditation standards. So, if you walk into the ER minus an arm or you walk into the ER with a paper cut, they still have to see and treat you. Don't think that this hurts the hospitals a lot. They get to write off unpaid bills to taxes and receive charity care funds from both federal and state governments. This is an important difference from public and private care centers. Who is paying (CAP, AF, the patient or their insurance) doesn't matter in terms of receiving care from public hospitals.

[DNall]

Obviously, an ER will provide emergency care. That is not in question. The example stated overnight stay & continuing care. The coverage CAP has for missions (AF or corp) is not health insurance & does not provide such coverage. It is accident/liability type coverage, similiar to your car or home owner's policy. You could not present such a policy at a hospital & demand non-emergency care, nor can you bill such a policy for any type of medical care. All medical care is on you as a member. An accident claim against our coverage may reimburse you some amount after the fact based on coverage levels & liability involved, but the medical bill is between you & the hospital, the insurance claim is between you & the coverage provider. That's clear to everyone, right?

The original discussion was seeking an understanding of the degree to which coverage will be refused (in whole or part) by the provider based on unrelated rule violations. In this case violations of 39-1. That has & will continue to happen. It is an industry standard. It is part of the coverage. It is necessary to have that be part of the coverage so that we can have an on-paper high coverage amount to show customers so they don't feel they will end up liable for things they ask us to do. It is not designed to provide best protection to our members. If you feel you need such protection, you need to weigh that in your decisions to either participate or to purchase your own coverage. That is unfortunately how it works.

[RiverAux]

His treatment was delayed for hours because it was difficult to establish his relationship to the USAF and what if any treatment he was eligible for. It took great effort to finally get him treated.

There was really two parts to the issue, and I think the one above is more critical to most members. 

[DNall]

My read of that situation was that it was non-emergency and/or ongoing care that required an overnight stay for observation. As in they checked him in & determined his concusion wasn't life threatening, but they wanted to keep him overnight to manage pain & observation but he didn't have insurance & check-in was delayed a few hours while that was sorted out.

My point was actually that members need to understand that neither CAP nor AF/fed/state govt provides CAP with ANY kind of health coverage under any circumstances. If you have private insurance or no insurance, the medical facility will treat you according to that, relationship with the AF or CAP has zero bearing on it. What coverage we do have will kick in well after the fact & may help defer some or all the medical expenses based on liaibility & through reimbursement. Your medical care is your responsibility.

[Ned]

Your medical care is your responsibility.

Concur.

On the cadet side of the house, we have had a long-running debate about whether we can or should exclude cadets who lack health insurance from participating in optional cadet activities like NCSAs or the various weekend leadership schools offered by many wings.

In any challenging and vigorous activity, occasional injuries and illnesses occur despite an aggressive ORM program.  And when un-insured cadets have health problems that require professional medical attention, it creates significant administrative and supervision problems for the activity command staff.

Uninsured cadets are extremely limited in where they can be treated and by whom, because most providers will decline uninsured patients without cash in hand unless it is an emergency.  This places a huge burden on seniors who then have to find a provider (usually a government-run hospital offering indigent care), and stay for many hours in the usually overcrowded hospital until the cadet is seen and treated.



Question for the masses:  How does your wing deal with uninsured cadets who require medical attention?

Ned Lee
Frequent Encampment Attendee

[wingnut]

My read of that situation was that it was non-emergency and/or ongoing care that required an overnight stay for observation. As in they checked him in & determined his concusion wasn't life threatening, but they wanted to keep him overnight to manage pain & observation but he didn't have insurance & check-in was delayed a few hours while that was sorted out.

My point was actually that members need to understand that neither CAP nor AF/fed/state govt provides CAP with ANY kind of health coverage under any circumstances. If you have private insurance or no insurance, the medical facility will treat you according to that, relationship with the AF or CAP has zero bearing on it. What coverage we do have will kick in well after the fact & may help defer some or all the medical expenses based on liaibility & through reimbursement. Your medical care is your responsibility.

Actually that is not the case.

If you are on an AFAM or a California OES mission Workers compensation is to be used first,  ,and it is illegal to require someone to use their Health insurance for a WORK RELATED INJURY. Once again! If you are injured while performing work for CAP during an Official mission CAP does have medical  insurance, it is called "WORKERS COMP". And one more thing, I was in Management for a large hospital and I can tell you your nuts if you think someone walks in with no insurance gets the same treatment as someone  who does.  The law requires treatment for life threatening situations, and if it is a work related injury you are not to be billed: for anything needed for treatment, in the ER or followup, including therapy.

Tags - MIKE

[mikeylikey]

Your medical care is your responsibility.

Concur.

On the cadet side of the house, we have had a long-running debate about whether we can or should exclude cadets who lack health insurance from participating in optional cadet activities like NCSAs or the various weekend leadership schools offered by many wings.

In any challenging and vigorous activity, occasional injuries and illnesses occur despite an aggressive ORM program.  And when un-insured cadets have health problems that require professional medical attention, it creates significant administrative and supervision problems for the activity command staff.

Uninsured cadets are extremely limited in where they can be treated and by whom, because most providers will decline uninsured patients without cash in hand unless it is an emergency.  This places a huge burden on seniors who then have to find a provider (usually a government-run hospital offering indigent care), and stay for many hours in the usually overcrowded hospital until the cadet is seen and treated.



Question for the masses:  How does your wing deal with uninsured cadets who require medical attention?

Ned Lee
Frequent Encampment Attendee

Not a legal beagle here, but is that legal?  To exclude cadets from cadet activities because they lack health insurance?  First, I have seen cadets excluded from activities because they "had medical conditions", that were in my opinion a non-issue for attendance. 

So, I can't answere that, but I strongly believe to exclude cadets from CADET ACTIVITES simply because they are lacking health insurance, is WRONG.  But then again, perhaps someone should push this up to the Legal Officer at CAP NHQ.

[DNall]

My read of that situation was that it was non-emergency and/or ongoing care that required an overnight stay for observation. As in they checked him in & determined his concusion wasn't life threatening, but they wanted to keep him overnight to manage pain & observation but he didn't have insurance & check-in was delayed a few hours while that was sorted out.

My point was actually that members need to understand that neither CAP nor AF/fed/state govt provides CAP with ANY kind of health coverage under any circumstances. If you have private insurance or no insurance, the medical facility will treat you according to that, relationship with the AF or CAP has zero bearing on it. What coverage we do have will kick in well after the fact & may help defer some or all the medical expenses based on liaibility & through reimbursement. Your medical care is your responsibility.

Actually that is not the case.

If you are on an AFAM or a California OES mission Workers compensation is to be used first,  ,and it is illegal to require someone to use their Health insurance for a WORK RELATED INJURY. Once again! If you are injured while performing work for CAP during an Official mission CAP does have medical  insurance, it is called "WORKERS COMP". And one more thing, I was in Management for a large hospital and I can tell you your nuts if you think someone walks in with no insurance gets the same treatment as someone  who does.  The law requires treatment for life threatening situations, and if it is a work related injury you are not to be billed: for anything needed for treatment, in the ER or followup, including therapy.

Worker's comp is not health insurance.

There's two kinds of medical facilities here. There's the public hospital that'll provide emergency & follow on care to anyone regardless of insurance. In that case, they will treat you & then bill workers comp after the fact & within the limits of that coverage.

Then there's the all the other medical facilities, which is the overwhelming majority. For the most part they will provide emergency care, but nothing past that unless you have insurance. In that case, workers comp & liaibility insurance will not sufice to get you treated. I'm not saying your personal insurance coverage will or will not get charged, but having it will get you treated. Reimbursement or billing the right party can be worked out later.

Our coverage is meant to reimburse medical expenses within limits, not to ensure rapid treatment. It does what it's designed to do, not what it's not designed to do. You should have your own insurance & you should not count on the varrious coverage CAP provides.

[DNall]

On the cadet side of the house, we have had a long-running debate about whether we can or should exclude cadets who lack health insurance from participating in optional cadet activities...

Not a legal beagle here, but is that legal?  To exclude cadets from cadet activities because they lack health insurance?  First, I have seen cadets excluded from activities because they "had medical conditions", that were in my opinion a non-issue for attendance. 

So, I can't answere that, but I strongly believe to exclude cadets from CADET ACTIVITES simply because they are lacking health insurance, is WRONG.  But then again, perhaps someone should push this up to the Legal Officer at CAP NHQ.

That's real dicey at best. Excludding them for conditions might be a violation of our non-discrim/EEO stuff (fed law, AF & CAP regs). There are times when that might be appropriate to do, but I'm not sure we're allowed to do so.

For not having insurance would I'm about positive be illegal. You'd catch a case for discrimination based on economic = targeted at race, or something along those lines. That's the legal system for ya.