Uniforms, AFAMS, and Health Insurance, Oh My!

[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.