Phil Gaimon's Olympic dream becomes $200,000 medical bill nightmare

[fiamme red]

https://www.npr.org/sections/health-...bill-nightmare

In a sprint with a pack of riders at the velodrome track in eastern Pennsylvania, Gaimon sailed over his handlebars after colliding with a fellow racer. Gaimon hit the ground hard. The result: a fractured collarbone, five broken ribs, a partially collapsed lung and a broken scapula — injuries worse than any he had suffered in the 10 years he had raced on pro road teams in the U.S. and Europe...

Total bills: $151,804 from Lehigh Valley Health Network and $49,526 from the Hospital for Special Surgery. He had additional bills from various physicians. Health Net has paid approximately $27,000 to Lehigh Valley, according to Gaimon. His secondary insurance, with USA Cycling, paid $25,000 to the Hospital for Special Surgery and his surgeon there...

[Hellgate]

Ouch. That's racing.

[bicycletricycle]

Hospital pricing is madness.

[mecse]

What a horrible story to read. I think I'm going to have an unpopular opinion here:

When I moved apartments in a fancy condo building the building demanded the movers show they were appropriately insured before they were allowed to come in the building.

I thought that USA cycling was responsible for insurance here - where's their liability in this? NPRs article briefly mentions that.

On the flip side, this is the horror story from a similar story years ago at the red hook criterium; It's a shame nothing has changed.

https://gothamist.com/news/after-cyc...y-improvements

[merckx]

How does someone who competes in a high risk sport like cycling not have health insurance?

[fiamme red]

Originally Posted by merckx

How does someone who competes in a high risk sport like cycling not have health insurance?

He did.

He paid about $500 a month for his insurance policy with Health Net through Covered California, the state's health insurance exchange. He also had a secondary health insurance policy with USA Cycling...

Gaimon collided with three health system dangers in this physically and financially painful crash: an out-of-state emergency, out-of-network care and gold-plated prices from both hospitals that treated him. Gaimon said he could sell his house and pay these bills, "but I shouldn't have to. I have insurance."

[tctyres]

Originally Posted by merckx

How does someone who competes in a high risk sport like cycling not have health insurance?

Out of network costs.

[s4life]

Hospitals are an extremely profitable business. It’s insane how much they get away with without any sort of backslash

[ripvanrando]

BCBS in network would have paid $20K. Medicare maybe $10k.

Out of network?

Welcome to bankruptcy. Because? They can.

[Mark McM]

Originally Posted by mecse

I thought that USA cycling was responsible for insurance here - where's their liability in this? NPRs article briefly mentions that.

I think a lot of people misunderstand sporting event insurance. In this case, USA Cycling provides two types of insurance:

The first is rider medical insurance. There are two caveats to this insurance: It is a secondary insurance, so it only takes over after the rider's primary health insurance ends; and it has a limited cap of $25,000, as mentioned in the article.

The second type of insurance is the event organizer liability insurance. This insurance has a per incident maximum of $1,000,000, and an event maximum of $3,000,000. But this insurance only covers the event organizer's liability, i.e., what was caused the event organizers actions or negligence. In Phil Gaimon's case, it appears the crash was caused by a collision between riders. Unless the collision was due to something the organizers did (or didn't do), the USAC event liability insurance won't cover it. If the crash was caused by deliberate action of the other rider, he could potential sue the other rider for damages, but that would likely be difficult to prove, and even if he could prove it, the other rider may not have the assets to cover it.


The lesson here is that it would behoove participants in amateur sports to make sure they have their own insurance adequate to cover potential medical expenses.

[mecse]

The lesson here is that it would behoove participants in amateur sports to make sure they have their own insurance adequate to cover potential medical expenses.

I'd go further and say events shouldn't allow riders to race without proving that they do in fact have such insurance.

[joevers]

Originally Posted by mecse

I'd go further and say events shouldn't allow riders to race without proving that they do in fact have such insurance.

As if bike racing doesn't have enough financial barriers

[C40_guy]

Originally Posted by tctyres

Out of network costs.

This may become a non-issue next year.

https://www.nytimes.com/2021/07/01/u...lls-biden.html

[FlashUNC]

"Hey you can't race in our crit unless you can prove your insurance plan will cover a quarter million in hospital costs."

Yeah, great idea.

In before the lock because we can't discuss how the rest of the industrialized world pays for healthcare.

[mecse]

Originally Posted by joevers

As if bike racing doesn't have enough financial barriers

You're right! It's a tough barrier.

Neil Gaimon's story is ugly though, and he thought he was covered - so he was already paying for insurance, just not correctly.

I feel its uglier to have these rare cases on my conscience when I am in or watching a race. I know that the others in the group near me could hurt themselves - but i'm not fine with the thought that a mishap could bankrupt them in the name of some prizemoney (or in Gaimon's case, a spot at the olympics)