Backpacking into remote wilderness allows for an unparalleled sense of independence. You pack your own shelter, water filtration and food. Therefore, while prepared for all predictable trail risks as a backpacker, you are very easily able to become obsessed with gear weight, blister prevention, weather tracking, and so on. However, many outdoor enthusiasts do not even know that they have a massive financial vulnerability when they step off into the depths of singletracks miles from civilization; their health insurance policy doesn’t cover them.
The Geography of Healthcare Networks
While most health insurance options are based upon geographical areas; HMOs and EPOs limit your ability to see non-localized doctors or visit hospitals outside their defined area. The only time your out-of-area health costs would likely be covered is if it is in an urgent need for treatment at an emergency room. PPOs give you some flexibility when choosing a doctor/hospital, but visiting doctors/hospitals that do not participate with your PPO would result in increased deductible costs as well as a lower maximum amount you could spend in one year.
As a thru-hiker on the Appalachian Trail or the Pacific Crest Trail, you will often find yourself crossing into new counties and states. As such, there may come a point where the hospital located near a trailhead is completely out of your insurance company’s service area.
Evan Tunis, President of Florida Healthcare Insurance, emphasizes checking the out-of-state coverage before purchasing any travel related insurance. “Find out what each plan covers for out-of-state emergencies,” Tunis says. “Also, check to see if all of your regular physicians will accept this plan. If you want to keep seeing the same physician, but he/she does not accept this particular insurance plan, then you will either have to select a different physician who accepts this plan, or you will have to pay the difference in cost when going out of network.” In essence, hikers should verify which emergency situations qualify as an ‘out-of-state’ emergency under their specific plan, and identify potential regional trauma centers on their designated hiking route.
The Reality of Remote Emergency Care
The Affordable Care Act (ACA) states that hospitals are required to provide “emergency services” to patients, regardless of whether they are insured within the hospital’s network. However, what constitutes an emergency service may be subject to strict scrutiny by insurers. Therefore, if you go to a rural clinic with a serious tick bite; a deep cut that will need stitches; or, suspect you have broken a bone, it is possible that your insurer will later designate the clinic visit as “non-emergency urgent care,” and since that clinic was likely not part of your plan’s network, you would then be liable for all expenses related to that visit.
Additionally, out-of-network providers may use a process called “balance billing” against you when federal protections such as the No Surprises Act do not protect their practice. The facility can send you a separate bill for the amount that your insurance provider did not reimburse.
According to Mike Schroeder, founder and president of Roundstone Insurance, the traditional structure of most forms of health insurance create many opportunities for unsuspecting charges. “Insurance for health issues can be very complicated and difficult to manage from both an administrative and monetary standpoint,” Schroeder says. He emphasizes that true financial protection comes from having clear system processes, being informed through data analysis, and developing pre-emptive strategies for managing costs. From a perspective of one individual who hikes, this means that it is necessary to understand exactly how your particular insurance coverage responds to claims made from remote/rural healthcare systems.
The Search and Rescue Insurance Trap
In the course of hiking, there are many who believe that their basic health insurance will cover them in case they need to be rescued, either through Search & Rescue (SAR), or if they need an air-medical evacuation.
When you are airlifted off a mountain on which you were hiking, your health insurance company will most-likely reject your request for reimbursement for the SAR effort. Most health-insurance plans only pay when a person is officially under the direct medical care of a licensed healthcare provider, while riding in an ambulance, or hospitalized.
It is at this point that local police departments, volunteer SAR units, or military units locate you, extract you from whatever perilous situation you find yourself in, and then get you transported safely down to an accessible road. While some volunteer SAR units offer their services free of charge, other private SAR/Rescue companies can bill as much as $50-$100k+ per incident for the use of helicopters, etc.
Therefore it would behoove those who are going to hike long-distances to take advantage of supplemental insurance coverage specifically designed to protect against such catastrophic financial losses. Organizations like the American Alpine Club offer memberships that include specialized back-country supplemental coverage that provides financial protection for “coordinates-to-hospital” type transports.
Telehealth as a Trailside Asset
Telehealth is an alternative to in-person medical treatment for less than life-threatening medical emergencies. Telehealth provides a solution to geographical network limitation issues; for example, conditions such as mild rash, minor infection, or strain on joints are generally not serious enough to warrant an arduous trek to a rural emergency room. A cell phone with a stable connection (and/or a sat-phone with internet capability) will allow for consultations via video conference which may reduce both cost and time spent obtaining a diagnosis.
Most of today’s insurance companies have contracts with a national telehealth platform where you pay a fixed co-pay for each consultation. Once you obtain a diagnosis from a doctor using one of these platforms, he/she will be able to electronically prescribe medication to the local pharmacy in the town at the end of your hike. Before you leave make sure to download your insurance company’s selected app, set up your profile/credentials and find out if your plan covers out-of-state prescription refills.
How to Audit Your Policy Before Departure
Conducting a comprehensive review of your insurance is an essential part of preparing for your trip. Do not depend solely upon your summary that appears within the marketing brochure of your travel plan. Your insurance agent or representative can assist you with clarifying what is included within your specific policy.
During the initial phone call with your insurance agent, please use the questions below as a guide to ensure that all of your questions are addressed:
- Ask your insurance provider if they have policies or procedures regarding emergency treatment at out-of-state hospitals and/or urgent care centers.
- Also ask them about the specific factors that determine when a medical visit will be considered emergent vs. non-emergent.
- Inquire as to how much you will need to pay (deductible) per doctor visit for providers who are “out-of-network” and also confirm the total amount of money that you will owe (maximum out-of-pocket) for doctor visits per year.
- Lastly, verify if your policy has any provisions for paying for either ground or air transportation to an emergency facility and inquire if there are any pre-authorization requirements.
Final Trail Preparations
Treat your health insurance as if it were one of your pieces of equipment. The same way you will not go out into the backcountry with a new, untested water filter or an untested shelter; do not go backpacking without checking through your medical insurance first. Take the appropriate amount of time to evaluate your medical insurance (just like evaluating your other equipment) so that if an accident occurs and turns into a long-term financial disaster for you.
Carry a hard copy of your insurance card stored in a waterproof container and also store a soft copy of your card in local memory on your phone. Also make sure all of your emergency contact people have access to your insurance information and are aware of your supplemental medical evacuation options.