As part of our work to enable adventures by reducing risk, I spend time talking with fellow outdoor enthusiasts about their experiences. My friend Matt shared his recent saga
Matt, sitting in an urgent care center in Colorado with his arm still in the temporary sling that ski patrol had fashioned on the slope, had been on the phone with his health insurer for almost an hour, trying to get his policy number.
A couple hours earlier, Matt had been atop Grouse Mountain, in Beaver Creek on a bluebird Monday afternoon, ready to make his next run of the day.
This particular lap, however, was not going to be a smooth one. As he dropped into the steeps, Matt’s pole snagged on something beneath the snow. His full body weight continued down the mountain, but his left arm was ripped awkwardly behind him.
He heard and felt a pop, and he instantly realized that he was severely injured. The pain set in immediately.
In his late 30s, Matt’s been on skis for most of his life, including living and skiing in Colorado for two years and spending four years as a member of the National Ski Patrol.
Skiing solo that day, Matt’s experience kicked in. Rather than panic, he ran through the protocol of how to get out of the situation and get care. Before crumpling onto the snow, he moved across the slope so that he was visible from above and signaled to other skiers on the slope that he needed help.
Once he was confident that Ski Patrol was on the way, Matt called a friend to come pick him up at the mountain. While he waited, Matt compiled a mental checklist of everything that was about to happen. He knew he’d be waiting a few minutes for Patrollers to arrive, they would conduct an on-the-mountain assessment, transport him down the hill, and have an intake team ready for him at the base. He made himself as comfortable as possible, and began to extend the timeline beyond that day.
Looking up at the sky, Matt began to plan for surgery in the immediate future. He also made a mental note that he had travel scheduled to a critical professional conference the following week, and those plans might now be up in the air. Refocusing to the immediate future, he hoped he could get to an urgent care facility before the orthopedic center’s office staff left for the evening.
Some necessary background at this point in the story is that Matt found himself in Colorado in the first place because he was waiting for his next job to start, and had a few months to enjoy peak ski season. This meant, however, that his employer-sponsored health plan was a thing of the past.
Professionally, Matt is a healthcare management consultant, so he’s no slouch when it comes to what it takes to get care and coverage in the US. His journey following his accident would, nevertheless, be a royal pain.
Knowing the risks of gaps in coverage, Matt was careful to ensure he had a health plan in place. In fact, when a clerical error caused a one-day gap, he stayed indoors that entire day, missing a group outing to Vail’s Back Bowls. Because he’s a Virginian, he couldn’t get a marketplace plan that would cover him in Colorado, and he couldn’t get a plan in Colorado as he wasn’t a legal resident. COBRA coverage was insanely expensive, so Matt opted for a short-term, catastrophic health plan for his three months in the mountains.
The insurance carrier, which shall remain nameless, is a subsidiary of one of the major health insurers, but runs a fairly barebones operation for short term and alternative types of health insurance. These plans are useful when you’re transitioning from one life stage to another, if you need something that’s affordable, if not necessarily ACA compliant, or if you find yourself out of network for an extended period of time.
Ski Patrol arrived and performed an initial assessment in place, as expected. They immobilized his left arm and took him down the expert terrain on the sled. By the time he got to the Ski Patrol Medical Center, his friend was already waiting to give him a ride to a local urgent care facility, so he could skip the pricey trip in the ambulance and avoid the resort medical center, which is often billed as an Emergency Room.
When Matt arrived at the care facility, he hadn’t yet received any documentation from his insurer, and the only way that he knew he was covered was that they had drafted his premium payment from his bank account. To check in, he needed to provide a policy number.
He called his insurer and waited. By this time, the adrenaline had worn off, and Matt was starting to experience unrelenting pain, sending him into the early stages of neurogenic shock. He waited for an hour on the phone for the carrier to find his information, which brings this story back to where it started, arm throbbing, the reality of it all starting to sink in, and unable to get treatment until he had the magic numbers.
Finally, someone on the other end of the phone had gone through the records and found a policy number. Matt was able to check in. He was taken to get X-rays, to have a physician check him out, and to get some much-needed pain medication. This was where things started to turn in Matt’s favor.
With an important work trip the following week, it was paramount that Matt be in some kind of condition to travel. The urgent care physician was able to get in touch with the surgical coordinator for the orthopedic center and get Matt in the queue for operating room time.
Matt left that night with his arm in a sling and prescription for painkillers, which he’d have to pay for out of pocket as he had no drug coverage with his bare-bones plan.
The next day, Matt had his work cut out for him. From scheduling MRIs to checking in with loved ones, there was quite a bit to do. First, he had to figure out how to get his pants on. This would be a recurring source of frustration early on, and it’s something that’s a common frustration following an injury. Not only are you hurting, unrested, and operating under the mental fog of painkillers, but you can’t operate normally in your life, which creates additional stress.
On Wednesday, Matt had his MRI imaging and intake exam at the Steadman Clinic, which is the US Olympic Committee designated medical center. The results were in. Matt had torn his left bicep and would require surgery to reconnect the tendon. In another stroke of luck, Matt found himself with the last surgical time slot that Friday, allowing him to make his Tuesday morning flight.
Friday rolled around, and Matt walked into the clinic, passing walls of signed jerseys of professional athletes. He plopped down a $2,500 payment for his surgery, which was estimated at a total cost of $16,000, and they took him back to the surgical admission area. As he counted backward from 99, he couldn’t wait for it all to be over.
A few hours later, Matt’s bicep tendon was repaired, and he was waking up. The procedure took less than 50 minutes, and the orthopedic team expects him to regain 100% of the use of his arm, once it’s fully healed and rehabbed.
I caught up with Matt to get his story organized over the past weekend. We took a walk on one of our local trails and then headed out to grab a cold beer. While he’s still in PT, Matt’s spirits are high. But, as we sat sipping some of the local brews, cyclists began to trickle in, and he lamented that he’s sitting out some of the best mountain biking weather we’ve had in recent memory. He won’t come close to his annual average of 110 mountain bike rides this year.
While Matt’s accident was a rare one, he had taken many steps to be prepared. He was uniquely armed with experience and knowledge of what to do in case of a skiing accident. He had health insurance that provided coverage in the geography he was skiing in, and he had purchased a higher level plan to reduce his deductible to $1,500. He was fortunate to have a ride from a friend to the urgent care facility. He also was very lucky to be referred to a world-class orthopedic surgery clinic that could see him relatively quickly. Matt also had savings to be able to cover the roughly $6,000 that he owed out of pocket for his care.
Not everyone is so lucky or prepared. Many adventurers—pros and enthusiasts alike—head out for a day, week, or longer with coverage gaps. In our research, we found that only a third of respondents knew when they’d owe out of pocket if they had an accident that sent them to the ER.
We’re putting together a quick guide to help you understand coverage gaps in your current health insurance, so check back soon to see what you might owe in an accident. As always, our team is working to bridge these gaps with easy to understand insurance products, so we can all enjoy our adventures with a little less worry.
It’s a journey of a thousand steps, and we’re on our way.
Big thanks to Matt Curtin for sharing his experience, and we hope to see him on the trails soon!