By Dr. Robert Darling
Injuries and illnesses experienced as a result of alcohol or other substance abuse is often excluded in health and medical insurance. Here are some details about what’s covered, how and why.
Q. What are some insurance options for alcohol-related incidents:
It’s valuable to point out that alcohol-related events often touch on different types of insurance products in different ways. Health insurance, travel insurance, disability insurance, workman’s comp insurance, and general liability insurance all come into play on the direct injury side. A whole host of other insurance products come into play when property damage occurs in the setting of alcohol consumption.
- Health insurance provides the broadest coverage. Most health insurance policies will cover injuries or illnesses related to the acute effects of alcohol abuse, including the admission to a hospital for detoxification. Residential recovery programs and long-term treatment programs are covered by some health insurance policies, but coverage is widely variable. People should realize that not all insurance carriers provide coverage for travelers outside their home countries. And not all foreign hospitals accept insurance. Many foreign hospitals require significant upfront cash payments.
- There may be a distinction worth making between health insurance and travel insurance. Travel insurance programs, including medical evacuation policies, typically include exclusions related to alcohol-related injuries. ISOS, for instance, will not cover a member whose injury or illness was the direct result of his or her over-consumption of alcohol. A lot of expat seafarers who come from countries with universal health care just get travel insurance so that someone will take them home to their free health care when they get hurt, but if they are injured as a result of intoxication, the travel provider won’t move them home.
- Good hospitals vs. good insurance: Having all the right types of coverage is only one part of the equation. There are physiological considerations that are unique to alcohol-related illness and injury; poorly trained medical providers often fail to account for these changes when caring for patients – and the patients suffer a worse outcome as a result. Unfortunately, many healthcare providers also have a bias against intoxicated patients; this leads to bad outcomes, too. When an acute emergency occurs, the local healthcare system also has a big impact on survivability and patient outcomes.
As my colleague, Dr. Desjardins, frequently points out: this is why it is essential that travelers have good international health insurance coverage, a high-quality medical evacuation policy, and a solid understanding of which hospitals around them will take good care of them.
“Everyone understands the need for a coverage umbrella for their property or business, but tend to think that just one form of coverage is needed for our health,” Dr. Desjardins said. “That’s not true. A good health umbrella is vital to travelers.”
The issues are so complex that Patronus recently started a new travel health program to give our patients comprehensive coverage.
Q. Is alcohol coverage specifically excluded?
People must be careful with the elements of coverage in any insurance policy. We are speaking primarily from the perspective of American laws and health insurance products. Those laws and health insurance programs can differ significantly by country. Many policies differ even within the same provider (Blue Cross Blue Shield has hundreds of types of policies, for example).
Many policies do exclude alcohol-related incidents from coverage. The wording of those exclusions differ, but most of them aim at the same reality: people perform high-risk activities when they are intoxicated, and we do not want to responsible for covering this high-risk behavior.
One policy says: “Vendor’s services are not available to the subscriber if his or her illness or injury is a result of or is contributed to by the following.” The policy lists five exclusions, including “a subscriber’s use or abuse of alcohol or drugs (illicit or prescription), including, without limitation, hospitalization for addiction, withdrawal, or complications of alcohol or drug abuse.”
Another policy reads: “We will not pay benefits for a disability that is caused by or occurs as a result of your being addicted to alcohol or drugs, unless administered by a physician and taken according to the physician’s instructions.” This type of policy only covers dependency that arises from a legal, prescribed use of narcotic medications.
Q. Do plans cover things like treatment, counseling and time-off?
As mentioned above, health insurance typically covers most parts of the treatment programs that a person might need to recover from a drug or alcohol dependency issue. Unfortunately, there are often limits to this coverage that fall short of the full cost of treatment. Each policy is different, so one needs to read the fine print.
There are various options for ongoing therapy. Some, like Alcoholics Anonymous, are free and provide exceptional community-based support. While excellent, it can be hard to use this approach when your job involves significant travel. Another colleague, Dr. Miles Cunningham, uses telemedicine to provide psychiatric care. This approach is new, but can be a life saver for those who need support and access that can follow them wherever they go. About half of his telepsychiatry patients live and/or work in remote places.
The best way to address the income loss that occurs as a result of inpatient treatment and/or significant recovery periods (such as from a serious, alcohol-related injury) is disability coverage. Group disability coverage, which almost always comes from employers, typically covers treatment for alcohol-related conditions because they are seen first and foremost for what they are: either an acute injury or a serious disease (such as alcohol dependency).
Unfortunately, many voluntary short-term disability providers (such as AFLAC) do not provide income replacement when addiction or alcohol-related injuries are involved. Unlike group disability insurance, these voluntary providers are something that anyone can buy as an individual. The voluntary carriers believe that they would go bankrupt if they cover these kind of problems. These programs are not governed by the same regulations that govern health insurance and traditional disability insurance.
Q. Do you see any trends or problems in this regard?
There are many things here to note. First, the opioid crisis in the United States has impacted those who suffer from anything that requires alcohol substance abuse treatment. There is a greater focus on recognizing addiction and removing the stigma (helpful), but it is much more difficult to get into an in-patient recovery program.
Next, local culture (especially on a yacht) is often “work hard, play hard.” This can contribute to binge drinking and can mask serious substance abuse problems. Drinking in moderation is fine for most people, but heavy drinking leads to a host of other problems and risks.
Mixing prescription and over-the-counter medications with alcohol is a constant problem. People don’t realize that alcohol plus OTC medications can be deadly.
Supervisors should be trained to spot substance abuse patterns and the signs of acute intoxication, especially for safety sensitive positions. The signs of intoxication can be a lot more subtle than people realize. The fall-down drunk that comes to mind is the very far end; people can be impaired with much less obvious signs. And, the signs of minor impairment can overlap with low-blood sugar concerns, too. We used to talk about all these supervisory concerns, but it is concerning that training on these topics seems to have fallen away.
The use of telemedicine to treat mental health problems is a significant improvement that should be widely adopted by the maritime community in general.
Q. What do you recommend?
The three most important recommendations are:
- Comprehensive insurance coverage, especially with a travel orientation. These waters can be hard to navigate. We are experts in the field, but we even had to take the extraordinary step of creating and standardizing our coverage umbrella into its own distinct program (Patronus Elite Travel Health). If you decide to go it on your own, international health insurance and travel insurance are key.
- Comprehensive employee wellness and disability programs: These are quite simple and usually very affordable. Short-term and long-term disability, an outsourced Employee Assistance Program, and easy-to-access mental health coverage.
- Solid medical responder program and telemedicine solution. Alcohol-related emergencies are serious and medical problems are made worse by drinking. Each crew needs an experienced medical provider who receives regular training. The ship also needs immediate, reliable access to an emergency physician via telemedicine.
Dr. Rob Darling is an emergency physician also trained in functional and lifestyle medicine. He retired from the U.S. Navy in 2006 after 25 years of service, including physician to the President of the United States in the Clinton Administration. Dr. Darling is chief medical officer of Patronus Medical, including oversight of Patronus’ maritime medical programs. Dr. Andy Desjardins, an emergency physician, and Kevin Sullivan, a veteran paramedic, contributed to this report. Dr. Desjardins oversees Patronus’ destination and remove service divisions, including numerous crew emergencies and emergency evacuations. Sullivan is senior VP of operations for Patronus Medical. For more information, visit www.patronusmedical.com.
Alcoholics Anonymous offers a 12-question assessment to help you determine if your drinking is becoming a problem. Click here.
To read one captain’s story about losing his partner and stew to alcohol abuse, click here.