Dive Medical Services around the World

The good, the bad and the ugly




In DAN's 30 years of managing emergency evacuations and claims for divers around the world, we are proud to have worked with so many excellent care facilities. The vast majority of hyperbaric and other medical facilities that have treated DAN® members are staffed by consummate professionals, and in most cases care is exceedingly good.

These health-care professionals maintain constant contact with DAN staff in the United States, and together we work diligently toward effecting the best available treatment and/or evacuation for our members.

But DAN members should be aware that there are emergency-service providers who are more motivated by profit than patient well-being. People who have just experienced a dive accident are vulnerable and may not be thinking as clearly as they otherwise would be. Injured divers are rarely familiar with the local "system" for hyperbaric care and may be susceptible to advice from whoever offers it. In some places bounties are paid to dive operators or cab drivers to get injured divers into the care of one medical provider over others. In these cases, divers become commodities in a revenue machine rather than, as DAN would prefer, patients to be treated with immediacy and concern.

Unfortunately, we have discovered serious issues with a few hyperbaric-chamber facilities outside of DAN's direct sphere of influence.
Deceptive Practices
We have seen centers that represent themselves as "DAN referral facilities" or claim they are approved by DAN. The display of posters, tank decals or certificates with DAN logos should not be interpreted as endorsement or certification by DAN. These materials are readily available to anyone. DAN does not certify health-care facilities or endorse particular operations. A DAN logo on a chamber does not prove legitimacy.

Hyperbaric-chamber staff may claim to be DAN physicians or medics. This is at best misleading and at worst blatantly dishonest. With the exception of Dr. Dario Gomez in Cozumel, Mexico, DAN does not employ physicians to provide medical services in any country outside the U.S. DAN staff consults with local medical professionals to make sure divers get the best care possible. When you call the DAN Emergency Hotline (+1-919-684-9111), we can provide up-to-date information on local medical services, but the care providers do not work for DAN. If you are ever told otherwise, immediately be suspicious; that might be the first of several lies you are told.

Lately we have seen repeated instances of diagnosis and treatment plans being influenced by financial benefit to the facility rather than by the medical needs of patients. In our experience, most cases of decompression illness (DCI) are either resolved or stabilized with one to three hyperbaric-chamber treatments. In severe cases, more treatments may be appropriate, but the patient can usually fly safely and resume treatment at a facility closer to home. If your symptoms worsen or persist without improvement, further diagnostic testing may be warranted to identify other possible causes. More of the same treatment is seldom the answer. If repeated chamber treatments are being recommended, it's a good time to call the DAN Emergency Hotline. Perhaps further treatment will be recommended, but it may be better to arrange a transfer to a medical facility with a broader range of diagnostic and treatment capabilities.

In reviewing insurance claims made by some of these unscrupulous chamber operations, we have seen exorbitant fees for basic services, invoices for services that were never provided and multiple billings for the same services. While most facilities offer services for reasonable and customary fees, those with questionable billing practices increase the costs for everyone. Just as Medicare fraud costs the U.S. billions of dollars each year, on a much smaller scale, avaricious chamber operations may charge rates well in excess of industry standards. Ambulance charges can likewise be outrageously inflated — even when the "ambulance" is little more than a taxi driver rewarded by a chamber operator to divert accident victims to one treatment facility over another.

We have seen unethical demands for advance payment of copays and deductibles. DAN's dive accident insurance program guarantees the payment of 100 percent of treatment costs; members should never be required to pay out of pocket. Reputable chamber operators know this and look solely to DAN for payment once presented with a member's DAN insurance credentials. Finding yourself immersed in a corrupt system is difficult, and again we urge you to reach out to DAN for clarification of financial procedures — just as you would for medical treatments. DAN is just a phone call away 24 hours a day, every day.

If a medical facility ever restricts access to a phone to call DAN, consider that a huge red flag. A DAN member or a traveling companion must contact DAN to allow us to arrange necessary payments or guarantees. Calling the DAN Emergency Hotline ensures we know you had an accident, and it initiates the procedure for payment of related costs. Be aware that even the most basic level of DAN membership provides for evacuation from an accident site as long as it's at least 50 miles away from your home. Unless we are engaged early in the process, our ability to help and to compensate members fully may be compromised.

If you only have a hammer, you tend to see every problem as a nail. This can be true among providers of hyperbaric medicine; if your only available tool for treating scuba divers is a recompression chamber, your inclination may be to treat all injured divers for DCI. But prematurely concluding that symptoms require chamber treatment can delay proper care and may even exacerbate an injury that's not actually bubble-related. If a stroke is assumed to be DCI just because a patient was diving earlier in the day, permanent damage, which could have been prevented, might result. Not every ache or pain that occurs after diving is the result of DCI.

Be very concerned if there is local interference with DAN's efforts to arrange a medical evacuation. DAN TravelAssist® is a benefit available to all DAN members. When it is determined that a member's condition warrants a higher level of care than is available in the current location, DAN will arrange to transport the member to a more suitable medical facility. Members should not make these arrangements themselves or ask anyone other than DAN TravelAssist (via a call to the DAN Emergency Hotline) to organize an evacuation.
CASE 1
During a recent dive trip in the Caribbean, a DAN member suffered a serious cut to her leg while diving on a shallow wreck. First aid was given immediately, and the bleeding was under control by the time the boat reached the dock. Although efforts were made to have an ambulance meet the boat, one was not available. Instead, a taxi was dispatched to take the member to the local hospital. After learning that his passenger had been diving, the taxi driver bypassed the hospital and delivered the member to the local hyperbaric chamber. The staff at the chamber examined the cut, determined that the bleeding had stopped and, despite the absence of any symptoms of decompression sickness (DCS), recommended a precautionary Table 6 chamber treatment. When the member came out of the chamber almost six hours later, she was put into another taxi and transported to the hospital, where the wound was finally cleaned and sutured.

Fortunately, this delay did not cause serious harm to the injured member. A call to the DAN Emergency Hotline for support and assistance could have precluded the absurd and expensive chamber treatment and gotten the member to needed medical care much more quickly. If treatment inconsistent with your injuries is recommended, question the judgment and motives of those making the recommendation. You are entitled to a second opinion. You can trust DAN; hundreds of thousands of divers have for more than 30 years.
CASE 2
Following several days of diving, a member began to experience symptoms that suggested DCS. The local physician conducted a series of hyperbaric treatments over the next few days. Although the member felt better after each treatment, the symptoms always returned within a few hours of exiting the chamber. The member called the DAN Emergency Hotline; the physician to whom he spoke suggested he be evacuated to the U.S. for further evaluation and a higher level of care. Since the member was stable, arrangements were made for a flight the next morning.

The member had mentioned to the resort staff that he had other insurance in addition to his DAN coverage. Even though the staff was fully aware a DAN evacuation had been initiated, they offered to make alternate arrangements, suggesting there was no reason to wait until the next morning (even though the patient was stable after several days of hyperbaric treatment). The member gave the resort staff his insurance information and thought everything would be arranged in coordination with DAN.

He had no further contact with DAN and was taken to the airport at 2:30 a.m. by the resort staff for evacuation. When a DAN medic called to check on the condition of the member the following morning, he was advised that the patient had already been evacuated. No one had called DAN to arrange an earlier evacuation or to cancel the one that was already scheduled.

Several weeks later the member received an Explanation of Benefits from his health-insurance company. It showed a total cost for the evacuation of $62,000. With his $5,000 deductible and 20-percent copay for "out-of-network services," the member was billed $16,400. Had DAN evacuated the member, his TravelAssist benefit would have covered the full cost of the evacuation. DAN would have paid the $62,000, and the member would have paid nothing.

Be sure you understand your membership benefits. DAN TravelAssist and emergency medical evacuation are not "insurance" benefits, per se. They are services provided by DAN TravelAssist, and DAN must make all the arrangements. If you elect to have someone else provide these services, under most insurance plans you will be liable for deductibles and copays. Stay in contact with DAN at all times to ensure you receive the full benefits of your membership and insurance. DAN is here for you, but we have to be in the communications loop to ensure your welfare.

Most of the hyperbaric facilities DAN members will encounter are professionally staffed, modern, safe and honorable. But a few people have found ways to exploit the system to their own benefit — at the expense of traveling divers who may be hurt and vulnerable. By sharing our experiences with these unscrupulous individuals, we hope to improve divers' understanding of how services should be delivered and what practices are cause for concern.
More Information
DAN is available to help you, your traveling companions and local health-care providers better understand your symptoms and make the correct diagnosis.

If you have symptoms after diving, call the DAN Emergency Hotline at +1-919-684-9111.

© Alert Diver — Fall 2012