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4 Things Cyclists Should Know About Our Healthcare System

Hospital visits among cyclists are on the rise across the nation. In fact, an estimated 596,972 emergency room visits between 2008 and 2018 were due to bicycle crashes leading to possible traumatic brain injuries. 

Landing in an emergency room, urgent care or doctor’s office because of a bicycle crash could leave you with months or years of care that isn’t covered by your insurance. And the emergency room is an unfortunate place to learn about our country’s health care system. Learning some key points so that you can advocate for yourself if you are in a bike accident can save you money and also give you the best shot of healing completely. 

So before you hit the road next time, keep in mind these four things about the healthcare system and how they pertain to your life as a cyclist.

One: The ER can miss conditions 

If you show up to the emergency room for a bicycle injury, you’re very unlikely to be the only patient in the waiting room. ERs are busy (and stressful) places, which could be the reason why so many people are misdiagnosed in these settings. 

Estimates suggest that about 12 million people per year are misdiagnosed by health care professionals, and many of these cases are occurring in emergency room settings. If you’ve suffered from a bicycle accident, ER doctors may be looking for broken bones, serious lacerations and internal organ damage. Those are things that may require immediate care. In a fast-paced environment where other serious life-altering medical emergencies are happening all around, it’s easy (and common) for injuries that aren’t immediately obvious or life-threatening, such as concussions, to go misdiagnosed or undiagnosed. 

“A study published in the American Journal of Emergency Medicine demonstrates that misdiagnosis of concussion in adults is somewhat common in the emergency department (ED), despite patients presenting with known concussion signs and symptoms,” writes Neurology Advisor. “Longer length of ED stay, involvement in a motor vehicle collision, and variation in physician experience and practice may partially explain these misdiagnoses in the ED setting.”

We mean no insult to ER doctors. It is simply that their job is primarily to look for life threatening conditions, and they are almost always working under time constraints. With bicycle accidents especially, it may be wise to get a second opinion after visiting an ER. 

Consider following up with another provider, perhaps one that is skilled in spotting traumatic brain injuries and concussions, even if you are feeling mostly ok following a crash and ER visit. And definitely don’t be shy about making additional medical appointments as long as you have any unexplained pain or changes in your balance, mood, or cognition. This could give you a better chance at total recovery.

Two: Subrogation 

Insurance companies are working hard to get money from those at-fault in an accident. “Subrogation” is the process of recovering expenses from the at-fault person’s insurance carrier, and it happens with both car and health insurance companies. If you’ve ever been involved in a car accident, you may have heard this term in relation to auto insurance – but many are surprised to learn that it also applies to their health insurance. 

Almost certainly, when you signed up for health insurance, you signed a subrogation agreement with the health insurance company. This means that your health insurance contract obligates you to reimburse them for payments made on your behalf due to injuries suffered in a bicycle accident, if the crash was someone else’s fault.

Yep, you read that right. Your health insurance will want you to pay them back for the medical bills that they cover after you’re in a bicycle accident.

When you start your personal injury claim, your health insurance company will put a “lien” on your case for the amount that they want to be paid back. These liens can sometimes be negotiated down, meaning that your take-home settlement increases. To help your bicycle accident lawyer get the best settlement possible, and to enable them to have the best shot at negotiating down medical liens, it is important to put them in contact with your health insurance provider and/or medical providers at the outset of your case.

Three: Health insurance wants to get you back to work 

It’s true that health insurance can help protect you from a major unexpected medical cost, but that doesn’t mean it still won’t be expensive, or that your coverage will help get you back to 100% of where you were before an accident. 

Our healthcare insurance system is mostly set up so that you can return to work, which is probably where you’re getting your coverage from. If you’re involved in a bicycle accident and want to return not just to work but to how you felt before the collision, it might take more than what your coverage will pay for. 

For instance, perhaps you love backpacking, but your pack straps rub on metal hardware that was installed to help repair your broken clavicle bone. Your health insurance might not cover additional surgeries and treatments needed to allow you to get back to backpacking without pain. Rock climbers also often need additional treatment for clavicle or wrist fractures in order to be able to get back to climbing pain-free, because of the type of pressure climbing puts on the body.

And if you suffer a mild traumatic brain injury (aka concussion), there are very few treatments that your health insurer will cover.

The bottom line is that even if you have an excellent health care policy, you could still have costs that are unmet. This may be for a specialist or for extra follow-up visits. A personal injury lawsuit can allow you to pay for the cost of returning to your best self. Attorneys at Bay Area Bicycle Law are trained to handle cases specific to bike accidents, so we know what you’re up against when it comes to medical bills, insurance companies, and getting what you need to be able to return to the road.

Four: Not all concussions are the same

Concussions are common injuries, but they vary greatly from case to case, and even how you sustain your concussion may change the outcome, side effects, and treatment plan. This means that you should take the prognosis of a concussion seriously after a bike crash, and ask your medical professional questions so that you understand your injury and take the necessary steps to recover completely. 

The term “concussion” refers to a traumatic brain injury. “Think of the human brain as an egg yolk and your skull as an eggshell. When your head or body takes a hit, it can cause your brain to shake around inside your skull and injure it,” explains the University of Pittsburgh Medical Center. It is important to note that although helmets do reduce the severity of head injuries, often what injures the brain are the ridges on the inside of the skull itself, when the brain bumps up against them – and helmets can not prevent this (although they can absorb some shock and cause the brain to bump into your skull with less force).

Concussions can cause a wide range of symptoms. Although many times these symptoms will resolve in a few months or less, up to half of those with mild traumatic brain injuries will suffer symptoms long-term

Sports medicine concussion experts have split concussions into 6 different “clinical paths,”  each of which requires a different kind of treatment. They are:

  • Cognitive/fatigue: You may experience tiredness  and have trouble completing complex mental tasks. 
  • Vestibular: With this concussion you will experience problems with your balance and may cause trouble coordinating head and eye movements. 
  • Ocular: You have trouble with your vision. Reading or looking at computer screens may cause you trouble. 
  • Post-traumatic migraine: You may experience headaches, nausea, sensitivity to light or noise. This can cause changes in your routine because you avoid such triggers.  
  • Cervical: You experience pressure on the neck or spine, ongoing headaches. 
  • Anxiety/Mood: You experience excessive worry, your social life suffers or worsens due to avoiding routine activities. 

Don’t expect your ER or even primary care doctor to know about these different categories, though. The brain is extremely complex, and the medical understanding of brain injuries is constantly evolving. Doctors who don’t specialize in brain injuries usually won’t be able to keep up with the current science and treatment options.

If you suspect that you have a concussion of any kind, you will need to learn to advocate for yourself in the medical setting. Ignoring a traumatic brain injury could put you at risk for long term side effects, which wouldn’t be included in a personal injury claim, thus costing you more out-of-pocket. And if you continue to have symptoms related to your traumatic brain injuries after a few months, you should ask for a referral to a neurologist who is experienced with traumatic brain injuries to give you the best shot at recovery.

Having a lawyer who you trust on your side can also be a huge help. At Bay Area Bicycle Law, we always have our eye out for concussion symptoms in our clients, and pride ourselves on helping our clients advocate for themselves in a medical setting to get the best diagnosis and treatments possible.