Balance in Action: "Mike's Story"

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Editor’s Note: We wanted to illustrate how Balance might work for the individual cyclist. So we created the story of Mike, an avid cyclist who finds himself with a hefty bill after a crash.

Mike has been a road cyclist for over 12 years. He’s had injuries due to falls, but nothing more serious than some cuts and bruises. However, that changed during a recent training ride. A driver fell asleep at the wheel and struck Mike, tossing him over 40 feet. If it weren’t for his helmet, it could have been much worse. Although Mike didn’t have a severe or moderate traumatic brain injury, he suffered a concussion and broke his leg. His bike was totaled, too.

Mike was airlifted to the nearest emergency room - over 50 miles away. He was hospitalized for 4 days and had to have surgery on his leg, as well as being monitored for his concussion. After his release, he had 10 physical therapy sessions - 2 per week for 5 weeks.

Weeks later, the bills began to arrive. Mike was stunned. His hospital bill alone was $18,000. On top of that, the helicopter ride was another $9,500, of which his insurance company only paid $7,000. Despite having health insurance, Mike still had to pay $1,500 that was remaining on his annual deductible plus the $2,500 of air ambulance charges that the insurance company did not cover. He was on the hook for $4,000 - and also had to replace his bike.

Luckily, Mike had enrolled with Balance. So, he filed a claim and utilized Balance’s cash benefits to offset the costs of his medical bills. Balance paid:

Emergency Room: $300 ($300/visit)
Hospitalization: $1200 ($300/day for 4 days)
Physical Therapy: $750 ($75/session, 10 sessions) Ambulance: $2,500 (covers what is left unpaid by other

insurance, up to $5,000)

Total Benefits Paid: $4,750

After Mike paid his $1,500 deductible and his $2,500 share of the air ambulance bill, he still had $750 to put towards a new bike! Ride safe, Mike.