UFC fighter outlines issues with health coverage
January 6, 2014
Bloody Elbow reports on the issues UFC Lightweight Conor Heun has had in paying his medical bills despite being covered by UFC medical insurance. He has declared bankruptcy due to unpaid medical bills.
Heun has multiple issues with his body which has precipitated multiple surgeries. The issue with Heun’s medical coverage was that his doctors did a procedure on the hip of his right labrum that was deemed not medically necessary. Heun stated that the plan covered about $200k of his surgeries but billed him for the procedure as the claim was denied. Heun stated, via twitter, that the UFC was going to cover the surgery (presumably the portion not covered by insurance) but not cover his rehabilitation from the injury. He claims that he still has 39K in unpaid medical bills. The tweet has now been deleted.
The first question that you might ask is who to blame? In this instance, the UFC may be the least responsible. Sure, it was the one that provided Heun with the medical insurance for which a portion of his medical bills were not covered. But, the organization likely signed on with a standard medical insurance policy and did not know what was and what was not covered. It’s a tricky subject and the costs likely exorbitant for the UFC to cover every type of procedure to make its fighters better. Moreover, it’s unlikely an insurance company would offer this type of coverage, especially to an MMA organization when it knows it will be paying out for many of its policyholders.
Like anyone else with medical insurance, there are things that insurance will pay, and others that it will deny for one reason or another. Here, according to Heun, his doctors did the procedure without knowing it would not be covered. But, from my experience, the doctors usually do not know what is covered by insurance. Rather, they do what they believe is medically necessary and do not check with the insurance company. While support staff for the doctor could have checked with Heun’s insurance, it likely did not happen here.
Is it the insurance company’s fault? Of course it is. I am half-joking here, but what’s not being asked is whether Heun appealed the decision. There are times where if the policyholder persists and appeals the denial decision, it may be reversed. Certainly, there are times that you have to be persistent with insurance companies.
Is it Heun’s management’s fault? It could be if Heun had a manager that should be on top of these types of things. While we write a lot about sponsorships for fighters, it seems like a part of a manager’s job is taking care of their medical issues. Strapped with hefty medical bills, there should have been some talk with either the hospital or insurance company as to how to deal with the situation. Was Bankruptcy the answer? Perhaps. But filing for Chapter 7 (or 11) may create a whole other set of problems.
In the end, it was not Heun’s difficulty with UFC insurance, but the broader problem with the medical insurance industry. Patients are not clear what is or are not covered and are not given sufficient information on how to address the situation.