This American cyclist was rushed to the hospital after a crash during Olympic qualifiers — he was double-insured but still landed with $250K in health debt. Here’s how he beat it

With the crash behind him but the billing nightmares still on his tail, Gaimon took viewers through his journey, highlighting the challenges Americans face with debt and an industry infamous for leaving patience at the back of the pack.

With the fatal shooting of UnitedHealthcare CEO Brian Thompson making headlines — and sparking a "torrent of hate" for the health insurance industry on social media — Gaimon decided it was time to update his own story “to explain what happened, how I got out of it, maybe how it applies to you.”

The “it” he refers to involves some $250,000 in medical bills, inflated by hospitals and denied by his primary insurer. This drew Gaimon into a different sort of stamina test: fighting a six-figure debt compounded by what he labels as “hospital and health insurance lies.”

Not that Gaimon began the race without protection. Aside from his United Healthcare coverage through the Covered California marketplace, he also had a supplemental policy through USA Cycling. When only a small portion of his bills was covered, Gaimon — who knows a thing or two about competitive vigor — refused to quit, even with the odds stacked squarely against him.

A health insurance travesty, uncovered

Invited by a USA Cycling coach to try out for the 2020 Tokyo Olympics, Gaimon was competing at an Eastern Pennsylvania velodrome when he collided with a fellow racer, sailed over his handlebars and hit the ground — hard. Unconscious, he was rushed to Lehigh Valley Hospital in Allentown, which coincidentally was part of the health system that sponsored the cycling event.

The injuries were severe: a fractured collarbone, five broken ribs, a partially collapsed lung and a broken scapula. (In the video, Gaimon pulls up his shirt to reveal his scars and describes the lung damage as “life-threatening.”)

What’s more, the scapula break was so dangerous that for three consecutive days, surgeons who visited him declined to operate. Suffering from “crazy amounts of pain” and texting frantically for a solution, Gaimon was referred by a friend to Manhattan’s Hospital of Special Surgery and “a total badass surgeon.” It was out of his health network, but Gaimon knew he had to prove medical necessity. That proved to be much harder than ever imagined.

The surgery was successful, but months of painful recovery followed, and along the way an avalanche of medical debt hit. That he had five surgeons to vouch for the medical need didn’t help because the hospital called the surgery a voluntary outpatient procedure.

This triggered UnitedHealthcare to deny coverage. It was a case of what’s known as “balance billing,” a controversial (and now illegal) practice where out-of-network hospitals and insurance companies disagree on the price of services, leaving the patient stuck paying the difference.

Adding insult to injury, Lehigh Valley, which had failed to find him a surgeon, hit him with astronomical charges: $25,915 for a night in the intensive care unit and $29,785 for a night in the burn unit.

Winning the race

Just as Gaimon relied on advice to locate the scapula surgeon, he enlisted help online to strategize his next moves. For example, he learned to use the phrase, “I reject the validity of this bill” in his many letters to collection agencies.

His frequent online conversations also turned into crowdsourced news leads. They caught the attention of media outlets that did some heavy lifting on his behalf, including NPR (in cooperation with KFF Health News) and CBS News.