NEWS & EVENTS
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Athlete Insurance Information
  • The goal of the Athletic Training Department and the health care providers in our Sports Medicine Network is to provide the best possible health care for our student-athletes. To achieve this goal, communication and cooperation between the attending physician and our Athletic Training Department is essential from the time of injury through complete rehabilitation. Your cooperation in adhering to the policies and procedures outlined below will enhance care and is necessary to make claims against our athletic insurance.
     

    Guidelines for Claim Resolution

    The Athletic Department of Capital University does not assume any liability for expenses generated for the medical care of an athlete. We carry excess secondary insurance coverage as a service to our student-athletes and their parents in an attempt to relieve any financial burden that may occur from the care of athletic injuries. However, this is not an all-inclusive policy and benefits will only be applied subject to the terms and limitations of the policy.

    Once an athletic injury has occurred and a referral has been made by the Athletic Training Staff to a provider in the Capital University Sports Medicine Network, the insurance claims process begins. The following guidelines outline the claims resolution process.
     

    1. The Athletic Training Staff sends the medical provider(s) of service your primary insurance information. The medical provider(s) should file a claim with your insurance company for the services they rendered. Your insurance company will evaluate the claim and either pay you or the provider directly or deny the claim. If the provider does not file a claim with your insurance company for the services they rendered, the medical provider may send you a bill for the services rendered for you to file with your (primary) insurance company.

      If after 60 days of the date of injury, you have not received anything from your (primary) insurance company, you should: Call your (primary) insurance company to check the status of the claim, and/or submit the bill from the medical providers to your (primary) insurance company.
        
    2. The Athletic Training Staff notifies the secondary excess insurance company that a claim may be forthcoming. That claim must be filed within 90 days of the date of injury, or the secondary excess insurance company may deny claims for bills after that date. The provider may file a claim with our excess insurance company for the balance of charges after your primary insurance has been exhausted.
        
    3. Once your primary insurance coverage has been exhausted, you must then forward the following information to Capital University’s Athletic Training Department:
          •  All Explanation of Benefits sheets from your insurance company related to the care of this athletic injury.
          •  A copy of the itemized bills from all medical provider(s) reflecting the current balance.

      In all cases, the athletic department's secondary excess insurance can only be applied to those bills:
          •  Where services are rendered for the treatment of an athletic injury, AND
          •  When prior approval of that referral was granted through the Athletic Training Staff, AND
          •  When the care has been coordinated through the Athletic Training Staff, AND
          •  When your primary insurance company has responded to and resolved all claims.
        
    4. If after 60 days of your submission of a claim to our secondary insurance company you have not received anything, you should call Capital’s secondary insurance company, Pearce and Pearce at 800-222-6491 to check on the status of that claim.


    We are willing to advise you through this process, but the responsibility for the payment of all bills and the resolution of all claims rests with you. Should you have any questions about the claims process, please feel free to contact the Athletic Training Department at (614) 236-6558. Should you have questions concerning any bills from medical providers, please contact them first before contacting the Athletic Training Department.

    Insurance Frequently Asked Questions

    What type of supplemental athletic insurance does the athletic department carry?

    As a service to our student-athletes, the Athletic Department provides a secondary or supplemental athletic accidental insurance. The secondary insurance policy requires that the injured athlete first make a claim under their primary medical or hospitalization insurance. Medical expenses not covered by the primary insurance will be paid under the school's policy (subject to its limitations and conditions). Although we attempt to purchase the most comprehensive policy within our resources, this is not an all-inclusive policy.

    The secondary policy will only be applied to medical costs incurred for services rendered by a participant in the Capital University Sports Medicine Network and their specific written referral for further care. That care must still be coordinated through the Athletic Training Staff prior to the visit. The secondary policy is applicable only for athletic injuries that are a direct result of intercollegiate activity during a required practice or competition supervised by a coach.

     

    How does my child qualify for secondary coverage?

    You must complete an annual Health Insurance Form that asks for the personal insurance information under which your child is covered. In addition, you must complete the Insurance Card Form in which you must attach a copy of the front and back of your insurance card. These two forms must be on file in the Athletic Training Facility prior to an injury.

     

    How does the insurance coverage work?

    The secondary insurance policy requires that the injured athlete first make a claim under the primary insurance. At the time of treatment, we submit your primary insurance information to the healthcare provider. The provider should file a claim with your insurance company for the services rendered. Your company will evaluate the claim and either pay you or the provider directly or deny the claim. If the provider does not file with the primary insurance, the provider may send you a bill for you to file with your insurance company.

    If after 60 days of the date of injury, you have not received anything from your insurance company call your company to check the status of the claim, and/or submit the bill from the provider to your insurance company.

    At the time of injury, the Athletic Training Staff notifies the secondary excess insurance company that a claim may be forthcoming. After your primary insurance has been exhausted Capital University will notify the healthcare provider of its secondary excess coverage. The provider will then file a claim against the secondary insurance company. You should contact the providers directly to make sure they have filed with primary and secondary insurance companies. You may need to file these claims yourself. All claims must be resolved with the secondary insurance company within 2 years of the date of injury.

     

    When is an athlete referred to a physician?

    Whenever the team physician or the athletic trainer is of the opinion that a consultation would facilitate/improve the care of an injury, arrangements for such a visit will be made. Coaches do not have the authority to refer an athlete to any physician except for emergency medical care when the Athletic Training Staff is not available.

     

    What if I belong to an HMO?

    If you belong to a Health Maintenance Organization (HMO), you are limited to the HMO's physician and facilities. You are requested to send us specific instructions, requirements, and/or limitations which may be included with the policy. This information is necessary for the claims process to be filed correctly. Failure to follow the proper HMO procedures will void your eligibility for coverage under the athletic department's secondary insurance.

     

    Which physicians can an athlete see under the secondary insurance plan?

    For an athlete to be covered under the athletic department's secondary insurance, they may be seen only by participants in our Sports Medicine Network. This network is composed of a wide range of specialists from the local medical community. This group is dedicated to providing the best possible health care to Capital University athletes. We formed this network to insure accurate and continuous communication between the physicians and the Athletic Training Staff. Prior written authorization must be obtained if an athlete wishes to seek medical attention outside of the network. Authorization is grated only in cases where our consulting physicians cannot provide the required care. If an athlete seeks a second opinion or care from an out-of-network provider, he/she will be medically ineligible to participate in athletics or utilize the services of the Capital University Athletic Training Program until medical records are received and reviewed by the Athletic Training Staff. The athlete has the responsibility to see that the physician forwards all requested information. You also assume the financial responsibility for any travel cost and the services of that provider. Our secondary insurance cannot be applied to those services.

     

    Secondary insurance coverage can be applied toward which bills?

    Capital’s secondary insurance can be applied only to those bills for an athletic-related injury when:

    • Prior approval for a referral was granted through the Athletic Training Staff.
    • Care has been coordinated through the Athletic Training Staff.
    • Services are rendered by participants in the Sports Medicine Network with specific written referral.
    • Care is rendered within 180 days of the date of injury.
    • Your insurance company has responded to and resolved all claims.

     

    What types of things are not covered under secondary insurance?

    1. Any injury sustained in an activity that is not associated with a required intercollegiate practice or competition supervised by a coach.
    2. A chronic or recurrent injury that was sustained prior to participation in athletics at Capital University.
    3. Any degenerative condition as diagnosed by a physician.
    4. Any illness (cold, flu, infection, etc.).
    5. Unauthorized consultations or treatments.
    6. Conditions as a result of non-compliance with school's policies, team rules, or the advice of the team physician, attending physicians, the athletic trainers or coach.
    7. Any injury that is not reported to the athletic trainers within 7 days of occurrence or onset of symptoms.

     

    What are the parent's and/or athlete's responsibilities?

    It must be clearly understood that you and/or your child are financially responsible for all charges for the care of an athletic injury and the resolution of all claims. The Athletic Department of Capital University assumes no financial liability for expenses generated for medical care of an athlete. We will try to relieve any financial burden that may occur from the care of athletic injuries through the department's secondary insurance policy. However, this is not an all-inclusive policy and benefits will be applied subject to the terms and limitations of this policy.
    In addition, the parents and/or student-athletes have the responsibility to follow the proper procedure to access the secondary insurance policy to seek benefits for charges that arise from an athletic injury. Again, all charges are ultimately the responsibility of the student-athlete. Therefore, if the threat of collection or garnishment arises from an unpaid bill, the parents and/or student-athletes are strongly urged to pay all balances to avoid harm to his or her credit rather than wait for the insurance company to decide on benefits.

     

    Where can I find more information regarding secondary insurance?

    Specific questions should be directed to Robert Thorne, Head Athletic Trainer at (614) 236-6558.

     

    What if my primary insurance coverage changes during the year?

    It is the student-athlete's responsibility to notify the Athletic Training Staff promptly of any changes in his or her primary insurance coverage including changes in insurance carrier, address, benefits, primary care physician, etc.