Athletic 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
  • ŸWhen 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, First Agency, Inc. at 269-381-6630 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.