Secondary Insurance Policies and Procedures

Lewis & Clark Athletics Department

Insurance Claims Policies

1. Any medical or dental services connected with the care of injuries sustained during participation in intercollegiate, varsity athletics (excluding club and intramural sports) must be arranged through the Head Athletic Trainer. In emergencies, if an athletic trainer is not available, the student should consult the Student Health Center. A student-athlete who is injured in a practice or a contest should report the injury as soon as possible to an athletic trainer.

2. Care for which Lewis & Clark College is to be responsible must be arranged through the Head Athletic Trainer. Individuals injured while participating in intercollegiate, varsity athletics (excluding club and intramural sports) may not be reimbursed for unauthorized services.

3. Written authorization and all necessary paperwork will be given by the Head Athletic Trainer for referral to the appropriate physician. If this documentation is not on file in the athletic training room, bills for services may not be considered and the student-athlete can be held responsible for payment. No exceptions.

4. If a student-athlete is injured while participating in an actual game, practice, scrimmage session, meet, tournament, or while in transit to or from a contest, the college’s policy with regards to insurance coverage is as follows:

• College policy requires the parents/guardians or students have accident or medical insurance, and that this insurance be applied primarily to pay for such medical/dental and hospital costs that it covers. Claims procedures MUST be followed for your private insurance. If not, a delay in payment or denial of payment may occur.

• The college athletic secondary insurance policy is an “excess coverage plan” over any current insurance coverage held by the student or their parents/guardians. If there are any limits to personal coverage on the student-athlete, the policy will then pay the remaining eligible charges to a maximum of $75,000. NCAA Catastrophic Insurance is provided above these amounts except to those participating in Men’s Crew.

• The Head Athletic Trainer will coordinate insurance coverage matters for all student-athletes. The injured athlete is responsible for filling out an insurance claim form with the Head Athletic Trainer and submitting any medical paperwork, bills, or insurance paperwork immediately upon receipt. All claims must be initiated within 90 days of the date of the initial injury.

• The college’s secondary insurance carrier does not reimburse for claims above what is considered “Usual and Customary” (UAC). Any claims amounts above UAC will be the responsibility of the student-athlete or their parents/guardians.

• The secondary insurance will only reimburse on the remaining eligible expenses after the primary insurance company has paid.

5. If a serious injury should occur to a student-athlete while representing Lewis & Clark College at a sanctioned game, scrimmage, meet, or tournament, for which treatment cannot await the return to campus, the student-athlete should seek appropriate medical attention and notify an athletic trainer within 24 hours.

The Lewis & Clark Athletic Department carries this policy to assist in the payment of medical services. Lewis & Clark is not responsible for medical bills. If guidelines are not followed, the student-athlete or their parents/guardians may be financially responsible.

Lewis & Clark College
Secondary Athletics Insurance Claims Procedures

You have sustained an injury during participation in intercollegiate, varsity athletics (excluding club and intramural sports) that requires referral for additional medical evaluation. The following are guidelines you will need to follow to ensure payment of bills for services resulting from an injury sustained during participation in intercollegiate, varsity athletics (excluding club and intramural sports). It is extremely important that these guidelines are followed otherwise it may result in you or your parents/guardians being held financially responsible for the bills.

Policies

1. Any medical or dental services connected with the care of injuries sustained during participation in intercollegiate, varsity athletics (excluding club and intramural sports) must be arranged through the Head Athletic Trainer. In emergencies, if an athletic trainer is not available, seek medical attention and notify an athletic trainer as soon as possible.

2. Individuals injured while participating in intercollegiate, varsity athletics (excluding club and intramural sports) may not be reimbursed for unauthorized services. Care for which Lewis & Clark College is to be responsible must be arranged through the Head Athletic Trainer. The Head Athletic Trainer must give written authorization for each service provided.

Procedures

If a student-athlete is injured while participating in an actual contest, practice, scrimmage, meet, tournament, or while in transit to or from an event, the college’s policy with regards to insurance is as follows:

• All medical bills for an injury will be sent directly to you or to your home address, unless the athletic trainer has instructed the medical vendors otherwise. In some cases the Athletics Department may receive a copy of the bill, but in no case will the college be the billed party. In most cases, the provider will bill your personal insurance directly. If not, you will be held responsible for submitting the bills incurred to your personal insurance plan first for consideration.

• If a balance remains after your insurance company has contributed towards the claim, send the Explanation of Benefits (EOB) from your insurance company and a copy of any itemized bills for services rendered to the Head Athletic Trainer.

• If you receive a letter of denial from your insurance, send the letter along with the associated itemized bills to the Head Athletic Trainer. The Head Athletic Trainer will then forward the claim to the college’s secondary insurance carrier for processing.

• It is important that the necessary information be provided to the Head Athletic Trainer in a timely manner to expedite payment since all bills incurred are the responsibility of the student-athlete or their parents/guardians.

HMO’s

If your primary family coverage is through an HMO (Kaiser Permanente, Group Health, etc.) you must follow the proper procedures required by your plan in order for the college’s secondary insurance carrier to satisfactorily complete the claim. Except for emergency procedures, all services must be performed by a contracted provider. In other words, if you are a Kaiser member, you must see a Kaiser physician. The college will not be responsible for out-of-network claims.

Contact Information

If you have further questions or concerns regarding these procedures please use the following contact information. Please use this address for all correspondence regarding insurance claims arising from injuries sustained in intercollegiate, varsity athletics (excluding club and intramural sports):