1. What type of athletic insurance does the athletic department carry?
2. How does my child qualify for secondary coverage?
3. How does the insurance coverage work?
4. When is an athlete referred to a physician?
5. What if I belong to an HMO?
6. Which physicians can an athlete see under the secondary insurance plan?
7. Towards which bills can the secondary insurance coverage can be applied?
8. What types of things are not covered under secondary insurance?
9. What are the parent's and/or athlete's responsibilities?
10. Will I have to pay for any health care costs that arise due to an athletic injury?
11. Where can I find more information regarding secondary insurance?
12. What if my primary insurance coverage changes during the year?

What type of 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 policy will only be applied to medical costs incurred for services rendered by a participant in the William & Mary 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.

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.

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You must complete an annual Health Insurance Form that asks for the personal insurance information under which your child is covered.  The Understanding Your Health Insurance Coverage While Away From Home form explains the procedures that we must follow to access your primary insurance.  In addition, you must complete the Insurance Card Form in which you must copy, paste, or otherwise attach a copy of the front and back of you insurance card.  These three forms must be on file in the athletic training room prior to an injury.

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The secondary insurance policy requires that the injured athlete first make a claim under the primary insurance.  We send your primary insurance information when the athlete is referred for care.  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:

1. Call your insurance company to check the status of the claim, and/or
2. Submit the bill from the provider to your insurance company.

We will also send the providers our secondary insurance information and notify our insurance company that a claim may be forthcoming.  The provider should file a claim against our secondary insurance company after your primary insurance has been exhausted.

• 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 52 weeks of the date of injury.

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Whenever the team physician or the athletic trainers are 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 Sports Medicine staff is not available.

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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.

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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 William & Mary athletes.  We formed this network to insure accurate and continuous communication between the physicians and the Sports Medicine staff.

Prior written authorization must be granted by a Sports Medicine Network physician if an athlete wishes to seek medical attention outside of the network.  Authorization is granted 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 William & Mary Sports Medicine Program until medical records are received and reviewed by the Sports Medicine 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.

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The athletic department's secondary insurance can be applied only to those bills for an athletic injury:

1. When prior approval for a referral was granted through the Sports Medicine Staff,
2. When the care has been coordinated through the Sports Medicine Staff,
3. For services rendered by participants in the Sports Medicine Network and their specific written referral,
4. For care rendered within 52 weeks of the date of injury, and
5. Your insurance company has responded to and resolved all claims.

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• Any injury sustained in an activity that is not associated with a required intercollegiate practice or competition supervised by a coach.
• A chronic or recurrent injury that was sustained prior to participation in athletics at William & Mary.
• Any degenerative condition as diagnosed by a physician.
• Any illness (cold, flu, infection, etc.).
• Unauthorized consultations or treatments.
• 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.
• Any injury that is not reported to the athletic trainers within 7 days of occurrence or onset of symptoms.
• Costs, including travel, associated with second opinions.
  

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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 the College of William & Mary 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.

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For all athletes--both those who receive athletic grant-in-aid and those who do not--our secondary insurance policy carries a $250 deductible per injury that must be met by either a) your primary insurance or b) the student-athlete or his or her parents.  Further, any remaining balances or charges that are not met after all insurance benefits are exhausted are the responsibility of the student-athlete.

Where can I find more information regarding secondary insurance?

Specific questions should be directed to Steven L. Cole, Assistant Athletic Director for Health Services at (757) 221-3405.

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It is the student-athlete's responsibility to notify the Sports Medicine staff promptly of any changes in his or her primary insurance coverage including changes in insurance carrier, address, benefits, primary care physician, etc.  In order to maintain coverage under our athletic injury policy, the student athlete must provide the following:

1. Health Insurance Form completed with the new information
2. Understanding Your Health Insurance Coverage While Away From Home completed
   
3. Insurance Card Form completed with new insurance card attached

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In an attempt to provide the best possible health care to our student-athletes, our staff is headed by Michael B. Potter, M.D.  Dr. Potter is a Family Practice physician, with specialized training in Sports Medicine.

 If your health insurance requires a referral from a specific physician for care, we would ask that you transfer that designation to Dr. Potter.  If he is not listed under your insurance plan, you should designate Jeffery Blanchard, MD, as they both work in the same practice.  Their office addresses are below.  To make this change, you will need to contact your insurance company. Your efforts now will help expedite care for you son/daughter in the event of an injury.

 Please feel free to call upon us if we can be of assistance to you with this process.
 

Once an athletic injury has occured and a referral has been made by the Sports Medicine staff to a provider in the William and Mary Sports Medicine Network, the insurance claims process begins.  The following guidelines outline the claims resolution process.  It must be clearly stated that you and/or your child are financially responsible for all charges for services rendered for the care of an athletic injury.  The Athletic Department of the College of William and Mary 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.  This secondary excess insurance policy has a $250.00 deductible that must be met by your primary insurance coverage or by the recipient of medical services.

1. The Sports Medicine 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:
1. Call your (primary) insurance company to check the status of the claim, and/or
2. Submit the bill from the medical providers to your (primary) insurance company.
2. We also send the providers of our excess (secondary) insurance information and notifythe secondary excess insurance company that a claim may be forthcoming.  That claim must be resolved within 52 weeks 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.
• In all cases, the athletic department's secondary excess insurance can only be applied to those bills:
1. Where services are rendered for the treatment of an athletic injury, and
2. When prior approval of that referral was granted through the athletic training staff, and
3. When the care has been coordinated through the athletic training staff, and
4. When your insurance company has responded to and resolved all claims.
3. Once your primary insurance coverage has been exhausted, you must then forward the following information to our excess insurance company:
• A copy of our secondary excess insurance claim form (enclosed with this letter), and
• All Explanation of Action sheets from your insurance company related to the care of this athletic injury, and
• A copy of the itemized bills from all medical provider(s) reflecting the current balance.
4. If after 60 days of your submission of a claim to our secondary insurance company you have not received anything, you should call the secondary insurance company to check on the status of that claim.
• For injuries that occurred after August 1, 2003, call Administrative Concepts, Inc at 888-293-9229, ext 155.

The Division of Sports Medicine developed this document to keep you informed as to how the Sports Medicine Staff may use and disclose your protected health information to carry out treatment, payment, or health care operations.  It describes your rights to access and control your protected health information and governs the mechanism in which you can give your consent to the Division of Sports Medicine to release your protected health information to other entities.

Please click on the following link to view or to download the entire Notice of Privacy Practices: