Insurance Policies and Procedures
The purpose of this site is to inform you of Case Western Reserve University's Athletic Department's policies and procedures regarding insurance coverage and athletic injury claims. NCAA rules prohibit Case from providing coverage or paying bills incurred for expenses related to illnesses or conditions that are not a direct result of participation in our intercollegiate sports program (this includes pre-existing conditions and non-athletic injuries). In addition, CWRU is not financially responsible for further testing required while obtaining clearance at the time of physical exams. Every student-athlete at Case must carry primary health insurance. It is the student's responsibility to know and follow the policies/procedures and limitations of their primary insurance plan. Case's Athletic Department has secondary insurance for the student-athletes protection in the event of an injury during supervised practice or competition. The athletic insurance is secondary coverage (defined below) and is subject to the following limitations:
- Only injuries sustained in a competition or supervised practice will be covered. This excludes any captain's practices, open-gym workouts, or any activity prior to the first official practice.
- Medical expenses will only be covered if the Case Sports Medicine staff refers the student-athlete. Non-referred visits or expenses will not be covered by this policy and will be considered the student-athlete's responsibility.
- If you are a member of a HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization), you must use an authorized vendor from your list. If you choose not to use the authorized medical vendors of the plan, this will void Case's secondary insurance coverage. Therefore, if the primary/family coverage is through a HMO or PPO, you must follow the proper procedures required by your plan in order for the university's insurance to complete its portion of the claim.
- During the course of the school year, if the student-athlete's health insurance coverage changes, the sports medicine staff must be notified immediately. Failure to do so will terminate the university's financial responsibility toward any medical expenses incurred.
- Case's secondary coverage is provided for expenses incurred in excess of your primary insurance coverage. Secondary coverage means that claims must be filed with the primary/family insurance before this coverage is available. Secondary coverage is designed to cover any remaining balance not paid by the primary insurance. The bills incurred must be submitted to the primary/family insurance first. All secondary claims must be submitted within 104 weeks from the date of injury. It is imperative that student-athletes report injuries immediately to the sports medicine staff.
- All bills and explanation of benefits (EOB) from the primary/family insurance company must be submitted to the sports medicine staff in a timely manner in order for a secondary claim to be made. DO NOT assume that Case's secondary has paid the balance without going through the process of submitting the necessary paperwork. Failure to submit proper paperwork in a timely manner can void secondary coverage and you will be responsible for the remaining balances.
Submitting a secondary claim:
The student-athlete is responsible for supplying the medical provider with their primary insurance and current contact information at the time of the visit. The provider is responsible for directly billing the primary insurance company.
- Your primary insurance company will do one of the following:
- Honor the claim by paying the entire bill or a portion of the bill.
- Not honor the claim and send you an EOB or letter explaining the denial.
- If any or all parts of the bills incurred are not paid by the student-athlete's primary insurance company, the following must occur:
- The student-athlete must forward all bills and EOBs to the sports medicine staff.
- The student-athlete needs to complete a secondary insurance claim form with the sports medicine staff.
- The student-athlete is responsible for getting either a Health Insurance Claim Form (HCFA 1500) or UB-92 from the provider. These are the billing forms the providers generate when billing insurance companies.
- Once all documents and forms are on file, the sports medicine staff will submit all paperwork to the secondary insurance carrier for processing. If the insurance company needs any additional information, please cooperate with them in processing your claim.
Lastly, please review your insurance policy regarding "out of state and/or out of area coverage" prior to the student-athlete's arrival at Case. Many standard insurance plans (especially HMOs) do not provide adequate coverage for student-athletes requiring non-emergency medical attention while attending college out of state. In order to provide the best treatment and to minimize problems (such as denial of treatment or payment), it may be beneficial for you to explore the possibility of modifying your current plan or purchasing Case's Student Health Plan Coverage to ensure the student-athlete will have access to coverage while away from home. Understand that the student health plan provided by the University will not cover varsity athletic injuries. Furthermore, if a student chooses to enroll in the student health plan in addition to their primary insurance, the primary insurance MUST be utilized first in all athletic injury claims.
Please understand that insurance processing can often take extended periods of time to complete. It is very important that you take a proactive role in following these policies and procedures to ensure that the insurance claims process proceeds smoothly. Furthermore, it is in your best interest to have the claim settled promptly. All bills will be in the student-athlete's name and will affect credit scores if left unhandled.
All student-athletes and their parents will be required to sign an Insurance Consent Form prior to participating in Case Varsity Athletics stating they have read and agree to follow Case's Insurance Policies and Procedures as stated above.
Should you have any questions concerning this matter, please feel free to contact the sports medicine staff at 216.368.2863.
Thank you for your cooperation and immediate attention in this manner.