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UNLV Sports Medicine


INSURANCE COVERAGE POLICY:

The University of Nevada Las Vegas Athletics Department seeks to provide comprehensive athletic training services for its student-athletes, including preventive services, first aid, and physical rehabilitation. The goal of the UNLV Athletic Department is to provide the best health care system for the student-athlete. Communication and cooperation between the head coach, student-athlete and the UNLV Sports Medicine Staff is essential in order to make necessary claims with insurance companies. The information on the page is designed to help explain the Athletics Department's insurance policy, referral procedures and any questions you may have concerning our athletic injury coverage.

Insurance Coverage of Student-Athletes:
A. The Athletic Department is the SECONDARY provider of funds to pay medical costs associated with athletic injuries and illness. All UNLV student-athletes should be covered by their own individual health insurance before participating in any practice, game, and/or competition. The student-athlete's insurance should cover athletics related injuries and/or illnesses, and shall be considered the PRIMARY insurance coverage for all athletic related injuries. The student-athlete must complete a Health Insurance Information / Authorization Form and supply a photocopy (front & back) of the health insurance card on a yearly basis. Coordination of all medical care must be through the Sports Medicine staff. Unauthorized, outside medical expenses are the student-athlete's own responsibility. Parents and student-athletes are strongly advised to continue their health insurance coverage or purchase health insurance coverage that provides for coverage of non-athletic injuries and illnesses (car accidents, emergency surgeries, pregnancies, appendicitis, falling down stairs, etc.). Parents and student-athletes should notify their health insurance company that the student-athlete will be attending school out of state.

B. The UNLV Athletics Department provides a medical and catastrophic insurance program for its student-athletes. This policy, is SECONDARY to, or in excess of, personal family medical insurance coverage, and covers only injuries / illnesses / accidents resulting from the direct participation in the intercollegiate athletics program as approved by the Director of Athletics according to NCAA regulations.

C. All non-scholarship student-athletes must have medical insurance that covers them during intercollegiate athletics while they are enrolled at UNLV. For student-athletes on scholarship, in the absence of primary coverage from the student-athlete, the parent/guardian of the student-athlete, and/or spouse, the coverage provided by UNLV will become primary only for injuries that are a direct result of intercollegiate activity during a required practice or competition supervised by a UNLV Athletic Department countable coach.

D. 104 Week Limitation on Secondary Insurance Coverage. The UNLV's medical and catastrophic insurance program will pay for the excess of the "Necessary" medical treatment up to the "Usual" and "Customary" charges for such expense incurred within 104 weeks (2 years) from the initial date of the injury / illness / accident. The first expense must be incurred within sixty calendar days of the date of the injury / accident. It is the responsibility of the UNLV athletic trainer supervising the sport to keep track of the 104 week time period and notify the Director of Sports Medicine and/or his designee of any cases approaching the 104 week limitation.

E. Compliance with Insurance Company Requests. It is the student-athlete's and his/her parent(s) / guardian(s) responsibility to understand the conditions that apply to their policy and comply with any requests for information, etc. from the primary insurance company. The Sports Medicine staff will provide information to all student-athletes on an annual basis regarding these policies. Any delinquent bills resulting in bad credit due to non-compliance with insurance company requests may be the responsibility of the student-athlete and/or his/her parent(s) / guardian(s).In the event that a student-athlete and/or his/her parent(s) / guardian(s) receives payment / reimbursement directly from their insurance company for athletic related injury / illness claims, the full account balance becomes the responsibility of the student-athlete and/or his/her parent(s) / guardian(s), until payment is turned over to the provider.

F. Insurance Policy Changes. The UNLV Sports Medicine Department must receive any changes to a health insurance policy as soon as they occur. If proper notification is not received, the UNLV Athletics Department may not be responsible for any delays in payment, collections notices, credit reports, etc. that occur. It is the responsibility of the student-athlete to keep your insurance information up to date with the UNLV Sports Medicine Department. They must be notified immediately of any changes. Failure to do so will result in an inability to process any claims for payment.

G. Medical Bills. The UNLV Athletic Department's secondary medical insurance policy requires that the injured student-athlete make an initial claim with their primary insurance company. When the student-athlete is seen by a provider within the UNLV Sports Medicine Network, UNLV will provide them with the primary insurance information. If the student-athlete is seen by a provider outside of the network, it is the responsibility of the student-athlete to supply the primary insurance information to the provider. The provider will then submit a claim with the student-athletes primary insurance company. While waiting for payment from the student-athletes primary insurance, the provider will continue to send the student-athlete bills. The student-athletes primary insurance company will evaluate and either pay or deny the claim and will send the student-athlete a statement called an EOB (explanation of benefits). The EOB from the primary insurance will explain the processing of the claim. It is very important that all bills and EOB's for covered expenses be brought to the UNLV Sports Medicine Department in a timely manner. Without this information, UNLV's secondary insurance cannot act. Once these are received, the Athletic Department will process and send the information to its secondary insurance company for consideration.

In the event that a student-athlete should receive a bill / statement for an injury / illness that occurred as a direct result of participation in intercollegiate athletics at UNLV, the student-athlete must submit the bill / statement to a UNLV certified athletic trainer in a timely manner. Bills not received in a timely manner may be the responsibility of the student-athlete and/or the student athlete's parent(s)/ guardian(s). The UNLV Department of Intercollegiate Athletics and/or the UNLV Sports Medicine Department WILL NOT be responsible for any delays in payment, collections notices, credit reports, etc. that occur due to bills not being submitted in a timely manner. Submit all correspondence to:

Attn: Insurance Coordinator
UNLV Sports Medicine Department
4505 S. Maryland Parkway
Box 450007
Las Vegas, NV 89154-0007
(702) 895-3702 office
(702) 895-4474 fax

H. Exclusions and Limitations (What is NOT covered under UNLV's secondary insurance policy).

The UNLV Athletics Department's secondary insurance policy WILL NOT apply to the situations indicated below (Note: This list is not all-inclusive).

  1. Injuries / illnesses that are not the direct result of intercollegiate athletics (car accidents, pregnancies, appendicitis, falling down stairs, removing wisdom teeth, etc.).
  2. Injuries / illnesses that are a result of intramural, club sports, and recreational activities (non-intercollegiate activities).
  3. Injuries / illnesses that are recurrences of old injuries/ illnesses which were sustained before participation in the intercollegiate sports program.
  4. Injuries / illnesses that are not reported within seven (7) days of the onset of symptoms.
  5. Conditions that result from non-compliance.
  6. Unauthorized consultation or treatment.
  7. Experimental procedures.
  8. Cosmetic surgery or procedures unless directly related to an athletics related injury.
  9. Hospital room and board charges in excess of the semi-private room rate unless hospitalized in an intensive care unit.
  10. Expenses for athletic injuries incurred after completion of the student-athlete's intercollegiate athletic eligibility.
  11. Medical expenses beyond the limitations and exclusions of, or not covered by the UNLV Department of Athletics insurance policy.

The importance of having some form of personal health insurance coverage cannot be overemphasized. Medical bills resulting from the aforementioned activities will be submitted to the student-athlete's primary medical insurance.

Any unpaid balances are the responsibility of the student-athlete and/or the student-athlete's parent(s)/guardian(s). The Master Policy on file at the University contains all of the provisions, limitations, exclusions, and qualifications of the UNLV Athletics Department's insurance policy, some of which may not be included in this brochure. If any discrepancy exists between this brochure and the Policy, the Master Policy will govern and control the payment of benefits.

I. Student-Athlete Opportunity Fund (SAOF). SAOF money is intended for qualified student-athletes with a financial need. It may be offered to identified student-atheltes for health insurance or medical expenses not covered by the institution. Regardless of scholarship status the SAOF assistance requires a referral and/or approval of an application. Student-athletes should contact the compliance office in these instances.

J. NCAA Catastrophic Injury Insurance Program. The catastrophic injury insurance program is provided by the NCAA. The insurance premium is paid by the NCAA, after the first $90,000 has been paid by the primary and secondary policies. The catastrophic insurance will pay for any catastrophically injured student-athlete during play, practice or travel related to either activity. In addition, a college education benefit will pay the cost of attendance for the student-athlete to complete his or her degree. A complete copy of the policy and program is on record in the Athletic Department.

K. Missed Doctor's Appointment Policy. Student-athletes who are late and/or fail to show-up for scheduled appointments with the team physician, medical consultants, and/or diagnostic tests / procedures will be financially responsible for any and all charges resulting from the missed appointment. In addition, the student-athlete will be responsible for rescheduling the appointment and providing his / her own transportation.

L. Injury / Illness Reporting Procedures. Any certified intercollegiate athletics participant who is injured / becomes ill must IMMEDIATELY report the injury / illness to a member of the UNLV Sports Medicine Department. Costs pertaining to an injury and/or illness not reported within seven (7) days may be the responsibility of the student-athlete and/or his/her parent(s) / guardian(s).

M. Non-Sport Related Injury / Illness Procedures. The UNLV Sports Medicine Department may assume financial responsibility for injuries and illnesses that are not directly related to participation in the intercollegiate athletics program (e.g. colds, cough, flu, etc.) at the discretion of the Director of Sports Medicine.

N. Injury Rehabilitation. Injury rehabilitation will be provided by the UNLV Athletic Department with the following limitations:

  1. All injuries must be a direct result of intercollegiate activity during a required practice or competition supervised by an Athletic Department countable coach.
  2. All injury rehabilitation must be provided by the UNLV Sports Medicine Staff; and rehabilitation conducted outside the UNLV policy and procedures may not be covered by UNLV.
  3. The receipt of free or reduced cost rehabilitation is contrary to NCAA rules and may have a negative impact on eligibility.
  4. All injury rehabilitation provided by off-campus sports medicine centers, physical therapy clinics, rehabilitation centers, etc. will be the student-athlete's financial responsibility.
  5. The student-athlete is financially responsible for off-campus injury rehabilitation even when a UNLV Team Physician makes a referral to an off-campus clinic or sets up an off-campus appointment.
  6. The UNLV Athletic Department is not responsible for any health care related to pre-existing injuries.

O. "Out-of-town" Physical Therapy / Rehabilitation Procedures. At times, it may be necessary for a student-athlete to utilize an "out-of-town" physical therapy facility. In such situations, permission must be granted from the Director of Sports Medicine and/or his designee. Such referrals must come from a member of the UNLV Sports Medicine Department. If a student-athlete decides to utilize physical therapy / rehabilitation services without the authorization of a member of the UNLV Sports Medicine Department, the student-athlete and/or the student athlete's parent(s) / guardian(s) will be financially responsible for any and all medical bills incurred. The receipt of free or reduced cost rehabilitation is contrary to NCAA rules and may have a negative impact on eligibility.

P. Contact Lens Policy. Student-athletes in need of an eye exam and/or contact lenses during the student-athlete's competitive in-season will be referred by a member of the UNLV Sports Medicine Department. If applicable, student-athletes will receive an applicable supply of contact lenses. One (1) pair of lenses will be kept by the student-athlete's certified athletic trainer in case of an emergency. Student-athletes may not:

  • Schedule an appointment without prior authorization and the proper referral from a member of the UNLV Sports Medicine Department;
  • Receive colored and/or novelty contact lenses;
  • Receive glasses/sunglasses in lieu of contact lenses; and/or
  • Receive more than a six-month supply of contact lenses at any one time.
  • Receive glasses/contacts unless the physician states that the student-athlete needs them to compete

Q. Dental Care. The UNLV Athletics Department's medical insurance program will assume financial responsibility for dental care resulting from the direct participation in the intercollegiate athletics program as approved by the Director of Athletics according to NCAA regulations. As with other injuries, this insurance is SECONDARY to, or in excess of, personal family medical insurance coverage. The UNLV Athletic Department will not be held responsible for any general dentistry, including teeth cleaning, fillings, tooth extractions, or other pre-existing conditions, unless the condition has been aggravated by participation in intercollegiate athletics. All dental appointments must be arranged through the director of Athletic Training.

Custom molded mouthpieces will be fitted for student-athletes participating in high-risk sports (e.g. football, basketball, etc.) and other student-athletes who express a desire for them. Football players are required by the NCAA to wear a mouthpiece at all times as a part of their required equipment.

The UNLV Athletics Department and its medical and catastrophic insurance program WILL NOT assume financial responsibility for dental injuries, head and facial injuries, and/or mild traumatic brain injuries (concussions) if the student-athlete is not properly wearing his/her required mouthpiece at the time of injury. Medical bills associated with such injuries will be the sole responsibility of the student-athlete and/or his/her parent(s) / guardian(s).

R. Student Health Center. Each student-athlete may utilize the student health services and/or purchase student health insurance to cover non-athletic injuries and illnesses. All deductibles and incurred expenses from the student health center or student health insurance will be the financial responsibility of the student-athlete

S. Prescriptions. A UNLV Sports Medicine Department prescription (Appendix G) completed by a UNLV Team Physician along with a Medical Referral Form will serve as authorization for permissible payment by the UNLV Student Health Center Pharmacy. All prescriptions must first be presented to the UNLV Sports Medicine Staff. Any prescription written on a standard physician's prescription pad must be presented to the pharmacist with a completed Medical Referral Form to guarantee payment. Failure to follow this procedure will result in the student-athlete being held financially responsible for payment.

T. Physician Referrals / Consultations. The UNLV Department of Intercollegiate Athletics and Sports Medicine Department has fostered positive relationships with many medical providers in the UNLV and Las Vegas, Nevada area who have consistently provided high quality service to UNLV student-athletes. Members of the UNLV Sports Medicine Department will refer student-athletes to these providers, unless extenuating circumstances necessitate a different provider. All student-athletes are covered under the UNLV Athletic Department's secondary insurance policy when they see a physician in the UNLV Sports Medicine Network. This network is comprised of a wide variety of medical specialists from the medical community. The group is dedicated to providing the best possible health care to the UNLV student-athletes. This network was formed to insure accurate and continuous communication between the physicians and the UNLV Sports Medicine Staff.

All student-athletes must be seen and evaluated by a member of the UNLV Sports Medicine Staff. Decisions regarding referrals are at the discretion of the UNLV Sports Medicine Staff. A member of the UNLV Sports Medicine Department must authorize and properly refer all student-athletes to see a physician or medical consultant, and/or for diagnostic tests. If a student-athlete decides to see a physician / medical consultant, and/or undergo a diagnostic test WITHOUT prior authorization / referral from a member of the UNLV Sports Medicine Department, the student-athlete and/or the student athlete's parent(s) / guardian(s) will be financially responsible for any and all medical bills incurred. Also, all student-athletes shall be educated annually that the receipt of free or reduced cost rehabilitation is contrary to NCAA rules and may have a negative impact on eligibility.

U. Orthopedic and/or Medical Second Opinions. If a student-athlete decides to see an orthopedic and/or medical physician without the authorization of a member of the UNLV Sports Medicine Department, the student-athlete and/or the student-athlete's parent(s) / guardian(s) will be financially responsible for any and all medical bills incurred. If a student-athlete decides to seek medical attention outside of the UNLV Sports Medicine Network, the student-athlete and/or the student-athlete's parent(s) / guardian(s) will be financially responsible for any and all medical bills incurred. If a student-athlete seeks a second opinion or care from an out of network provider, he/she will be medically ineligible to participate or utilize the services of the UNLV Sports Medicine Department until medical records are obtained and reviewed by the UNLV Team Physician. Additionally, UNLV will not be financially responsible for travel, costs and services generated by the second opinion. See attachment "Second Opinions".

V. Medical Referral / Consultation Form Procedures. A Medical Referral Form ("Blue Sheet" / triplicate / APPENDIX F) must be filled out in its entirety and signed by a member of the UNLV Sports Medicine Department whenever a student-athlete is sent to a UNLV Team Physician's office, is seen by a consultant physician, is sent to the UNLV Student Health Center, is referred for a diagnostic test, surgery, prescription, etc. Coaches and administrative staff DO NOT have the authority to refer a student-athlete to any physician except for emergency medical care when the UNLV Sports Medicine Staff if not available.

UNLV Department of Intercollegiate Athletics Authorized Expense / Medical Referral Form.

  • Used when the student-athlete is being referred for an injury and/or illness that is the direct result of participation in the intercollegiate athletics program.
  • Also used for injuries and illnesses that are not directly related to participation in the intercollegiate athletics program (e.g. colds, cough, flu, etc.) that will be paid by the UNLV Sports Medicine Department at the discretion of the Director of Sports Medicine and/or his designee.
  • The top 2 sheets are to be sent with the student-athlete with the student-athlete's insurance information and physician's prescription (if applicable) attached.
  • Place the 3rd sheet in the appropriate file box within the Sports Medicine Center.

Non-UNLV Department of Intercollegiate Athletics Authorized Expense:
(NOTE: If the student-athlete decides to seek non-UNLV authorized care, the student-athlete is responsible to obtain all medical records.)

W. Insurance Claim Form Procedures. (if required by UNLV's secondary insurance company)

  • An insurance claim form must be filled out when a student-athlete suffers any "sport-related" injury / illness that:
    • Is seen by a physician off campus;
    • Is referred for x-rays and/or other diagnostic testing;
    • Necessitates the consignment of a brace, splint, etc. from Donjoy, Breg, Inc., etc.;
    • Is a dislocation, regardless of whether or not the student-athlete is seen by a physician or undergoes diagnostic tests;
    • Athletic trainer is suspicious that the student-athlete will need further treatment in the future (e.g. low back pain, shoulder pain in thrower, shin splints, etc.)
  • Insurance claim forms must be typed using the current template.
  • Insurance claim forms must be signed by a representative of the UNLV Sports Medicine Department
  • It may also be necessary to obtain signatures from the student-athlete and/or his/her parent(s) / guardian(s).
  • Completed insurance claim forms should be placed in the appropriate file box within the athletic training room.

X. UNLV Diagnostic Imaging Procedures. The following procedures must be followed when referring student-athletes to diagnostic imaging centers:

  1. Complete an insurance claim form on the student-athlete and his/her injury.
  2. Fill out a Medical Referral Form as per the aforementioned procedures.
  3. Fill out a Diagnostic Imaging Request Form, making sure to include the following-
    • Student-athlete's name
    • Student-athletes SSN
    • Date
    • Requested by Dr. XXX (name of UNLV Team Physician)
    • Check appropriate box for imaging
    • Write "Please Release Copy of Films with the Student-Athlete" in the "Other Instruction" box;
    • Write a brief history and any special views that are warranted (see Standard X-ray Views) in the "Clinical Data" space
  4. Send the student-athlete to the imaging center for the imaging studies with the signed Referral Form and the Diagnostic Imaging Request Form.
  5. Instruct the student-athlete to return to the Sports Medicine Center with copies of the images.
  6. Have the student-athlete's x-rays/diagnostic images and the student-athlete (if applicable) examined by the UNLV Team Physician as soon as possible.

Y. Doctor's Appointment / Diagnostic Test Scheduling. When scheduling student-athletes for doctor's appointments, diagnostic tests, etc., the following procedures are to be followed:

a) Make sure that there is a completed insurance claim form filled out on the student-athlete and his/her injury (if required by UNLV's secondary insurance company).

b) Call the student-athlete's primary insurance company to secure authorization for the appointment BEFORE MAKING THE APPOINTMENT for the student-athlete.

c) Fill out a Referral / Consultation form on the student-athlete, checking the appropriate box.

d) Confirm with the student-athlete his/her class and practice schedule and a reliable phone number where he/she can be reached in case of changes, cancellations, etc.

e) Call the physician's office to make an appointment for the student-athlete. Identify yourself as a UNLV certified athletic trainer making an appointment for a UNLV student-athlete.

f) Confirm the appointment time, transportation, and directions with the student-athlete. Make sure that the student-athlete understands the importance of being on-time for all appointments and the UNLV Sports Medicine Department's Policy regarding charges associated with "missed" doctor's appointments.

g) Attach the top 2 sheets of the Medical Referral Form, the student-athlete's insurance information, and any other applicable information. Give this packet of information to the student-athlete, along with directions to the physician's office.

Z. Surgical / Medical Procedure Scheduling Procedures. When scheduling student-athletes for diagnostic tests, medical procedures, and/or surgery, the following procedures are to be followed:

a) Obtain a Surgical Protocol for Student-Athletes Checklist to help guide you through the process.

b) Communicate with the physician about the medical procedure and/or surgery.

DO NOT schedule the test, procedure, and/or surgery until you receive authorization from the student-athlete's insurance company and from Dave Tomchek or Kyle Wilson.

c) Obtain departmental authorization (contact David Tomchek). Include the following:

  • Student-athlete's name and sport;
  • Injury and injury date
  • Physician;
  • Diagnostic test, medical procedure, and/or surgical procedure to be performed;
  • Information related to the primary insurance authorization; and
  • Any other pertinent information related to the student-athlete, injury, procedure, etc.

d) Fill out a Referral Form on the student-athlete.

e) Confirm with the student-athlete his/her class schedule and a reliable phone number where he/she can be reached in case of changes, cancellations, etc.

f) Call the appropriate office to schedule the procedure and any other applicable appointments for the student-athlete. Identify yourself as a UNLV certified athletic trainer making an appointment for a UNLV student-athlete. Confirm with the office the date, time, and place of the procedure, along with what time the student-athlete must report, and any other special instructions.

g) Attach the top 2 sheets of the Referral form with the student-athlete's insurance information. Give this packet of information to the student-athlete, along with directions to the procedure site.

h) Confirm the appointment time, transportation, and directions with the student-athlete. Make sure that the student-athlete understands the importance of being on-time and strictly following any special instructions. i) If the procedure is a surgical procedure-

  • 1-2 days before the surgery, review confirm the surgery time and transportation plans with the student-athlete;
  • Review post-surgery directions, prescription pick-up, billing procedures, rehabilitation plans, etc. with the student-athlete.

SECOND MEDICAL OPINION POLICY

Provided the initial examination is performed by a UNLV team physician, any student-athlete at UNLV can chose to be seen by a physician, chiropractor, physical therapist or other healthcare provider of their choice outside of the UNLV Sports Medicine network. In this regard, the following applies:

  1. UNLV is not financially responsible for any medical expenses, including surgery, MRI's, diagnostic tests, office visits, physical therapy and/or treatment provided by individuals outside of the UNLV Sports Medicine network.
  2. UNLV provides a staff of physicians and these physicians are no longer responsible for any medical problems that may arise from this injury / illness.
  3. The student-athlete releasing the UNLV team physicians from any liability must sign the Waiver of Liability / Second Opinion Policy Form (Appendix D).
  4. The student-athlete must sign a Release of Medical Records Form.
  5. All medical records generated as a result of the second opinion must be forwarded to the UNLV Director of Athletic Training. Failure to do so may preclude UNLV from allowing the student-athlete to practice and or compete.
  6. The UNLV team physicians will evaluate the forwarded medical records and will determine the playing status of the student-athlete prior to clearing the student-athlete for any practice and/or competition.
  7. The student-athlete must be cleared in writing by the UNLV team physicians before he/she can actively participate in any conditioning, practice and/or competition.
  8. The athletic training staff, coaches, and administrators at UNLV are restricted from offering any assistance to the student-athlete unless directed by the "second opinion provider".
  9. In the event of re-injury to the same body part, the student-athlete must be seen by the "second opinion provider" and then must be cleared by the UNLV team physicians.
  10. It will be the responsibility of the student-athlete to make all scheduling arrangements for the second opinion.
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