The goal of the Athletic Department is to provide the best health care delivery system for student-athletes at St. Bonaventure University.
The information below will help explain, referral procedures and procedures for filing insurance claims. The Athletics Department has purchased a secondary insurance policy for student-athletes. The policy will be applied to medical costs incurred for services rendered by authorized health care providers. The Department's policy is not all-inclusive.
The policy is only applicable for injuries and illnesses that are a direct result of intercollegiate activity during a required practice or competition supervised by a staff member of the Athletics Department. The parents of the student-athlete must complete an annual medical insurance information form regarding the insurance company that provides coverage for the student-athlete. This form must be submitted to the athletic training staff at the beginning of each academic year.
How does the Department's insurance policy work?
St. Bonaventure's insurance policy requires that the injured student-athlete make an initial claim under their primary insurance (parent's policy or one owned by the student athlete). The athletic training staff provides this information to our medical care providers. It is the medical care provider who files a claim with your insurance company for services rendered. Your company will evaluate and whether pay or deny the claim. The insurance company will send you a statement, Explanation of Benefits (EOB), which shows that they have paid or denied. The provider will send you a bill for services rendered and will continue to send you statements until the claim is paid.
If you have not received any information from your insurance company within 45 days after the date of injury, you should call your insurance company and question the status of your claim. If necessary, resubmit the bill from the Provider to your insurance company.
The student athlete or parent should provide copies of all information from insurance company(s) and medical providers to the athletic training staff.
All claims must be resolved within 2 years (104 weeks) from the date of injury.
Second opinions
Prior written authorization from the Department's Team Physician must be obtained if a student-athlete wants medical attention outside of the Department's network.
If a student athlete seeks a second opinion or care from a non-authorized provider, he/she will be medically ineligible to participate until all medical records are reviewed by the Team Physician. Additionally, the university will not assume any financial responsibility for non-authorized services.
What if I belong to an HMO or PPO?
If you belong to a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) insurance company, they may limit their reimbursement. YOU are requested to provide the athletic training staff with the specific instructions, requirements and limitation of your insurance coverage. It is strongly suggested that you purchase the Markel Student- Accident - Illness insurance plan to cover any costs that your HMO or PPO do not cover.
What is NOT covered under SBU's Secondary Insurance Policy?
What are the parent's and/or student athlete's responsibilities?
It must be clearly understood that you and 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 St. Bonaventure University assumes no financial liability for expenses generated fro medical care of the student-athlete. This is not an all inclusive policy and benefits will be applied subject to the terms and limitations of the 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 the 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 of wages arises from an unpaid bill, the parent and/or the student-athletes are strongly encouraged to pay all balances to avoid harm to his or her credit rather than wait for the insurance company to decide on benefits.
FREQUENTLY ASKED QUESTIONS
Q: WHAT IF I RECEIVE A MEDICAL BILL IN THE MAIL, WHAT DO I DO WITH IT?
A: If you receive a medical bill in the mail, and Markel is your Primary insurance you should ALWAYS forward it to your athletic trainer. The athletic trainer will then forward it Markel Insurance.
Q: WHAT HAPPENS IF I DO NOT HAVE A PERSONAL INSURANCE POLICY?
A: It is mandatory for all students to show proof of insurance. If you do not have an insurance policy you can purchase the Accident Illness Policy that is already included on your tuition bill. This policy has a $5,000 limit for accident or illness and a $2,000 limit for athletic related injuries for further information please go to www.collegeinsurance.com.
Q: WHAT IS AN EXPLANATION OF BENEFITS (EOB)?
A: An Explanation of Benefits is the form sent to you or to the medical provider explaining exactly what your primary health insurance provider will or will not cover. It gives you information such as the date of service, the medical providers name, the medical facility's name, the amount of the bill, whether the bill was paid, the amount of payment, whether it was applied to the deductible or rejected and the reason for rejections. Most out of state health insurance providers will send the explanation of benefits directly to the policy holder.
Q: WHY IS IT NECESSARY TO FORWARD THE EXPLANATION OF BENEFITS TO THE ATHLETIC INSURANCE COORDINATOR?
A: Without a copy of the explanation of benefits, Markel insurance cannot make payment on any medical bills or claims, This form verifies that the bill was filed with your primary health insurance provider, and that action was taken on their behalf and provides Markel with the action taken.
Q: HOW DO I FILE A CLAIM IF I HAVE MY OWN PRIMARY INSURANCE AND PURCHASED THE SCHOOLS ACCIDENT AND ILLENSS PLAN?
A: If the student-athletes sustain an athletic related injury the Insurance coordinator will file a claim with Markel. It is the parents and/or student athlete's responsibility to forward any bills that have already been submitted to your insurance company and EOB's from your primary insurance to the Insurance coordinator to file with Markel insurance. If it is an accident/ illness claim it is the student-athletes responsibility to file a claim through Health Services. The accident/ illness plan is a secondary policy therefore it is still important to follow the proper procedures with your primary insurance when seeing a specialist. Failure to follow your insurance companies procedures may result in you being responsible for the services rendered.
REMEMBER
CALL FOR HELP
The Athletics Department Insurance Coordinator: Renee Kleszczynski Head Athletic Trainer
tel: 716-375-4098
fax: 716-375-2280
** It is recommended that all student-athletes purchase the student-accident plan to help defray any costs associated with an athletic injury. Especially for those who have an HMO or reside outside the state of New York. This plan not inclusive but will help cover costs not covered under your primary insurance.
