INSURANCE FREQUENTLY ASKED QUESTIONS
This information is designed to help explain our insurance policy, referral procedures and any question you may have concerning our athletic injury coverage Insurance coverage carried by the Coastal Carolina University.
The goal of the Department of Athletics is to provide the best student-athlete health care system. Communication and cooperation between the student-athlete and the Athletic Training staff is essential in order for the system to function.
The Department of Athletics has purchased a Secondary Insurance policy for its student-athletes. The policy provides for secondary coverage on injuries that are a direct result of intercollegiate activity during a required practice or competition supervised by a staff member of the Department of Athletics. This policy will be applied only to medical expenses for services rendered by a participant in our network. The secondary policy requires that all claims be filed with the primary insurance company.
Athletic injury expenses that are authorized and are not covered by primary insurance will be paid according to policy and procedures of the Department of Athletics. Please note that Coastal Carolina University's policy is not all-inclusive.
The Athletic Training staff must approve all referrals to specialists in writing. Failure to gain advance approval in writing, will result in the student-athlete being responsible for the charges.
REQUIREMENTSEach year student-athletes must provide a copy of current primary insurance coverage. This information and a photocopy (front and back) of the applicable ID card must be on file prior to participation.
It is the responsibility of the student-athlete to obtain all necessary demographic, primary insurance and secondary insurance forms (secondary insurance provider letter) from a member of the Athletic Training staff prior to a medical appointment outside of the training room.
FILING A CLAIMOur secondary insurance policy requires that student-athletes make an initial claim with their primary insurance company. The Athletic Training staff will assist in providing this information to the medical vendor.
The provider will submit a claim with your primary insurance company. While waiting for payment from your primary insurance, the provider will continue to send you bills. Your company will evaluate the charges and either pay or deny the claim. Your insurance company will send you a statement called an EOB (explanation of benefits).
The EOB from your primary insurance will explain the status of the claim. If all of the necessary insurance forms were submitted to the medical vendor, then that vendor will file and submit the claim to our secondary insurance carrier (Mutual of Omaha). It is very important that all bills and EOBs, for covered expenses, be brought to Coastal Carolina University's Athletic Training room in a timely manner. Without this information, our secondary insurance may not be able act on your claim.
Once these are received, the Department of Athletics will send the information to its secondary insurance company for consideration.
When is a student-athlete referred to a physician?
Whenever the team physicians or the certified athletic trainers determine that a medical consultation would enhance the health care of an injury, arrangements will be made for medical referral. Coaches DO NOT have the authority to refer a student-athlete to any physician except for emergency medical care when the Athletic Training staff is not available.
What if I belong to an HMO or a PPO?
If you belong to an HMO or PPO you are limited to the physicians and facilities that you may utilize. We request that you send the Athletic Training staff specific instruction, requirements and limitations that may be included in your policy. This information is necessary for claims to be processed and filed correctly.
What If my insurance information changes?
It is your responsibility to keep your insurance information up to date with the Athletic Training staff. They must be notified immediately of any changes. Failure to do so will result in an inability to process any claims for payment. This may result in the student-athlete being responsible for all claims.
Which physicians can a student-athlete utilize under this plan?
As a student-athlete you are covered under the Department of Athletics' secondary policy when you see a physician in Coastal Carolina University's Medical Network. This network comprises of a wide variety of specialists from the medical community. The group is dedicated to providing the best possible health care to Coastal Carolina University student-athletes. This network was formed to insure accurate and continuous communication between the physicians and the Coastal Carolina University Athletic Training staff.
Can a student-athlete see a physician outside of the Coastal Carolina network?
Yes, if prior written authorization is obtained. The student-athlete will be responsible for all costs incurred with out of network care without this authorization.
Can a student-athlete seek a second opinion?
If a student-athlete seeks a second opinion or care from a physician outside of the Coastal Carolina University's Medical Network he/she will be medically ineligible to participate until he/she has been cleared by a Department of Athletics team physicians. Additionally the Department of Athletics may not assume any financial responsibility for travel costs and services generated by the second opinion.
What is NOT covered under Coastal Carolina University's secondary insurance policy?
• Injury sustained in an activity that is not associated with required intercollegiate practice or competition or a not within NCAA rules.
• Pre-existing injuries
• Conditions that result from non-compliance
• Unauthorized consultations or treatments
• Injuries sustained after collegiate eligibility has been completed
• Care and removal of tonsils, appendix, etc.
• Routine or non-athletic related dental exams and/or treatment
• Routine or non-athletic related eye exams, prescriptions, and/or treatment
What about illness coverage?
1. Illnesses are not covered under Coastal Carolina University's Secondary insurance policy.
2. Illnesses are covered at no cost to a full-time enrolled student at Coastal Carolina University's Student-Health center.
a. If diagnostic testing or further treatment is necessary, then the student-athlete's primary insurance will be solely responsible.
3. In the event that Coastal Carolina University's Student Health Services staff is unavailable, then the Athletic Training staff can assist in making arrangements to be seen at an alternate facility, while in consultation with the Medical Director.
For claims and bill processing
Send all requested information to:
Coastal Carolina University
P.O. Box 261954
Conway, SC 29528-6054
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