INJURY EVALUATION & INSURANCE PROCEDURE

Transcription

1 INJURY EVALUATION & INSURANCE PROCEDURE A. Evaluations Injury evaluations are an important part of athletics and one of the functions of an athletic trainer. An injury/illness evaluation helps to determine the extent and nature of a health issue, necessary or recommended medical treatment(s) and referral(s), a proper rehabilitation protocol, return to play, verification for medical insurance and payment, and documentation of the frequency of health issues. These items not only help the student-athlete, but also Southwestern College and the athletic program as a whole. When a student-athlete is injured (non-life threatening) at Southwestern College, the sports medicine staff should be notified before any other action takes place. Obvious, emergency, and urgent injuries (i.e.; life-threatening injuries, major joint dislocations, fractures, open wounds requiring stitches, obvious concussion) are some examples of exceptions to the rule. Otherwise, ANY medical, physician visit, or other hospital visit made without prior notification to the sports medicine staff will not be covered by Southwestern College and the financial responsibility will fall on the student-athlete in all such cases. If a student-athlete is injured during an away event and Southwestern Colleges sports medicine staff are not present, the certified athletic trainer or other medical coverage personnel of the host school should be notified for an evaluation. After the evaluation, Southwestern Colleges sports medicine staff should be notified upon return to campus to follow up on the initial evaluation. Ultimately, it is the responsibility of the student-athlete, not the coach or the host athletic trainer to notify us of any injury. If the sports medicine staff is not properly notified, the student-athlete may be unable to receive the benefits from our insurance provider and the school s secondary policy. B. Medical Referrals Except for emergency transportation and treatment, all medical referrals must have prior consult and approval from the sports medicine staff at Southwestern College. Medical services rendered prior to this approval could become the sole responsibility of the student-athlete. You must see a doctor within 60 days of the initial injury for our athletic policy to cover. Student-athletes must attend all rehabilitation, treatment, and doctor appointments, or cancel and reschedule 24 hours prior to the visit. Failure to keep any medical appointment could release Southwestern College of all financial and legal responsibilities. While the sports medicine staff will do its best to assist the student-athlete in finding transportation, we cannot provide transport, and will not pay for gas, food, or mileage for doctor visits. Southwestern College and its team physicians (Kansas Joint & Spine Specialists/Advanced Orthopedic Associates/& Hillside Medical Group) will do our best to see your son or daughter ASAP for their athletic injury. You may choose to see the physician of your choice (at our discretion); however, regardless of whom you choose for your medical care all medical referrals and information must first be brought to the sports medicine staff at Southwestern College. If you choose to use a physician besides the team or other referred physician(s), the student-athlete must list the sports medicine staff as someone with HIPAA release privileges with their medical provider(s). In addition, you must provide the staff at Southwestern College with the doctor s name, address, and phone number for consultation and written documentation of the visit, including medical clearance, within 24 hours of the visit. This information is to be given to the sports medicine staff and not go through a coach or parent. C. Return to Play If a student-athlete becomes injured, they will be eligible to return to athletic participation once a completed evaluation has occurred by the sports medicine staff, proper medical follow-up has been completed (ex: doctors visit, rehabilitation, etc.) and applicable functional return-to-play testing by the student-athlete has been passed. THE SPORTS MEDICINE STAFF HAS THE FINAL WORD REGARDING RETURN TO PLAY. A student-athlete who participates in sport activity of any kind against the medical advice of the sports medicine staff and/or the team physician(s) may be unable to receive benefits from Southwestern College s secondary insurance policy and/or be withheld from practice or play. D. Insurance Injuries do occur, and we, the sports medicine staff, attempt to provide our student-athletes with the very best possible care that is within our means. Medical bills are incurred when a student-athlete is treated, whether it is locally, during a road

2 trip or by a medical vendor in his/her own home area. The athletic accident insurance coverage provided by Southwestern College is for an accident (a sudden, specific definable event) sustained while participating in the play or official practice of intercollegiate sports at Southwestern College. Our college athletic coverage is a secondary provider and will only work as such meaning you will be required to carry a primary athletic insurance that will cover athletic injuries. In order for our sports medicine staff to provide the best possible care for our student-athletes, it is vital that you provide complete and accurate insurance information. If your insurance information changes for any reason, you will need to update the information as soon as possible either with the sports medicine staff or within Vivature itself. Insurance must be on file with Southwestern Colleges sports medicine staff before you will be cleared for participation in intercollegiate athletics which include practice and/or competition. E. Procedure to follow with medical bills: 1) All bills will first be filed with your primary insurance provider. a) Medical bills for your son or daughter incurred as the result of an injury sustained while participating in an official Southwestern College practice and/or competition will be sent to your primary insurance provider. Sometimes the bills are sent directly to your son or daughter, to your home address, and/or the athletic department. In no case will the athletic department be the primary place for the bill(s) to be sent. If you get a bill, make sure it gets passed along to your primary insurance provider so they can process the bill ASAP. b) Once medical bills are submitted to your primary insurance provider, they will do one of two things: i. Honor the claim and pay all or a portion of the bill(s) ii. Not honor the claim and send you a letter of denial. An example might be that your son/daughter is no longer a part of your group policy after attaining the age of twenty-three. 2) Southwestern College will then file a claim with our secondary insurance provider on your behalf. 3) Our Secondary insurance provider will review the balances not paid by your primary insurance provider and cover those expenses. They need the following: Explanation of Benefits (EOB), this is the notification you receive from your insurance provider showing the amount they are paying on the claim and leaving what balance that still needs to be paid. Bring the EOBs or any other bills you receive to us IMMEDIATELY so that we can begin the process of getting these bills paid. Otherwise you run the risk of being turned into collections for not paying If we don t know about the bill, we can t get the bill PAID! 4) Any and all provisions of your policy are your responsibility. Office visit co-pays, primary care referral policy, and network provider provisions are the most common provisions. Be sure that your son or daughter understands how to use the policy before they come to school and that they have a copy of both sides of the insurance card in their possession. You (they) will be reimbursed for these expenses, but you will be charged upfront. (KEEP YOUR RECIPTS) One way to lower the cost is to sign up for guest membership privileges through your insurance provider a document with this heading, Health Insurance Guest Membership, is provided on the athletics website to explain this further. 5) Conditions existing prior to your participation at Southwestern College will not be covered. The studentathlete must provide appropriate medical clearance to participate in athletic activities while at Southwestern College. This will be done with a new physical each year by a Physician, Physician Assistant, or a Registered Nurse. Returning athletes with any injury in the previous 12 months must also have a signed medical release from their attending physician to participate at Southwestern College. 6) Student-athletes, by choosing to participation in intercollegiate athletics, assume responsibility for their wellbeing. Student-athletes are expected to use good judgment, reasonable care, and common sense when dealing with an injury. Student-athletes must communicate with coaches, parents, and the sports medicine staff immediately following an injury and throughout the insurance process. F. Primary Insurance Billing The Southwestern College sports medicine staff provides unlimited, convenient, and caring service to each patient that we attend to. All student-athletes are eligible to use our services and costs you the parent nothing out of pocket. This is how we have operated for years, but recently we changed this structure and are currently billing for services we provide in the athletic training room. These changes will allow us to continue to provide high quality health care to all of our student-athletes.

3 With increases in the costs of providing health care, we have decided to offset these rising costs, by billing primary insurance providers for physician prescribed rehabilitation and treatment services rendered in the Southwestern College Athletic Training Room. This should facilitate a continuation of improving health care services without putting the financial burden on you or your student-athlete. Any out of pocket cost that is to be paid by you will be paid by Southwestern College. When student-athletes require medical care for an injury the charges are applied to the student-athlete s family medical coverage. For athletic injuries the copays, coinsurance, and deductibles will be covered by Southwestern College. Unlike car insurance, using your primary insurance does not cause your rates to go up. In fact, with the recent law changes associated with healthcare reform, all rate increases can only be assessed using community rating. This means that next year s rate will be based on the performance of all the members of a specific healthcare plan, and what the costs were compared to the premium the insurance provider collected for all members of that plan. You will receive an EOB (Explanation of Benefits) in the mail or online each time a charge is filed. THIS IS NOT A BILL. When you receive a bill or EOB for these or any other services related to your student-athlete s injury, please us a copy at lock.schnelle@sckans.edu or by fax at (620) We will not bill you or your son or daughter for these services - only the insurance company. Please Note: If these charges are not due to injuries related to direct participation in a Southwestern College sanctioned practice and/or competition you are responsible for the payment(s) Some insurance carriers will only send payment(s) to you, the policy holder, and not directly to the provider. If this happens, you will be responsible for forwarding the payment(s) to the provider (Southwestern College). I,, have read the INJURY EVALUATION AND INSURANCE PROCEDURE for Southwestern College and understand the statements contained therein. In the event the above student-athlete sustains an athletic injury, the sports medicine staff at Southwestern College is hereby authorized to file a claim on my behalf. Sport(s): Social Security #: Date of Birth: Signature of Student-Athlete: Signature of Parent or Legal Guardian: (Athlete under the age of 18 must have parent s/guardian s signature)

4 Concussion Information & Acknowledgement WHAT IS A CONCUSSION? A concussion is a brain injury that: Is caused by a blow to the head or body. From contact with another player, hitting a hard surface such as the ground, ice or floor, or being hit by a piece of equipment such as a bat, lacrosse stick or field hockey ball. Can change the way your brain normally works. Can range from mild to severe. Presents itself differently for each athlete. Can occur during practice or competition in ANY sport. Can happen even if you do not lose consciousness. HOW CAN I PREVENT A CONCUSSION? Basic steps you can take to protect yourself from a concussion: Do not initiate contact with your head or helmet. You can still get a concussion if you are wearing a helmet. Avoid striking an opponent in the head. Undercutting, flying elbows, stepping on a head, checking an unprotected opponent, and sticks to the head all cause concussions. Follow your athletics department s rules for safety and the rules of the sport. Practice good sportsmanship at all times. Practice and perfect the skills of the sport. WHAT ARE THE SYMPTOMS OF A CONCUSSION? You can t see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up hours or days after the injury. Concussion symptoms include: Amnesia. Confusion. Headache. Loss of consciousness. Balance problems or dizziness. Double or fuzzy vision. Sensitivity to light or noise. Nausea (feeling that you might vomit). Feeling sluggish, foggy or groggy. Feeling unusually irritable. Concentration or memory problems (forgetting game plays, facts, meeting times). Slowed reaction time. Exercise or activities that involve a lot of concentration, such as studying, working on the computer, or playing video games may cause concussion symptoms (such as headache or tiredness) to reappear or get worse. WHAT SHOULD I DO IF I THINK I HAVE A CONCUSSION Don t hide it - Tell your athletic trainer and coach. Never ignore a blow to the head. Also, tell your athletic trainer and coach if one of your teammates might have a concussion. Sports have injury timeouts and player substitutions so that you can get checked out. Report it - Do not return to participation in a game, practice or other activity with symptoms. The sooner you get checked out, the sooner you may be able to return to play. Get checked out - Your team physician, athletic trainer, or health care professional can tell you if you have had a concussion and when you are cleared to return to play. A concussion can affect your ability to perform everyday activities, your reaction time, balance, sleep and classroom performance. Take time to recover - If you have had a concussion, your brain needs time to heal. While your brain is still healing, you are much more likely to have a repeat concussion. In rare cases, repeat concussions can cause permanent brain damage, and even death. Severe brain injury can change your whole life. IT S BETTER TO MISS ONE GAME THAN THE WHOLE SEASON. WHEN IT DOUBT, GET IT CHECKED OUT! For more information and resources, visit and Reference to any commercial entity or product or service on this page should not be construed as an endorsement by the Government of the company or its products or services.

5 Return to Play Protocol Returning to play following a concussion involves a stepwise progression once the individual is symptom free. 1) There are many risks to premature return to play which can include: a) A greater risk for a second concussion due to a lower concussion threshold. b) Second impact syndrome (abnormal brain blood flow that can result in death). c) Exacerbation of any current symptoms d) Increasing the risk of injury due to alteration in balance. 2) No student-athlete should return to play while symptomatic. 3) Student-athletes are prohibited to returning to play the day the concussion is sustained. 4) If there is any doubt Sit them Out Once a student-athlete is symptom free at rest for 24 hours and has signed a release by the treating ATC/clinician, she or he may begin the return to play progression below: Day 1: Light Aerobic Activity (walking or stationary bike, no resistance training) Day 2: Sport-specific Activity (running resistance training may begin) Day 3: Non-contact Training Drills (Skill Drills) Day 4: Full Contact Practice Day 5: Return to Play Each step should take 24 hours so that an athlete would take approximately one week to proceed through the full rehabilitation protocol once they are asymptomatic at rest and with provocative exercise. If any post-concussion symptoms occur while in the stepwise program, then the student will stop for the day and try the same step again after a further 24-hour period of rest has passed. I understand that it is my responsibility to report all injuries and illnesses to my athletic trainer and/or team physician. I have read and understand the NCAA Concussion Fact Sheet and the Return to Play Protocol. After reading the NCAA Concussion Fact Sheet as well as the return to play, I am aware of the following information: A concussion is a brain injury, which I am responsible for reporting to my team physician or athletic trainer. A concussion can affect my ability to perform everyday activities, and affect initial reaction time, balance, sleep, and classroom performance. You cannot see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up hours or days after the injury. If I suspect a teammate has a concussion, I am responsible for reporting the injury to my team physician or athletic trainer. I will not return to play in a game or practice if I have received a blow to the head or body that results in concussion related symptoms. Following a concussion the brain needs time to heal. You are much more likely to have a repeat concussion if you return to play before your symptoms resolve. In rare cases, repeat concussions can cause permanent brain damage, and even death. I,, have read the above and foregoing NCAA Concussion Fact Sheet and the Return to Play Protocol and I understand the statements contained therein. Sport(s): Social Security #: Date of Birth: Signature of Student-Athlete: Signature of Parent or Legal Guardian: (Athlete under the age of 18 must have parent s/guardian s signature)