Effective Practices for Managing Student-Athlete Insurance

Transcription

1 The NCAA requires that all member institutins certify that student-athletes have cverage fr medical expenses within the deductible f the NCAA catastrphic plicy, currently at $90,000 ($75,000 fr institutins participating in the NCAA Grup Basic Accident Prgram). This can be satisfied by the student-athletes r parents persnal insurance cverage, r thrugh a basic accident medical plicy maintained by the institutin (r thrugh an institutin s frmal self-insurance plan). Establishing plicies t manage csts related t athletic injuries can be an verwhelming respnsibility fr ne persn due t the many variables influencing csts. This guide is designed t prvide items fr cnsideratin t assist in cntrlling csts related t student-athlete injuries. Risk Management Team Develping a risk management team will allw a grup f individuals with varius backgrunds t cllabrate n the develpment f plicies fr effectively managing studentathlete insurance and t assist in managing csts assciated with athletic injuries. The team des nt need t be large but shuld include members with varius expertise. Sme suggestins f rles t cnsider are the athletics directr, athletic trainer, business manager, university risk manager, team physician, finance fficer and health center representative. Establish gals that yu wuld like t accmplish with this team, such as the fllwing: What type f injuries will the risk management team review? What factrs will the team evaluate fr these injuries? > Is it mre cst and care-effective t fund the travel t have student-athlete care administered in-netwrk vs. ut-f-netwrk? What resurces are available at the institutin t minimize expenses? Establish plicies t avid case-by-case decisin-making t decrease ptential legal liability t the institutin: > Cnsistency amng sprt and schlarship/nnschlarship student-athletes (if applicable). > Identificatin f pre-existing injuries and psitin n cverage fr these injuries. > Pst-separatin care f injury (fr example, exit interview/questinnaire). > Cverage and care fr nnathletic injury and illness. > Prcuring and funding primary insurance cverage. Athletics department representatin n the institutin s campuswide student health insurance cmmittee t advcate prcuring cverage fr athletically related injuries within the student-health cverage plan. Primary Insurance Requirement Using primary health insurance t its maximum is the mst effective way t cntrl csts fr athletic injuries. It is imprtant t establish a plicy and cmmunicate it well t student-athletes, parents and guardians. The fllwing are items t cnsider in develping a frmal requirement: Request cpy f each student-athlete s primary insurance card(s). Request student-athlete/parent/guardian t cnfirm cverage applies while n campus. Primary insurer may need t be ntified f temprary residence. Establish acceptable primary health insurance plan criteria that each student-athlete must meet t be eligible t participate, and address the fllwing: Des the plicy need t cver athletic-related injuries? Is there a cap n the acceptable deductible level fr primary health insurance?

2 Page N. 2 Des the student-athlete need t purchase supplemental cverage, r assume respnsibility fr the gap? The grwing trend fr health insurance is in high-deductible plans, which can create additinal claims csts fr institutins. Are gvernment-administered prgrams accepted as primary health insurance? Gvernment administered health care plans, including but nt limited t TriCare and Medicaid, have taken the psitin that their plicies are the payer f last resrt, including t basic accident cverage intended t be excess. Therefre, if accepted as primary insurance, a basic accident plan will be required t pay as primary cverage. Methds t clearly cmmunicate primary insurance requirement plicy: Annual cmpliance meeting/student-athlete rientatin. Athletics department website. Written ntice t student-athletes/parents/guardians with signature cnfirming the individual understands the plicy with request fr primary health insurance card(s). Insurance cverage flwchart t assist with explaining the institutin s claim payment prcess. Primary Insurance Verificatin Once yu have established a primary insurance requirement and secured prf f such cverage, cnsider taking the next step; primary insurance verificatin. Verifying student-athletes primary health insurance benefits assists in cnfirming the insurance infrmatin prvided is accurate and currently in effect. The fllwing are items t cnsider when implementing primary insurance verificatin: Hw ften will cverage be verified? At the time the student-athletes are reprting fr physicals. At the start f each seasn. Crdinating with health insurance pen enrllment (Nvember t mid-december). Identify the depth f infrmatin yu wuld like verified: Deductible. Cpay/cinsurance amunts. Cverage fr athletic injuries. In-netwrk and ut-f-netwrk. Pre-authrizatin requirements. Methds t verify primary insurance cverage: Identify a staff member t call each student-athlete s insurance prvider t cnfirm cverage is in effect while the student-athlete is at the institutin and verify pre-authrizatin requirements. Use a third-party vendr fr efficiency: > Explre new and existing partnerships with lcal hspital t access verificatin services and sftware capabilities. > Sme basic accident insurance cmpanies prvide insurance verificatin at varius levels and fees. > The NCAA Grup Basic Accident Prgram prvides this service at n additinal fee. Identify categries f primary insurance: Billable vs. nnbillable primary insurance. Deductible level. Ptential ut-f-netwrk cverage (i.e., Kaiser Permanente and nnparticipating HMO cverage). What t d with primary insurance verificatin results: Develp a plicy fr prcuring primary cverage if a cverage lapse is identified. Optins fr insurance cverage:

3 Page N. 3 > Institutin student-health plan that cvers athletic injuries. > State insurance exchange. > Individual health plicies. > Limited primary accident cverage fr athletic injuries. > Shrt-term health insurance plicy if utside pen enrllment perid. Primary Insurance Preauthrizatin Clear and cnsistent preauthrizatin prcedures are imprtant t avid primary insurance claim denial. Pssible methds t manage this prcess: Hire r designate a staff member t cntact the student-athlete s primary insurance cmpany, r wrk with a medical prvider t cnfirm preauthrizatin has been btained. Assign the athletic trainer managing the student-athlete s injury the respnsibility f cnfirming with the insurance cmpany r medical prvider that preauthrizatin has been btained. Depending n the level f verificatin purchased, yu may be able t have a primary insurance verificatin vendr identify if preauthrizatin is required. Medical Bill Discunts Being aware f hw much is being spent with lcal hspitals and physicians is an area t be explred fr cst-saving pprtunities. It is als imprtant t understand hw the savings are being cmmunicated and the baseline f the discunts received. Belw are items t cnsider when wrking with yur insurance representative: Develp strng relatinships with lcal prviders and understand the full extent f the relatinship between the medical prvider and the institutin. Is the medical prvider prviding n-site care at n charge? Is the medical prvider prviding spnsrship funds t the institutin? Target institutin s alumni base fr discunted r in-kind services. Identify hw much is being paid t frequently used medical prviders, including what has been paid by primary insurance, and use this infrmatin t negtiate with medical prviders. Hw are savings results being cmmunicated? Grss r net savings: Repricing vendrs typically used by basic accident insurance cmpanies charge a fee t access their netwrks. Data set factrs: Are all claims submitted fr repricing included r nly thse where a discunt was btained? Is a large bill skewing the results? Once yu have a full understanding f prvider relatinship and savings, lk fr pprtunities t negtiate with medical prviders: Direct prvider arrangements: These arrangements can be negtiated in varius capacities but are typically hw the mst significant savings are realized. Yu can negtiate directly with medical prviders r verify if yur insurance representative will negtiate n yur behalf. Belw are frequently used prvider discunting methds: > Percent-f-Medicare: This is an effective ptin if yu have access t this data as Medicare prvides a lw baseline by gegraphic area t begin negtiatin. > Fee schedule: A fee schedule is als an effective ptin as yu are setting a rate fr the service and the prvider cannt inflate the rates n the billed side t make up fr the agreedupn discunt. > Percent-f-billed: This is the least effective ptin as the prvider can inflate the billed rates t make up fr the agreed-upn discunt.

4 Page N. 4 Using Time-Saving Methds Institutins reprt that access t the fllwing prvides significant time savings: Online claim reprting. Online access t claim infrmatin. Online claim reprts. Accessible service team. Miscellaneus Effective Practices Yur internal evaluatin will help identify ther cst and timesaving pprtunities. Sme items t cnsider when evaluating areas fr cst savings: Track and benchmark a metric fr evaluating cst trends, such as establishing a cst per studentathlete. An evaluatin culd include the fllwing: Insurance premiums, including primary, basic/secndary, and supplemental catastrphic cverage, if applicable. Athletics department s ut-f-pcket claim expenses (i.e., deductibles and c-pays). Third-party claims administratr csts, if applicable. Physical therapy guidelines. Hw much is being spent n physical therapy referred utside the athletic training rm? Is it mre cst effective t hire anther part-time r full-time athletic trainer t d the rehabilitatin f student-athletes? Are yu mnitring the treatment plan and prvider prgress ntes t cnfirm it is in line with the athletic trainer s treatment plan? Durable medical equipment and rthtic guidelines. Has the durable medical equipment/rthtic been prescribed by a physician? D yu keep an inventry f durable medical equipment in the athletic training rm and track this inventry? Is it mre cst-effective t rent equipment r purchase the equipment? If yur institutin maintains basic accident cverage r is lking t add basic accident cverage as part f yur effective practices, please review the Guideline fr Selecting an Insurance Representative.

5 Page N. 5 Effective Practices: Piecing It All Tgether