Department of Athletics: Policy on Financial Coverage of Injuries, Surgeries, and Post-Operative Rehabilitation

Unit Policy

Title

Department of Athletics: Policy on Financial Coverage of Injuries, Surgeries, and Post-Operative Rehabilitation

A. General Availability of Care

The University of North Carolina at Chapel Hill's Department of Athletics recognizes the dedication each student-athlete provides to their team. We take pride in our capacity to address, both medically and financially, injuries that have occurred due to sports participation as a student-athlete at the University and while under the supervision of the Department. Through the team of providers in UNC Sports Medicine, a student-athlete can rely on an accessible and knowledgeable staff to provide excellent care in diagnosing and managing injuries. Allowing care to flow through the team of physicians, athletic trainers, physical therapists, dieticians, and psychologists affiliated with UNC Sports Medicine provides optimal care for the student-athlete.

B. Definitions

For purposes of this Department of Athletics Policy on Financial Coverage of Injuries, Surgeries, and Post-Operative Rehabilitation, the terms below shall have the respective meanings ascribed.

1. "Cover" shall mean payment by the Department of a particular amount of costs or expenses attributable to a Covered Injury. "Covered" or "Coverage" may also be used herein with the same meaning.
2. "Covered Injury" shall mean any injury which occurred due to participation in varsity athletics as a student-athlete at UNC and while under the supervision of the Department.
3. "Department" or "Department of Athletics" shall mean the Department of Athletics at UNC.
4. "Mild Injury" shall mean any Covered Injury not requiring surgery or rehabilitation.
5. "UNC" or "University" shall mean the University of North Carolina at Chapel Hill.

C. Coverage of Mild Injuries

Student-athletes with Mild Injuries that require an evaluation, simple diagnostics, and rehabilitation are Covered financially by the Department.

D. Use of a Student-Athlete's Primary Insurance before Coverage of Expenses for Covered Injuries Requiring Surgery or Rehabilitation

A student-athlete's primary insurance must be fully utilized before any costs are Covered by the Department or the University for Covered Injuries requiring surgery or rehabilitation.

E. Covered Injuries Requiring Surgery or Rehabilitation

1. Expenses and Insurance

1. It is the responsibility of each student-athlete, on his or her own or through another policyholder, to maintain primary insurance coverage throughout each year. It is recommended that each student-athlete also have hospitalization and accident insurance through a family policy or through a policy designed to provide such insurance for University students.
2. Student-athletes are advised to check with their insurance carriers about the availability of and payment for care in the Chapel Hill area. Prior to coming to Chapel Hill, each student-athlete should notify his or her HMO that the student-athlete will be living out of their network area (if the student-athlete expects them to authorize any medical expenses).
3. The Department carries supplemental insurance for Covered Injuries. This insurance is used to Cover costs not paid by the student-athlete's primary personal insurance. The Department will only be responsible for bills approved by the Director of Sports Medicine or his designee(s) prior to the services being rendered.
4. If a student-athlete sustains a Covered Injury and services and surgeries are provided by University physicians or their affiliates to address such Covered Injury, the Department will Cover 100% of the balance for expenses not paid by the patient's primary insurance company. To receive payment from the Department, the student-athlete's health care provider should submit billing to the primary insurance company. The Explanation of Benefits document should be sent to the UNC Sports Medicine Insurance Coordinator for payment of the balance. Should a student-athlete receive a provider's bill directly, the bill should be submitted to the Sports Medicine Insurance Coordinator for payment of the balance of expenses not paid by the student-athlete's primary insurance company.
5. If a student-athlete's primary insurance policy is terminated or lapses, or if the student-athlete's primary insurance company denies payment at the University due to being "out of network," the UNC Sports Medicine Insurance Coordinator should be informed as soon as possible. The Department may decide not to pay costs incurred from an injury if the student-athlete's primary insurance has lapsed or terminated. If the student-athlete's primary insurance company denies payment due to being "out of network," the student-athlete should attempt to have the University placed as an "in network" provider with the insurance company while the student-athlete is away from his or her home.

1. Second Opinions

1. For expenses incurred from a student-athlete's clinic visit for a second opinion, the Department will Cover 100% of the balance for expenses not paid by the patient's primary insurance company. The Department will pay this balance after the physician who provides the second opinion communicates that opinion to the University physician. The Coverage shall solely Cover the costs of the clinic visit for the second opinion. The Department will not pay for diagnostic tests or procedures associated with the second opinion unless written approval is provided in advance by the Director of Sports Medicine.
2. If there is a difference in opinion on how to manage or direct treatment of the student-athlete, a decision will need to be made before treatment begins regarding the appropriate management and whether the Department will be financially responsible. Whether or not a University physician ultimately directs the care, the various considerations should be discussed among the student-athlete, family, team physicians, and the Director of Sports Medicine prior to initiating treatment. UNC's Director of Sports Medicine shall make the final decision in such cases, including determining the level of financial responsibility, if any, assumed by the Department.

2. Stallings-Evans Sports Medicine Center

During the school year, Stallings-Evans is usually open six or seven days per week and is the preferred provider of sports medicine rehabilitation for University student-athletes. If closed, student-athletes typically still have access to an athletic trainer daily. Stallings-Evans Sports Medicine Center is open five days a week over the summer. There is no limit to the frequency of services a student-athlete may receive if rehabilitation is done on campus with UNC Sports Medicine staff.

3. Services Provided Outside the University System

1. The Department will Cover the student-athlete's costs of a procedure provided outside the UNC system only if the student-athlete is referred to the treating physician from a UNC Sports Medicine physician. The Department will not be responsible for services provided outside of the University system due to patient or family preference when the procedure could have been performed by University physicians.
2. If physical therapy is necessary for the student-athlete while he or she is at home over a break from the University's academic school year, the number of visits that will be financially Covered by the Department will be based on the University physician's determination of need. For cases of physical therapy provided while a student-athlete is home, it is the student-athlete's responsibility to get a referral from the UNC Sports Medicine physician or performing surgeon and communicate with the UNC Sports Medicine Insurance Coordinator before services are provided. This communication is necessary to determine if the student-athlete's primary insurance company will pay for visits at the outpatient clinic and, if so, how many they will pay for the course of treatment. In these situations when a UNC physician determines a specific number of necessary outpatient sessions while the student-athlete is away from campus, UNC will Cover the balance of the amount that is not paid by the student-athlete's primary insurance. It is the student-athlete's responsibility to arrange for payment prior to treatment by submitting the contact information of the clinic billing officer to the UNC Sports Medicine Insurance Coordinator and submitting a referral so that bills can be sent directly to UNC Sports Medicine.
3. If the UNC Sports Medicine physician or performing surgeon determines that more visits than the number initially determined are necessary, prior approval for further payments for such treatment must be made by a committee which shall include, but may not be limited to, the Director of Sports Medicine and Team Orthopedic Surgeon.
4. Upon returning to campus, it is the student-athlete's responsibility to provide the team's athletic trainer or physician with all office notes, operative notes, copies of MRI results, therapy notes, and any other relevant information pertaining to services rendered by non-UNC providers.

F. Pre-Existing Injuries, Injuries that Occur Outside of Sport, or Congenital Issues that Require Cost-Generating Services (Outside of UNC Campus Health)

Except under special circumstances deemed necessary by the team physician and Director of Sports Medicine, UNC does not pay for any expenses, costs, or other liabilities associated with pre-existing injuries, injuries that occur outside of sport, or congenital issues that require cost-generating services outside of UNC Campus Health. In addition, the Department is not responsible, financially or otherwise, for any injury that occurs in the student-athlete's sport while not directly under the supervision of UNC coaches (an injury that occurs during a summer league, pick-up game, or club team activity, for example). The Department also is not financially responsible for expenses associated with any medical condition unrelated to injuries sustained through participation in varsity athletics at UNC.

G. Dental Coverage

With the exception of dental injuries which also constitute Covered Injuries as defined above, UNC is not financially responsible for expenses related to dental issues and dental treatments. Any Covered Injuries which are dental in nature will be treated by the Dental School at the University.

H. Routine Medical Care

The Department shall not be responsible for the costs of student-athletes' routine medical care (including, but not limited to annual physicals, other periodic check-ups, and care for illnesses and/or diseases).

I. Post-Graduation Coverage

1. Following his or her graduation from UNC, the Department will continue to support a former student-athlete in accordance with the provisions herein for a period of two years for Covered Injuries provided that: (1) the supported individual maintains primary health insurance coverage; and (2) all injuries are reported by the injured student-athlete to the UNC Sports Medicine staff prior to the student-athlete's graduation from UNC. Each such student-athlete shall be required to complete a health history form and verify the truthfulness of their disclosures with their signature. Any unresolved injuries or medical conditions related to participation in sport shall be evaluated by the Team Physician. Failure to complete these prerequisites will result in the individual's forfeiture of the right for financial coverage of Covered Injuries after graduation.
2. The Department will not be financially responsible for any injuries that are not reported to UNC Sports Medicine staff before the student-athlete's graduation, regardless of whether such injury constitutes a Covered Injury as defined above. Any necessary diagnostic tests must be completed within one month after the student-athlete's graduation from UNC and a plan to address the injury over the ensuing 24 months following surgery should be developed promptly upon completion of such surgery.
3. Should the individual choose to receive further care outside of the UNC system, the Department shall not be responsible, financially or otherwise, for the costs of such care unless advance written approval is provided by the Director of Sports Medicine. The Department shall not be responsible, financially or otherwise, for any costs related to travel required for medical care.
4. Each individual receiving care shall be required to follow the recommendations of the Team Physician. Among other things, this may include discontinuation of training and/or participation in sport. The Department shall not be responsible, financially or otherwise, for treatment of a Covered Injury if the treated individual does not follow the recommendations of the Team Physician.
5. Following a student-athlete's graduation from UNC, the Department will provide housing for a former student-athlete for one (1) month to allow for surgery to treat a Covered Injury. After such surgery takes place, additional housing may be provided at the discretion of the Department in or near Chapel Hill to allow the former student-athlete to receive physical therapy treatments from UNC Sports Medicine. Housing shall not be provided by UNC or the Department if care occurs outside the UNC system or if there is a delay in seeking treatment.
6. The Department shall also cover expenses associated with non-surgical medical treatment for concussions, mental health issues, and other similar issues related to participation in sport at UNC. This care must be coordinated through UNC Team Physicians and Psychologists. The Department shall not be responsible, financially or otherwise, for expenses related to care sought outside the UNC system.

J. Medical Non-Counters

If a student-athlete is medically disqualified from participation in intercollegiate athletics (as determined by UNC Sports Medicine), the Department will continue to fiscally support the student-athlete with medical services to provide care for the injury that caused the disqualification. Consistent with the practice for all student-athletes, such injury must be a Covered Injury as defined above. If needed, Coverage will continue throughout the student-athlete's enrollment at the University and may further extend for up to two years following the student-athlete's graduation from the University.

K. Student-Athletes Who Voluntarily Quit Intercollegiate Athletics at the University or Withdraw from the University

Any unresolved or unaddressed Covered Injury must be reported to UNC Sports Medicine prior to a student-athlete quitting the varsity team or withdrawing from the University. Each such student-athlete shall be required to complete a health history form and verify the truthfulness of their disclosures with their signature. Any unresolved injuries or medical conditions related to participation in sport shall be evaluated by the Team Physician. Failure to complete these prerequisites will result in the individual's forfeiture of the right for financial coverage of Covered Injuries. Care for each such reported Covered Injury shall be directed by UNC Sports Medicine. The Department shall not be responsible, financially or otherwise, for anything other than care for the reported Covered Injury as determined by UNC Sports Medicine. The Department shall also not be responsible, financially or otherwise, for any injury which is not reported to UNC Sports Medicine prior to a student-athlete quitting the varsity team or withdrawing from the University, whichever occurs first.

L. Former Student-Athletes Who Have Exhausted their Eligibility and/or Turned Professional

Former University student-athletes who are not governed by the above provisions involving continued care nonetheless may still receive medical care from UNC Sports Medicine after their graduation from the University. In such cases, the Department shall not be responsible, financially or otherwise, for any such medical care whatsoever or any new injuries that may occur.

Publication Details

Policy Number: 00084833

Date Last Reviewed: Spring 2025

Date of Next Review: July 2028

Responsible for Review: Director of Sports Medicine