Nothing is more frustrating than guiding injured athletes and/or their parents through the insurance claim process, only to see a letter come through that their secondary athletic insurance claim has been denied.
Sports medicine is often on the front lines of the medical world when it comes to trying new drugs, procedures or equipment with the goal of helping an athlete heal faster or better. Getting athletes "back to play" often requires treatments that traditionally have been considered "experimental" or "non-medically necessary". Does that ring a bell for you? Bottom line, there are only a few athletic insurance companies that really understand sports medicine and are able to cover some (if not all) of these treatments.
Let's look at a few scenarios…
Claims being denied due to missing information is another common scenario. You'd think that in today's digital age, the claims filing process would be more automated and streamlined. Unfortunately, most insurance companies and hospitals seem to have an affinity for sending PAPER notices and requests for additional information. The key here is to find an athletic insurance claims payer (also referred to as a Third-Party Administrator, or TPA) that will obtain necessary paperwork directly from the medical providers, reducing if not eliminating the need for you to get involved. In sum, look for a partner that can help take the paperwork off your desk and get you back to helping your student athletes.
Another dreaded reason for the denial of claims is "untimely filing". Sorry but that is just ridiculous. Again, some "old school" insurance companies (and TPAs) don't understand what athletic trainers go through each day within an athletic department. You are pulled in many different directions and some things will slip through the cracks, only to be discovered a year or two later when the athlete is in collections. Dissinger Reed "gets it", and we're on your side. Our claims partners don't rush to the "90-day claim filing deadline" as an excuse to deny claims. While we prefer to always have an initial claim form on file, which helps us track down the necessary paperwork on your behalf, we do understand that things happen. We work hard to solve problems as they arise so that our clients can stay focused on what's important, running their athletic departments efficiently.
As our clients will attest, Dissinger Reed's programs end up having very few (if any) denied claims. Our coverage is more comprehensive in terms of covered services and equipment. And our TPA partners work harder to secure information directly from medical providers, which significantly reduces/eliminates denials, delays and collections down the road. All of this, coupled with an unparalleled service and a dedication to athletic insurance, is what makes Dissinger Reed the logical choice. While it may be enticing to roll the dice on a lower cost alternative, the feedback that we've received is that it is not worth it.
If denied claims or collections are a problem for your athletic insurance program, please reach out to us so we can help. Contact a Dissinger Reed athletic insurance expert at (913)491-6385 or college@dissingerreed.com