Medical Expenses and Insurance Coverage
The Athletic Department is the secondary provider of funds to pay medical costs associated with athletic injuries and illness (i.e., Notre Dame will be responsible for medical costs not covered by the student-athlete’s own insurance). Coverage applies only to injuries and/or illness arising from practice and/or play. NCAA rules limit the University to bear financial responsibility for injuries and/or illness not associated with practice and/or play. Payment for medical services outside of play or practice must comply with guidelines established by NCAA and the University of Notre Dame and will probably be one’s personal insurance only.
Consultation with the Sports Medicine staff during treatment of an injury or illness is imperative. Coordination of all medical care must be through the Sports Medicine staff. Unauthorized, outside medical expenses are the student-athlete’s own responsibility.
NOTE: The student-athlete’s current insurance information must be on file before the start of the current season’s practice and competition. Without this information, the athlete could be withheld from practice and/or competition along with being financially responsible for medical expenses.
Although every situation may not be addressed, what follows are some general guidelines that may help in determining what is a permissible and payable expense and those that are not.
What types of services will the University provide secondary coverage?
In general, Notre Dame can provide financial assistance as a secondary provider for the diagnoses and treatment of all injuries and illnesses directly arising from practice and play. It is expected that the athlete will first seek treatment from the Sports Medicine staff unless the nature of the injury is an emergency requiring immediate treatment elsewhere. The athlete’s personal insurance will be listed as the primary provider.
Examples of services that are included in this section are:
- X-rays, MRI, laboratory tests, custom bracing;
- Referrals to other physicians pre-authorized by the Sports Medicine staff;
- Surgical procedures, outpatient and inpatient, by physicians pre-authorized by the Sports Medicine staff;
- Hospital charges at all local hospitals and outside area hospitals authorized by the Sports Medicine staff;
- Physical therapy if done at outside facilities at the request of our Head Athletic Trainer/Physical Therapist;
- Second opinions if pre-authorized by the Sports Medicine staff;
- Most infirmary charges for treatment and medications for inpatient stays;
- Dental work for traumatic injury;
- Any condition or injury that the Directors of Sports Medicine deems necessary to investigate and treat to permit safe participation.
What are some examples of services not covered in the practice and play category?
Generally speaking, these are the same conditions that would apply if the athlete were just a regular student at the University and never played varsity athletics and never was injured or made ill as a consequence of practice or play. An athlete is considered a regular student during the summer and during the academic year when he/she is not officially practice or playing. The athlete is also automatically considered a regular student as soon as his/her eligibility is finished, i.e., the last varsity competition. Examples are:
- Medications for conditions present before entering Notre Dame (asthma, attention deficit disorders, etc.);
- Medications for conditions unrelated to practice or play such as acne, hypertension, etc.;
- Some psychotherapeutic medications;
- Injuries incurred in an accident (auto, bike, etc.);
- Surgeries for conditions such as appendicitis, gall bladder disease, wisdom teeth;
- Injuries from an altercation in the dorm or off campus;
- Any over the counter medication;
- Any injury incurred while preparing for a professional athletic tryout after conclusion of the athlete’s final game;
- A lab test ordered to diagnose mononucleosis during the academic year when the athlete is not officially practicing or playing.
What is the University’s position on surgeries, second opinions and examinations performed away from the University?
The University of Notre Dame Sports Medicine Department recognizes the value of second opinions for injured or ill varsity athletes. The University will pay for this second opinion only if the following conditions are met:
- Prior approval should be obtained from one of the directors of Sports Medicine (Dr. Moriarity or Dr. W. Yergler) or from the Head Athletic Trainer/Physical Therapist, Jim Russ. Requests must include the physician’s name, specialty, location, and other pertinent information as needed;
- Specific diagnostic testing over and above routine laboratory tests or office X-rays must be approved by the Sports Medicine staff before such testing takes place;
- The varsity athlete is requested to forward all results of a second opinion evaluation to the Sports Medicine staff;
- Results of a second opinion examination will be reviewed by the Sports Medicine staff along with recommendations for further treatment and care. Final decisions regarding care and suitability to return to competition and practice will be the responsibility of the Notre Dame Sports Medicine staff;
- Requests for payment for surgeries performed by physicians not referred by the Sports Medicine staff must be reviewed on an individual basis prior to the surgery or procedure being performed;
- In cases where there is a discrepancy of opinion between the Sports Medicine staff and a consulting physician, a third opinion may be requested. In such a case, the third consultant will be chosen by the Sports Medicine staff (in agreement with the athlete) at University expense from a group of prominent, nationally recognized sports medicine experts. The results of this evaluation, along with recommendations for care and treatment, will be reviewed by the Sports Medicine staff. Decisions regarding return to competition and practice remain solely with the Sports Medicine staff.
What is the team physician’s role in returning athletes to competition?
Authorization to return to practice or play after all injuries or illnesses come solely from Notre Dame team physicians. Outside health care provider’s recommendations must be endorsed by Notre Dame team physicians, this includes physical therapy plans, lifting/reconditioning regiments, etc. Notification from the Notre Dame team physicians comes through the athletic trainers to the appropriate head coach and administrator.