Atlanta,
10
July
2013
|
03:39 PM
America/New_York

Catastrophic Care Coverage for High School Athletes

Experts urge parents to determine coverage available from schools before kids play sports.

After making the catch, Arquevious Crane began “fighting” for yards in a high school JV football game near Atlanta in 2007. Then, his life changed.

“It was a normal hit, front and back, just a freakish accident,” says the young man who goes by “Q.” “I was face down and about to start panicking about not being able to breathe. I wanted to turn over because I was eating a lot of dirt.” Q couldn’t move. He had sustained a C-5 to -6 spinal cord injury and was paralyzed from the chest down.

As he began rehabilitation at Shepherd Center, Barbara Crane, the grandmother who years earlier adopted Q and his four younger siblings, was in a daze. She didn’t know who would pay the medical bills that could total millions of dollars.

Many medical insurance plans have a $25,000 limit, and much like homeowners are rarely insured against flood damage to homes unless they have flood insurance, those medical plans often don’t provide adequate coverage for catastrophic injuries like Q’s.

Barbara’s answer? In Georgia, high school student-athletes are covered for life-altering injuries sustained in sports by a $5 million catastrophic insurance policy. The state’s governing bodies for athletics — the Georgia High School Association (GHSA) and Georgia Independent School Association (GISA) — purchase the policy from Mutual of Omaha. Crane’s high school, South Gwinnett, is in the GHSA.

“I didn’t know that until (South Gwinnett) coach (John Small) came to the hospital and told me,” Barbara recalls. “At that time, I didn’t realize what it meant.”

The GHSA policy helps Q, now 21, with disability benefits, college tuition, an assistant who accompanies him to class, a power wheelchair, an adapted van and more equipment plus custodial home care. It is only a partial benefit list.

Former Shepherd Center patient Arquevious “Q” Crane and his grandmother, Barbara Crane, of metro Atlanta, are thankful that Q’s high school carried catastrophic injury insurance, which has covered many of the medical expenses Q has had since he sustained a spinal cord injury in a school football game in 2007.

Every high school student-athlete in Georgia must have medical insurance to play, but few, if any, medical or supplemental plans cover expenses like Q’s. And some states do not require schools to purchase catastrophic coverage.

In Illinois, estimates suggest that 5 percent of the state’s student-athletes have catastrophic insurance through their schools. Individual catastrophic policies for young people are rare in the United States.

A bill before the Illinois House of Representatives that would have mandated catastrophic coverage of $7.5 million or 15 years for athletes at every high school failed to pass in fall 2012. A similar bill is before the Illinois Senate this year.

Utah officials may begin charging $3 per student-athlete to defray a rise in catastrophic coverage premiums prompted by recent claims. The alternative may be a hike in game ticket prices.

Meanwhile in Georgia, the GHSA’s policy is funded by a portion of annual dues (ranging from $345 to $985) paid by each of more than 500 member schools. High schools seek to verify that student-athletes have medical insurance through parents or guardians, or that they buy a supplemental plan, before they can participate in sports at school.

Yet few parents seek to understand their insurance coverage limits, nor do they realize these plans may be helpful for a broken ankle or a knee injury, but are not likely to cover a catastrophic spinal cord or brain injury.

Many parents have no idea if there is a statewide, school system-wide or even a school specific catastrophic insurance plan in place to do that.

Why? They don’t ask. Who thinks a catastrophic injury will ever happen to them?

Here are some experts’ suggestions for parents of aspiring school athletes:

  • Determine the breadth and depth of your primary insurance coverage and/or supplemental policy.

“Health insurance coverage varies dramatically from family to family,” says Scott Boatright, vice president of BB&T Insurance Services, which has handled the GHSA catastrophic policy for 20 years. “It is important to be aware of the benefits, exclusions and limits within your policy.”

Marilyn Taylor, a Shepherd Center post-acute case manager for spinal cord injury, says: “I spend a lot of time explaining to clients, ‘Yes, you have Blue Cross, but that does not mean you bought the whole pie.’ They only have a piece. A lot of people don’t realize they can call customer service and discuss their benefits.”

  • Talk to a school official about insurance coverage available through the school. Find out if they cover ambulance service, emergency room care, outpatient care and, most importantly, whether the school provides catastrophic coverage.

“Ask the school exactly what the policy covers,” says Heddi Silon, director of workers compensation at Shepherd Center. “How much rehabilitation is included? What about durable medical equipment (such as wheelchairs, etc.)? What are the limits? Parents need to know whether there is a policy that covers catastrophic injury.”

Taylor adds: “There are not a lot of (personal) policies that provide catastrophic coverage. Rehabilitation is usually expected to be short term for injuries such as a broken limb or joint replacement, but not injuries that require a $30,000 wheelchair.

  • Realize that football is not the only sport in which serious injuries occur. Brain and spinal cord injuries can result from many types of sports.

Mutual of Omaha vice president of special risk Scott Hanson says the company has seen claims for every sport.

For example, at the University of Georgia, baseball player Johnathan Taylor, a former Shepherd Center patient, sustained a C-5 to -6 spinal cord injury in a 2011 game in which he collided with another player in the outfield. Fortunately for Johnathan, UGA has a supplemental policy that paid the bulk of the medical expenses incurred before the NCAA’s catastrophic policy kicked in, says Claude Felton, senior associate athletic director at UGA.

Hanson notes that a catastrophic plan may be the only safeguard to sufficiently care for a catastrophically injured young person and avert financial ruin.

Q Crane is a case in point. Though he has seen increased function in his arms, he must still use an expensive power wheelchair, which his policy covers. It also pays his tuition. As a junior at Georgia Gwinnett College studying political science with a minor in criminology, he wants to attend law school after graduation. Also, he plays billiards and tinkers around in a garage music studio at a home donated to the family.

“I took what I had and never gave up,” Q says. “Keep striving. I’m a competitor.”

Barbara, a disabled former meat packer, has three grandchildren in college (including one on a basketball scholarship) and two in high school. Life is not easy, but her family is getting by with help from the people of Snellville, Ga., and catastrophic care insurance.

“I can really feel for people who don’t have insurance like Arquevious has,” she says. “We try to do what we can, and we’ve been blessed as far as help.”

Written by Matt Winkeljohn
Photography by Gary Meek

About Shepherd Center

Shepherd Center, located in Atlanta, Georgia, is a private, not-for-profit hospital specializing in medical treatment, research and rehabilitation for people with spinal cord injury, brain injury, multiple sclerosis, spine and chronic pain, and other neuromuscular conditions. Founded in 1975, Shepherd Center is ranked by U.S. News & World Report among the top 10 rehabilitation hospitals in the nation. In its more than four decades, Shepherd Center has grown from a six-bed rehabilitation unit to a world-renowned, 152-bed hospital that treats more than 900 inpatients, 575 day program patients and more than 7,100 outpatients each year.