Some College Athletes Stuck With Medical Bills After Injuries

((HT: NY Times/Peterson via Howard Bloom))

After years of concerns about inadequate health coverage for college athletes, the National Collegiate Athletic Association started requiring universities to make sure their athletes had insurance before competing.

But the association never established clear standards for that coverage when it introduced the rule four years ago, leaving colleges to decide for themselves. While some colleges accept considerable responsibility for medical claims, many others assume almost none, according to a review of public documents from a cross section of universities and interviews with current and former athletes, trainers, administrators and N.C.A.A. officials.

University officials say they go out of their way to inform students about the limits of insurance. Yet the situation has confused and frustrated athletes and their families, some of whom have had to shoulder large and unexpected medical bills.

“I thought I would be covered,” said Erin Knauer, a Colgate University student who piled up $80,000 in medical bills after injuring her back and legs in training for the crew team. Insurance has covered less than a third of the cost because of the way her condition was diagnosed. “You never think you’re going to rack up that much of a bill.”

Other athletes discover their financial problems long after their bodies have healed. An Ohio University football player, temporarily paralyzed during a workout, learned that he still owed $1,800 in unpaid medical bills when he went to buy a car six years after his injury.

Many students, whether athletes or not, have medical insurance through their parents. But these plans often exclude varsity sports injuries, limit out-of-state treatment or do not cover much of the bill. Some colleges buy secondary policies to fill the gaps, although even these plans have holes. And only players hurt badly enough to require extensive care can turn to the N.C.A.A. for coverage. Its catastrophic insurance carries a $75,000 deductible, which will increase to $90,000 next year.

The absence of mandated coverage for athletes has prompted calls for change.

“That’s part of the cost of having an athletic program,” said David Dranove, a professor of health industry management at Northwestern University’s Kellogg School of Management. “It makes no more sense to tell the athletes, ‘You go buy your own health insurance,’ than it does to say, ‘You go buy your own plane tickets and uniform.’ ”

Some colleges provide for their athletes. At Middlebury College in Vermont, a Division III institution, all varsity athletes and students in club sports have accident insurance paid for by the college, said Tom Corbin, Middlebury’s business manager.

Spalding University, in Louisville, Ky., also pays for secondary coverage for athletes. “These young men and young women are representing your institution,” said Charlie Just, the compliance director there. “Ethically, I think it’s the right thing to do.”

Some of the nation’s largest universities, which benefit from lucrative television contracts for their football and basketball programs, also provide comprehensive coverage. At Michigan State, for instance, Aisha Jefferson, a women’s basketball player with no private insurance, has had four operations for sports-related injuries without receiving a single bill.

The University of Iowa, which like Michigan State is a member of the Big Ten, provides among the most comprehensive coverage for varsity athletes. The university received 4,200 medical bills for them last year, paying $776,454, according to documents obtained through an Iowa Public Records Law request. The university has also begun paying for uninsured full-scholarship athletes to enroll in the student health care offered on campus.

Still, many athletes are not so lucky — victims to disagreements over who is responsible for payment or what constitutes a medical condition.

Knauer, 20, was a first-semester freshman at Colgate when she joined the crew team in 2007 as a walk-on. She was battling a cold when the team was scheduled for a five-kilometer workout test on rowing machines. Despite her condition, she was on a pace for her fastest time when she felt a shooting pain rip through her back to the tips of her toes.

Over the next month, she said, the pain increased and she ended up in an emergency room twice, eventually spending a week at the University of Maryland hospital, closer to her family’s home in Ellicott City, Md. She also went through physical therapy to heal her strained back and a bulged disk.

Her symptoms were later diagnosed as postviral myositis, a muscular inflammation that can cause weakness and pain. Because Colgate officials deemed the condition an illness — not an athletic injury — they said financial responsibility fell to Knauer.

“There has to be some direct line from the injury to what she’s being treated for,” said Steve Chouinard, an assistant athletic director at Colgate who assumed responsibility for insurance matters after this decision was made.

In fact, the situation is more complicated, according to two medical experts. They said it would be difficult to attribute every symptom to either a virus or an injury, an illustration of the ambiguity of treating and paying for care when an athlete has more than one health concern.

Sustaining an injury while sick can make both situations worse, said Dr. Jerry Mendell, a professor of pediatrics and neurology at the Research Institute at Nationwide Children’s Hospital in Columbus, Ohio. An injury could have intermingled with the disease, he said. “I don’t think we can say where one starts and stops.”

What is clear is that if Knauer had been treated the same way under the university’s athletic insurance, she would have had full coverage after a $1,000 deductible. Instead, she had to tap her student health policy, which offers up to $25,000 in coverage a year, leaving her with $55,000 in debt on the original $80,000 in bills.

Knauer had some financial assistance and additional coverage from her family, but her father, a chemical engineer, twice lost his job and the accompanying insurance. Knauer is now working two jobs to help meet her minimum monthly payments of $200 to $250. After paying off some of the debt and negotiating discounts with the hospital, she still faces $7,000 to $8,000 in bills.

“I never thought I’d be in this position today,” she said.

Still in physical pain, Knauer has struggled with the stress of weekly phone calls from bill collectors, some of whom have threatened to sue her. “I definitely have broken down over the year,” she said.

Even scholarship athletes in major sports can end up in similar situations.

Jason Whitehead, a former football player at Ohio University, was so badly injured during a workout in 2001 that he had to be airlifted to a hospital. He was temporarily paralyzed.

“The next day, when I woke up, the doctor came in and informed me that surgery went well, but this was a career-ending injury,” he said. “You’re a 19-year-old kid. It took awhile to sink in.”

He said he took the bills not covered by his father’s insurance to the Ohio University trainers. His father’s insurance and Ohio University refused to pay the claims.

Whitehead lost his scholarship one academic year after being medically disqualified by a team physician, per university policy. University officials declined to comment on his situation, citing their commitment to student privacy. They also said they would not pay bills for procedures that occurred more than a year earlier.

But Whitehead, now a 28-year-old district manager for Frito Lay in the Cleveland area, said he discovered he owed roughly $1,800 in unpaid medical bills while reviewing paperwork to buy his first car about six years after his injury.

“The coach says: ‘You’re on full scholarship. If you ever get hurt, we’ll make sure to take care of you,’ ” he said. “There’s a lot of us out there that get used.”

Within a single state university system, health coverage can vary widely. At the University of Wisconsin’s Division I Madison campus, all varsity athletes fall under secondary sports coverage. By contrast, the Division III campuses of the University of Wisconsin have training rooms to treat minor athletic injuries; anything beyond that is the responsibility of athletes and their families.

After Dustin Tervelt broke his leg while playing football for the University of Wisconsin-Stout, he spent nearly a year rehabilitating to get back on the field. Tervelt quit his part-time job at a liquor store because he said he could no longer hoist kegs or stock the shelves.

“Everything was just piling up,” he said. “It just felt like there was no coming back out of it.”

He eventually worked his way back to the field, where he earned all-conference and all-American honors for the 2008 season. By then, he was also carrying about $6,000 in medical debt, the amount left over after his private insurance coverage reached its limit. Had Tervelt played football on the Madison campus, where the Badgers compete in the Big Ten, he would have had full coverage. “I knew I wasn’t going to get the scholarship money, but I knew that I wanted to play football,” said Tervelt, who now coaches football and plays on a team in Denmark. “When you do something you love, not just in football but in everyday life, you take those risks.”

The National College Players Association, an advocacy group, is lobbying for legislation to further protect athletes. The N.C.A.A.’s focus is misplaced, said Ramogi Huma, the group’s executive director.

“Their top priority is not to do right by the players,” said Huma, a former football player at the University of California at Los Angeles. “It’s to do right by the schools and maximize profits and exposure for the member institutions.”

Last summer, the N.C.A.A. was required to establish a $218 million relief fund as settlement for a class-action lawsuit brought by football and basketball players who argued that their scholarships did not adequately cover certain living expenses, including medical bills. Many athletes do not know the money is available, so some of it has gone unspent.

“For us to insure all our athletes, it would be five figures, if not six,” said Scott Doberstein, the head athletic trainer at the University of Wisconsin, La Crosse, which offers no coverage to athletes. “I think we need health-care reform. Under the current structure, it is just too cost-prohibitive, especially in these economic times.”

Ultimately, the N.C.A.A. is unlikely to require universities to provide more insurance any time soon.

“The only way to increase coverage would be to make it mandatory,” said Joe D’Antonio, the chairman of the N.C.A.A.’s legislative council and associate commissioner of the Big East Conference. “It could be too demanding financially on some of our institutions.”