Dear Tiger Family:

I feel it is important that each of you thoroughly understand the athletic insurance and medical policy of The University of West Alabama. Hopefully, the following letter will explain answer any questions.

The National Collegiate Athletic Association (NCAA) does not permit us or any university to pay medical bills that occur related to illnesses, injuries or conditions which are not the direct result of accidents occurring during supervised athletic trips, practices, or games. This includes DENTAL WORK, EYE GLASSES, EYE EXAM, HEARING AIDS, MEASLES, CHICKEN POX, WARTS, TUMORS, APPENDICITIS, PREGNANCY, LEUKEMIA, INJURIES FROM FIGHTS, or any other conditions not related to their participation in their intercollegiate athletics. We will assist the athlete in getting proper medical care for the above, if desired, but we will not accept financial responsibility.

The University of West Alabama will only be financially responsible for the payment of medical bills that result from injures occurring during supervised athletic trips, practices, or games. However, The University of West Alabama will pay the balance of these bills only after each bill has been filed with and processed by the primary and/ or secondary insurance company of the student-athlete. We will make payment on the balance of these bills only after we receive notification that the primary / secondary insurance company has paid their maximum eligible amount; or that insurance has denied the payment of the bills. The exact procedure for handling these medical bills is outlined on the attached Medical Expense Payment Procedure sheet.

The University of West Alabama will only be financially responsible for the payment of medical expenses resulting from injuries that occur during supervised athletic trips, practices, or games. The University of West Alabama will pay the balance of these bills only after each bill has been filed with and processed by the primary and/or secondary insurance company of the student-athlete. We will make payment on the balance of these bills only after we receive notification that the primary / secondary insurance company has paid their maximum eligible amount; or that insurance has denied the payment of the bills. The exact procedure for handling these medical bills is outlined on the attached Medical Expense Payment Procedure sheet.

Each student-athlete is required to have a physical examination by our physician and sports medicine staff prior to any participation in any intercollegiate sport. The final decision of physical qualifications or reason for rejection is the responsibility of the team physician. The team physician also makes the decision on when an athlete may return to competition after a previous injury.

It is the responsibility of the athlete or the parent / guardian(s) to notify the Athletic Training Staff or Team Physician of any athletic injury / illness to obtain prior approval for medical expense. The University of West Alabama Athletic Department will not be financially responsible for any medical expense incurred unless prior approval has been obtained from the team physician(s); E. Lyle Cain, M.D., and William R. Simpkins, M.D. or from the athletic trainers: R.T. Floyd, Brad Montgomery, Andy Grubbs, Shanna Grubbs, or Laurie Fincher.

The University of West Alabama Student Health Services program is operated through an agreement with Dr. William R. Simpkins. The University physician, William R. Simpkins, M.D., maintains office hours at the Livingston Clinic Inc. (Hwy. 11 North) from 9:00 am until 5:00 pm on Monday, Tuesday, & Thursday; and from 9:00 am until 12:00 pm on Wednesdays and Friday for the purpose of seeing students on routine matters. The University physician may write prescriptions and/or treat the student on an outpatient basis, as necessary. Student Health Services provides this service as part of the arrangement through the University and the doctor’s office. It is covered under the student medical fee.

The student will be responsible for the purchase of all prescriptions needed other than those prescribed for a covered athletic injury/illness. If the student needs to be hospitalized for non-athletic reasons, it will then be the responsibility of the student to select his physician and hospital. The student will be responsible for any charge incurred.

James R. Andrews, M.D., and E. Lyle Cain, M.D., from the Andrews Sports Medicine and OrthopedicCenter in Birmingham, AL serve as our orthopedic consultants. They and other staff members at the Andrews Sports Medicine and OrthopedicCenter are widely recognized as being some of the top sports medicine specialists in the United States. They provide us with excellent medical care.

I am enclosing The University of West Alabama Insurance Status Form. We must have this information completed in order to provide maximum protection for every student-athlete. Until this form is complete, and on file the athlete will not be allowed to participate in any athletic event or practice and the University will not be responsible for any medical expenses occurred prior to the submission of this form. For this reason, I am asking you to take a few minutes and complete this form now. Return in along with a photocopy of the front and back of your insurance card as soon as possible. Please be sure that the athlete and the parent / guardian sign and date in the appropriate spaces. Your quick and complete co-operation with this form now will prevent a great deal of future problems, should any occur. Please save this letter and the enclosed Medical Expense Payment Procedure Form for future reference.

Please feel free to contact me if you have any questions.

Sincerely,

Brad Montgomery

Head Athletic Trainer

UWA Station 14

Livingston, AL35470

205-652-3696

205-652-3799 Fax

/ UWA ATHLETIC MEDICAL EXPENSE PAYMENT PROCEDURE /

All medical bills for the athlete incurred as the result of an injury in the intercollegiate sports program should be sent directly to the athlete or to the athlete’s home address. In some cases the athletic department may receive a bill, but in no case will the athletic department be the primary place for the bill incurred to be charged. Athletes incurring medical expenses as a result of participation in the University of West Alabama Varsity Sports Program should follow the procedure below in regards to the handling of their medical bills.

  1. Submit all of the medical bills incurred to your family or employer group coverage first. This willresult in one or more of the following actions:
  1. Your insurance company or parent’s employer may ask for more information regarding thepatient, enrollment in college, injury, treatment, hospitalization, etc. If this is the case, it is your responsibility to forward this information to your insurance company. If we canassist in obtaining this information, we will be glad to do so.
  1. Your insurance company may honor the claim and pay all or a portion of the bills incurred.
  1. Your insurance company may not honor the claim and send you a denial of benefits letter. An example might be that the athlete is no longer part of the group policy after attainingthe age of twenty-three.
  1. If a balance remains after your family or employer group insurance has contributed towards theclaim, send the claim sheet from the insurance company and a copy of the bills incurred to Brad Montgomery at the U.W.A. Athletic Department.

If you receive a denial of benefits letter from your family or employer group insurance carrier, then send the denial of benefits letter and a copy of the bills incurred to Brad Montgomery at the U.W.A. Athletic Department.

  1. If you do not have any insurance at all, then ask your employer to write a letter stating that you are not covered by any group insurance with the company. Forward this letter and a copy of the billsincurred to Brad Montgomery at the U.W.A. Athletic Department.
  1. Our athletic insurance may require that you and/or your parents complete a claim form or other formsthat we will forward to you. We will not accept financial responsibility for these medical chargesuntil you comply with these requests.

Address all correspondence to:Brad Montgomery, ATC

Head Athletic Trainer

UWA Station 14

Livingston, AL35470

Phone (205) 652-3696

Fax (205) 652-3799

e-mail: