How to Report an Athletic Injury and File a Claim
Every athlete is automatically covered by the GAP Insurance plan as soon as you are medically cleared to play. If you become injured while participating in an athletic practice or competition, your team’s athletic trainer will fill out a claim form which is emailed to our excess insurance company.
What to do if you are injured while participating in intercollegiate sports:
· Report any injury to the Athletic Trainers immediately or as soon as possible after occurrence. If it is not reported prior to 90 days following the date of the injury, GAP insurance coverage will be denied.
· If a referral to a physician is deemed necessary, the Athletic Trainer will fill out a Notice of Injury form, which will be forwarded to the GAP insurance company.
· The Athletic Trainer will give you an insurance card for the GAP policy, which again is an excess policy. You must bring your primary insurance information and the GAP insurance card to each provider you see. KEEP THE GAP INSURNCE CARD AND HAVE THE PROVIDER MAKE A COPY OF IT FOR THEIR FILES.
· All claims must FIRST be filed with your primary insurance carrier. The GAP insurance policy is an EXCESS policy.
The GAP insurance policy has a $1,500 deductible per injury. This policy will pay 100%, once your primary insurance pays out anything over and above $1,500. Some very broad examples are listed below:
· Example #1, all charges amount to $1,500. Your deductible is $2,000. The GAP insurance will not pay anything and you are responsible for the first $1,500.
· Example #2: All charges amount to $3,000. Your deductible is $2,000. Your insurance company pays, $1,000, you pay $500, and the GAP insurance pays, $500.
· Example #2) All charges amount to $6,000. Your deductible is $2,000. In this case, your insurance company pays $4,000, and the GAP insurance pays $2,000.
· Example #3) All charges amount to $100,000. Your insurance company picks up $80,000. The GAP insurance would then cover the next $10,000, and the NCAA Catastrophic Policy would pick up $10,000, leaving you with zero out of pocket costs.
How do I file a claim with the GAP insurance?
· Save all itemized bills from each provider and all Explanation of Benefits (EOB) from your primary insurance company. Once you have received ALL itemized bills and EOBs, send them (or copies of them) make sure you have the following information before sending anything to Gallagher-Koster Insurance:
1) Itemized bills – This is called a HCFA or UB92, and it contains the following information:
o Provider’s Name
o Provider’s Address
o Tax ID Number
o Date(s) of Service
o Type of Service(s) Rendered
o The Fee for Each Procedure
2) Primary Explanation of Benefits (EOB) – This is a statement from your primary insurance company that outlines what charges will be covered and what the patient might owe. If a primary insurance company denies charges for one reason or another, a DENIAL will be sent instead of an EOB.
Gallagher Koster cannot process a claim that is missing one or more of the above documents. They cannot accept balance due, balance forward, or past due statements for claims processing. Sending these without the required information will only prolong the processing time.
· Send all of the above information to:
Gallagher Koster
c/o Sports
500 Victory Rd.
Quincy, MA 02171
or you can fax it to them at: (617) 479-0860
Make sure you note: The ID number for the student is their Student ID#
Group Number on the Policy is St. Norbert Athletics