Jun 1, 2017Lacking Coverage
Helping student-athletes who suffer an injury is challenging in and of itself. But when they don’t have adequate health insurance, getting that treatment can be even more difficult.
“It comes down to schools not being able to foot the bill for all these kids and insurance policies that don’t adequately take care of them,” Toby Foreman, Head Football Coach at Central High School in Beaumont, Texas, told the Beaumont Enterprise.
When high school athletes are without insurance, they must often turn to Medicaid. Some care, like concussion testing, isn’t covered by Medicaid, meaning treatment options may be limited.
“When these kids got injured it became difficult to send them places because they wouldn’t accept their insurance,” said Foreman. “I felt bad for the kids because it took them longer to get rehab and recover from their injuries, concussions, or something else.”
At a concussion clinic run by Kimberly Pitts, DO, a Family Medicine/Concussion Specialist at Christus Southeast Texas, more than five percent of athletes treated for concussion have Medicaid. That number may be higher, due to the way the insurance claims work.
“When most of these kids or families aren’t covered, they default to the school insurance,” said Bill Klamfoth, MHSA, MS, Regional Director of Outpatient Operations at Christus Health. “That makes it harder to track because the school’s insurance is listed as the primary insurance.”
If Medicaid won’t cover concussion testing, the secondary insurance from schools may not cover the cost either. Dr. Pitts uses the ImPACT concussion software to test cognitive recovery, but Medicaid doesn’t cover it. As a result, she says her facility often forgives portions of bills in order to provide sufficient care.
“They put this testing in the psychiatric realm, they don’t consider it a necessity like they would for treatment of a broken leg,” said Dr. Pitts. “It’s up to us to fight that system, within the law, and make sure every kid gets the attention they need. But we know some kids still go untreated.”
One way to solve this problem may relate to the way concussions are listed on the paperwork. For one athletic trainer, listing a concussion as a multi-trauma injury has been a way to get athletes coverage.
“It gives doctors more leeway to investigate other things and keeps the insurance companies off their back,” said Matt Lewis, LAT, ATC, Athletic Trainer at Nederland (Texas) High School. “If I list it this way, it can eliminate the possibility of a kid not getting treated.”
