Do professional athletes pay for their injuries? The short answer is yes, and sometimes without legal responsibility. How common are surprise medical bills? They’re not as frequent as they once were but are still more typical than they should be.

The No Surprises Act

The 2022 No Surprises Act (NSA) has done much to alleviate the frequency of surprise medical bills in sports, but more than two years on, there’s still work to do if athletes are to benefit from the legislation.

Uninsured Athletes

In instances where you — perhaps as a college athlete struggling to make ends meet — might have no medical insurance, the NSA protects you from surprise medical bills. Health care providers now must issue good faith estimates to uninsured patients for their charges before supplying a product or treating you or whenever you request one.

If you receive a bill at least $400 higher than the estimate, you can start a dispute process involving a dispute resolution entity. Once contacted by this third party, the provider must furnish the original estimate, their bill and any other documents indicating why the billed amount is higher. The NSA doesn’t, however, provide a resolution process for bills lower than $400, which might still result in a lot of money for a student-athlete to find.

Medically Insured Athletes

The act has successfully protected millions of insured patients — including professional athletes — from unexpected medical expenses from out-of-network (OON) health care providers. Surprise bills range from OON air transportation to OON emergency room treatments and could include in-network facilities using OON medical contractors. In such situations, even with the NSA, you may become a third party in a resolution process between the health care provider and your medical insurance.

This process will involve arbitration known as Federal Independent Dispute Resolution, or will occur through a private arbitrator certified by the government. While this process is pending or underway, the surprise medical bill you received remains outstanding in your name. 

While the NSA has limited the frequency of surprise medical bills for athletes, there is much the government can do to remove the unnecessary stress they create, with serious injuries already creating enough. Professional athletes can likely afford these bills they really shouldn’t receive. A loophole in the NSA system means more decide to do so instead of dealing with the alternative.

This loophole means that, should a health care provider and medical insurer both decide against filing for arbitration due to the costs involved, the surprise amount remains outstanding for the patient to cover. If you refuse to pay the bill in this scenario, you could face late interest, collection charges, bad credit ratings and a potential court case, all for a surprise medical bill you should’ve received protection from receiving.

University Medical Policies

As concerning as the gray areas in the NSA are, the new law has reduced the number of surprise bills athletes receive since its adoption. More significantly concerning are the flawed university medical policies the National College Players Association (NCPA) exposed at some D-1 National Collegiate Athletic Association (NCAA) colleges. 

Who pays if a college athlete gets injured? NCAA programs have already resulted in surprise medical bills for students and could continue to do so.

Misleading Medical Policies 

After sending a medical policy disclosure form to every NCAA Division One athletic program, the NCPA found some weren’t willing to disclose their policy information. Some of the results include:

• Some universities retroactively alter their medical policies to exclude covering some sport-related injuries.
• Several university medical policies don’t address the periods that coverage for their athletes will last.
• Athletics coordinators at some universities deferred returning the disclosure form because they knew their athletics programs would grade poorly.
• Certain universities refuse to cover sport-related injuries during university-led voluntary sessions.

One former college football player — John Clark, who suffered a knee injury while representing his university — describes in an NCPA video how he only found out long afterward that he had a bad credit score after his college never paid his medical expenses. While the NSA will cater to athletes in certain instances, including restricting the chance of a shortfall between insurance rates and OON ones, it has no legal standing if your university policy refuses payment after an injury.

Minimizing Surprise Medical Bill Risk

To prevent a substantial resulting bill, you and your parents must be aware of the small print in your university medical policies and any insurance documentation. As much as it costs, taking out additional coverage may be worthwhile. While the NCPA is working hard to eliminate the current inadequacies within the medical policies of many universities, problems that could result in you receiving a surprise medical bill remain.

Be Proactive in Checking Your Treatment and Insurance

From NSA loopholes to unclear university medical policies, you can still receive surprise medical bills. The NSA and the ongoing endeavors of the NCPA lessen the risk of getting these unnecessary and unwanted documents, but it’s up to you to ensure your medical treatment conforms to the law and that your medical coverage is all it claims to be. Doing so will further decrease your risk of receiving surprise medical bills.

Author: Beth Rush