For years, occasional stories surface of former college athletes who pay out of pocket to cope with injuries they suffered while in school. The medical costs can be thousands of dollars and create lasting debt.
Undoubtedly, there are athletic departments that pay for some post-college medical expenses. But since there has been no NCAA requirement to do so and hardship stories kept emerging, a perception formed that athletic departments flush with new dollars don’t properly treat their former players who sacrificed their health.
That’s about to change this fall in the Pac-12 — maybe.
The Pac-12 is believed to be the first conference to direct schools to pay post-college medical costs for sports-related injuries that an athlete suffered at their school. What eligibility criteria is used by Pac-12 schools will help determine how much help former athletes receive and at what costs without people abusing the benefit. The new practice could also set a blueprint for the NCAA or other conferences to follow or avoid.
Pac-12 schools must provide direct medical expenses for at least four years following the athlete’s graduation or separation from the university, or until the athlete turns 26 years old, whichever occurs first. The timeframe for coverage was chosen in part because by the age of 26 a person is covered by the Affordable Care Act.
Each school will establish its own policies and procedures to determine who is eligible for the benefit. The conference office has no role in oversight, leaving Pac-12 schools to figure out the best approach.
“It’s going to be hard to calculate,” Washington athletic director Scott Woodward said. “When was the injury created? How will we do it? We want to do the right thing and try to help out, and wherever it lands I’m going to support it. But I’m not sure right now what that is.”
The Pac-12 bylaw states that a school’s policies to determine eligibility “may include the required disclosure of pre-existing conditions not related to participation in intercollegiate athletics, mandatory reporting of injuries suffered during athletics participation at the institution, required participation in an exit physical upon graduation or separation from the institution, and other criteria that an institution deems appropriate.” In other words, Pac-12 schools are on their own to figure this out.
“It’s such a difficult thing to wrap your head around because what’s continuation of a problem and what’s a new problem?” Arizona athletic trainer Randy Cohen said. “How do you handle people who continue to do activities and maybe you recommend they don’t continue doing that? We really want to take care of these kids. But at what point is it the risk of playing sports and having injuries versus we hurt you?”
Most likely, Pac-12 schools will use exit medical evaluations of players to determine eligibility and buy insurance policies that carry stipulations, such as for in-network and out-of-network coverage. However, Cohen said finding insurance to cover an injury for four years out is difficult because most providers want a condition treated within two years. Cohen said Arizona will likely add four years to its insurance plan at a cost of a couple hundred thousand dollars a year, and require that for athletes to have costs covered they show a preexisting injury, undergo a departing physical when leaving the college, and demonstrate they followed recommendations for their health.
Cohen, who chairs the college committee for the National Athletic Trainers’ Association, rattles off potential challenges to managing the Pac-12 rule. What if an ex-player elects for surgery against the wishes of medical experts who say surgery will only make the injury worse? Is the school responsible for that surgery and if the injury worsens? Does the university get portrayed as the bad guy in the media if the former player tells the public the school wouldn’t pay its costs?
How should caring for mental health related to concussions be treated? If a school agrees with research that shows hits to the head can cause long-term brain damage, that degenerative process might not occur until after the Pac-12’s four-year window. So should there be payments to the athlete if dementia occurs 20 years later?
What if a gymnast tore an ACL in college that leaves her with an arthritic knee, she runs marathons two years later, and tells the school her knee is bothering her and needs to be treated? Then what if a 225-pound football player left college saying his knee felt fine, blew up to 300 pounds after his career ended and has a bad knee while mainly sitting on the couch?
“Do I not take care of the girl when she’s exercising and making it worse, but I take care of the guy who’s doing absolutely nothing and gaining 75 pounds?” Cohen asked. “Most people logically would say if you’re doing something that aggregates the knee, don’t pay them. But on the other end, if the guy does nothing to help his knee, how do I balance those two? We don’t want to encourage people not to have active lives after they’ve stopped playing. I don’t have an answer to that.”
Will Pac-12 rule help change perceptions?
The Pac-12 is trying to address a longstanding criticism: The NCAA and its members don’t pay for athletes’ physical needs once they’re done playing. In addition to medical costs, the Pac-12 is also guaranteeing four-year scholarships for athletes in good standing, allowing athletes to return to school to complete their degree and liberalizing transfer rules within the conference.
“Hopefully this demonstrates to anyone that’s paying attention that reform is possible within a conference, within the NCAA, and that there are schools out there serious about it and will redirect a lot of resources toward it,” Pac-12 commissioner Larry Scott said.
Tax records show the SEC, ACC, Big Ten, Big 12 and Pac-12 totaled $1.57 billion in revenue during 2013-14, up 63 percent from three years earlier. No major conference had a bigger revenue jump than the Pac-12, which increased from $111.8 million in 2010-11 to $374 million in 2013-14.
The NCAA requires that college athletes have a primary health insurance policy while they play, but the universities don’t have to pay for it. The insurance can come from the school, a parent, or an athlete’s personal policy, and must cover up to the deductible of the NCAA’s catastrophic injury insurance program that starts when expenses exceed $90,000.
CBSSports.com asked the NCAA for research data showing a breakdown of who pays for athletes’ insurance policies, how frequently colleges pay for post-career medical expenses, and how much money the NCAA’s catastrophic program pays out and to how many athletes. An NCAA spokeswoman said the association does not publicly disclose those details.
At UCLA and USC, for instance, those schools’ 2014-15 athlete handbooks said the primary insurance policy is billed first for a current athlete and all subsequent approved costs are paid for by the athletic department. Anecdotally, this appears to be a typical practice by NCAA members. UCLA’s handbook stated that athletes have one year from the date they leave a team — whether they quit, transfer, graduate or medically retire — “to take care of documented injury issues.”
In 2012, California passed a state law requiring colleges to provide medical care or insurance for sports-related injuries for up to two years after an athlete leaves a university. The law covers California universities that generate more than $10 million in media revenue from athletics, meaning UCLA, USC, Stanford and California.
Sen. Cory Booker (D-N.J.), a former Stanford football player, argued at a Senate hearing in July 2014 that athletes are exploited when they have to pay for their post-career surgeries. A pair of ex-football players, Florida State’s Myron Rolle and North Carolina Devon Ramsay, agreed with Booker’s statement that many linemen undergo 4-6 knee surgeries.
NCAA president Mark Emmert testified that insurance today for athletes is “much better” than people think but acknowledged some areas need to be improved.
“It’s costing some athletes thousands of dollars into their lifetime,” Booker said.
“Yes,” Emmert replied.
Medical costs could be “all over the map”
It’s not clear how much extra money Pac-12 schools could be spending to care for former athletes.
“It’s all over the map,” Scott said. “Some schools provide the medical care themselves. Others will reimburse bills. Some were doing it anyway up to two years and this extends to four years. Some were doing it less. You could have very little in the number of claims, and other times there could be some very significant events, so it’s very, very hard to model.”
Currently at USC, a significant financial year for covering former athletes’ medical costs is in the low six figures. That will likely increase since the Pac-12 is now promoting this rule and the length of USC’s benefits to eligible athletes will increase from two years under California law to four under the Pac-12 provision.
“The only issue is it will place some additional financial burden on athletic programs that are becoming more burdened with other benefits like enhanced snacks and full cost of attendance,” said Dave Roberts, USC vice president of athletic compliance. “In my view, you like rational order. You don’t like things that are confusing and difficult to apply and track. It’s well-intentioned. We’re hopefully going to have a program that benefits athletes and doesn’t become so economically burdensome that it drags down the program.”
The costs under the new Pac-12 rule could be “astronomical” depending on how a school sets its criteria, said Cohen, Arizona’s athletic trainer. Medical officials at some Pac-12 schools asked the conference to obtain a group insurance policy with the same coverage criteria due to concerns that taking care of ex-athletes will be used in recruiting.
“We don’t want this medical stuff to be, ‘If you come to Arizona, we’ll pay for everything four years afterward and if you go to USC and come in with an ACL, there are stipulations that they won’t pay,’” Cohen said. “We want this medical care to very much be independent of the sport process.”
Cohen said he now understands why a group Pac-12 policy is not feasible due to differing campus resources and state laws.
One potential quirk to the Pac-12 rule, which is effective for injuries starting in 2015-16 and moving forward: How the rule may differ from California law for transfers. The Pac-12 rule says the original school is not required to provide this benefit if the player transfers elsewhere; the California law makes no distinction.
Say an injured player transfers from a Pac-12 school in California to a new university. Typically, if the new school thinks highly of the transfer, the athlete will get proper medical treatment paid for immediately. But that’s not always the case, especially if the transfer is a lesser player with not as much value to the new university. In that case, the new university could tell the transfer to seek medical costs from his or her former university in California based on California law.
“I hate to say it, but it’s probably something that has to shake out in the future,” said USC’s Roberts. “I could see instances where we might be obligated to take care of a transfer who transfers away, but under the Pac-12 guidelines that wouldn’t be the case.”
There’s another reason the Pac-12 is directing schools to create its own eligibility criteria: litigation threats.
“One thing that’s a valid point is one of the things college athletics is being knocked on — and losing lawsuits on — is a lack of fair trade,” Cohen said. “If we all say this is how we’re going to do it, is that collusion? So you say, ‘Figure it out on your campus.’”
On the website of the law firm Hagens Berman, there is an advertisement seeking football and basketball players from SEC, Big Ten, Big 12, Pac-12 and ACC who paid out-of-pocket medical expenses for sports-related injuries either while in college or within the four years after playing. “Attorneys believe the NCAA and Power 5 conferences have conspired to limit health insurance coverage for college-athletes,” states an undated ad from Hagens Berman, which has filed several class-action lawsuits against the NCAA.
A spokeswoman for Hagens Berman said she does not know when the advertisement was posted or the status of the firm’s investigation.
One thing is clear: Proper medical evaluations of athletes before they arrive to college and once they leave will carry added meaning in the Pac-12. Woodward, the athletic director at Washington, said the athletic department already repairs injuries to so many athletes when they arrive on campus but will now need to evaluate on the back end.
What athletes say to trainers could carry extra meaning as well.
“The hard part of what we do in college athletics is if the kid tells you the truth (on how he got injured), they might invalidate your coverage,” Cohen said. “Does the kid say, ‘I played pickup basketball and reinjured it,’ or do you have a kid who lies and says, ‘No, I didn’t do anything, it just started hurting.’ So do you encourage them to lie to you?
“We want to do the right thing. It’s complicated.”