Georgia Soccer Youth Medical Insurance Claim Procedures (Sept 10)
 
This memo should be used to advise all league members (coaches, officials, players, parents) of the procedure that needs to be followed to ensure that all medical insurance claims are processed properly.
 
Georgia Soccer-Youth maintains medical injury insurance for all registered members.  Claims are electronically filed and then processed through our insurance company. If the steps listed below are met, medical insurance claims can be processed timely and accurately. 
 
We offer secondary insurance coverage with Pullen Insurance. You should file with your primary insurance company first.   You will file a claim, with our insurance company, for any remaining balances and/or out of pocket costs incurred.  Coverage is applicable for 52 weeks from the date of injury. 
 
Our deductible per claim is $1,000.00.  This is in addition to any deductible that the primary insurance company already has.  The deductible can be paid or it can be met through out of pocket expenses and/or any additional charges that have been incurred. Each claim is also subject to the application of an 80/20 co-insurance provision.  We cover most expenses to include, but not limited to, casts, braces, sprains, and physical therapy.
 
If it seems that the medical treatment is going to continue over a significant period of time, we do not recommend that the parent wait until all services are complete to file.  The claim with our insurance company can be filed immediately after the case report has been received and verified by our office.  It is much easier for the parent to add additional charges to an already active claim than it is to initially get the claim started.
 

Procedures for filing medical insurance claims:

1.  The Report of Injury needs to be electronically completed by the coach, assistant coach, or team manager, NOT THE PARENT.  The coach should fill out the injury form for ALL injuries.  Many times what does not look so bad on the field later turns out to be quite serious. Pullenins Accident Medical Claim form Click link, then Georgia Soccer. 

In order to complete the case report you must have the following information:Player name, address, date of birth and player ID number 

  • Parent name and email
  • League and Team information
  • Specific description of body part injured (ie: right ankle)
  • Details of what occurred to cause injury
  • Case report of injury must be completed by a league official (coach, team manager, referee, etc.) and not the parent.

2.  Once the injury report is received, GA Soccer will verify and forward to insurance company.   The coach will receive notification that the injury report has been received and approved or disapproved.  If disapproved, coach needs to make corrections and resubmit form or contact us to update information. 

3.  The insurance claim form is then e- mailed to the parent to complete. It is usually sent within 1-3 days.  Sometimes the e-mail will go to the junk/spam box.  If not immediately received, please check there. 

4.  The parent then completes the claim form on line.  After completing the form, the parent should print and sign the claim form.  Attach completed claim form, a copy of all itemized bills and an explanation of benefits and mail all information directly to Pullen Insurance.  Please do not return information to Georgia Soccer.

From speaking to parents, I have received very positive information that claims are usually processed and completed with our insurance quite efficiently.  If, at any time, a parent is unsatisfied with the service or feel that they are getting the “run around” they should contact me immediately.

Depending on the circumstances, some exceptions are made to the above listed procedures.  If you have a parent that has particular circumstances or questions about our coverage, if there is no primary insurance coverage available, or if further assistance is needed, please contact:

Jade Beaulieu
GSSA, Dir of Operations
678-993-2111 Phone
770-452-1946 Fax
jade@georgiasoccer.org

Please pass this information along to others and it will help answer any questions that may arise.



Guidelines for Submitting a Youth Soccer Accident Claim Form

  1. Coach, assistant coach or team manager completes ALL questions on the Accident Claim Form.
  2. File this new report of claim within 30 days of the date of accident or as soon thereafter as is reasonably possible.
  3. Once injury form received and approved, an email with the claim form will be sent to the parent. 
  4. If you have other insurance, submit your itemized bills to the other carrier first. You will receive a payment Explanation of Benefit worksheet (EOB) from your carrier. Do NOT wait until your other carrier has processed all your bills before filing a Youth Soccer Accident Claim Form.
  5. You may attach itemized bills and your other carrier’s EOBs that are ready at the time of submitting this Claim Form.
  6. Upon receipt of the claim form from your state association we will forward an acknowledgement form advising you of your claim. All future correspondence concerning your claim should be directed to K&K Insurance, who is the claims payor for National Union Fire Insurance Company, at the address and phone number listed on your acknowledgement.

  1. There is a $1,000 deductible per covered accident for the 9/1/10 – 9/1/11 policy year. Each claim is also subject to the application of an 80/20 co-insurance provision with a $50 physical therapy/chiropractic limit per visit/$2,000 total maximum.
  2. Each itemized bill MUST show the following:
    Provider of Service’s Name                                Date of Service
    Provider’s Address                                    Diagnosis Description or Codes (ICD-9)
    Provider’s Federal Tax ID #                        Procedure Description or Codes (CPT)
    Provider’s Telephone #                              Charge for each Procedure

  3. Additional bills to be submitted at a later date (after the initial submission of your claim) should be mailed directly to K&K Insurance with the following information: Name of the claimant, date of the accident, and name of the State Youth Soccer Association.
  4. Please allow time to properly process your claim.
  5. Please respond promptly to any correspondence requesting additional information. It is the Parent / Guardian / Claimant’s responsibility to request this information from the provider of service or from your primary carrier.
  6. At Explanation of Benefits will be sent to you by K&K Insurance on behalf of National Union Fire Insurance Company.      

What is an itemized bill?

An itemized bill is a detail of the procedures performed by a licensed provider of service; i.e. Hospital, Clinic, Physician, etc.

What if I don’t have an itemized bill?

The Parent/Guardian must request this information from the provider of service. Some providers only mail a balance due statement. This claims payor, K&K insurance, is unable to process this charge without an itemized bill. Again, request this information from the provider service. Explain that you have Youth Soccer Excess Accident Coverage.

Can you process this claim with other insurance carrier’s worksheet alone?

No, the Payment Explanation (EOB) from your other insurance does not have complete information to process this claim.

What if I don’t have my other carrier’s payment explanation (EOB)?

The Parent/Guardian must request the EOB from their other insurance carrier.

Who do I contact if I need further assistance?

State Association Contact Pullen Insurance Contact
Georgia State Soccer Assoc. Pullen Insurance
2323 Perimeter Park Dr. NE 2560 River Park Plaza, Suite 300
Atlanta, GA 30341 Forth Worth, TX 76116
ATTN: Jade Beaulieu ATTN: Cecelia McDonald
678-993-2111 866-738-6100
jade@georgiasoccer.org cmcdonald@pullenins.com