Sun Sentinel Palm Beach Edition
MEDICAL BILLS ‘COST OF DOING BUSINESS’
UCF’s McKenzie Milton injury gives glimpse into how colleges, athletes deal with growing medical issues
McKenzie Milton stretched both feet out in front of him, his injured right leg in a boot, aboard a private plane en route from Orlando to the Mayo Clinic in Minnesota.
“How’s your air ambulance?”
his mom, Teresa Milton, asked from behind the camera in a video posted on Twitter.
“Solid,” answered the star UCF quarterback as he looked at his phone and the beat of music thumped in the jet’s cabin.
Milton was on his way to knee surgery at the hospital in Rochester, Minn., along with members of his treatment team, including two Orlando orthopedic surgeons involved in his care.
That procedure in January came two months after emergency surgery in Tampa to repair the popliteal artery behind his right knee and restore blood flow to his leg, a potentially career-ending injury that came from a hit the quarterback took during the final regular-season game last year at the University of South Florida.
The bills from Milton’s care and rehabilitation at two hospitals have started to come in — though Teresa Milton said she couldn’t yet venture a guess for the total. Then there’s the private jet — the cost of flights from Orlando to an airport near the Mayo Clinic and back is estimated at $24,000, according to private charter company PrivateFly.
But Milton and his family are unlikely to owe anything for the care he’s received so far.
“They’ve [UCF] told us not to worry about anything,” Teresa Milton said. “They take charge of the medical and they manage it. They do it for every athlete and I’ve seen it. It’s amazing.”
Welcome to the unique health care system inside college athletics.
It’s a system that can have wide disparities regarding what universities will pay for and for how long. The NCAA gives institutions discretion over how to handle insurance coverage for athletes with some schools picking up the expense of medical premiums for students while others do
“It should be the most important thing a parent looks at.”
Teresa Milton, mother of McKenzie Milton, on how universities care for the health of athletes
not — all while the cost of health care is soaring.
Milton’s case provides a glimpse of how it works at UCF, which like a number of programs, aims to protect students from any out-ofpocket costs related to sports injuries.
“It’s unbelievable,” Milton said about his medical care. “From the moment I got hurt to right now, I’ve been in the best hands possible.”
Yet, the extent of a school’s investment in athletes’ medical treatment and coverage depends on the school.
With mounting concerns about long-term health problems, such as neurological function related to concussions, there is intensified focus on how universities are providing medical care to athletes — an effort driven, in part, by lawsuits from players over injuries.
“It’s a very stark change from 10 years ago,” said Tom McMillen, chief executive officer of the LEAD1 Association, which represents athletic directors at the NCAA’s 130 Football Bowl Subdivision universities, like UCF, Florida and Florida State. “Medical is a growing expense category, no question about it, in college sports.”
FBS schools spent about 70% more in 2017 than they did in 2007 on medical expenses and insurance premiums for athletes — or a median of $844,000 a year, according to data from the Knight Commission, an independent group that pushes reforms related to the health and education of college athletes.
At UCF that figure increased by about 50% to $595,013 during that same period. Records provided by UCF show medical costs hit $608,867 in 2018.
Still, medical expenses and premiums make up the tiniest slice of UCF’s overall athletics budget — just 1% of the $61 million spent in 2018.
That’s also the case across the FBS and at the top football revenue schools in the Southeastern Conference, the Atlantic Coast Conference and others with much larger budgets than UCF’s.
Schools say total medical-related costs make up a much bigger piece of the pie when athletic training staff salaries, team doctors and health-related facilities are factored in.
“It’s a cost of doing business,” said Jon Oliver, former executive associate athletic director at the University of Virginia, who led the LEAD1 study into how FBS universities handle medical coverage. “I worked in athletics for 22 years and our No. 1 fear every single year was the unpredictability of the costs of coverage. One year you might have three surgeries. The next year you might have one.”
The cost for athletes: The NCAA requires that schools certify students have insurance before they can play, a rule since 2005. The insurance premiums can be paid for by the school, which was formally allowed by the NCAA in 2008, or in many cases at UCF and other big Florida college programs, through a policy bought by the student’s parent.
Universities then typically pay out-of-pocket expenses that the insurance policy doesn’t cover such as co-pays and deductibles.
“The intent of the UCF policy is that no studentathlete will incur any expenses for medical care for sports-related injuries or illness,” said John Heisler, a spokesman for the Knights athletics department, in an e-mail.
He said UCF has picked up those bills for athletes’ sports-related injuries for more than two decades.
But Milton’s case was unusual in some respects, Heisler said. Typically, students are treated at local hospitals and private flights are rarely used.
“Seldom does medical care for UCF student-athletes occur away from the Orlando area,” he said. “However, exceptions are made, with the specifics for treatment for any studentathlete handled on a caseby-case basis. McKenzie Milton’s case was a rare exception.”
The NCAA has a catastrophic injury insurance policy that kicks in after a $90,000 deductible is paid on an injury over a two-year time period.
The NCAA, however, doesn’t require schools to pick up athletes’ co-pays or other bills left after the player’s insurance policy pays its portion.
“The school is not obligated to pay any out-ofpocket expenses,” said Ramogi Huma of the National College Players Association.
Questions about what kind of coverage athletes receive consistently come down to money. Budgets vary from one university to another.
“… Some institutions may choose to cover some areas that others do not,” said a head team doctor for a LEAD1 school, who agreed to answer questions through a LEAD1 attorney on the condition that the doctor not be named. “Very true that a university may not be able to afford some of these expenses.”
The same team doctor also noted that as health care costs increase, universities will need to make choices about how to fund them.
“It becomes a question of where does the revenue from college sports go and is a proper proportion of this going to the student-athletes,” he said in the statement through LEAD1. “This question is still evolving.”
That sentiment was echoed by Amy Perko, chief executive officer of the independent Knight Commission. She noted that it’s not just standard medical insurance and the cost of treating injuries. More of the most elite athletes are being recruited with the notion that the university will help pay for insurance policies to protect them from future loss of income in a professional league if they are injured in college.
“It’s a very interesting dynamic,” Perko said. “You see what’s happening with coaches’ salaries, so the question is shouldn’t more of that money be allocated for these insurance policies that are going to protect against future potential professional losses?”
Protecting athletes – now and later: It’s up to athletes to find out what part of their medical expenses might be covered by the schools where they agree to attend and compete.
Recruits typically sign letters of intent, which Huma said contain few protections for the athlete and often aren’t any more meaningful than a verbal promise.
“You need transparency on protections and benefits because coaches too often break verbal promises,” says a downloadable “College Athlete Protection Guarantee” on the players association web site. “Coaches themselves don’t rely on verbal promises from their college and neither should you.”
Huma added, “it’s hard to know” if the schools are following their own policies. “When was the last time you heard about a conference enforcing a rule? The conferences act on behalf of the schools within that conference. The commissioner is elected by the schools.”
The amount of discretion universities have and the potential inequities in medical coverage were addressed last year in law journal article by Nicole Kline of the Cleveland-Marshall College of Law called, “Bridging the NCAA’s accident insurance coverage gaps?”
“If the NCAA will not allow any form of compensation for athletic achievement, how can it explain allowing universities the discretion of choosing which student-athletes will be covered by university policies and which student athletes must pay for their own?” the paper asked.
Pushed by the players association, California passed a law in 2012 that requires the state’s schools that receive $10 million or more in media rights revenue to provide scholarships for athletes, including those who are permanently injured, to complete degrees and also mandated medical coverage for at least two years after an athlete leaves the university.
Oliver’s study group supported a push by schools in the so-called Power 5 conferences — the high-revenue SEC, ACC, Big Ten, Big 12 and Pacific 12, plus independent Notre Dame — to allow them to continue to provide medical care for athletes for sports-related injuries for at least two years after they graduate or leave campus.
Ultimately, the NCAA adopted that requirement for schools in the Power 5 in 2018. Schools in the Pac-12 go even further, providing medical care for four years after a student leaves the university.
Some schools outside Power 5 conferences, such as UCF, have said they want
to play at the same level and have adopted similar standards. But the language in UCF’s student-athlete handbook reads differently, specifying that the school will provide care for two years after the injury date up to the $90,000 maximum when the NCAA’s catastrophic policy would take over.
Medical care beyond football: At UCF, though, it isn’t just the star quarterback who felt he got good medical care.
Megan Fish tore both her ACLs while playing soccer for UCF and she said the care she received was topnotch.
“They were amazing,” said Fish, who graduated in 2015. “I know my mom didn’t have to cover anything.”
She said the experience at UCF was far easier than when she was hurt later on while playing in a semi-pro league in Australia.
“You don’t have that same infrastructure behind you,” she said of her experience overseas.
As for Milton, he continues working on his rehabilitation.
Teresa Milton says she has been impressed by the facilities at UCF that don’t just triage illnesses and injuries, but offer preventative care, too.
“It should be the most important thing a parent looks at,” she said. “When you go to orientation, there’s a class for parents and students by the trainer. They tell you, ‘We’re your people. If you hide an injury we can’t help you.’”
McMillen, the CEO of LEAD1, says that as research on the long-term effects of concussions and other injuries continues to progress, he expects more focus on the health care of athletes.
McMillen, who played in the NBA for 11 years and served three terms as a congressman from Maryland, called the agreement by some schools to provide at least two years of postcollege care a first step.
“Health and student-athlete well-being will be the most important issue over the next 10 years for college sports,” he said.