Sixth and final installment in a periodic series examining whether the rules and practices of college sports treat athletes fairly. Today's installment focuses on medical insurance for injured athletes.

BIRMINGHAM, Alabama -- The first time the McBride Clinic in Oklahoma called Valerie Hardrick, seeking payment for the MRI done on her son, she told the company it had the wrong person.

Kyle Hardrick was a sophomore on the University of Oklahoma basketball team with a history of knee problems. He had complained during that 2010-11 season of further knee issues that Valerie claims team medical officials did not identify correctly or treat aggressively. But the parents knew nothing of the MRI taken nine months earlier.

When the second call came from the clinic, Valerie was stunned to learn what the test found: Kyle had a torn lateral meniscus. Valerie said a rehabilitation plan for Kyle was prescribed by a team doctor for Oklahoma, whose officials would not comment on details of the case. Two months later, Kyle had surgery that found far more damage than suspected. He has improved but still experiences pain today while sitting out a year of basketball at his new school, Pratt Community College in Kansas.

Valerie estimates the family has paid $10,000 in medical bills while its health insurance covered $20,000. "It's been difficult, no doubt," Valerie said. "You don't imagine paying those medical bills out of your own pocket when your child gets a scholarship."

The Hardricks' story may be an exception to the rule regarding health care in college sports. But it does reflect a gap that can exist in medical coverage because universities create their own policies on what to pay when treating athletes.

Since 2005, the NCAA has required universities to certify that athletes have insurance for athletically-related injuries before they can compete. The insurance can come from the school, a parent or an athlete's personal policy, and must cover up to the $90,000 deductible of the NCAA catastrophic injury insurance program.

The NCAA says its requirement protects athletes from substantial, unexpected medical expenses and eliminates misconceptions about the university's responsibility. It also protects schools from lawsuits because covered athletes are less likely to sue when expenses are paid by some form of insurance, the NCAA says.

Even some critics of the NCAA say that medical coverage seems to have improved for athletes in recent years. Some athletics departments accept significant responsibility for medical claims. But others assume far less, sometimes causing confusion and frustration for athletes.

In one case, an ex-Ohio University football player told The New York Times in 2009 that he learned he owed $1,800 in unpaid medical bills from his temporary paralysis when he tried to buy a car six years after the injury.

The great unknown is how many ex-athletes are footing bills to treat significant injuries sustained while in college.

"It's hard to know how many players are being hit with big bills," said Ramogi Huma, president of the National College Players Association, an advocacy group for college athletes. Because of potential loopholes in some schools' policies, "the bottom line is schools are not on the hook for one penny. I don't think players know what to expect."

Hidden costs

There are many cases of athletics departments paying medical expenses for athletes who suffer significant injuries.

For instance, former star Alabama wide receiver Tyrone Prothro said the university has paid for all of his surgeries since his gruesome fractured leg and infection in 2005, injuries that still affect him today. "I just know it's a lot of money (Alabama has spent)," Prothro said. "Something I couldn't afford."

Former college baseball pitcher Derik Olvey, a Pelham native, said he never paid any money for two elbow surgeries and numerous MRIs and X-rays he underwent while playing for LSU, Arizona State and Notre Dame. "I probably wouldn't have ever tried for the second (surgery) if I knew the money would have come out of my pocket," he said.

Like any health-care plans for Americans, though, there can be hidden costs for college athletes.

When the NCPA surveyed Division I athletics departments in 2009 to disclose specific medical policies the association was seeking, about 90 percent of the schools refused. The NCPA wants more states to pass legislation requiring public universities to provide additional transparency about how they care for injured athletes.

California and Connecticut recently adopted laws requiring public schools in their states to put their medical policies in writing. Athletes and families can now see on paper the school's costs and the family's costs for premiums, deductibles and co-payments, whether independent second opinions are allowed by the school, and how long medical expenses are covered after an athlete's eligibility expires.

"It's a first step. Transparency is important," Huma said. "In the recruiting game, coaches are going to tell you everything you want to hear. There are some objective facts that should be available."

How schools care for college athletes has taken on greater significance lately due to concussions. Growing scientific evidence continues to show that head injuries in sports can lead to long-term dementia or other health problems.

Many ex-pro football players have sued the NFL for negligent care when they played. When Congress and the public became outraged, the NFL started subsidizing care for some of its most seriously damaged players.

The financial exposure of the NCAA is being tested, too. Last September, three recent college football players and a former women's soccer player filed a class-action suit claiming the NCAA has been negligent about awareness and treatment of brain injuries to athletes. The NCAA has said the suit has no merit.

The case raises the question of whether the NCAA should provide some aftercare for former athletes -- and if so, whether that would jeopardize the future of some contact sports because of the costs associated with such care. Steve Berman, an attorney involved in the suit, told The New York Times he wants to force the NCAA to arrange insurance that would provide training and evaluation for players about concussions and follow-up care for former athletes.

Huma said he knows of no studies showing the long-term health of college football players whose careers end without going to the NFL.

"I don't think that's a study the NCAA wants to see," said Huma, a former football player at UCLA. "I have no doubt there are ticking time bombs out there among college football players who didn't go to the NFL and who are going through some of these same long-term health issues."

State school policies

The flexibility that universities have to determine what they cover is evident in medical policies The Birmingham News obtained from Alabama, Auburn and UAB through open-records requests.

Alabama provided a coverage plan that's identical to the NCAA's catastrophic injury insurance program. The plan covers medical, dental, rehabilitation and custodial care expenses for injuries at an official team activity, conditioning or practice session.

Auburn's plan describes its insurance as the secondary carrier in all claims. The document says if any portion is not covered by the athlete's family insurance, the balance will be paid by Auburn's plan. Also, if athletes are uninsured, that athlete goes on Auburn's primary medical coverage.

"Therefore, there is no out-of-pocket expense for the student-athlete and his/her parent/legal guardians for injuries occurring due to participation in intercollegiate athletics," the document reads.

Auburn suggests that athletes covered under an HMO insurance plan should change the primary care provider to Auburn's team physician to expedite health care. The athletics department also recommends athletes carry accident/illness insurance to cover issues not related to athletic events.

UAB's coverage says its health plan is a secondary provider for all athletes who have primary insurance. UAB recommends all athletes carry personal medical insurance. If an athlete fails to have primary insurance, UAB acts as the primary provider for approved athletics-related medical expenses.

All medical referrals must originate from the UAB athletics training department. Second opinions must be referred by a UAB team physician for the athletics department to be financially responsible.

A five-person Athletic Training Review Committee helps evaluate medical expenses for individuals. Athletes have one year from the time they leave a roster to report any athletic injuries from their participation at UAB.

The amount of money Alabama, Auburn and UAB reported spending on medical expenses and insurance varies significantly, according to an analysis by The News of their NCAA financial reports from 2005-06 to 2010-11.

During those six years, Alabama averaged $1.41 million per year on medical expenses and insurance, which came to $2,493 per athlete. Alabama spent $1.96 million in 2010-11, or $3,573 per athlete.

Auburn averaged $716,151 on medical expenses and insurance over those six years, equating to $1,484 per athlete. The 2010-11 costs were $852,477, or $1,798 per athlete.

UAB, which has fewer athletes and resources than Alabama and Auburn, averaged $428,421 on six-year medical costs, or $1,274 per athlete. The total cost in 2010-11 was $617,123, meaning UAB's $1,848 cost per athlete surpassed Auburn's figure.

Since 2005, when the NCAA began mandating some type of coverage, Alabama's medical and insurance costs increased 213 percent. Increases were 82 percent for UAB and 14 percent for Auburn.

Auburn spokeswoman Cassie Arner said the difference in medical costs between the schools on the NCAA financial reports could be due to athletics departments not reporting information the same way. The costs Auburn reports to the NCAA are primarily from surgeries and outside medical expenses, not daily costs such as taping ankles or medical staff salaries, she said.

Arner said another reason could be Auburn's ability to limit claims made under its catastrophic insurance, which kicks in above $12,500. Auburn does this, she said, by comparing costs at various hospitals across the country and seeking to pay only the industry standard rate.

Attempts to interview athletics department officials at Alabama for this article were unsuccessful.

Insurance and deductible costs have increased annually at UAB, university spokeswoman Dale Turnbough said. UAB's annual medical costs have sometimes fluctuated due to when payments are made to its insurance provider and when injuries occur, she said.

The waiting continues

Time isn't on the side of Kyle Hardrick, the ex-Oklahoma basketball player. He and his family have fought unsuccessfully with Oklahoma to obtain a medical hardship waiver so he can play at Pratt, his new school.

The biggest reason the Hardrick family says it has fought for the waiver -- through lawyers, the media and in Washington, D.C., on a Congressional panel -- is that Kyle wants his terminally ill father, Michael, to see him play again. It is the waiver that the family wants; it is not seeking payment from OU for any medical expenses, Valerie Hardrick said.

COLLEGE ATHLETES' RIGHTS

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Paying the true cost of attendance

Before Jeff Capel was fired as Oklahoma's coach in March 2011, he and his staff agreed on Kyle seeking a waiver. Capel, now an assistant at Duke, wrote to the Big 12 last September that a waiver for Kyle was warranted. But Oklahoma compliance director Jason Leonard wrote to Valerie Hardrick in April 2011 that the school had no medical documentation to support filing for a waiver and that doctors concluded Kyle was able to play.

Valerie claimed in a waiver request to the Big 12 that Oklahoma team physician Dr. Brock Schnebel said he had no documentation of the injury and didn't want to get embarrassed in front of the NCAA by asking for a medical waiver. Valerie believes the real reason for the reluctance is that Oklahoma did not properly treat an injury. Kyle's personal doctor in Oklahoma later documented the injury and treatment.

"Because of the extent of the injury and how long it was going on, Oklahoma is afraid they're going to have to explain why the injury was hidden for so long," Valerie said. "They're going to protect their doctors."

Oklahoma officials said in a statement: "We rely on a highly-respected team of medical doctors, many of whom have experience with teams representing the United States in international competition, to diagnose, treat and render decisions related to the care for our student-athletes. Even with the level of care provided, student-athletes and their parents or guardians retain the option of seeking medical attention from physicians not associated with the university and do so, by policy, at their own expense."

Last September, Oklahoma offered a 12-page settlement agreement to the Hardricks to assist in filing a medical hardship waiver as a "courtesy," according to the document. In return, the Hardricks would agree never to sue Oklahoma or seek enrollment at any school governed by the University of Oklahoma Board of Regents.

The document described an "alleged injury" to Kyle that never caused him to miss a game or practice. It noted that Kyle stopped participating with Oklahoma in January 2011 due to academic reasons.

Valerie said Kyle would have been on academic probation if his scholarship had been renewed, which it wasn't. The Hardricks wouldn't sign the settlement agreement. Valerie said she is concerned that Oklahoma's help in getting a waiver now could be detrimental to the request if the school provided a statement to the Big 12 saying Kyle wasn't injured.

So the frustration continues.

Despite suffering from terminal cancer, Kyle's father continues to work every day to help pay off Kyle's medical bills, even when he's weak after chemotherapy, Valerie said.

"We've really taken a hard hit with OU not renewing his scholarship and not paying for rehab and medical costs," Valerie said. "That's a hard toll on the family."

Some good news is that Kyle visited Central Arkansas last weekend and was offered a scholarship, Valerie said. He plans to make one more visit before deciding where to play next season.

Valerie said she never imagined during Kyle's original recruitment that an injury would lead the family to being out $10,000.

"When you go through the NCAA Clearinghouse, you have to answer all these questions like, 'Did you ever take any money (to sign with a school)?'" Valerie said. "I think they need to put a little notation there: 'By the way, do you have insurance?' Not all colleges are going to pay if your child is injured. I think they need that out in the open."

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