Frequently Asked Questions

Questions & Answers From A-G Administrators

Let us help you navigate the claims process with our crucial insurance FAQ. If your question is not answered below, please call us for immediate assistance.

What is accident insurance, and why do we need it?

Accident insurance, sometimes referred to as participant accident insurance, is coverage that helps pay medical treatment expenses when someone is injured in an accident. It is usually used to pay for the deductibles, copayments, and other out-of-pocket expenses primary health insurance does not cover. Or, in instances where someone does not have primary health insurance, its benefits can be used toward medical bills.

With rising healthcare and health insurance costs, accident insurance is an affordable way to help protect a family’s budget from financial risk if a child is accidentally injured.

What is required to file a claim?

All claims require an Accident Claim Form, Itemized Bill, and the corresponding Explanation of Benefits (EOB) from the patient’s primary medical insurance (if the accident policy is secondary) to process payment. Submitting incomplete insurance claim forms and files may cause a delay in processing. You will be contacted by the Claim Examiner if the information is missing.

Also, please make sure all attachments are clear and legible as illegible documentation may cause a delay in processing. PDF attachments are the easiest for our Document Center to view and upload into our system.

What is an Accident Claim Form?

This is the form that starts the claim process when a child is injured. When submitted, a completed Accident Claim Form is used to open a new claim in our system. We cannot process insurance claim payments without one. It verifies the date of injury, the body part that was injured, and how the injury occurred. It also includes required signatures from the athlete/participant (or guardian) and the school or organization official. Please view our Document Library for electronic copies of the Accident Claim Form.

What is an Itemized Bill?

An itemized bill is a detailed billing form that includes the date of service, billed amounts, CPT Codes (Current Procedural Terminology), Diagnosis Codes, Provider Tax ID Number and Address, along with patient information. This information is required because we cannot process payments from statements that are not itemized. Itemized bills can be accessed from your provider. A CMS 1500 form is a common form from a physician, and the UB 04 form is a common form from a hospital or facility. These forms will have all of the necessary information A-G Administrators requires to satisfy each charge’s itemized bill requirement.

What is an Explanation of Benefits (EOB)?

Because our policies are excess accident, all charges must first be submitted through the patient’s primary insurance. To verify that each charge has been submitted through your primary insurance, and show how they have processed the charge, we also require an Explanation of Benefits (EOB). The EOB breaks down each charge by date of service and CPT Code and includes the total billed amounts, discounts, adjustments, and payments made.

The easiest way to access your EOB’s is through your primary insurance’s online portal. Almost all major insurance companies have electronic EOB’s accessible to participants online for prior treatments. You may also receive hard copies of the EOB’s in the mail, or can receive copies through your provider.

If you or your child does not have primary medical insurance, or have a Medicaid/Medicare Plan, A-G Administrators may act as the primary insurance. Please submit documentation stating you do not have any other insurance or your Medicaid/Medicare Insurance Card for review.

How do I submit the required claim documentation?

A-G Administrators provides a variety of methods for submitting claim documents. Please refer to the Claim Submission page for full details.

Do I need to preauthorize treatment?

A-G Administrators does not pre-authorize or guarantee benefits, and all claims are reviewed upon receipt. Benefits are paid at Usual, Customary, and Reasonable (UCR) rates.

How do I confirm eligibility and benefits?

Please contact customerservice@agadm.com or (610) 933-0800 and have the patient name, patient date of birth, date of injury, and school or organization they belong to ready. Benefits and eligibility are based on the school or organization they belong to, and the injury that occurred.

What if I already made payments on the claim?

If you have already made payments, you may be reimbursed for covered charges. We will still need the itemized bill and corresponding EOB for each charge, in addition to your proof of payment (receipt, copy of check, etc.). If proof of payment is not submitted prior to processing, payment will be issued directly to the provider, and you will need to contact the provider for reimbursement.

How long do I have to submit a claim?

The timely filing deadline for each policy may vary, however we recommend submitting claims within 90 days from the date of service. A-G Administrators will always review a claim submission, so please submit the complete claim documentation for final determination.

When will my claim be paid?

Once the completed Accident Claim Form, Itemized Bills and Corresponding EOB’s are submitted and legible, the processing time of a claim is approximately 5-10 business days. If additional information needs to be requested, this will delay the process.

How can I check on the status of a claim?

To check the status of a claim, complete the short form on the Check Claim Status page or call A-G Administrators directly at (610) 933-0800 (M-F 8:30am-6pm EST). We will return your call or respond to your form submission as soon as we are able.

What does accident insurance cover?

Accident insurance covers the excess medical treatment costs of accidental injuries (the deductibles, copayments, and out-of-pocket costs after the primary insurance has paid). We offer several different types of plans at A-G. Examples include:
Student accident plans that cover children from accidents that happen during the school day. From playground injuries to slips and falls in the cafeteria to cuts from broken glass in chem lab—if a child is injured in an accident, that’s what we’re here for.
Student-athlete accident plans that cover children from accidents that happen during sports. Whether it’s at practice or at a game, when sports injuries happen, A-G is there.
We provide mandatory, voluntary, compulsory, and catastrophic plans for K-12 schools, colleges and universities, events and camps, and offer other special risk accident insurance solutions.

How much does accident insurance cost?

Accident insurance is an affordable way to protect against the financial risks of accidents and their treatment. However, each school and program’s needs are unique, and we work closely with them to develop their best solution. Because of this, we’ve found it’s more accurate to talk to one of our insurance specialists to get an idea of how much it may cost you. But we think you’ll be surprised at what you learn.

Does accident insurance cover sickness?

No, accident insurance only covers injuries caused by accidents. It doesn’t cover any illnesses.

Does A-G Administrators sell personal policies?

No, we only offer the policies to a school or program as a group. Coverage is not available on an individual basis.

Does A-G Administrators offer General Liability coverage?

No. We only offer accident insurance coverage to help cover medical expenses.

Why should I work with A-G?

Al Gillis, our founder, started A-G Administrators in 1983, and his sons Dixon and Jake grew up in the business. We have been providing accident insurance to thousands of K-12 schools, colleges and universities, events, camps, tournaments, and other organizations for nearly 40 years. Protecting families, students, student-athletes, schools, and programs from financial risk is at the heart of everything we do. You can relax knowing that’s the commitment you get from us. (Plus, we have industry-leading technology in our proprietary claims management system, EGBAR, that practically eliminates paperwork and red tape.)

What is the financial rating of A-G carriers?

Our carriers are rated A+ (Superior) by AM Best for their ability to meet ongoing obligations and their financial strength. You can read more about the rating here.

What if I can’t find the answer to my question here?

Please don’t hesitate to call us directly at (610) 933-0800 (M-F 8:30 a.m. – 6 p.m. EST) or complete this form. We will return your call or respond to your form submission as soon as we are able.

For the past ten years, I have had the pleasure of working closely with A-G Administrators as they provide stellar service for the District’s student sports insurance needs.They understand the value of providing outstanding products that are competitively priced, benefiting a school budget that relies heavily on local funds. As a local, multi-generation family business, they have consistently provided reliable and committed service while working with our families to deliver the best possible outcome in their time of need.

Arthur J. McDonnell

Business Manager

Tredyffrin Easttown School District

A-G Administrators, A-G for ‘Always Game’. The team led by Dixon and Jake, are always game for a challenge, always game for performance at the highest level, and most importantly based on my experience and one who considers A-G a trusted partner of the University of Pennsylvania, always game for positive results and outcomes. A-G Administrators focus is client centric.

Benjamin Evans

Associate Vice President- Office of Risk Management and Insurance

The University of Pennsylvania

Without a doubt, I can tell you that A-G Administrators is awesome! The staff at A-G is professional and courteous, focused on facilitating the care the athletes need, and they do it in a manner that saves their schools and organizations money…all while making the collection process easy for my staff. What else can I say — they get it and they are great!

Dr. William C. Meyers

Core Muscle Injury Surgeon

Founder, The Vincera Institute

Achieve Greatness!

The time is NOW for you to partner with the undisputed sports insurance leader.

ACHIEVE GREATNESS!™

A-G has the experience to offer the best custom coverage for every program and the best customer service to ensure a worry-free process for every claim. The nation’s most competitive K-12, collegiate and youth programs Achieve Greatness with A-G!

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