Teamcare conference call
- Thread starter WESLA
- Start date
BrownBrokeDown
Well-Known Member
I did find out something interesting on the ER visits. I brought up a question, since my daughter had an allergic reaction earlier this year, they gave her a shot and sent her home, if that was the 80% or full 100% since she wasn't admitted. They said since it was a sudden onset ( i forget what term they used) it would have been covered 100%.
Oak
Well-Known Member
Sign at the entrance to the building says no Bluetooth devices allowed. Something to do with it interfering with their system.
saintrick
Well-Known Member
Took our child last night with an allergic reaction. Talked to Teamcare this morning and was told it would be covered at 80%.
BrownBrokeDown
Well-Known Member
read the following post by me.
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BrownBrokeDown
Well-Known Member
Ok, just called teamcare myself and asked them again about this. It is all about how the ER codes it. If the ER codes it emergency it is 100%, if the ER codes it non-emergency it is 80%. Teamcare cannot change the coding as it is illegal. You probably need to talk to the hospital/ER and see if they can/will recode it and then resubmit it. The way the rep explained it is it's all about the severity. Some poisen ivy on your leg is non-emergency, however a progressive reaction that would cause concern for life or future well-being is an emergency.
kingOFchester
Well-Known Member
Why would Teamcare need to change the coding? They do not need to change the codes. They can have us pay 20% regardless of how it is coded.
saintrick
Well-Known Member
Called Teamcare again today and was told under no condition would anaphylaxis due to a allergic reaction be paid at anything other than 80%.
BrownBrokeDown
Well-Known Member
re-read what I typed then reply. I never said Teamcare would have to change the coding, it is the hospital. If the hospital codes it as an emergency (potentially life-threatening) it is 100%, if they don't it is 80%.
BrownBrokeDown
Well-Known Member
This seems to be a problem. I have received variations of the same answer everytime I talked to them about the allergic reaction, BUT on other issues I don't always receive the same answer. After looking up the definition of anaphylaxis (lol), you need to check and see how the hospital coded it. The explanation I got this last time wasn't just for allergic reactions but everything. If they coded as emergency it is 100%, if not your screwed. The lady I spoke with used another example that I will include here since I have more time today. She said they get a lot of calls on chest pain ER visits only being paid 80%. What happens is it is a minor non-life threatening issue (heartburn, etc) and the ER codes it as non-emergency. Where, if it is actually something life threatening (heartattack, etc) it is 100%.
I have been happy with everything else on this insurance, but this is starting to bug me. Basically we have to self diagnose and make sure our's or our families lives are threatened in order to get the 100% benefit.
BrownBrokeDown
Well-Known Member
Just spoke with my union hall. They said I was the first person that had brought this to their attention. I told them, I understood why the rule was in place (colds, flu, etc) but that it wasn't right that we would have to self-diagnose on allergic reactions, chest pain, etc. They told me they agreed and that was what the doctors was for. They also said they would try to get in touch with someone higher up and would get back to me in a day or so. I will post what I am told. Between now and then...
BOMBARD ALL OF THE UNION HALLS WITH CALLS ON THE ER SELF-DIAGNOSIS ISSUE. IT CAN'T MAKE IT ANY WORSE, AND MAYBE IF ENOUGH UNION HALLS GO HIGHER UP, WE CAN AT LEAST GET SOME OFFICIAL CLARIFICATION, IF NOT SOME CHANGE.
BOMBARD ALL OF THE UNION HALLS WITH CALLS ON THE ER SELF-DIAGNOSIS ISSUE. IT CAN'T MAKE IT ANY WORSE, AND MAYBE IF ENOUGH UNION HALLS GO HIGHER UP, WE CAN AT LEAST GET SOME OFFICIAL CLARIFICATION, IF NOT SOME CHANGE.
brown_trousers
Well-Known Member
I agree.. it would at least be nice to get some concrete rules for situations like this, so we know before hand EXACTLY what will be covered 100% vs 80%
UpstateNYUPSer(Ret)
Well-Known Member
In an emergency would it make a difference? Would you forsake vital health care just to save a few bucks?
Resident know-it-all.
BrownBrokeDown
Well-Known Member
My families health, no...my own, depends, lol. Listen, we just want an official clarification so we can know what to expect. You have chest pains, go to the doctor, its a gas bubble, you owe $1000 can lead to you have chest pains, well maybe it's not a heart attack and I don't want to pay $1000, to a dead UPS employee on the living room floor.
Keep in mind, no matter how good I think this insurance is compared with all the others i have had to deal with in the last 15 years, I am making the 3 yr skilled worker PT pay, and the $1000 out of pocket max is approximately 5 UPS paychecks. The $2000 family out of pocket max would be 10 paychecks. For those of you bad at math, thats 19.2307% of my UPS paychecks in 1 year to cover the family out of pocket max.
