Teamcare - something to watch for on procedure claims

[BrownBrokeDown]

The intent of this post is an fyi...not to start a bitchfest.

When you or a covered family member have a procedure done that involves the use of a scanning device (eg ultrasound), make sure that it is paid at 100% not 80%. When it is part of a procedure, you do not have to go to an approved facility for full coverage (would be kind of hard for the doctor to work long distance).

Story: My wife had to have an injection into her shoulder. The doctor used ultrasound during the procedure for placement of the injection. I have been watching this claim as I had a feeling that there would be an issue. After taking almost a month to process, it came back as 100% coverage on the shot, $10 copay on office visit, and only 80% coverage on the ultrasound. I just got off the phone with Teamcare. The lady I spoke with didn't understand the 80% coverage either, and said she had always seen 100% coverage when it was part of a procedure. She re-submitted to the claims department. I will have to wait and see what they say (she estimated a week). She also said it could have been improperly submitted by the doctor and they might have to submit a correction form.

tldr: Whether it was submitted wrong by dr, or processed wrong by Teamcare, I am being billed for 20% of an ultrasound that was used during a procedure, instead of 0%. Watch all procedure claims that utilized some form of a imaging device.

 

[undies]

Good luck.

 

[BrownBrokeDown]

Good luck.

Luckily, it was only an ultrasound. 20% an ultrasound is relatively cheap (speaking from the point of a pter that has a ft job on the side), but everyone will play hell getting this money from me.

 

[nayrsiem]

I've had the same type of issue in the past under the company plan. Doctors office supposedly put in the wrong code for a procedure and I got billed when it should have been covered 100%. I hate that crap.

 

[BrownBrokeDown]

20% an ultrasound is relatively cheap (speaking from the point of a pter that has a ft job on the side),

Just wanted to clarify what I quoted above. The bill is for about 40% of one of my UPS checks.

 

[UpstateNYUPSer(Ret)]

You should always check all insurance claims regardless of carrier.

 

[BrownBrokeDown]

You should always check all insurance claims regardless of carrier.

I do, but a lot of people don't, just pay the bill.

 

[oldngray]

There are times when they will say something will be covered but then later refuse to pay.

 

[UpstateNYUPSer(Ret)]

There are times when they will say something will be covered but then later refuse to pay.

That is when you appeal the denial.

 

[BrownBrokeDown]

Update...Teamcare said that the doctor didn't submit it with a modifier. Have turned it back over to the doctor to fix. Seems like that is the most important part if Teamcare is the doctors correctly identifying all claims due to all of the clauses.


One other note of interest...She is getting a CPM device for a couple of weeks after the surgery. The medical rental company stated that they had never had Blue Cross/Blue shield approve charges on one. After stating I didn't have typical coverage, they said that they had attempted to file claims under some of Blue Cross/Blue shield's better insurances and they had never approved $0.01 on any of them. Called Teamcare. We are covered at 80% under Major Medical for this. Will have to see if the claim goes through without any issues. Will only pay $90 for 14 day rental/delivery/setup/pickup. Very cheap for what it is. (Of course that is about 45% of my UPS paycheck.)

 

[upschuck]

There are times when they will say something will be covered but then later refuse to pay.

My son is about to have surgery in a couple days, and they say it is 100% paid for by Teamcare. Hope they code it properly.

 

[bleedinbrown58]

Luckily, it was only an ultrasound. 20% an ultrasound is relatively cheap (speaking from the point of a pter that has a ft job on the side), but everyone will play hell getting this money from me.

So are ultrasounds covered at 80% under Teamcrap...or did someone screw up?

 

[BrownBrokeDown]

So are ultrasounds covered at 80% under Teamcrap...or did someone screw up?

It was coded incorrectly, it seems. Waiting on the docter to resubmit and we'll see from there. Will try to keep this updated as i find out info, if i remember.

 

[BrownBrokeDown]

So are ultrasounds covered at 80% under Teamcrap...or did someone screw up?

It is 100% regardless of where it is done at IF it is part of a procedure.

 

[BrownBrokeDown]

It falls under major medical then

 

[Notretiredyet]

Wife has mammogram scheduled for next week, been getting different answers from Teamcare about coverage. Anyone have any experience with this yet?

 

[oldngray]

Maybe you should avoid the places like a mammogram/tattoo parlor.

 

[pjs]

I spoke to teamcare about this same issue after receiving bills for diagnostic procedures. Teamcare told me that all diagnostic procedures that are not preformed at US Imaging are only covered at 80% I was supposed to get a nuclear stress test done which US Imaging does not do, last one 5 years ago cost zero dollars. According to the new plan after talking with the diagnostic center the test is done US Imaging does not preform this procedure, at my cost with new teamcare plan would be $568. Also recently had a biopsy done as part of the removal of a growth on skin, teamcare only paid 80% of the biopsy even though the biopsy was done as part of the removal procedure and was processed through quest labs. New Teamcare plan is nothing like the old plan.

 

[upschuck]

Call Teamcare, we had a small bill due with Quest, and they said they should have paid all, and put in adjustment.

 

[BrownBrokeDown]

I spoke to teamcare about this same issue after receiving bills for diagnostic procedures. Teamcare told me that all diagnostic procedures that are not preformed at US Imaging are only covered at 80% I was supposed to get a nuclear stress test done which US Imaging does not do, last one 5 years ago cost zero dollars. According to the new plan after talking with the diagnostic center the test is done US Imaging does not preform this procedure, at my cost with new teamcare plan would be $568. Also recently had a biopsy done as part of the removal of a growth on skin, teamcare only paid 80% of the biopsy even though the biopsy was done as part of the removal procedure and was processed through quest labs. New Teamcare plan is nothing like the old plan.

I would call Teamcare and ask about the biopsy being part of the removal. That was what I did. It is a possibility that it was submitted wrong by the doctor.