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UPS Union Issues
Teamcare - something to watch for on procedure claims
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<blockquote data-quote="BrownBrokeDown" data-source="post: 1407182" data-attributes="member: 46824"><p>The intent of this post is an fyi...not to start a bitchfest.</p><p> </p><p>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).</p><p> </p><p>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. </p><p> </p><p>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.</p></blockquote><p></p>
[QUOTE="BrownBrokeDown, post: 1407182, member: 46824"] 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. [/QUOTE]
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Teamcare - something to watch for on procedure claims
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