Another Teamcare concession

[Mugarolla]

Had a coworker break a tooth six months ago under the old insurance. Dental paid for a tooth implant. I think his portion was $300.

Had another coworker break a tooth recently. Teamcare denied the tooth implant. He has to pay $4800 to get the implant.

Both people had the tooth broken so bad that it had to be removed. Teamcare drawback #476.

 

[greengrenades]

I'll be honest, I'm newly fulltime and I don't really understand is our insurance teamcare or blue cross or that southern whatever it's called on the back. When I call places to check if they take my insurance should I ask them if they accept blue cross or team care? I'm hoping I can just keep going to the same places I always go.

 

[UpstateNYUPSer(Ret)]

The generic term for our health insurance is Teamcare, which is short for Teamster Healthcare. The plan is actually administered by a private health insurance carrier. We use BC/BS in our local.

 

[upschuck]

I'll be honest, I'm newly fulltime and I don't really understand is our insurance teamcare or blue cross or that southern whatever it's called on the back. When I call places to check if they take my insurance should I ask them if they accept blue cross or team care? I'm hoping I can just keep going to the same places I always go.

Ask them about BC/BS or whoever yours is through? They will probably ask you another question so keep your card handy. Or you can check for your doctors through the Teamcare website which will direct you to the proper website to check for providers in the network.

 

[ChickenLegs]

I'm waiting for the YES voters to explain this one

 

[greengrenades]

Ask them about BC/BS or whoever yours is through? They will probably ask you another question so keep your card handy. Or you can check for your doctors through the Teamcare website which will direct you to the proper website to check for providers in the network.

Okay thanks

 

[kingOFchester]

I'm waiting for the YES voters to explain this one

Crickets.

 

[upschuck]

From what I understand, UPS is suppose to cover anything dental that Teamcare does not, if the old plan would of covered it.

 

[Bagels]

This is not true -- UPS administered plans absolutely did not cover implants. I know this because I had a tooth knocked out and UPS refused to pay for the implant, but would pay for a "flipper" (cheap fake tooth usually used as a temporary solution until an implant is made). The implant was about $5K and after three years (of using a flipper), my gum was constantly swollen, sore & becoming friend-d up. I had a dentist and oral surgeon sign off that an implant was medically necessary, appealed all the way to UPS but lost.

There's also several lawsuits available for viewing on the internet of people in similar situations -- e.g. told implants were medically necessary, but UPS refused to cover them saying a flipper was good enough -- and nobody has been successful.

The generic term for our health insurance is Teamcare, which is short for Teamster Healthcare. The plan is actually administered by a private health insurance carrier. We use BC/BS in our local.

No, the plan is administered by the Teamsters and managed by BC/BS (or equivalent).

Previous plans were administered by UPS. As in my case, final appeal was determined by UPS itself. Now it's the Teamsters.

 

[BigUnionGuy]

Had a coworker break a tooth six months ago under the old insurance. Dental paid for a tooth implant. I think his portion was $300.

Had another coworker break a tooth recently. Teamcare denied the tooth implant. He has to pay $4800 to get the implant.

Do you have any documentation ?

How about some proof.

This is not true -- UPS administered plans absolutely did not cover implants.

Hold on there Bagels....

Let's see if the OP, can produce anything other than BS.


I mean, it's not like some of us (don't) have the SPD.

And.... can readily verify the claim.



-Bug-

 

[Mugarolla]

Don't know what kind of proof you need besides maybe the bills and the denial letter. I personally know both of these guys. The first one had the UPS administered plan and the total bill was around $5000. He got a tooth implant screwed into his jawbone. The insurance picked up most of the bill. He had to pay around $300.

The second guy had the dentist do a preapproval for the implant. Teamcare denied the claim and the dentist told him it would be around $4800, none of which Teamcare would pay.

Teamcare would pay for the "fake" tooth, but not an implant.

 

[Inthegame]

Was the first case a medically required event or a dental issue? Very few insurance plans anywhere cover dental implants unless its medical.

 

[BigUnionGuy]

Don't know what kind of proof you need besides maybe the bills and the denial letter.

That is a start.

Let's see it....



-Bug-

 

[Mugarolla]

Directly from the benefits summary of the plan that I was in before I was forced into Teamcare under covered services.

• Other services

— Precision attachments (eligible with

dentures if they are functionally

necessary)

— Implants (Pre-approval is recommended

in advance. The teeth must

be extracted or become missing while

covered under the Plan)

 

[Mugarolla]

Proof enough? The summary of benefits lists implants as a covered service. Your welcome to call Teamcare to see if they cover them.

 

[The Milkman]

Had a coworker break a tooth six months ago under the old insurance. Dental paid for a tooth implant. I think his portion was $300.

Had another coworker break a tooth recently. Teamcare denied the tooth implant. He has to pay $4800 to get the implant.

Both people had the tooth broken so bad that it had to be removed. Teamcare drawback #476.

Prior to the benefits forced on me, I had an estimate for 2 implants...My cost total is around 2k..I was worried that the pre authoization would not be honored by the time these implants take to finish...Started last December and hope by November will be done.. 1st dr. I went to wanted like 8-10k...one of the drs. in that group took our insurance but still was too high. Found another dr. after seeing and ad in our paper....and sure enough...about 2k which included a sinus bump. I Had a cracked tooth pulled Xmas eve(had no choice) swollen face, pain etc..Could not find anyone to do it but this 1..charged about $900 to pull tooth, it was part of a bridge, did bone graft and I did a follow up visit. When I heard of the cost I balked, shopped around, found this other dr..His total cost from me out of pocket $1235 bucks for implants...and his office is really up to date with all the bells and whistles..no cheapo place.Got 2 for less than the price of the high priced doctor for 1, in the fancy office bldg...Implants healing, teeth to be done in about another month after some more healing..Shop around

 

[Anonymous 11]

Do you have any documentation ?

How about some proof.



Hold on there Bagels....

Let's see if the OP, can produce anything other than BS.


I mean, it's not like some of us (don't) have the SPD.

And.... can readily verify the claim.



-Bug-

sometimes I want to get a gold tooth. My wife says no though.

 

[Bagels]

Here's the now defunct UPS Administered National PT Health Plan. Implants are explicitly listed under "what's not covered;" the exception is unless it's specifically approved in advance. The problem is that the verbiage favors UPS -- "not covered" and absolutely no definition of what would make it approved in advance. UPS told me that implants would be approved ONLY when medically necessary, as I noted above. There are oodles of examples of people having doctors sign off their claim as medically necessary and UPS rejecting it for various reasons.

Your co-worker got lucky, but this is no change to benefits.

 

[The Milkman]

From me?

 

[The Milkman]

sometimes I want to get a gold tooth. My wife says no though.

BTW..I am not on Teamcare