I will certainly get back to you on this but I do believe it is 20% of billed charges. So since medical providers have no cap on their charges it can range quite a bit. Do the math though 20% of a $2,000 MRI and there is your $400. And under a Teamcare plan we would have to come out of pocket for $2,000 (out of pocket expense limit) before anything is paid in full. Check the Teamcare SPD if you don't believe me.
Sylvester caught red handed.
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UpstateNYUPSer(Ret)
Well-Known Member
Medical providers can charge whatever they want. Insurance companies will pay based upon their payment schedule. (Google "DRG's ")
Look at your next bill. It will show provider charges, insurance payment and member responsibility.
Very different for sure. My point being a change in the health plan to Teamcare at 804 is not needed and would be a downgrade for us. On the Teamcare site they only "highlight" what can be described as the positives without having login credentials but you need the entire SPD to get to the rest of the details. I will try and get more information
Convenient for you Wide but not the case for everyone. I've never even heard of US Imaging. Have you? Honest question, not being facetious. And this would make a place like Zwanger Persiri out of net and we'd pay 20% of charge until we hit $2K for the year before Teamcare paid in full. That goes for Zwanger and EVERYWHWRE else except US Imaging.
DRG only applies if the provider is "contracted" and when Teamcare says they have "partnered" with Quest and US Imaging that's what they mean. Quest and US are not subject to the 20%. Either way though we'd be responsible for up to 2K/year. 20% of charge or 20% of allowable (DRG).
BigUnionGuy
Got the T-Shirt
Are you so naive.... to believe that would last forever ??
In this "day and age" of spiraling health costs ??
How many MRI's (in a lifetime) do you think.... you'll need ??
-Bug-
Also
That goes for all radiology not just MRI. So god forbid any one of us gets seriously ill... This applies for CT scans, PET scans, x rays, ultrasounds.... etc. Each plan's Trustees set the copays. At least at L804 the union trustees have a say. Do you think they'll have a say in the "national" plan? I'm not naive my brother.
BigUnionGuy
Got the T-Shirt
Without a copy of the TeamCare SPD....
Isn't it premature (and irresponsible) to try and definitively define TeamCare as
inferior, to your current plan ??
-Bug-
1
10 Pt
Guest
Four so far. Two to go that I know about.
Ok so US Imaging turns out to be a smaller "network" of radiology and diagnostic facilities. And I have seen and read the Teamcare SPD with my own eyes. Ask any part timer about the "expense limit". Trust me I'm right about this.
UpstateNYUPSer(Ret)
Well-Known Member
No, you're not.
Same here... 2 on my neck, 1 on my should and 1 on my knee.... 4 and counting
Shoulder*
You asked, I provided. Anyone can take an answer then change the rules of the game. It sucks you had to endure change but are you going to dwell on the past or try to improve the future. Or are you just on here for political reasons?
That's a lot of MRI's brother.
It was an honest question. I never heard of US Imaging. Thought maybe it was a stand alone entity as opposed to a network of facilities. I'm comparing benefits not "changing the rules of the game". Again... two words brothers and sister .... EXPENSE LIMIT.... ask about it. And Proud Grandpa... you ask also.
BigUnionGuy
Got the T-Shirt
Got it right here in front of me.
Wrong.
So now, you are saying you've read it ??
Must have missed.... this part.
-Bug-
Yes!!! Exactly that. Thank you for finding this piece of info. Unless we use US Imaging (which for some may be possible but not for all) the bills are paid at 80% of the ALLOWABLE (major medical) rate (not charge) and we would pay the remaining 20% of the ALLOWABLE rate PLUS (since this would be out of network) any remaining balance over and above the ALLOWABLE after Teamcare pays its portion and the 20% COINSURANCE from the patient. This would continue until we have satisfied the "EXPENSE LIMIT" which is $1,000 individual and $2,000 family annually. Keep in mind that only the 20% of the allowable (major medical) rate is applied towards the EXPENSE LIMIT and not the balance in excess of the allowable rate not the deductible (starts in 2018). Once that EXPENSE LIMIT has been satisfied after deductible (which begins in 2018) then Teamcare would begin to pay 100% of the ALLOWABLE (major medical) rate leaving a balance for which we would be responsible.Got it right here in front of me.
Wrong.
So now, you are saying you've read it ??
Must have missed.... this part.
-Bug-
For example
MRI or any other radiological diagnostic done anywhere except by US Imaging:
Charge- $2,000
Major Medical (allowable) -$400
Teamcare pays 80% of major medical-$320
Member coisurance 20% of major medical -$80 ($80 applied to expense limit of $1,000 annually individual, $2,000 family annually)
Balance remaining after 80/20 -$1,600 which is patient responsibility since this is not a US Imaging provider.
Let's be honest. It can be done in network but with Teamcare there are far fewer providers and a much higher risk of being out of network.
God forbid any of us or our families become seriously ill, wouldn't you opt for a more expansive network with more options? I would.
BTW- same scenario for Lab work if not done by Quest and ONLY Quest. That's what Teamcare means when they say they've "partnered" with Quest and US Imaging. Teamcare is a cheaper healthcare option for UPS!!!!
hopefully a non issue since our president said at the general membership meeting Sunday that he was not putting the FT members into Teamcare. Let's see. Stay true to your word. Please.
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