BrownBetty1
Member
Shouldn't a CT scan be covered at 100%?
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Teamcare - something to watch for on procedure claims
- Thread starter BrownBrokeDown
- Start date
Theking30
SHORTY
Th majority of my customers do not work as hard as I do or as many hours as I do. Nor did they work part time for years waiting to go full time. Many more things I deal with most of my customers do not.
Just sayin!
Bubblehead
My Senior Picture
Really????
That's all you got?
Perhaps you'd be better off in the Life After Brown forum, picking on old ladies.
Pathetic.
Heavy on speculative contentions, light on facts. But just for fun I'll add some speculative contentions of my own (with a little basis in experienced facts) to some of your worries.
1) If you think that meager annual deductible will save a plan that is destined to have their "wheels come off", you need to learn much more about H&W plans. While an annual deductible has proven its worth as a responsible method of reminding its participants to be thoughtful when seeking service and it is much more palatable than a weekly co-premium of say $90, unless the contributions are sufficent the plan fails.
I'm in a plan with a modest deductible and since that requirement has been in place our plan has steadily built reserves (security) with no loss of benefit level and has actually increased offered benefits. Miraculously with this horribly onerous deductible, none of our members were struck by the falling sky or have filed bankruptcy. Our deductible is a complete non-issue.
2) It's not counter-intuitive to think we were duped and lied to, it's reckless. Without a factual basis, which is absent from your response, you've perpetuated the myth that Union officials have an ulterior motive to friend over the members they represent. You've concocted a theory in which UPS has either outwitted our guys, who have successfully negotiated previous deals which has shown their competence, or UPS and the IBT is in cahoots. Now that's several degrees of conjecture on your part and assumes UPS upper management and the IBT's leadership would chance this conspiracy getting out and ending many careers. Not very likely...
3)You speculate further... "With virtually every other sector of the union contracting and retiree numbers increasing, actuarial reports certainly indicated that the Central States Healthcare Fund would soon spiral downward if not infused with a new supply of members to contribute."
Now you do understand that with the "infused supply of members" comes additional claim obligations. Or are you suggesting the stumblebums from the IBT actually negotiated higher contributions from UPS than needed in order to "bolster" the plans for non UPSers. And how do you know what these imagined actuarial reports "certainly indicate"? Have you read these reports somewhere? Please post the reports for us Neanderthals who don't have such superior deductive ability.
How exactly are increasing retiree numbers affecting TeamCare's viability? You do know coverage ends at 65 right? If a sudden increase in early retirements occur, and these retirees all seek extraordinary medical care, you might be on the right trail. After all, a broken clock is right twice a day.
Remember, this isn't a Pension plan where obligations continue until death (and beyond for survivors). This is a pay as you go H&W plan. If participation levels drop, claim obligations correspondingly drop. Different levels of coverage in the many CS plan offerings are driven by negotiated contribution rates so lesser contributions buy lesser coverage. Nobody is getting bolstered by UPS's participation except UPS members with their enhanced plan.
Bubblehead
My Senior Picture
Wow!!!
Well written.
I wish I had time to reply in red font tonight, to every point, but it's late.
I only get a few minutes at lunch and at the end of a long day to bang out these posts. (your welcome Dave)
After all, I have packages to deliver tomorrow?
What I am asking you to consider, is that you are trying to sell yesterdays ice water to people who have no reason to believe that they were in the market for it.
Bubblehead
My Senior Picture
I'm curious, and sometimes amused, when people ask for "proof" on this forum?
It always seems so desperate.
How is "definitive proof" ever truly achieved here, aside from hindsight?
I understand we need to ask, but...
It always seems so desperate.
How is "definitive proof" ever truly achieved here, aside from hindsight?
I understand we need to ask, but...
BrownBrokeDown
Well-Known Member
Another 
ing Update:
So Doctor's office called again, had me call again. Wow...Once again today the person i spoke with at Teamcare gave me an intirely different response. What this one said is Ultrasounds and X-rays even during procedures are only covered 80% as they are non-invasive whereas something like a scope (which is invasive) utilized during a procedure is covered 100%. She told me to have the doctors office go ahead and submit the appeal but that it would most likely be denied. Also, ultrasounds and x-rays are 80% regardless of where it is done as US imaging is for CTscans, mri's and petscans only. I then spent 15 mins explaining to her how I was sick and tired of getting different answers everytime i called. I also told her about the instance where i called spoke with one lady that said the file stated it was medically unnecessary. She then transfered me to someone i had spoke to before that said she had no idea where the other lady had seen that as it didn't say it anywhere. The one i spoke to today seemed amazed at everything i told her. She said that she almost would have understood if someone didn't give enough information, but was appalled at the idea that i had received so much "misiniformation".
On another note. a month ago, my son sustained a grade 2 concussion. Wife took to hospital because he was having severe concussion symptons. At the hospital he kept repeating the same 2 questions over and over, etc. I owe $500 because it's not listed as life-threatening. Funny story though (that is sarcasm), last week someone I work with at my other job, had his daughter get dropped during cheerleader practice. Took her to an urgent care facility. They sent him straight to the emergency room. She had a "minor" concussion without a lot of the issues my son had.
This is getting on my ing nerves.
Brownbetty, ct scans are covered 100% if you utilize us imaging, 80% if you do it at the hospital, cancer facility, spine and specialty facility, etc that you are already at for an appt.
ing Update:So Doctor's office called again, had me call again. Wow...Once again today the person i spoke with at Teamcare gave me an intirely different response. What this one said is Ultrasounds and X-rays even during procedures are only covered 80% as they are non-invasive whereas something like a scope (which is invasive) utilized during a procedure is covered 100%. She told me to have the doctors office go ahead and submit the appeal but that it would most likely be denied. Also, ultrasounds and x-rays are 80% regardless of where it is done as US imaging is for CTscans, mri's and petscans only. I then spent 15 mins explaining to her how I was sick and tired of getting different answers everytime i called. I also told her about the instance where i called spoke with one lady that said the file stated it was medically unnecessary. She then transfered me to someone i had spoke to before that said she had no idea where the other lady had seen that as it didn't say it anywhere. The one i spoke to today seemed amazed at everything i told her. She said that she almost would have understood if someone didn't give enough information, but was appalled at the idea that i had received so much "misiniformation".
On another note. a month ago, my son sustained a grade 2 concussion. Wife took to hospital because he was having severe concussion symptons. At the hospital he kept repeating the same 2 questions over and over, etc. I owe $500 because it's not listed as life-threatening. Funny story though (that is sarcasm), last week someone I work with at my other job, had his daughter get dropped during cheerleader practice. Took her to an urgent care facility. They sent him straight to the emergency room. She had a "minor" concussion without a lot of the issues my son had.
This
is getting on my ing nerves.Brownbetty, ct scans are covered 100% if you utilize us imaging, 80% if you do it at the hospital, cancer facility, spine and specialty facility, etc that you are already at for an appt.
BrownBrokeDown
Well-Known Member
Let me ask you this, on average who has more healthcare costs? 55 yrs olds approaching retirement or 25 yrs olds that are just coming into the plans? Btw, union employees can usually take retirement before 65 so that they are retired and still on a plan funded by the same insurance even if the coverage isn't the same.
Benben
Working on a new degree, Masters in BS Detecting!
BBD, I offer you 2 suggestions;
Next time you talk to Teamcare ask them if; 1. "The CPT code the doctor's office used to submit the claim was incorrect because if it is you will turn to your state's medical board for help." You will be told yes it was but.....blah...blah..blah..ect." When she has finally stopped talking tell her you have no recourse but to send a complaint to your state's insurance department, give her their address right then, about Teamcare asking them for their assistance. The matter will be resolved within 30 days.
You have demonstrated that you are willing to play their delay game and now you have an ER visit thrown into the mix. Your doctor's office may let things slide but a hospital will not and they will come after you for their money!
The insurance company will push you as far as you let them. At this point you shoulder a portion of the blame
Next time you talk to Teamcare ask them if; 1. "The CPT code the doctor's office used to submit the claim was incorrect because if it is you will turn to your state's medical board for help." You will be told yes it was but.....blah...blah..blah..ect." When she has finally stopped talking tell her you have no recourse but to send a complaint to your state's insurance department, give her their address right then, about Teamcare asking them for their assistance. The matter will be resolved within 30 days.
You have demonstrated that you are willing to play their delay game and now you have an ER visit thrown into the mix. Your doctor's office may let things slide but a hospital will not and they will come after you for their money!
The insurance company will push you as far as you let them. At this point you shoulder a portion of the blame
BrownBrokeDown
Well-Known Member
Re-read the post. They are now saying it didn't matter what code was entered or where it was done, ultrasounds are only 80% regardless. The only thing I could bring to the state is the fact that i get different information depending on who I speak to.
Also, on the ER Teamcare paid what the policy states for a non-life threatening emergency. My issue is that we have to self-diagnose, and in a similar but less-severe situation where a fellow worker went to an urgent care facility, they sent him to the ER anyway.
Benben
Working on a new degree, Masters in BS Detecting!
Head injuries are life threatening unless and until a bleed is ruled out. Stop being a patsy and file a complaint with your state's insurance regulatory department! You send a letter, the state sends a letter to teamcare and suddenly the insurance company fixes the problem and sends a letter back to the state saying, "we do not know why our insured complained we have remedied the issue long ago."
BrownBrokeDown
Well-Known Member
What part of the ER dr filed as non-life threatening do you not understand??? It is up to the dr on how to code it. If the dr says its not life threatening, and most things are coded as non-life threatening outside of heart attacks/strokes/etc, there is nothing to file on the insurance about.
Benben
Working on a new degree, Masters in BS Detecting!
BBD stop coming to us crying about this. You have been told what to do to fix the situation but are too lazy to do it. Please ask your wife to write the letter, maybe she wears the balls at your house because you sure seem to be lacking them. Let me take a wild guess here....The insurance company rep is the one who has told you that you have no reason to write the letter its all the doctor's fault? GET OFF YOUR FAT ARSE, MAN UP, TAKE SOME RESPONSIBILITY AND DEAL WITH THE ISSUE!
LOL, don't tell me about the ER. I have done 2 rotations in the ER. My wife is a PT, two of her sisters are nurses, and another of her sisters is a billing manager for my city's largest clinic (degreed in this by the way.) Signs of a neurological deficit following a head injury is potentially life threatening EVERY TIME. If it wasn't, the ER doctor would not have preformed an exam and would have told you to go see your family doctor! Only after preforming an exam can a life threatening condition be ruled out. My second office had a form letter on the computer to my state's insurance commissioner which we used anytime we got back a second denial on a claim. Input insurance company name, date of service and had the patient sign. We got paid within 30 days on all but a very, very few claims. Best part is those insurance companies never played games with us again!
So stop crying and do something about it!
LOL, don't tell me about the ER. I have done 2 rotations in the ER. My wife is a PT, two of her sisters are nurses, and another of her sisters is a billing manager for my city's largest clinic (degreed in this by the way.) Signs of a neurological deficit following a head injury is potentially life threatening EVERY TIME. If it wasn't, the ER doctor would not have preformed an exam and would have told you to go see your family doctor! Only after preforming an exam can a life threatening condition be ruled out. My second office had a form letter on the computer to my state's insurance commissioner which we used anytime we got back a second denial on a claim. Input insurance company name, date of service and had the patient sign. We got paid within 30 days on all but a very, very few claims. Best part is those insurance companies never played games with us again!
So stop crying and do something about it!
BrownBrokeDown
Well-Known Member
First of all,
you with the insults. Second, it doesn't matter what you or anyone says, its all about coding. I don't give a about you working in the ER. THERE WAS NO DENIAL BY THE INSURANCE. THEY PAID WHAT TEAMCARE IS SUPPOSED TO PAY. DO YOU NOT REMEMBER ALL OF US BITCHING MONTHS AGO ABOUT THE ER. IT DOESN'T MATTER WHAT THE SYMPTOMS ARE, IT MATTERS WHAT THE ILLNESS IS. CHEST PAIN...80% UNLESS HEART ATTACK. WHY DO YOU THINK WE WERE ALL BITCHING ABOUT SELF-DIAGNOSING BEFORE GOING TO ER. THE ONLY TIME TEAMCARE PAYS 100% IS IF YOU WOULD HAVE DIED IF YOU DIDN'T GO TO THE ER. NOW IS THIS LARGE ENOUGH OR DO I NEED TO MAKE IT LARGER SO YOU CAN READ IT. TEAMCARE PAID WHAT THE POLICY STATES, THERE IS NOTHING TO CONTEND. AT NO POINT WAS I SAYING THEY SHOULD HAVE PAID MORE ON THE CONCUSSION. THAT WAS A SEPERATE ISSUE, WHERE ONCE AGAIN, THEY PAID WHAT THE POLICY STATES, BUT I WAS FED MISINFORMATION ORIGANALLY LIKE MANY OTHER BY THE 1-800 LINE. ONCE AGAIN TEAMCARE PAID WHAT THE POLICY STATES. THE ISSUE ABOUT THE ER HAS BEEN KNOW SINCE WE WENT ON TEAMCARE. IF YOU HAD CRAWLED OUT OF YOUR ROCK THEN YOU WOULD KNOW THIS.
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BrownBrokeDown
Well-Known Member
Let me try explaining it another way where you might understand it.
Teamcare doesn't give a flying what was going on when you went to the ER. They only care what was causing it. examples:
1. Having chest pains - Many things cause chest pains. Until you have an exam there is no way of knowing what it is. Heart attack = 100%, everything else - 80%
2. allergic reactions - once again, many things cause it with many different reactions. On severe reactions, no way of knowing how severe until an exam. Skin reaction, covering childs body within about a 45 min period. 80% because it did not affect the child's breathing. THIS IS NOT WHAT WAS SAID BY A TEAMCARE HIGHER UP ON ONE OF THE NATIONAL CONFERENCE CALLS, BUT IT IS WHAT IT SHOULD PAY ACCORDING TO THE POLICY. The only way it pays 100% is if it is affecting breathing. Swelling, reduced vision, etc only pays 80%.
3. Broken bones - require an exam. Still only 80% unless they have pierced an artery, lung, etc causing your life to be in jeapordy.
AFTER the exam, if the exam states you would have died without going to the ER, it pays 100%. Everything else pays 80% regardless of what it is. REGARDLESS OF WHAT IT IS. If you don't believe me look through the policy. It's all there. Insurance commisioner isn't going to do a damn thing, because teamcare is not refusing coverage. They have levels of coverage that we have to deal with. Look back to the original post. This was always about the fact the we can't get accurate information from the new hires at the call center for teamcare. The only reason the concussion was mentioned is that it is something most of us already new we were going to have to deal with. See, I did my research on the ER months ago. I know I am going to have to pay 80%. I know I will not risk my kids and wife's live self-diagnosing. I have already had the conversation with my wife stating that if in doubt, go to the ER, and we'll deal with it. Once again, because I already knew it for what it was. I have spoke months ago with the Union about it, with Teamcare about it, and it is what it is. A multi-level policy in which we will rarely qualify for the 100% ER coverage. The real issue is in a policy that has as many techincalities as this, that a portion of the Teamcare people can't even answer questions correctly on it.
Teamcare doesn't give a flying
what was going on when you went to the ER. They only care what was causing it. examples:1. Having chest pains - Many things cause chest pains. Until you have an exam there is no way of knowing what it is. Heart attack = 100%, everything else - 80%
2. allergic reactions - once again, many things cause it with many different reactions. On severe reactions, no way of knowing how severe until an exam. Skin reaction, covering childs body within about a 45 min period. 80% because it did not affect the child's breathing. THIS IS NOT WHAT WAS SAID BY A TEAMCARE HIGHER UP ON ONE OF THE NATIONAL CONFERENCE CALLS, BUT IT IS WHAT IT SHOULD PAY ACCORDING TO THE POLICY. The only way it pays 100% is if it is affecting breathing. Swelling, reduced vision, etc only pays 80%.
3. Broken bones - require an exam. Still only 80% unless they have pierced an artery, lung, etc causing your life to be in jeapordy.
AFTER the exam, if the exam states you would have died without going to the ER, it pays 100%. Everything else pays 80% regardless of what it is. REGARDLESS OF WHAT IT IS. If you don't believe me look through the policy. It's all there. Insurance commisioner isn't going to do a damn thing, because teamcare is not refusing coverage. They have levels of coverage that we have to deal with. Look back to the original post. This was always about the fact the we can't get accurate information from the new hires at the call center for teamcare. The only reason the concussion was mentioned is that it is something most of us already new we were going to have to deal with. See, I did my research on the ER months ago. I know I am going to have to pay 80%. I know I will not risk my kids and wife's live self-diagnosing. I have already had the conversation with my wife stating that if in doubt, go to the ER, and we'll deal with it. Once again, because I already knew it for what it was. I have spoke months ago with the Union about it, with Teamcare about it, and it is what it is. A multi-level policy in which we will rarely qualify for the 100% ER coverage. The real issue is in a policy that has as many techincalities as this, that a portion of the Teamcare people can't even answer questions correctly on it.
BrownBrokeDown
Well-Known Member
Another thing. I use the terminalogy, "life threatening", and a lot of people that I know use "life threatening" to refer to the difference between the 100% and 80% thresholds. Since you know so much about insurance, you should realize that no insurance has anything so vague in the actually policy itself. They have a small list of "illnesses" that qualify. It just so happens that they are all life threatening. If what is medically happening is not on that list, oh well, 80%.
Can you understand all that or is it all still above your head...
Can you understand all that or is it all still above your head...
BrownBrokeDown
Well-Known Member
No one that i know personally. I have never really trusted those nurse lines, but that is a personal opinion.
upschuck
Well-Known Member
I wonder if they say to go, if you'd have any recourse if teamcare denies paying 100%
BrownBrokeDown
Well-Known Member
Actually, that sounds like there might be some possibilities there.
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