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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: 1440012" data-attributes="member: 46824"><p>Let me try explaining it another way where you might understand it.</p><p> </p><p>Teamcare doesn't give a flying <img src="/community/styles/default/xenforo/smilies/group1/censored2.gif" class="smilie" loading="lazy" alt=":censored2:" title="Censored2 :censored2:" data-shortname=":censored2:" /> what was going on when you went to the ER. They only care what was causing it. examples:</p><p> </p><p>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%</p><p> </p><p>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%.</p><p> </p><p>3. Broken bones - require an exam. Still only 80% unless they have pierced an artery, lung, etc causing your life to be in jeapordy.</p><p> </p><p>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.</p></blockquote><p></p>
[QUOTE="BrownBrokeDown, post: 1440012, member: 46824"] Let me try explaining it another way where you might understand it. Teamcare doesn't give a flying :censored: 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. [/QUOTE]
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