Coordination of Benefits- Teamcare not paying/Run around

[Horrorcraft]

Anyone else having issues Teamcare not paying when they are the secondary insurance?


I am "lucky" that both my employer(Anthem-not UPS) and my husband's (UPS) pay for my insurance, so I am doubled insured. My employer's insurance is primary and UPS is secondary. You would think because I am double insured, I would pay 0. Well apparently, Teamcare thinks that they have 0 responsibility and have been dicking me around since June 1st.

I am responsible and whenever I get a new insurance card from my employer I notify whomever is managing the UPS insurance. When I had Anthem and Aetna, Aetna covered my copays, deductibles and RX. When UPS switched us Blue Cross Blue Shield Illinois, BCBS-I paid most of the copays and deductibles, sometimes they didn't (ER visit). Medco covered my RX.

Well June 1st came around and my Doctor orders a CT scan to check for Kidney Stones. I go to my CT Scan on June 6th and mass confusion ensues. 1st- 2 cards for 1 insurance plan overwhelmed the receptionist. Teamcare isn't even in their system and BCBS says I am not eligible. Lots of phone calls and finally I have approval for BCBS to pay the 20% of the CT Scan cost.

June 3rd- I attempted to get our RX's filled at Meijer which is part of the Caremark network. The Pharmacist said he couldn't get our info to enter the system and tells me to contact Caremark. I go home and check the Caremark system and it allows to me request refills from our doctors for our "maintenance" Rx.
My husband's RX shows up yesterday and I check the status on mine after I get home today on Caremark's website and it shows that "order still processing". So I call. Guess what? Caremark says "I am not eligible" and that I contact Teamcare.

I also got my first Ct Scan bill in the mail today. Teamcare didn't pay anything toward the CT Scan. So that's one more thing I will have to call about tomorrow too.

I call Teamcare and I missed there office hours, so now I have to wait until tomorrow to find out what or if Teamcare is going to pay anything. I also checked the website and the benefits form does say "spouse has other insurance".

So is anyone else encountering issues?

 

[lookingleft]

I have been on teamcare since they started it is basically blue cross and you will probably have to meet deductibles before it kicks in. I do the same for my wife and her primary is also blue cross and her's pays fine but the secondary sometimes has to see about the deduct. I sometimes don't know for about 60 days,so make sure your dr is keying the info correctly I almost lost a $1000 on a clerical error at dr office. If you have a rx plan with your employer like my wife does Caremark will not pay as a secondary . About every months I send in what my wife's plan didn't pay to my local who forward to central states and they reimburse me.


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[Anonymous 11]

It's eleven freaking days. I'm sure the kinks are going to need to be ironed out. If it's the same in six months then cry bloody murder.

 

[lookingleft]

Yea be we were not it before the new contract here they just changed the name from central states and I'm chilled just trying to help


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[Anonymous 11]

Yea be we were not it before the new contract here they just changed the name from central states and I'm chilled just trying to help


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I'm a little gramerically challenged for sure but what?

 

[UpstateNYUPSer(Ret)]

Yea be we were not it before the new contract here they just changed the name from central states and I'm chilled just trying to help.

I'm sorry, what are you babbling about?

(I just noticed someone found this "post" informative)

 

[Anonymous 11]

I'm sorry, what are you babbling about?

(I just noticed someone found this "post" informative)

Yea that was me. I meant to hit the bad spelling.

 

[Horrorcraft]

Update- I apologize if it came across as me griping about Teamcare, that was not my intention. I was just wondering if there was some glitch system-wide with Coordination of Benefits and if I was the only one popping up as "ineligible".

I did get a hold of Teamcare and they did have me in their system and even had my Primary's insurance information on already on file. With Blue Cross Blue Shield still administering the plan, I can expect the same good communication (I actually receive 1 EOB total with Both insurance on it) between the companies as they are basically the same company.

Also, they showed no claims at all. I was told to not give the Teamcare card to the Doctor's Office, only give the Blue Cross Card. Only provide the Teamcare card if we need specific services at the time of service. So me providing both cards probably caused the confusion at the CT appointment.

And here is good news for some other secondary insurance folks. THEY WILL PAY RX COSTS. We don't have to use Caremark either. But we do have to go old school like back before we had that fancy Pharmacy card and couldn't go where we want. You present your Primary Card at the Pharmacy, Pay the Copay and then mail it in for reimbursement. A little bit of a hassle, but my Primary Insurance RX Plan is $10/$25/$60 and then 20%, so mailing it in will save me at least $30 a month.
Address for reimbursement should be on the back of your card. She confirmed mine as
Central States
PO BOX 5116
Des Plaines, IL 60017

The Teamcare lady was helpful and the minute I said "Coordination of Benefits", she explained how it would be administered. She answered all my questions and I have to give her credit with her professionalism and patience. After thanking her for her help and telling her she was "wonderful". She gave an audible sigh of relief. She told me this had been an extremely rough week and it IS A LEARNING CURVE FOR ALL OF US.

Oh yeah, I was little scared about how long I would be on hold because I have been hearing waits of over an hour. Mine was 18 minutes.

 

[BrownBrokeDown]

READ THIS HORRORCROFT

There is a common misconception about secondary insurances. Just because you have 2 insurances doesn't mean you will pay zero. I have been through this and consequently dropped the non-UPS healthcare. I will give you examples below to try to explain how it works.


Example 1 - primary insurance is better than secondary
primary pays 80%, secondary pays 70%

bill of $1000, goes through 1st insurance and you owe $200. Then the bill is sent to the secondary. Since they would have payed less, they say we are not responsible for anything and don't pay anything. You owe $200.

Example 2 - primary insurance is same as secondary
primary pays 80%, secondary pays 80%

bill of $1000, goes through 1st insurance and you owe $200. Then the bill is sent to the secondary. Since they would have payed the same amount, they say we are not responsible for anything and don't pay anything. You owe $200.

Example 3 - primary insurance is worse than secondary
primary pays 80%, secondary pays 90%

bill of $1000, goes through 1st insurance and you owe $200. Then the bill is sent to the secondary. Since they would have payed $900 (90%), they say we pay the difference, $100 (10%), between what the primary paid and what we would have paid. You still owe $100.

 

[Horrorcraft]

READ THIS HORRORCROFT

There is a common misconception about secondary insurances. Just because you have 2 insurances doesn't mean you will pay zero. I have been through this and consequently dropped the non-UPS healthcare. I will give you examples below to try to explain how it works.

I am aware of this. I have been double insured for 7 years. I have gotten bills for $3.99 to $200 after both insurances paid out. I have had 2 different surgeries in the past 5 years and paid 0. But I blow my knee out and go to the ER and paid $200.

You would think because I am double insured, I would pay 0. Well apparently, Teamcare thinks that they have 0 responsibility and have been dicking me around since June 1st.

This probably should have read "You would think because I am double insured, I would pay 0. In a lot of cases this is true, but not always. Teamcare thinks they have 0 responsibility and have been dicking me around since June 1st.

But after my call to Teamcare today, I can't even say that they were the ones dicking me around. It was the CT SCAN billing department jumping the gun by sending a bill to me before submitting to both insurances.

 

[BrownBrokeDown]

Teamcare thinks they have 0 responsibility and have been dicking me around since June 1st.

I had Aetna do this to me on Dental.