Teamcare - something to watch for on procedure claims

[BrownBrokeDown]

Here is another way to look at it. If they don't hold you overnight, you don't stand a chance in hell of 100% coverage. Grade 2 concussion with symptons, out of ER in 4 hrs with a prescription for ibriprofren (told otc was good enough though) and told to get in to see primary within 24-48 hrs = hello 80% coverage.

 

[saintrick]

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...

I have been told on multiple calls to the Teamcare reps that life threatening or how a visit is coded has nothing to do with how the claim is paid.

ER visits are 100% only for accident or if admitted.

 

[10 point]

Here is another way to look at it. If they don't hold you overnight, you don't stand a chance in hell of 100% coverage. Grade 2 concussion with symptons, out of ER in 4 hrs with a prescription for ibriprofren (told otc was good enough though) and told to get in to see primary within 24-48 hrs = hello 80% coverage.

Does our new plan "mirror our previous plan"?

Why wouldn't we trust the IBT's info?

There's no reason not to trust Hoffa's relationship with UPS Corporate folks.
When he became the default GP in the 90's the CEO of UPS reportedly remarked the he was glad to have him as GP because Hoffa was more of a businessman (than Carey).

It isn't about what the plan IS it's about what we were told that it was.

Credibility, that's the issue in my mind. Elections are around the corner.

 

[BrownBrokeDown]

I have been told on multiple calls to the Teamcare reps that life threatening or how a visit is coded has nothing to do with how the claim is paid.

ER visits are 100% only for accident or if admitted.

ER's usually only admit someone anymore if it is life-threatening.

 

[oldngray]

ER's usually only admit someone anymore if it is life-threatening.

Not really true. It doesn't have to be life threatening. ER will admit someone if the treatment can't be done outpatient.

 

[saintrick]

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.

If the concussion was due to an accident it is covered at 100% whether it is life threatening or not.

 

[Mugarolla]

If the concussion was due to an accident it is covered at 100% whether it is life threatening or not.

Agreed. And how do you get a concussion without it being an accident? It should be covered 100%