How to Appeal a Claim

There are several reasons why a claim may be denied. It’s possible that the claim was denied because it was for a service not covered by TeamCare, or for a treatment that was deemed as not medically necessary. A claim may also be denied because an out-of-network provider was used, or because another insurer should have been billed first. Your Explanation of Benefits includes a reason why your claim was denied.

If you’d like to appeal your claim using our appeals form, you can download and print a form by logging in to your MyTeamCare account and going to Claim Appeals. Simply fill out the form, and send it back to us.

If you are filing your appeal by letter, be sure your letter contains:

1. The member’s name and address
2. The member’s ID number
3. Claim number
4. The patient’s name
5. The patient’s relationship to the member
6. Date of loss
7. The EXACT reason you are dissatisfied with our decision

Whether you’re filing an appeal using our form or a letter you wrote, be sure to submit a copy of our denial letter or Explanation of Benefits. We also recommend submitting any additional information that you can to support your appeal, such as medical records to support a claim that was deemed not medically necessary. The more information you provide us, the easier time we’ll have processing your appeal.

You can send your completed appeals form or letter, as well as any questions or requests about your appeal, via the Message Center, or to:

Research & Correspondence Department
TeamCare, A Central States Health Plan
PO Box 5126
Des Plaines, Illinois 60017-5126
Fax: 1-847-518-9794