Frequently Asked Questions

Electronic claims may take up to 30 days to be processed after being received by TeamCare, especially if further information is needed. Paper claims may take up to 30 days from submission. You can check the status of all your claims at My Claims in the secure member area of our website.

Your provider must file a corrected claim to fix the patient's name. Advise them to indicate "CORRECTED CLAIM" on the re-file.

Providers can check eligibility online or by calling to verify eligibility and plan coverage. Your doctor may also need to pre-certify or pre-authorize certain procedures; certain procedures need predetermination in addition to precertification. The appropriate phone numbers and requirements are shown on your TeamCare Medical ID card.

No, TeamCare does not require a referral for claim payment. However, the specialist may request a referral from you or your doctor. Please note: Using an out-of-network specialist will affect claim payment and other benefits like Family Protection. If you are a member covered by Kaiser HMO, please contact Kaiser about referrals.

No, this information is not available online. To change your beneficiary, or if you are unsure who you have listed as beneficiary, you can submit an updated form. You can find a copy of the form from Forms & Documents. If you are unsure of who you have listed as your beneficiary, the fastest way to make sure your beneficiary is accurate and updated is to submit another form.

 

Your member ID number or UMI (Unique Identification Number) is the number listed on your medical ID card, and typically begins with 806. If your plan is through Blue Cross Blue Shield, your number will begin with “TEA.”

Eligible Blue Cross Blue Shield members can find more information on filing an international claim or locating international doctors and hospitals here.

For non-international claims, Blue Cross Blue Shield members can submit a BCBS claim form to pay insured/subscriber and an itemized bill to BCBS of Illinois regardless of the state where the claim occurred.

Coordination of Benefits takes place when you and/or one of your dependents are entitled to health benefits under more than one plan (including medical benefits under motor vehicle insurance and personal injury protection insurance).

When you or your dependents are covered by more than one health plan, TeamCare will coordinate up to the total amount the patient is responsible for on a covered expense. TeamCare will coordinate payments with other plans that provide health benefits according to the rules of each of the plans.

The plan that has covered you longer as an active employee is primary, and the plan that covered you for the shorter period of time is secondary.

If the parents are married or living together, the coverage of the parent whose birthday (month and day) falls earlier in the year is primary. For example, if your birthday is in October and your spouse’s birthday is in February, regardless of who is older, your spouse’s insurance will be primary for your children and TeamCare would be secondary.

TeamCare will coordinate benefits provided that the HMO rules are followed.

Providers normally handle the filing of claims. Once the primary carrier has processed the claim, a copy of the itemized bill along with the Explanation of Benefits (EOB) from the primary insurance should be filed according to the instructions on the back of your TeamCare medical ID card.

Depending on the primary plan’s rules, TeamCare will coordinate benefits if the procedures are normally covered by TeamCare. 

Yes, if you or your dependents are covered by another plan that provides dental benefits, we will coordinate with your other plan. In no case will the total payment from this plan and any other plan exceed the dentist’s charges.

It is very important that you complete the Supplemental Report and submit it to us. Your answers will help us properly administer your claims and determine if we need to seek reimbursement from a third party or an insurance company for these claims. If you do not return the report, we may suspend your medical benefits.

The Subrogation/Reimbursement and workers’ compensation clauses in your health plan require you to notify us if you receive an award or settlement from a third party or an insurance company. From that award or settlement, you must reimburse TeamCare for any medical benefits that we have paid for this injury or illness.

TeamCare may provide benefits for illness, injury, and/or disability related to an accident or injury, however, TeamCare's right to 100% reimbursement applies when there are other sources of recovery. Refer to your Summary Plan Description under My Documents on your Member Dashboard for detailed information.

TeamCare is entitled to full reimbursement from your settlement or any other recovery of 100% of the benefit payments made on your behalf. That full reimbursement is not reduced by attorneys’ fees and other costs you incur in obtaining your settlement or other recovery.

Yes, the letter is legitimate if it is from TeamCare's Law Department, Coghlan Law LLC, The PHIA Group, or Healthcare Recovery Solutions (HRS). TeamCare utilizes all four of these entities to pursue its Subrogation rights. Please respond to their request. Refer to your Summary Plan Description under Plan Documents on your Member Dashboard for detailed information.

You, or your attorney if you are represented by one, can call the TeamCare Subrogation Line at 1-847-777-4060, The PHIA Group at 1-888-588-7045, Coghlan Law LLC at 1-800-627-3360, or HRS at 1-855-201-1565 depending on who sent you the communication.

Subrogation refers to TeamCare’s right to recover 100% of benefits payments made by us for any physical or mental condition or injury that was or may have been caused by any person. The process to get the other party to reimburse us is called subrogation.

We have established a list of diagnosis codes that indicate an injury or illness, which may be accident-related or work-related. When claims are processed through our system, a questionnaire is generated if the patient has received treatment for an injury or illness that has one of these accident-type diagnosis codes.

These Subrogation procedures help to contain the cost of healthcare by reducing premium costs paid by you and/or your employer.

No, if another person caused your injury or illness or may be responsible for your injury or illness, whether this is through a vehicular accident, a slip and fall, premises injury, or even medical malpractice, you need to complete a Supplemental Report. If you were injured on the job, please indicate so when describing your injury.

The only way we will know if your claims are accident-related or not is if you complete and return the Supplemental Report. After we receive your information indicating this was an illness for which no one else is responsible, we will make sure your claims are processed and we will try to avoid sending future questionnaires for the same incident.

Your health plan contains a provision that excludes the payment of medical bills for work-related injuries and illnesses. This means that we will not provide benefits if Workers’ Compensation laws cover, provide or pay for the service, supply or treatment of any work-related accident or illness.

Depending on your collective bargaining agreement, your employer may be required to make contributions, providing coverage for you and your family. Coverage is limited to treatment unrelated to the Workers’ Compensation claim. You may also be eligible to make COBRA self-payments. Refer to your Summary Plan Description under My Documents on your Member Dashboard for detailed information.

The Plan does not provide benefits for illness or injury that are, in any way, work-related and/or covered by Workers’ Compensation or similar law. If you feel you have a work-related illness or injury, you should:

• Let your employer know immediately and complete a report; your union steward can typically help with this.
• Seek medical treatment and inform the doctor that the injury may be work-related.     
• Notify TeamCare immediately.

If Workers’ Compensation denied your claim because it determined your injury or illness was not related to your employment, TeamCare may cover your treatment; however, we may require that you file an appeal with Workers’ Compensation and may further require that you sign an Agreement to Reimburse.

In most cases, treatment for complications related to a work-related injury/illness is not covered for a five-year period from the date of injury or illness. After this, related treatment may be payable unless it is still compensable under Workers’ Compensation.