For information about your benefits, take a look at your Plan Benefit Profile
How long does it take to process my medical claim? How do I tell if my claim was received?
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.
How do I get the patient name corrected on a claim?
Your provider can file a corrected claim to fix the patient name. Advise them to indicate "CORRECTED CLAIM" on the re-file.
I am scheduled to have surgery soon. Who should call TeamCare, my doctor or me?
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.
Do I need a referral to see a specialist or for chiropractic services?
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.
Can I see my life insurance beneficiary online? How can I change my beneficiary?
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.
What is my member ID number?
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.”
- How do I submit a claim for services that happened outside of the United States?
- How do I submit a claim for out-of-network services I paid for myself?
Coordination of Benefits
When does Coordination of Benefits take place?
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).
How does Coordination of Benefits work?
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's policy for Coordination of Benefits is considered standard — we will coordinate payments with other plans that provide health benefits according to the rules of each of those plans.
Which plan is considered the primary plan in Coordination of Benefits when I have two policies through active employment?
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.
Which parent is primary in Coordination of Benefits for covered children?
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.
How does Coordination of Benefits work with a Health Maintenance Organization (HMO)?
TeamCare will coordinate benefits provided that the HMO rules are followed.
How is a secondary claim filed with TeamCare?
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.
Will TeamCare coordinate benefits as secondary for services not covered by a primary insurance plan?
Depending on the primary plan’s rules, TeamCare will coordinate benefits if the procedures are normally covered by TeamCare.
Does the plan coordinate dental benefits?
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.
Subrogation & Reimbursement
What do I need to do in the Subrogation process?
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.
Will TeamCare pay medical expenses if I or a family member was injured in an automobile accident?
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.
How much is TeamCare entitled to receive from my settlement or other recovery?
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.
I received a letter from an attorney's office stating they represent TeamCare. Is this legitimate?
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.
- I lost the letter I received from the TeamCare attorney's office. Whom do I contact about my case?
What is subrogation?
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.
How does TeamCare identify your claim as a potential Subrogation case?
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.
How does Subrogation help me?
These Subrogation procedures help to contain the cost of healthcare by reducing premium costs paid by you and/or your employer.
- Does the Subrogation process only apply to work-related accidents?
- What if this claim was not accident-related, or if no one else was responsible for the injury or illness?
What happens if I was injured on the job?
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.
Does my family have medical coverage while I am receiving Workers’ Compensation?
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.
If I am injured at work, what do I need to do?
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 my Workers’ Compensation claim was denied, will TeamCare pay my medical expenses?
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.
Can I file claims for future treatment related to the Workers' Compensation injury?
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.