Save $$$$$ and avoid surprises

Monday, June 4, 2018

It’s important to know how to use your excellent TeamCare benefits to avoid unnecessary charges and costly out-of-pocket expenses. All health plans, including TeamCare, follow standard established medical guidelines when reviewing to see if a surgery or procedure is medically appropriate. The most common surgeries performed are called “elective surgeries” because they’re not part of an emergency or lifesaving event. Types of elective surgeries or procedures include:

  • Back surgeries (laminectomy, laminotomy, spine)
  • Genetic testing procedures
  • Reduction surgeries (i.e. panniculectomy, breast) 
  • Selected durable medical equipment (implanted and external stimulators) 

The best way to determine if the surgical procedure is covered by TeamCare is for your physician to submit a “Predetermination of Benefits Request Form” which is available at MyTeamCare.org.  TeamCare will review the elective procedure along with the treatment plan, and let you and your physician know exactly what is or is not covered according to your Plan.

It’s also very important to make sure your physician and facility is in your PPO network. Using an out-of-network provider or facility will leave you owing thousands of dollars as out-of-network charges are on average twice the cost of our negotiated fees. In addition, by using an out-of-network provider, you will no longer be eligible for the Family Protection Benefit.

If you are in the Medical Mutual network, your physician needs to follow their contract with Medical Mutual for all predetermination requests.