Was your claim denied? Learn about the appeals process

After you receive medical services, your doctor or healthcare provider will submit a claim to TeamCare. Occasionally, a claim may be denied because the service isn’t covered under your plan, you may have visited an out-of-network provider, or another insurer should have been billed first.

As a TeamCare member or healthcare provider, you have the right to file an appeal when you disagree with a decision based on benefits. Appeals must be filed within 180 days from the date a healthcare benefit was denied, reduced, or terminated.

Here is how to get the process started:

Members

  • Log in and select Appeal Form found under My Plan on your Dashboard
  • Fill out Appeal Form and save document
  • Next, select the Message Center found on your Dashboard or the Contact Us page and choose Appeals from the topic menu
  • Attach the completed Appeal Form, and be sure to include any documents that would support your position. Click Send Message

You may find more information about the appeals process in your Summary Plan Description. For questions, call 800-TEAMCARE to speak to a Benefits Specialist.

Providers

  • Log in and select Search Eligibility and Benefits on the Dashboard
  • Select Medical or Dental
  • Fill in the patient’s Member ID number and birthdate, then click Submit 
  • Select Appeal Form found under Plan Information, fill out the form and save the document
  • Next, select the Message Center found on the Dashboard or the Contact Us page and choose Appeals from the topic menu
  • Attach the completed Appeal Form and any supporting documents, then click Send Message

For questions, call 888-323-4112 to speak to a Benefits Specialist.

Members and providers may also send the completed Appeal Form and any supporting documents to:

            Research and Correspondence Department
            TeamCare - A Central States Health Plan
            PO Box 5126
            Des Plaines, IL 60017-5126