Questions about Claim Reimbursement through Teamcare & BCBS of Illinois

Does anyone work in health insurance in the claims department that I can ask some questions? I’ve been going back and forth with Teamcare for about a year. I submitted a claim for reimbursement for medical services that my doctors have said are medically necessary, yet my claim & 1st appeal were denied as they don’t agree. I’ve been back & forth with BCBS of Illinois & Teamcare countless times. At first BCBS told me to submit the claim through them, then I called for a status update & was told to submit to Teamcare instead. I submitted all requested documents and it’s been denied 2x now through Teamcare. I called BCBS & now I’m being told to submit it to them. The timeframe to submit for reimbursement for these visits has expired (it’s for appointments in 2022 & 2023), but BCBS said if I can prove that I submitted everything to Teamcare within that timeframe then they’ll honor it.

I provided letters to Teamcare on the doctors’ letterheads with their signatures from the 2 treating doctors for this treatment, stating that they are in fact medically necessary, yet it’s still being denied. I’m trying to figure out if I should file a 2nd and final appeal to the denial with Teamcare or just go through everything with BCBS because I feel like I’m getting the run around in the hopes that I’ll give up trying. This would reimburse me of over $5K in out of pocket payments, as neither doctor takes any insurance. I wanted to pick someone’s brain who is familiar with the process so I can maximize my chances of getting this claim paid out to me. Also, if anyone has experience with claims for reimbursement directly through Teamcare or BCBS of Illinois, I’d be grateful to hear what your outcome was. TIA

submitted by /u/Lezgie
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