Frequently Asked Questions

Collective Health is the medical plan claims administrator. You will continue to utilize the BCBS network of providers. When you have a question, need to file a claim, or search for a doctor, you will contact Collective Health. Representatives will answer your questions and assist you as needed.

To find an in-network doctor visit bcbstx.collectivehealth.com or call 1-855-399-5599.

Collective is a Third-Party Administrator (TPA) that specializes in administering complex benefit plans. Energy Transfer engaged Collective Health to work as our TPA to bring you a better health care experience. They support you and your family with an experience that is easy to understand, navigate, and access.

Collective Health relies on BCBS to “price” in-network claims and uses the discounts that BCBS negotiates with providers to get you extra savings. You see these discounts noted on your Explanation of Benefits (EOB) as Provider Discounts. The Provider Discounts reflect the amount deducted from your off of the provider’s billed charges that you are not required to pay, thanks to the BCBS network.

Collective Health processes your claims based on the instruction they receive from your plan sponsor. They are required to pay or deny claims based on the language contained in the plan documents, including your SPD and SBCs. There are many reasons why claims might be denied, including limitations and exclusions placed on benefits, failure to pre-certify a service or failure to provide needed documentation that a service was medically appropriate.

For more information, please refer to your plan document or call Collective Health for specific questions.

Claims are often classified as pending when we require more information to process your claim properly. Two of the most frequent reasons that additional information is required are Accident Related Claims and Coordination of Benefits (COB).

If it appears that your claim may be accident related, a questionnaire is sent to you. Accident information is needed to identify if there is a third party, like an auto insurance policy, that may be responsible for damages. It is important that you include all the required information and complete all the fields on the form.

COB is intended to ensure that if other insurance exists, such as Medicare or other group coverage under a spouse or other employer, that benefits are coordinated correctly. You may update your COB information at any time online at bcbstx.collectivehealth.com.

Prior authorization is completed using nationally-recognized standards and guidelines while considering your individual clinical status. The BCBS physicians and registered nurses will review your doctor’s request for services for medical necessity and appropriateness of the recommended care.

The Collective Health and BCBS teams realize that there is a person behind every request and that your time is important; that is why they are committed to timely turnaround times when you are accessing care. With every request processed, they have the opportunity to ensure you are receiving quality, medically appropriate care.

If you are planning for a future medical procedure, be sure to review your plan document or call Collective Health to determine if your procedure requires prior authorization.

Exclusions are in place to ensure that our medical plans make the best use of your healthcare dollars. Exclusions help to prevent the plan from paying for services that may be elective, such as cosmetic surgeries, or unproven, such as experimental, non-FDA-approved treatments.

Due to HIPAA requirements, each member over the age of 18 must create a separate account. When the account is created, they can list who may have access to their information.

In addition to claims management and finding doctors, Collective Health offers many quality services to guide you through your health care needs. These services include:

• Case Management – If you are hospitalized or receive a new diagnosis, a Registered Nurse Case Manager can help guide and support you throughout your illness or injury.
• Disease Management – Registered Nurse Health Coaches will help you take control of your chronic health conditions.
• Baby Steps Maternal Health Program – You can receive education, support, and a specially trained Maternal Health Registered Nurse to help you stay healthy before, during and after your pregnancy.

To access these services and more visit bcbstx.collectivehealth.com or call 1-855-399-5599.