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Frequent Questions

Frequently Asked Questions  

Below is a list of commonly asked questions. If you have a question that we have overlooked, please contact us and we will be happy to respond.

How do I find information about benefits?

Please contact you insurance company or claims payor directly. TLC Advantage does not have access to benefit plan information. The phone number should be on your insurance ID card - look for a 'Benefits' or 'Claims' telephone number. If your coverage is through an employer group you can also contact the Human Resources office. 

How can I find out if my doctor is in the TLC network?

TLC Advantage offers free provider and facility search options through our web site. By clicking on Provider Search you will have the ability to search for a provider as well as print a directory based on a zip code, city, street address, or state. In addition, TLC's Customer Service line can also verify the status of your particular doctor in our network. Customer Service representatives are available Monday through Friday from 8:00 a.m. to 4:30 p.m., Central Standard Time by calling  877-893-9685.

How do I obtain a TLC directory?

By clicking on Provider Search you can print a customized directory for your respective area.  You will have the ability to customize the directory by location, provider, and speciality and print at your convenience.  With the weekly updates you will have access to the most current provider information.

If my hospital is a participating provider, will I be assured that my entire hospitalization will be covered as in-network?

You will also need to confirm that the physician, lab, x-ray, anesthesia, etc., providing services during your hospitalization are also participating providers.  Your admitting physician's office should be able to assist you with a list of providers who will be billing for services resulting from your hospitalization.

Who should I check with on the status of my claims?

Since TLC makes no determination of coverage or benefits and issues no payments, please contact your insurance carrier first (look for the 'Claims' or 'Customer Service' phone number on your insurance card) to check your claim status.  If they have not received your claim, check the back of your insurance ID card to see where your provider is directed to submit your claims.  If your claims are submitted to TLC you can contact TLC to see if they have received the claim and what date it was forwarded to the payer/insurance carrier.  If TLC has not received your claim you will need to contact your provider to determine where they filed the claim.

Is there anything I need to do to let my provider know I have access to the TLC PPO network?

You should show your insurance ID card to the registration desk at your provider’s office at every visit.  This will allow them to verify that they have accurate filing information and to update your information since your last visit.  Insuring that your provider has correct information may prevent claim processing delays.

What should I do if my provider is not in the TLC network?

You can submit a Provider Nomination Form  to TLC via the TLC website.  TLC will contact the provider and encourage them to join the network.  You can also encourage your provider to join the TLC network and let them know that you may be negatively impacted with higher co-pays and deductibles if you see them as a non-participating provider.

How do I know what the impact will be to me if I see a non-participating provider?

This is a question you will need to ask your insurance company as the impact is determined by each group’s plan design.

If I do not have access to a participating provider in my area, how will I be impacted?

This is a question you will need to ask your insurance company as the impact is determined by each group’s plan design.

Who do I call for Pre-Certification or Pre-Authorization?

Look for the 'Pre-Certification/Pre-Authoriation' or 'Benefit' telephone numbers on your insurance ID card.  Because TLC does not have access to your plan design, they can not provider pre-certification or pre-authorization information.

What is a PPO (Preferred Provider Organization) provider?

A PPO provider is a contracted provider who has chosen to participate in the TLC Advantage PPO network with their services provided at preferred rates.  Employers, insurance carriers (both health & workmens' compensation), third-party administrators (TPAs) contract with TLC to access the preferred discount rates for their insureds.

How often is the TLC website updated?

The TLC website is updated weekly at a minimum.

Do I have access to the TLC Pharmacy Network?

Contact your insurance carrier or Human Resources office to determine if you have access to the TLC Pharmacy Network.

How do I contact TLC?

You can e-mail TLC by clicking on Contact Us .  Or you can reach us by calling 877-893-9685.

As a health provider how do I join the TLC network?

You can contact us by clicking on Contact Us .  We will visit with you about the contractual arrangements and forward a packet to your attention for reveiw.  Or please feel free to contact our office by calling 877-893-9685.



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