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Don't Get Ripped Off by Mistakes on Health Insurance Claims

Dealing with medical bills and insurance claims can often become a full-time job. Too often, the insurance company makes errors on claims and bills, which can be costly to seniors and their caregivers. The first step to make sure this doesn't happen to you is to become familiar with all of the details of your coverage, says Sheri Samotin, President of Lifebridge Solutions.

For example, if your insurance has both in-network and out-of-network benefits, make sure you understand the difference. When you make an appointment with a new provider, ask if they are in your network and then check this out yourself on your insurance plan's website or by calling their customer service number.

Likewise, many plans require a referral and/or pre-certification from your primary care doctor for certain visits to specialists or for specific procedures. Don't assume that your doctor's office has checked this out for you. If they say that they will take care of it for you, call your insurance plan yourself anyway and find out if the provider did indeed call and whether the service will be covered and at what level. Understand the difference between what your provider charges and UCR (usual, customary, and reasonable). Most plans pay benefits based on a percentage of the lower of the charge or UCR and not based on a percentage of the actual charge. Finally, understand your deductibles and co-insurance responsibility.

Even when you do everything suggested above, there will be times when you don't agree with a provider's bill or how your insurance plan has processed the claim. Here are seven tips to help you handle mistakes on health insurance bills and claims.

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Sheri Samotin brings more than 30 years of business and management experience to LifeBridge Solutions. She is a Certified National Guardian, Certified Daily Money Manager & Certified Professional Coach. She is the author of Facing the Finish: A Road Map for Aging Parents and Adult Children.

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