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“I’m Getting Charged for a Costly Medical Procedure I Never Had”
Nearly 20 percent of medical claims have a processing error, according to the American Medical Association. If you find a mistake on a statement from your insurer, the first step is to call your insurance plan’s member-services department and clearly explain the mistake to the representative. That should resolve the issue. If it doesn’t, file a formal appeal with the insurer. (Find instructions on the company’s website, or ask your employer’s human-resources manager.) Federal law and many state laws require insurers to have a relatively straightforward appeals process; it involves submitting a written statement of your complaint along with any documentation, such as bills or letters from your health-care provider, and a log of phone calls you made to your insurer. “Keep your physician in the loop and let her know that you’re working with your health plan to fix the problem. Most will be patient until the billing dispute is resolved,” says Larry Gelb, the president and CEO of CareCounsel, a health-advocacy firm. “And if your employer offers a health-care advocacy program, enlist its help to provide hands-on support with your claim issue.”
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