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Claim - Health Insurance Definition
 
 

A claim is simply a request for payment of services. Typically, your health care provider will make the request but it is sometimes the responsibility of the patient. This is one of those questions that’s best asked before you take out a health insurance policy.

Start by talking to your health insurance broker. Ask if claims are normally submitted by the patient or the health care provider. Next, talk to the insurance person at your doctor’s office. Be prepared with specifics - the name of the insurance you’re considering, the type of policy, and whether there’s a deductible or co-payment. Ask whether they are willing to submit claims on your behalf and find out about their payment options while claims are being processed. Most physicians and pharmacies will accept whatever portion of the bill you’re required to pay as payment in full at the time services are rendered. But some may require that you pay in full with the understanding that your insurance will reimburse you. That’s an important detail and one that could change your mind about which policy to purchase.

Once your insurance policy is in place and you’ve made a claim, you’ll likely get a notice from your insurance provider. Though it’s tempting just to drop it in the trash - especially if you’ve had a series of illnesses and have seen lots of those letters. Avoid the temptation and look over the charges. You are the first step in eliminating insurance fraud and you are the only one who can spot bogus charges at this level.

 
 
 
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