Author: Aptiva Health Editorial Team
Articles
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What “in-network” really means
A network is the list of doctors, hospitals, labs, and other providers your insurance company has signed a contract with. In-network providers have agreed to charge the insurer pre-negotiated, discounted rates. Out-of-network providers have no such agreement — so they can charge their full price, and your plan may pay little or nothing.
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How a claim is processed
A claim is the bill your provider sends to your insurance company asking to be paid for the care you received. Understanding the steps helps you spot mistakes — which are common — and know what you actually owe.
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Denials and appeals: an overview
A denial is when your insurer refuses to pay for a service, in whole or in part. A denial is not the final word — you have the legal right to challenge it, and a meaningful share of appeals succeed.
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How to Get a Referral
What is a referral? A referral is when one provider (often your primary care doctor) recommends that you see a specialist. Depending on your insurance, a referral may be required for the plan to help pay for that specialist visit. Do you even need one? HMO plans usually require a referral from your primary care…
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How to Get a Second Opinion
What is a second opinion? A second opinion is when you ask a different provider to review your situation and share their view on the diagnosis or the recommended treatment. It is common and appropriate — good providers expect and welcome it, particularly before surgery or a major decision. When a second opinion makes sense…
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How your deductible works (in plain English)
If you have health insurance, you have probably seen the word deductible. It is one of the most important numbers on your plan, and it decides how much you pay before your insurance starts to help. Understanding it can save you real money — and a lot of surprise bills. What a deductible actually is…