How long should I give the insurance company to respond to my claim before following up? (Health Insurance)?

Question

I filed a claim with my health insurance carrier (the provider is out of network and does not file for me).

I sent the claim USPS Certified Mail, including all necessary claim forms and an explanation of the claim.

How long should I give the insurance company to respond before following up? Is 15 business days enough, or should I give them more time?

Answer 1

Legally, they have at least 30 days.  (Some states allow 45.)

But realistically, most insurers should at least have the claim entered into the system and pending within 2 weeks.

P.S.  I know you didn't ask about this, but just to save you another question later on...odds are you won't get the full amount you're expecting back.  

Your insurance company is going to process based on a UCR (Usual and Customary Rate), not the provider's actual billed charge.  For example, if you're expecting 60% back, they are going to reimburse you 60% of the reasonable and customary rate for the service.  Not 60% of the amount you actually paid.

Answer 2

I worked in health insurance for 20 yrs.  Typically, the goal for any health insurer is to be done processing the claim in 14 calendar days.  Then it takes another 3-7 days to send the check.  So under the best circumstances, you should get an explanation of benefits right about now.  However, they actually have 30 days before they have to pay any penalties (some states don't even apply penalties).  It depends on how complicated your claim is.  But at 15 days, if the claim is simple, you are right at the point to receive your check or explanation of benefits.  Call if it goes past 30 days.

Answer 3

15 business days from the date they sign for it is good. Most plans turn claims around to providers within three weeks, so giving them the same for an individual is ample.

Remember: squeaky wheel gets the oil. Keep after them to process the claim - even if you have to eventually resort to calling them daily.

Answer 4

30 days. Most health insurance take 15-30 days total. Give them more time. Or, sign up & check online @ their web site.

Answer 5

not more than 24hrs for health insurance,you must keep following up

Answer 6

Give it a month.  You didn't need to send it certified, but it's certainly good to have that proof of mailing just in case you need it later.

Out-of-network claims will either get paid immediately or take longer than in-network claims, depending on the workflow and process of the specific healthcare company.  Most claims get paid within two weeks, but there's no need to get worried or resubmit if it doesn't.  I say give it a month, then follow up with a phone call to the number provided on the back of your insurance card.