How long does my insurance company have to pay my claim after I file?

By Insure.com

Health Insurance Forum

Aug. 5, 2007

I have a fully insured group health plan. How long does my insurance company have to pay my claim after I file?

Harry, North Carolina

Dear Harry,

In North Carolina, fully insured group health insurance plans have 30 days to pay your claim, deny your claim, or notify you that additional information is required. If you have not received a claim determination within 30 days, you can file a grievance with the North Carolina Department of Insurance.

Prompt-pay laws, which vary from state to state, require health plans to pay your health insurance claims within a specified time period, or face fines, added interest payments, and other penalties. Note that prompt-pay laws apply only to "clean claims," meaning claims without defect and with full information provided.

To read more about what you can do when your health plan doesn't work the way it should, see Claim denials: Sometimes following the rules is not enough

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Disclaimer: We are journalists, not financial planners or insurance brokers. Nothing we say should be interpreted as a recommendation to buy or sell any insurance product, or to provide other financial or legal advice.

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