How long does a health insurance company have to pay a health insurance claim?
A. Health insurance companies, including HMOs, have 30 days to pay a claim to either you or your medical provider, if the claim is electronically filed with the health insurance company. If the claim is mailed to the health insurance company, the health insurance company has forty-five days to pay the claim. All of these time deadlines assume that the claim is considered a “clean claim,” or a claim falling squarely under coverage under the health plan, in which no further information is needed by the health insurer to process the claim. If the claim is however not “clean” or the health insurer needs more information to process the claim, the health insurer is allowed 30 days to collect the information, and after all of the required information is received by the health insurer, the 30 (electronic) and 45 (non-electronic) day payment rules then apply.
