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?
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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.
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