Question

Last question, what is the time limit for a medical insurance company to pay a claim?

I'm dealing with an insurance company out of the country. They cover subscribers inside the u.s. and it's taking them 6 months to pay claims. Any recourse??

7 years ago - 4 answers

Best Answer

Chosen by Asker

If the policy was issued to you on an individual basis here in the U.S., the fact the company is out of the country doesn't matter -- it must comply with your state's laws regarding timely claim decisions. This time limitation varies between 30 and 45 days, depending on the state. If you believe this applies to you, contact your state's insurance commissioner's office in writing and file a complaint.

However, if you're covered as a Certificate holder under a group policy issued to an employer or association located outside the U.S., then this insurer doesn't have to follow any U.S. insurance laws. Many foreign countries have governmental agencies that regulate the business of insurance. I would be happy to help you identify the appropriate agency if you contact me through YA.

7 years ago

Other Answers

im a medical biller and u have to call the ins company and ask them what their filing limit is. As long as the ins bill is submitted to the ins co within the filing limit they should pay the bill. However most ins companies take between 30 days up to the filing limit to pay claims. Every ins co has a turn around rate as of how long it takes them to pay out claims but most of them do not abide by it. I wouldn't worry though as long as the ins co got the bill and are paying. Only worry when it takes almost a yr for the ins co to pay the bill then the medical billers will bill the patient to get them involved with collecting the money from the ins co.

by Star R - 7 years ago

Probably not. My insurance company here IN the US has taken that long (with multiple followups from me).

Usually, though, you have to SUBMIT the claim within one year, or they don't have to pay it.

by mbrcatz17 - 7 years ago

Depends... Generally speaking,

If its an individual policy.... Claims must either be paid, pended, or denied within 30-45 days of the received date. (in most states) You can file complaints with the department of insurance in your state, in this instance. most states have resources available to do this online...

If it is a group plan, what's the hold up? The only thing I can think of that would cause a claim to be held up for such a long time would be if the employer group was, for some financial reason, withholding funds. I've seen that take weeks to work itself out.

Is there a problem with a claim? Or, are they simply not releasing checks? I'd be more than happy to help direct you

Source(s)

by Custo - 7 years ago