Health Insurance Center
Health Insurance Q & As
Question 1 of 6 in Collecting Claims, Dispute Resolution And Denials
Can I sue an insurance company or HMO when it has refused to pay for treatment?
ERISA provides that group health plans have 90 days to respond to presented claims. Employees have 60 days to appeal a denied claim. Within 60 days of the notice of appeal, the plan must respond with a written explanation of the reason for denial. This procedure is to be followed in order to exhaust administrative remedies prior to initiation of litigation. There are proposed Department of Labor regulations that provide for a much faster process in the event of denial of an urgent care claims.