Questions & answers · Health insurance
How do I file a health insurance claim for an illness or injury, and how long until I hear back?
Health insuranceHow to fileChecked Nov 6, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(f)(2)(i) View original ↗
In short
- Ask your plan how to send a claim.
- A job-based plan has set time limits to answer you.
- Keep a dated copy of what you send.
What this means
The federal sources used here do not list which forms or documents a claim needs. Your plan's papers say how to file.
They do set time limits once a job-based plan has your claim. If care is urgent, the plan must answer as soon as possible and no later than 72 hours [1]. If you need approval before care, the plan must answer no later than 15 days, and it may extend once by up to 15 days with notice [2]. If you already got the care, the plan must answer no later than 30 days, with one extension of up to 15 days [3].
Your next step
Ask your plan how to file and keep proof of the date you sent it. The time limits above are 72 hours, 15 days or 30 days, counted from the date the plan receives your claim.
Check it yourself
These limits are for job-based plans. Individual (marketplace) plans may have their own notice times: "Don't know yet" from these sources. The documents a claim needs: "Don't know yet" from these sources.
Where this comes from (3)
[1] govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(f)(2)(i) · checked 2026-11-06
In the case of a claim involving urgent care, the plan administrator shall notify the claimant of the plan's benefit determination (whether adverse or not) as soon as possible, taking into account the medical exigencies, but not later than 72 hours after receipt of the claim by the plan
[2] govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(f)(2)(iii)(A) · checked 2026-11-06
not later than 15 days after receipt of the claim by the plan. This period may be extended one time by the plan for up to 15 days, provided that the plan administrator both determines that such an extension is necessary due to matters beyond the control of the plan and notifies the claimant, prior to the expiration of the initial 15-day period
[3] govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(f)(2)(iii)(B) · checked 2026-11-06
not later than 30 days after receipt of the claim. This period may be extended one time by the plan for up to 15 days
How we found this
We matched your question to 3 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.
What we don’t know yet
Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.
Every answer is checked against the official rule it quotes.
Information only — not legal advice. Your plan, insurer or agency decides.
This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.
Related answers
- I paid the doctor myself and want my plan to pay me back. How do I file it, and how fast must the insurer answer?
- I have an HMO, I paid the bill myself, and I want the plan to pay me back. What clocks does it have to keep?
- Can my Medicare start date be backdated if I signed up late or got wrong information?
- My doctor didn't file my Medicare claim and I paid out of pocket. Can I file it myself?
Answer id CQ5003. Spotted an error? Tell us.