Questions & answers · Health insurance
My employer health plan has not decided my claim. What can I do?
Health insuranceSlow or stuckChecked 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
- Plans must decide within set days.
- The limit depends on the claim type: urgent, before care, or care already got.
- The days are counted from the day the plan receives your claim.
What this means
A job-based group health plan has time limits. They are counted from the day it receives your claim.
For urgent care, the limit is 72 hours [1]. For approval before care, it is 15 days. The plan can extend one time by up to 15 days [2].
For care you already received, the limit is 30 days. The plan can extend one time by up to 15 days [3].
Your next step
Count the days from the date the plan received the claim. The limits in the sources are 72 hours, 15 days (+15 once), or 30 days (+15 once).
Check it yourself
The sources do not list what happens to your claim if the plan misses its time: "Don't know yet". Your own papers show the date the plan received the claim.
Where this comes from (3)
[1] govinfo CFR 2024 · 29 CFR 2560.503-1 · § 2560.503-1(f)(2)(i) · checked 2026-11-06
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
[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
- How can I find out if Medicare denied a claim?
- My plan says it never received my doctor's claim, and the office says it sent it. What dates can I ask for?
- My coverage is an HMO, and it says it never got my doctor's claim. What does Texas law say about the date a claim is received?
- How can I find out if Medicare denied a claim?
Answer id CQ5009. Spotted an error? Tell us.