Questions & answers · Health insurance
My health insurance claim is delayed. 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)(iii)(B) View original ↗
In short
- A job-based plan has a deadline to answer. Count it from the day the plan got your claim.
- The plan may add one extra period if it tells you.
- For urgent care the limit is 72 hours.
What this means
A job-based plan has time limits. For care you already got, the plan must answer within 30 days. It can add 15 more days one time [1]. If you need approval before care, the limit is 15 days. The plan can add 15 more days if it tells you first [2].
For urgent care, the limit is 72 hours. The plan must also tell you within 24 hours what is missing [3].
Your next step
Write down the date the plan received your claim and count 30 days (care already received) or 15 days (approval before care). If the date passes with no answer, put your question in writing and keep a copy.
Check it yourself
Check which kind of plan you have (job-based or individual). These limits are for job-based plans. Individual plans: "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)(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
[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)(i) · checked 2026-11-06
not later than 24 hours after receipt of the claim by the plan, of the specific information necessary to complete the claim.
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.
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