decorative photograph

Time frames for processing out-of-network claims

Health claim processing activity
Time frame
Plan Initial Determination
  • Initial review decision
  • 30 calendar days
  • Extension period, including extension for missing information
  • 14 calendar days
Plan Notice of Incomplete Claim
  • Missing information
  • Included in extension period above
Claimant Time to Complete Claim
  • Provide additional information
  • 45 calendar days
  • Comply with required filing procedure
  • 45 calendar days