Can I Sue An Insurance Company Or Hmo When It Has Refused To Pay For Treatment?

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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UPDATED: Jul 16, 2021

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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.

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