Time Limit for Appealing Denied Insurance Claims

November 15, 2024

You may have heard it said that time is a valuable commodity. This is true in much of life; you always want to be able to leverage time on your behalf. That said, in some instances it is particularly important . . . like when you have received a denied insurance claim notification.

Being told your insurance company is refusing to pay your claim is concerning. Because you will not receive the coverage you expected, you may find yourself responsible for your costs (or even unable to get the treatment you need).  This can negatively impact your finances, both today and in the long-term, as well as harming your health and well-being.

During times like this, engaging an Oklahoma denied claims attorney may be in your best interests. This professional not only understands and appreciates the filing deadlines, but also knows how to frame appeals to increase your chances of success. Failing to file your appeal in accordance with deadlines often means your claim will not be reviewed.

Denied Claim Appeals

The Importance of Timely Appeals

The importance of filing your insurance denied claim appeal before your insurance company’s deadlines expire cannot be overstated. While some deadlines may be  soft and exceptions made in certain situations, the time limits for appealing denied insurance claims are not.

Please recognize that submitting your request for an appeal even one day late can result in a flat-out denial, and your documentation will not even be reviewed.

Unfortunately denied claims are a very real problem, and they occur across all segments of the industry including health, auto, property, and disability.

Seasoned denied claims attorneys are not only aware of the required deadlines but are also able to navigate the purposefully complex process efficiently, ensuring your appeal is submitted in a timely fashion.

Understanding the Federal Time Limits for Appealing Insurance Claims

The sheer volume of denied health care claims across the country is overwhelming. While policyholders have the right to appeal the decisions of their insurance companies, the process can be frustrating. With so many health insurance companies operating in the industry, it’s not surprising that confusion regarding denied claim appeals exists.

In 2010 the Affordable Care Act was passed, standardizing certain portions of the internal and external appeal processes. The deadline for filing an internal appeal, your first course of action after receiving an unfavorable response, is 180 days from the date your claim was denied. That said, you should confirm this with your insurance company immediately upon receiving a denial letter.

Oklahoma Laws

The state of Oklahoma takes insurance denials seriously. The laws governing timing of appeals for denied health insurance claims in state are in agreement with those enacted nationally.  In order for a health insurance appeal to be heard, it must be filed within 6 months (180 days) of the denial.

Deadlines for other lines of insurance, however, can vary.  For example, workers’ compensation insurance appeals must be made within 10 days of their denial.  A seasoned Oklahoma denied claims attorney will be familiar with all filing deadlines and can work with you to submit all requisite information within the stated time frames.

Policy-Specific Deadlines

The appeal process is  intentionally complex; many policyholders will simply accept their company’s decision as final because moving forward is too confusing. Each insurance company has unique policies and procedures.

 It is recommended that, in all cases, you confirm appeal and filing deadlines with your own insurance carrier.

While all insurance companies are required to abide by federal and Oklahoma state insurance laws, subtle differences in the appeal process do exist. Understanding the specifics set forth by the company with which you are working is critical to improving your chances for your appeal to be accepted.

The Insurance Claim Appeal Process

If your health insurance claim has been denied it is important to recognize that you do not need to accept your carrier’s decision as final. In fact, formal appeal processes exist within all insurance companies. That said, these processes are rarely simple, and they must be strictly adhered to in order for your case to even be reviewed. Below is a brief overview of the steps that comprise the health insurance appeal process.

• Denial letter received. By law this notification must be in writing and must document the reason for the denial.
• Filing of an internal appeal letter. This letter, often drafted with the assistance of a denied claims attorney, should clearly identify reasons why the denial was unfounded and state the ideal resolution.  Providing additional information including documentation from the policyholder’s physician, medical research, and copies of all communication is important.
• Insurer Review: During this time period, the insurance company will review your claim along with the additional information you provided
• Insurer Communication of Decision: A decision letter will be issued within a specified time period (depending upon the circumstances of your appeal).  This letter will either approve your claim or deny it once again.
• External Appeal: If you are unhappy with the internal appeal decision, you do have the right to file for an external appeal. 

If you are unable to come to a satisfactory agreement, and you believe your insurance company’s decision was unethical in nature, you do have the option to file a bad faith insurance lawsuit in pursuit of the settlement to which you believe you were entitled, as well as any damages incurred because of the delay in payment. In situations like this, engaging the counsel of an Oklahoma insurance bad faith claims attorney is in your best interests.

How an Insurance Lawyer Can Help

Managing the Appeal Process Is Complicated

Individuals facing denied insurance claims, of any type, have the right to file an appeal. It is important to recognize that the appeal process is composed of multiple steps and requires gathering a great deal of information. Submitting these letters appropriately, and in accordance with the time limits for appealing denied insurance claims, can be positively impacted by engaging the services of an Oklahoma denied insurance claims attorney.

These professionals not only understand the laws that guide denied claim appeals, but they also know how to draft clear and concise appeal letters that contain all necessary information.  Additionally, in those cases where appeal letters are unsuccessful, they can take the lead in filing a bad faith lawsuit, if appropriate.

Contact Doug Terry Law Today

For decades, Attorney Doug Terry  and his team have provided hands-on, quality guidance to individuals in Oklahoma who have been disappointed in their insurance company’s decisions.  They know how to handle the appeal process and are well-aware of all associated filing deadlines.

If your insurance claim has been denied you may be facing overwhelming costs and life-changing implications. You don’t need to accept your insurance company’s decision as final; appeal processes exist for just this purpose.  Contact Doug Terry Law today 405-463-6362 to schedule a free consultation during which Mr. Terry can review your specific case and share how he would address your situation.  Choosing with whom to work is an important decision as you move forward.  Take into account Mr. Terry’s reputation in the community and learn why so many engage him and his team.