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What is an urgent claim?

Urgent care claims are filed by doctors to require an insurance company to review a claim more quickly than the normal time permitted, because the patient's life could be in danger if the claim isn't decided quickly.

Here are some important points about urgent care claims.
  • Urgent claims must be reviewed as soon as possible, taking into account the medical needs of the patient, but not later than 72 hours after the plan receives the request.
  • If the plan needs more information to decide the claim, they must request the information within 24 hours; you will have no less than 48 hours to respond.
  • The plan must render a decision within 48 hours after the missing information is supplied or the time to supply it has elapsed. The plan cannot extend the time to make the initial decision without your consent.
  • The plan must give you notice that your claim has been granted or denied before the end of the time allotted for the decision. The plan can notify you orally of the benefit determination as long as a written notification is furnished to you no later than three days after the oral notification.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.