Get Your Money (Insurance Claim Follow Up Guide)

This guide is to help you follow up on the claim process with your insurance company.  Listed below are some facts, recommended actions and contacts.

Fact: 

NC General Statute 58-3-225 states:   “An insurer shall, within 30 calendar days after receipt of a claim, send by electronic or paper mail  to the claimant:

 (1)  Payment of the claim.

(2)  Notice of denial of the claim.

(3)  Notice that the proof of loss is inadequate or incomplete.

(4)  Notice that the claim is not submitted on the form required by the health benefit plan, by the contract between the insurer and health care provider or health care facility, or by applicable law.

(5)  Notice that coordination of benefits information is needed in order to pay the claim.

(6)  Notice that the claim is pending based on nonpayment of fees or premiums.”

Recommended Actions & Contacts:

• Ask us for an emailed copy of the receipt confirmation of your electronic claim verifying that your insurance company received your claim.
• Contact your insurance company to confirm that the claim was processed.  If excuses are made due to a lost, denied or delayed claim then register a written and dated complaint with the insurance carrier and with your employer’s human resources department.
• Register a written and dated complaint with North Carolina Department of Insurance (NCDOI):
          a.  Visit www.ncdoi.com and click on the green check mark “File a Complaint”
          b.  Call NCDOI at (919) 807-6750 and follow the prompts.
• Be persistent, patient and pleasant and take good records of your communication efforts.  If you are not getting the service you feel like you deserve, ask for a supervisor until you reach someone who can resolve your concerns.