UNCONTESTED PORTION OF CLAIM DENIAL

California HMOs

A health plan is required to reimburse any uncontested portion of a claim (e.g. emergency services) within 30 working days from the date of receipt. Health Maintenance Organizations (HMOs) are required to reimburse any uncontested portion of claim within 45 working days from the date of receipt. A plan's repeated failure to reimburse uncontested portions of claims within these timeframes constitutes an "unfair payment pattern."

This content is not viewable.

For full features, please log in or purchase the full program.