BillSherpa · Patient Advocacy · Updated 2026

Insurance company keeps stalling my claim — how long do they legally have to respond?

Insurance companies are legally required to process claims within specific timeframes. "We're still reviewing it" is not an indefinite excuse. Here are the actual deadlines — and what to do when your insurer misses them.

Federal deadlines for claim processing

Under the Employee Retirement Income Security Act (ERISA) and the ACA, employer-sponsored health plans are subject to these federal claim processing timeframes:

• Initial claim decision: 30 days for non-urgent pre-service claims. Can be extended once by 15 days with written notice to you.
• Urgent care claims: 72 hours maximum.
• Concurrent care (ongoing treatment) claims: 24 hours if the claim involves a sudden reduction or termination of ongoing care.
• Post-service claims (bills after care already received): 30 days. Can be extended once by 15 days with notice.

What counts as "stalling" vs legitimate delay

Legitimate delay scenarios include:

• The insurer is waiting for additional information from your provider and has notified you
• The insurer sent a notice extending the review period within the allowed timeframe
• You submitted incomplete information with the initial claim

Stalling scenarios that may violate the law include:

• No response after 30+ days with no extension notice
• Multiple extension requests beyond what's permitted
• Requests for the same information repeatedly without acting on what you've already submitted
• Vague denials without the specific reason required by law

How to hold your insurer accountable

1. Document everything. Keep records of every call (date, time, representative name, what was said), every letter received, and every piece of information you submitted. This paper trail is critical.
2. Send a formal written complaint to the insurer. Write to the appeals department (not just customer service) stating that the claim has exceeded the legally required processing time and demanding a response within 10 business days. Send certified mail.
3. File a complaint with your state insurance commissioner. This is the most effective lever. Insurance commissioners investigate complaints against insurers and have authority to impose fines. Most state insurance departments have online complaint portals. File one.
4. File a complaint with the Department of Labor. If your plan is an employer-sponsored ERISA plan, the Department of Labor has jurisdiction. File at dol.gov/agencies/ebsa.
5. Contact your employer's HR department. If this is a work-sponsored plan, HR has a relationship with the insurer and can sometimes intervene to escalate your claim.

If the delay is causing financial harm

If the insurer's delay is causing you immediate financial hardship — the bill is going to collections, a service is being denied, or you're being asked to pay out of pocket for ongoing care — tell the insurer and document it. Some state laws allow patients to recover damages including attorney fees for bad faith insurance delays when financial harm results.