BillSherpa · Emergency & Panic Guides · 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

• Non-urgent pre-service claims: 30 days. Can be extended once by 15 days with written notice to you.
• Urgent care claims: 72 hours maximum.
• Concurrent care claims: 24 hours if involving a sudden reduction or termination of ongoing care.
• Post-service claims: 30 days. Can be extended once by 15 days with notice.

How to hold your insurer accountable

1. Document everything — every call with date, time, representative name, and what was said.
2. Send a formal written complaint to the appeals department (not just customer service) stating the claim has exceeded the legally required processing time. Send certified mail.
3. File a complaint with your state insurance commissioner — the most effective lever. They have authority to impose fines.
4. File a complaint with the Department of Labor if this is an ERISA employer-sponsored plan at dol.gov/agencies/ebsa.
5. Contact your employer's HR department — they have a relationship with the insurer and can sometimes escalate your claim directly.