What is the required action if a health insurance claim is not paid promptly?

In South Carolina, if a health insurance claim is not paid promptly, the appropriate course of action is to wait for 60 days. This timeframe is established to ensure that the insurer has adequate time to review the claim and process it. If payment has not been received within this period, it is typically advisable for the claimant to follow up with the insurer to understand the cause of the delay. The 60-day rule helps establish a reasonable expectation for both insurers and insured individuals regarding the processing timeline of claims, ensuring that claims are handled efficiently and fairly.

Waiting for longer periods, such as 90 or 120 days, is usually unnecessary under typical circumstances, as the stipulated time is designed to balance the need for adequate processing time with the rights of claimants to receive prompt payments. Thus, a 60-day wait is the correct and most punctual approach when expecting a health insurance claim to be resolved.