07/23/2025    Paul Kesselman, DPM

Third-Party Deadlines

How long does an insurance company have to process
and pay a claim? We have had several instances
here in NY where insurance companies don't
acknowledge receipts of claims processing nor pay
the claims for months. What can I do to force them
to process/pay these claims?

NY Podiatrist

Response from thedoctorline.com: In NYS, generally
speaking an insurance company has 30 days to
process a claim. However, that does not mean
actually pay the claim. There are a myriad of
reasons why a claim may require further processing
prior to it being paid. If you have not received
any correspondence from the carrier 30 days after
submission of the claim, they may be in violation
of NYS regulations.

If continued correspondence from the insurer fails
in securing any acknowledgment from the carrier
that they have received the claim, you might want
to contact the NYS Attorney General's Health Care
fraud bureau for assistance.

Please note that this process will be further
enabled with a letter to the NYS Attorney
General's office from either your patient or their
employer's health insurance officer.

This fraud bureau will likely not be able to
assist you with Worker's Compensation or ERISA
plans, nor Medicare or Medicaid Advantage Plans.

Note again that if the claim is being held up
because they don't have requested information from
you (e.g.claim is under pre payment review or you
have not responded to their requests for more
information or there is an error on the claim)
that is on you and not a failure of the insurer.

For more information on NYS regulations of
insurance carriers, see:

https://www.dfs.ny.gov/consumers/health_insurance/
rights_responsibilities

Note that other states may have different
regulations and if you practice in New York but
the claim is being sent to another state, the
regulations in NY may or may not apply.

Paul Kesselman, DPM, Oceanside, NY

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