So often I talk to people that have worked themselves up in a tizzy because they received one response from their insurance and another from their provider's office on a claims issue. While it is entirely possible to call back three times and get three different answers, often times the discrepancy in answers can be attributed to time lapses.
The typical time period for a provider to enter smaller charges into their system is two days. Surgeries and more complicated bills can take up to a month. Once charges are entered into the system, it takes an average of two to three days before the claim actually arrives at the insurance company's electronic claims system.
The usual time that it takes an insurance company to process a clean claims is 14-30 days.It takes 60-90 days at best for a claim to be reprocessed by the insurance company.
Most of the time patients will receive their explanation of benefits before the provider's office receives their copy along with any payment. This is true for the initial processing as well as claims that are reprocessed.
Depending on staffing and set up, it can take anywhere from a week to a month for a provider's office to post a payment or to post an insurance response to an account. The time period for a claim's issue to actually be reviewed and worked can range anywhere from a month to three months.
Because of these lapses in time, it's not uncommon for statements and insurance responses to cross in the mail. When this happens, a patient may get a statement for a claim that's already been reprocessed.
In order to be efficient at getting your claims issues resolved, and to keep your blood pressure in check, it pays to understand the common time lines that providers and insurance companies work on. This will help you determine if what you've received or have been told is up to date and the final answer.