After how many days can legal action be taken against an insurer if a health insurance claim remains unpaid?

In Pennsylvania, a health insurance claim that remains unpaid for 60 days allows the claimant to take legal action against the insurer. This 60-day timeframe is significant because it provides insurers a reasonable period to review and process claims. After this duration, if the claim remains unresolved, it typically indicates a lack of communication or action on the insurer’s part, thus providing grounds for the claimant to seek legal remedies.

This rule serves to balance the interests of both the insured and the insurer. The insured has a clear timeline to expect a response on their health claims while also having the right to seek redress if the insurer does not fulfill their obligations in a timely manner. In contrast, choices like 30, 45, and 90 days do not align with the standard timeline established in Pennsylvania law, which can lead to confusion about when a claimant can rightfully initiate legal proceedings.