What are the laws pertaining to prompt payment, and what recourse do I have if plans fail to comply with these laws?
Non-HMO health plans such as PPOs are required to pay non-contested insurance claims within 30 working days of receiving claims. Knox Keene health plans including HMOs and IPAs are required to pay claims within 45 working days. (This assumes, however, that you have not agreed to a payment time frame greater than these limits in any contracts you may have signed with HMOs and other insurers.) Knox Keene health plans and IPAs that pay claims late are required by law to pay 15% interest per year on all late payments beginning on the first day after the 30-day (or 45-day) window. In addition, Knox-Keene plans that fail to pay interest automatically are subject to a $10 per claim surcharge (Health and Safety Code section 1371). Health insurers are required to pay interest at 10% annually (Insurance Code section 10123.13.)Non-HMO health plans must notify providers within thirty working days if a claim is to be contested or denied. HMOs must do the same within 45 days. If you receive neither
