State RegulationsNC specificDifficulty 1/5
A North Carolina insurer receives a health insurance claim from an insured. Under G.S. 58-3-225, within how many calendar days after receiving the claim must the insurer pay it, deny it, or request additional information?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under G.S. 58-3-225(b), the insurer must pay, deny, or request information within 30 calendar days of receiving a claim, and a mailed or electronically transmitted claim is presumed received five business days after it was sent. If the insurer pays late without reasonable cause, G.S. 58-3-225(e) imposes interest at 18% per annum on the unpaid amount, so the deadline carries real financial consequences.
Why the other options are wrong
- A) 15 days is the window for the insurer to furnish claim forms after notice of claim under G.S. 58-51-15(a)(6), not the pay-or-deny deadline.
- C) 60 days is the trigger for a claim status report on an unpaid, undenied provider claim under G.S. 58-3-225(g), not the initial decision window.
- D) 90 days is the period after which information requested by the insurer is treated as not received, allowing denial under G.S. 58-3-225(c).
Memory hook
Pay, deny, or ask within 30 days - late money costs 18% a year.