Is my appeal of denial timely, or am I too late?

[phoenyx]

What is the name of your state (only U.S. law)? MI

An appeal was submitted to an insurance company approximately 200 days after an initial denial. The insurance company is denying the appeal as being untimely. (The applicable section of their policy terms is below, in italics.) We didn't spend every waking moment on the appeal, but we also didn't move extremely slow on it. It took some time to retain appropriate and affordable legal council, and see additional doctors to firm up my appeal. I know it could have been sent in quicker.

I'm fighting the appeal denial. I am wondering if we in trouble with the "it must be given as soon as possible" clause included below, or since the appeal was well within one year, <u>should</u> we be OK. I underline "should" because I know anything can happen with insurance company appeal processes. I'm just looking for whether people think I screwed up the timeframe and should be denied, or if I should be considered timely.

You must submit an appeal to <us> within 30 days of our denial. If it is not possible for you to give us your appeal within this 30-day period, it must be given as soon as possible. However, your appeal must be given no later than one year after the time the appeal is otherwise requested.

 

[ecmst12]

You did not have to wait to have all your ducks in a row to submit notice of appeal. You should have, and COULD HAVE, submitted it within the 30 days, and provided the additional medical information as you received it. But at least you would have started the process and most importantly, they would have been aware of your appeal. I don't think your reasoning for taking over 6 months to turn in the appeal will be considered valid.

 

[phoenyx]

Thanks for your reply. I was looking for an honest opinion, not for someone to sugar coat it.

If anyone else agrees or has a different opinion, I would appreciate hearing from them as well.

 

[cbg]

I have to agree. When 30 days is the standard, 200 days, in the absence of some compelling reason why you COULD NOT submit the appeal within the time frame, is too long.

 

[jwmc1701]

Usually the most judicious of appeal timeframes is 180 days, so even going by that, you missed it by 20 days.