What are the DOL timeframes for notifying members of determinations on appeals?

The timeframes are:

  • Pre-service claims not later than 30 calendar days after receipt of the request for review (or 15 calendar days for each appeal step) 
  • Urgent care claims as soon as possible taking into account the medical urgency but not later than 48 hours after receipt of the request for review. 
  • Post-service claims not later than 60 calendar days after receipt of the request for review (or 30 days for each appeal step) 

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