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 72 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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