How long are claimants given to file an appeal of the claim denial?
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A) 150 days
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B) 180 days
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According to the Department of Labor, the plan's claims procedure must provide for a full and fair review of a benefit claim if a claimant files an appeal of the denial. The minimum standards for appeals are:
- Claimants must be given 180 days to file an appeal;
- A de novo review, that is, a review that affords no deference to the initial determination, must be conducted;
- When the denial is based on determinations of whether a particular treatment, drug or other item is experimental, investigational, or not "medically necessary," the reviewer must consult with a qualified health professional (and others as needed);
- No more than 2 appeals levels are allowed; and
- Mandatory binding arbitration of claims is generally prohibited. However, non-binding arbitration would be permissible if done within the required timelines.
C) 200 days
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D) 250 days
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