How Do Healthcare Insurance Companies Pay Out Medical Claims in Texas?

by Isabella Bautista Area Manager

In the State of Texas, Healthcare Insurance Companies must pay out medical claims within 5 business days of approving a medical claim, But, there are a few steps the insurance company must go through before they approve a medical claim. On average, the entire process should take around 35 business days from when you submit your medical claim, to when you're paid. Let's take a look at how that breaks down:

01. Notice of Medical claim

After you submit a medical claim to your insurance agency (not sure how? Check out this blog: you've experienced a loss, now what?), they have 15 business days to respond. In those first 15 days, your insurance agency must:

Acknowledge that they received the medical claim

Begin their investigation

Request any and all relevant information from you in order to continue with the medical claim investigation.

This is the setting-up phase of the process. At this point, your insurance agency is collecting the documents they need to evaluate your insurance medical claim.

02. Make A Decision On Medical claim

In the State of Texas, Healthcare Insurance Companies have another 15 business days to make a decision on your medical claim after they have received any additional documentation from you.

During this time, your insurance agency will review the documents you've provided and decide whether to approve or deny your medical claim.

03. Pay Out Your Medical claim

Once your insurance agency has approved your medical claim, they have 5 business days to make the final payment to you.