Exemptions to the Individual Mandate
There are some cases where there is no penalty to not having coverage.
In general, an insurer has 30 days to either pay a clean claim or send a notice to the provider. The notice would state why the payment has been delayed or denied.
Failure to follow this part of the act results in the accrual of interest equal to 1% per month of the billed charges. The interest is payable to the provider, individual, or entity submitting the claim.
An insurer may ask for extra information on an unpaid claim. However, they must do so within the first 30 days. When the insurer gets the extra information, they have 15 days to pay or deny the claim.
Again, failure to follow this part of the act results in the accrual of interest equal to 1% per month of the billed charges.
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The law applies to fully insured health plans including plans offered by HMOs. Plans typically covered include:
Individual or group major medical plans
Hospital /surgical policies
Organizations paying claims for fully insured plans
Such as Third Party Administrators.
The law does not apply to any of the following types of health related medical claims. Some plans not covered:
Self-insured employer plans
Medicare/Medicare supplement policies
Federal employee plans
Vision or drug plans
Medical claims paid by auto or homeowners insurance
Providers or covered individuals must give companies at least 30 days to respond to a claim.
During that time, the insurance company cannot ask for extra information regarding a claim.
They must notify you of this action within the 30-day time period.
If you don’t receive payment or a notice of delay within 30 days, the law allows you to file a written complaint.
If the insurance company asks for extra information, it has 15 days from when it received the required information to pay or deny the claim.
In situations where extra information is asks for, we suggest you check with the insurance company to see if the extra information was received.
You can then file complaints if you think the 15-day response time has expired.
To report a slow claim payment, send a written notice to the Kansas Insurance Department.
The complaint checklist below tells you what information to include.
You will be notified as soon as our Consumer Assistance Division begins investigating the claim.
You will also be notified of the results of the investigation.
Submit complaint in writing. While no special form is required, including the following information would help hurry the process:
Date the claim was sent to insurance company or date company acknowledged receipt
How the claim was submitted - electronically or by mail
Copy of the claim
Brief description of your attempts to collect
Copies of any written notices or other correspondence
Submit the claims for each patient together
Identify the complaint as "Prompt Pay"
Kansas Insurance Department
Consumer Assistance Division
420 SW 9th St.
Topeka, KS 66612
If you have questions, contact the Consumer Assistance Division of the Kansas Insurance Department:
Toll-free Phone Number: 800-432-2484
This article is published on KansasMoney.gov. Find more information by contacting these state agencies: