AHIP Practice Exam

What is the timeframe Mrs. Duarte has to file an appeal of her claim?

1. 60 days from receipt of the notice

2. 90 days from the date of service

3. 120 days from receipt of the notice

4. One year from the date of service

The correct answer is: 120 days from receipt of the notice

Mrs. Duarte has a 120-day timeframe from the receipt of the notice to file an appeal of her claim. This period is established under federal regulations governing health insurance practices, which dictate that members must be notified of their claim determination and given a specified timeframe within which to contest that decision. The 120 days allows claimants adequate time to gather necessary information, consider their options, and prepare their appeal, ensuring due process in the insurance claims process. This timeframe is crucial for maintaining members' rights and providing a structured way for disputes to be addressed. Other timeframes, such as 60 days or 90 days, would be insufficient and not compliant with these regulations, while a one-year timeline exceeds what is legally required, making it impractical in the context of timely claims management.