State RegulationsNC specificDifficulty 2/5
A North Carolina health insurer's policy requires claims to be filed within 60 days after the date of service. Under G.S. 58-3-225(f), is that filing window enforceable?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under G.S. 58-3-225(f), insurers may require claims to be submitted within 180 days after the date of service (facility claims: 180 days after discharge) but may not require fewer than 180 days, so a 60-day requirement is unenforceable. Late filing remains possible when not reasonably possible, never later than 1 year.
Why the other options are wrong
- B) The statute fixes a floor of 180 days under G.S. 58-3-225(f); insurer discretion ends at that minimum.
- C) Prompt-payment obligations and the filing floor operate independently; discretionary deadlines cannot undercut the 180-day minimum.
- D) The floor is 180 days, not 90; a 90-day cap is not the North Carolina rule.
Memory hook
180 is the floor; insurers cannot go lower.