CO-185Contractual Adjustment
Denied because the procedure or treatment is deemed experimental
What this code means
Your insurer considers the treatment or procedure experimental or investigational and therefore not covered under your plan.
What to do next
Request the specific clinical criteria your insurer used to make this determination. Appeal with peer-reviewed medical literature supporting the treatment and a letter from your physician. Check whether your state has a clinical trial coverage mandate.
Appeal outlook: Moderate with strong clinical literature
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