This service or item is not covered under your health plan. This is one of the broadest denial codes and can cover a wide range of excluded services.
Review your plan documents and Summary of Benefits to confirm the exclusion. If you believe the service should be covered, appeal with documentation. Also check whether your state has a mandate requiring coverage for this service.
Appeal outlook: Low to moderate depending on service type
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Bill Advantage can analyze your denial and generate a ready-to-send appeal or dispute letter in minutes.
Open Denial Letter TranslatorDenial codes on your EOB explain why a claim was denied. Learn what the most common codes mean in 2026 and the exact steps to fix or appeal each one.
Read articleWhat to Do When Insurance Denies a ClaimInsurance denied your claim? Learn the exact steps to appeal a health insurance denial in 2026, from reading the denial letter to external independent review.
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