Denied: coverage had ended
The plan says your coverage wasn't active on the date of service. Check the dates: coverage often ends at month's end, and retroactive cancellations have limits.
Official meaning (X12 code 27): Expenses incurred after coverage terminated.
Who pays
PR-27. Patient responsibility: the plan says this part is yours to pay (deductible, copay, coinsurance, or a non-covered service).
What to do
- Compare the service date with your coverage dates.
- If you were covered (for example during a grace period or COBRA election window), appeal with proof.
- A plan can't cancel coverage retroactively except for fraud or unpaid premiums.
If you appeal
Ask for the plan document section the denial relies on. Denials often hinge on a definition that your situation fits better than the reviewer assumed. State mandates may also require coverage.
Deadlines for the first appeal
- employer plan
- 180 days from the notice
- ACA Marketplace plan
- 180 days from the notice
- Medicare Advantage plan
- 65 days from the notice
- Original Medicare
- 120 days from the notice
- Medicaid
- 60 days from the notice
The date printed on your notice controls. Urgent care can be appealed on an expedited (72-hour) basis.
What the data show
Averages across all denials; not a prediction for yours.
Appeal this denial
Upload your denial. We draft the appeal around this code, you approve it, and we fax it to your plan and mail a certified copy. Free check first, then $59.
General information, not legal or medical advice. Owed is a document-preparation and sending service, not a law firm.