PR-27 Denial Code: Coverage Terminated

The official definition

“Expenses incurred after coverage terminated”

That is the verbatim definition of CARC 27 from the X12 Claim Adjustment Reason Code set, the standardized codes every insurer uses on EOBs and remittance advices. The letters in front of the number are the group code. PR: Patient Responsibility: the insurer says you owe this amount. Verify it against your plan before paying.

What it means in plain English

The insurer says you weren't covered on the date of service: your coverage had ended. Sometimes that's true (job change, missed premium, aging off a parent's plan). But insurer enrollment records are wrong often enough that this denial deserves verification, especially around job transitions, COBRA elections, and plan-year changes.

What to check on your EOB

• Your actual coverage status on the date of service: enrollment confirmations, premium payment records, employer HR records.
• Whether a retroactive termination occurred: coverage cancelled back to an earlier date than you were told.
• If you elected COBRA: whether the election and payments were processed correctly.

What to do next

1. If you were covered, send the insurer proof (enrollment confirmation, premium receipts, or an employer verification letter) and ask them to reprocess the claim.
2. If coverage was retroactively terminated incorrectly, file a complaint with your state insurance department, or the Department of Labor for employer plans.
3. If coverage genuinely lapsed, ask the provider about self-pay rates and financial assistance. The insured rate no longer binds them, but neither does the chargemaster price bind you.

Who's responsible

You. Most denials carry a clear owner. Knowing whether the fix belongs to you, your doctor, or the billing office is half the battle. If it's the provider's error, you should not be paying for it.

Want the fundamentals first? Start with how to read an EOB and the 7 most common billing errors. This page is general information about standardized denial codes, not legal or medical advice.