There's a denial on my EOB — what do I do?
Diagnose the CARC code, then either appeal or accept based on whether the code is appealable.
When your EOB shows a denial, the CARC code (Claim Adjustment Reason Code) explains why. Some denials are easily appealable (CARC 50 medical necessity, CARC 55 experimental, CARC 197 prior auth absent). Others are usually NOT appealable (CARC 1-3 deductible/coinsurance/copay, CARC 26 expenses prior to coverage). Look up your specific CARC code at DenialHelp.
Frequently asked questions
How do I know if my denial is appealable?
Look up the CARC code at /how-it-works/codes/carc/[code]. Each code page shows whether the denial is typically appealable.
What's the deadline to appeal?
Federal floor is 180 days from the denial date (ACA §2719 + ERISA §503). Some plans set tighter deadlines for specific claim types — check your plan documents.
More EOB guides
- EOB vs bill — what's the difference?Don't confuse them. EOB is informational; bill is what you actually pay.
- How to read your Explanation of Benefits (EOB)Your EOB is the statement your plan sends after processing a claim. Here's what
- My EOB shows I owe money — what does it mean?Several reasons you might owe — and some are appealable.
- Secondary insurance EOB — what does it mean?When you have two plans, both send EOBs. Read them in the right order.
Get help with your EOB
Upload the EOB and any denial — DenialHelp helps reconcile and appeal.
Get started →Contact: hello@denialhelp.com