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Denial code CO-198: what it means and what to do

Denial code CO-198 on your Explanation of Benefits: The service went beyond what the authorization approved.

What CO-198 means

The service went beyond what the authorization approved.

CO means contractual obligation: under its contract, the provider is usually responsible for this amount, so an in-network provider generally should not bill you for it.

What to do

Ask your doctor's office whether they requested authorization. They can often request it after the fact or appeal for you.

If it was emergency care, health plans cannot require prior authorization.

Your deadline

Most plans give you 180 days from the denial notice to file an internal appeal. Original Medicare gives 120 days from the Medicare Summary Notice, and Medicare Advantage plans 65 days from their decision. Check the date printed on your letter.

More on this reason: No prior authorization.

Other denial codes

• CO-50
• CO-197
• CO-15
• CO-16
• CO-18
• CO-97
• CO-4
• CO-11
• CO-29
• CO-96
• CO-204
• CO-119
• CO-167
• CO-55
• CO-242
• CO-22
• CO-109
• CO-27
• CO-26
• CO-31
• CO-45
• PR-1
• PR-2
• PR-3

Sources

1. HealthCare.gov: Internal appeals
2. 29 CFR 2560.503-1, claims procedure for employer health plans