Home › Denial codes › CO-242
Denial code CO-242: what it means and what to do
Denial code CO-242 on your Explanation of Benefits: The services weren't provided by network or primary care providers.
Check my letter freeWhat CO-242 means
The services weren't provided by network or primary care providers.
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
Under the No Surprises Act, emergency care, and care from out-of-network doctors at in-network hospitals, are generally covered at in-network rates.
If no in-network provider was available, ask the plan to cover the care at the in-network level.
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: Out of network.
Other denial codes
- CO-50
- CO-197
- CO-198
- 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-22
- CO-109
- CO-27
- CO-26
- CO-31
- CO-45
- PR-1
- PR-2
- PR-3