PR-2
Depends on the detailsCoinsurance amount
Group PR — Patient Responsibility — an amount the plan says may be billed to you, the patient.
PR-2 is your coinsurance — the percentage of the allowed amount you're responsible for after meeting your deductible (for example, 20% of the cost). It's a normal cost-share, not a denial.
As Patient Responsibility (PR), you generally owe it. Worth verifying is whether the coinsurance percentage and the allowed amount it's calculated from are correct.
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Why you're seeing PR-2
- Your plan splits covered costs with you after the deductible, and this is your percentage.
- The service is subject to coinsurance rather than a flat copay.
Can you appeal it?
Normally a valid cost-share — appeal only if the coinsurance rate or the allowed amount it's based on is wrong.
What to do next
- 1Confirm the coinsurance percentage matches your plan's benefits.
- 2Check that it's calculated on the plan's allowed amount, not the full billed charge.
- 3Ask for reprocessing if the percentage or base amount is incorrect.
Evidence that helps
- Your plan's Summary of Benefits showing the coinsurance rate.
- The EOB showing the allowed amount used for the calculation.
Frequently asked questions
How is coinsurance different from a copay?
A copay is a fixed dollar amount; coinsurance is a percentage of the allowed amount. PR-2 is coinsurance — for example, 20% of what the plan allows for the service after your deductible is met.
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Other common denial codes
Last reviewed July 18, 2026. Denial-code lists (CARC/RARC) are updated three times a year; we review these explanations against the current list.
Sources & references
These explanations are written in plain language and based on the authoritative sources below. Always confirm the specifics against your own plan documents and denial letter.
- ASC X12 — Claim Adjustment Reason Codes (CARC)
The standards body that maintains the official CARC list (the CO/PR codes), updated three times a year.
- CMS / X12 — Remittance Advice Remark Codes (RARC)
The remark codes (N-/M- codes) that accompany a CARC and give the specific reason for an adjustment.
- HealthCare.gov — Appealing a health plan decision
Official overview of internal appeals and external review rights for Marketplace and most private plans.
- Your state's insurance regulator
State agencies enforce external review and consumer protections; find yours via the NAIC directory.
Important: this is not legal or medical advice.
AppealBrain is a free, self-help tool that helps you draft an appeal letter using the information you provide. We are not a law firm, medical provider, or insurance company, and using this tool does not create an attorney–client relationship. Appeal rules and deadlines vary by plan and state — always review your own denial letter and plan documents, and consider consulting a licensed professional for your specific situation. We do not guarantee any outcome.