PR-27
Depends on the detailsExpenses incurred after coverage terminated
Group PR — Patient Responsibility — an amount the plan says may be billed to you, the patient.
PR-27 means the insurer believes the service took place after your coverage ended, so it isn't covered. It's billed as Patient Responsibility (PR).
This is very often a data error. Coverage end-dates can be wrong in the insurer's system — because of a delayed enrollment update, a COBRA election, or a mistaken termination — and those cases are appealable.
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Why you're seeing PR-27
- The insurer's records show your coverage ended before the date of service.
- An enrollment or reinstatement update hadn't processed yet.
- A COBRA or special-enrollment continuation wasn't recorded.
- The termination date in the system is simply wrong.
Can you appeal it?
Very appealable when coverage was actually active on the date of service — the fix is proving your true coverage dates.
What to do next
- 1Confirm your actual coverage effective and end dates with your employer or the plan.
- 2Gather proof that coverage was active on the date of service.
- 3If you elected COBRA or had a qualifying event, provide that documentation.
- 4Appeal with proof of active coverage; ask the insurer to correct the termination date and reprocess.
Evidence that helps
- Enrollment records or an eligibility letter showing active coverage on the service date.
- COBRA election paperwork or premium-payment proof, if applicable.
Frequently asked questions
What if my coverage was actually active?
Then PR-27 is likely a records error. Get written confirmation of your true coverage dates from your employer or the plan, and appeal asking the insurer to correct the termination date and reprocess the claim.
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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.