PR 204 Denial Code|Not Covered under Patient Current Benefit Plan

We have already discussed with great detail that the denial code stands as a piece of information to the patient of the claimant party stating why the claim was rejected. Today we discussed PR 204 denial code in this article.

When it comes to the PR 204 denial code, it usually indicates all those services, medicines, or even equipment that are not covered by the claimant’s current benefit plan and yet have been claimed.

For example, if you supposedly have a gallbladder operation and your current insurance plan does not cover that claim, it will come rejected under the PR 204 denial code.

Another specification that could be covered under the same segment is that the claimed product or service was not medically required at the moment and hence the claim will not be passed.

Most insurance companies have their own experts and they are the people who decide whether or not a particular service or product is important enough for the patient.

What to Do If You Find the PR 204 Denial Code for Your Claim?

If your claim comes back with the denial code 204 that is really nothing much that you can do about it. In case you are very sure and your agent also says that the plan or product is covered under your medical claim and the rejection has been made on the wrong grounds, you can contact the insurance company at the earliest.

In most cases, there is no stand for confusion because all the inclusions, as well as exclusions, are mentioned in detail in the policy papers. However, in case of any discrepancy, you can always get back to the company for additional assistance.

The denial code 204 is unique to the mentioned condition. Hence, before you make the claim, be sure of what is included in your plan.

How to handle PR 204 Denial Code in Medical Billing

If you received the denial on the claim that PR 204 or Co 204 – service, equipment and/or drug is not covered under the patient’s current benefit plan, in that case, if pat has secondary insurance then claim billed to sec insurance otherwise claim bill to the patient because the patient is responsible if any service is not covered under the patient insurance plan.

FAQ- Frequently Asked Questions

Q1. What is Medicare 204 Denial Code?

Ans. The medicare 204 denial code is quite straightforward and stands for all those medicines, equipment, or services that are not covered under the claimant’s current insurance plan.

Q2. Can I contact the insurance company in case of a wrong rejection?

Ans. Yes, you can always contact the company in case you feel that the rejection was incorrect. However, check your policy and the exclusions before you move forward to do it.

Q3. Is the PR 204 denial code and the medicare 204 denial code the same thing?

Ans. Yes, both of the codes are mentioned in the same instance. Both of them stand for rejection of term insurance in case the service was unnecessary or not covered under the respective insurance plan.