Find a denied claim on your EOB and read the reason behind it
A denied claim on an explanation of benefits is a service the plan declined to pay, usually shown with nothing in the plan paid column and a short code that points to the reason. Ask Search+ "Which services on this EOB were denied, and what reason does the statement give for each?" and the answer cites the claim line, the code and the code's description, so you can read the insurer's wording before you call anyone.
Creating an account needs no payment.
Last updated October 2026
How to track down denials with Search+
- Upload every statement for the episode of care
A single hospital stay or course of treatment can produce several EOBs, one per provider or per claim. Put all of them in one workspace, PDFs from the portal and scans of the ones that came by mail alike, together with any letter the insurer sent about the decision, so a denial on one statement is not read in isolation.
- Ask about full and partial denials as separate questions
First ask which whole claims were denied, then ask which individual service lines were denied while the rest of the claim was paid. Partial denials are easy to miss in a long grid, and a separate question brings each one out with its own citation.
- Follow the code to its explanation and the appeal notice
Open the citation for each denied line. If the answer quotes a code, ask a follow-up about what the code key says and what the statement tells you about requesting a review, so that wording is in front of you as well.
Questions to ask about denied claims
Which claims or service lines on this EOB show a plan payment of zero, and are they marked as denied or as pending?
What explanation does the EOB give for the denial of the imaging on this date, and which code is it tied to?
Does the statement say the service was denied because a prior authorization or referral was missing?
For the denied lines, does the EOB list the amount as patient responsibility, or does it say the provider may not bill me for it?
What does this EOB say about how to appeal a denial, where to send it and what deadline applies?
Across all the EOBs in this workspace, which denials share the same reason code?
What to look for in a denied claim
A whole claim can be denied, or one line can be denied while others are paid. Some statements also show claims that are pended for more information, which is not the same as a denial. Read the status wording on each line rather than relying on a zero in one column.
Common categories include a service the plan does not cover, missing prior authorization, an out-of-network provider, a coding or billing error, a duplicate submission, an eligibility problem or a request for more information. The code key on the statement says which one applies to your line.
Reason and remark codes are often defined at the bottom of the page or on the last page of the EOB. Ask for the code and its description in one question so the answer cites both places.
Many EOBs include a section on how to request a review of a decision. Deadlines and steps vary by plan and by place, so read the wording on your own statement and confirm it with the insurer rather than assuming a standard rule.
Search+ finds passages by meaning, so a question about rejected services can still find lines labeled with other terms. Each answer cites the excerpt it used, and AI answers can be incomplete, so open the citation before you act.
Denial wording you may see on an EOB, and what to ask next
| Wording you may see | What it usually signals | A follow-up question |
|---|---|---|
| "not a covered benefit" or "not covered under your plan" | The plan treats the service as outside its coverage | Which coverage term does the statement or plan document point to? |
| "prior authorization required" or "no authorization on file" | Approval was expected before the service | Does the EOB say who was responsible for getting the authorization? |
| "out of network" | The provider is outside the plan's network | How does the statement treat this provider's charges compared with in-network ones? |
| "duplicate claim" | The insurer believes it already processed this service | Is there an earlier EOB in this workspace for the same date and service? |
| "additional information requested" or "pended" | The claim is on hold, not finally denied | What information does the statement say is missing, and from whom? |
| "provider liability" or "member not responsible" | The denied amount should not be billed to the patient | Does the provider bill in this workspace still ask me to pay this amount? |
| "you may request a review" or "appeal rights" | Instructions for disputing the decision | What steps and time limit does this EOB give for an appeal? |
What is a denied claim on an EOB?
A denied claim is a claim, or a single service line within it, that the insurer has processed and decided not to pay. The EOB shows it with no plan payment and usually gives a reason code that refers to an explanation elsewhere on the statement.
Denied claim questions
Can Search+ find every denied line on a long EOB?
Will it tell me whether I should appeal a denial?
The denial code means nothing to me. Can it help?
Can it compare a denial with what my policy says?
My denial notice arrived by mail and I scanned it. Will that work?
Could an answer about my denial be wrong?
Read the reason before you make the call
Start a workspace, add the EOB with the denial, and ask what the statement says about it.
Start a workspace