PR-2 means the amount is the patient's coinsurance — the share of the allowed amount the patient owes under the plan. It is patient responsibility, not a coverage denial. The claim was processed correctly; the next step is to bill the patient, not to appeal.
What PR-2 means
After a plan applies its benefit, the patient typically owes a percentage of the allowed amount (for example, 20%). That percentage shows as PR-2 on the remittance. It reflects the plan design working as intended.
Why PR-2 fires
- The plan design includes coinsurance for the service.
- The service was paid at the in- or out-of-network coinsurance rate.
- The patient is in the coinsurance phase between deductible and out-of-pocket maximum.
Is PR-2 worth appealing?
Not an appeal
PR-2 — frequently asked
Can coinsurance be appealed?
How is coinsurance different from a copay?
Reason-code meanings are paraphrased from the X12 Claim Adjustment Reason Code list for plain-language reference; they are not reproduced verbatim. This is general information, not legal, coding, or medical advice — always confirm against the payer's remittance and policy.
Turn this PR-2 denial into a signed appeal
Upload the denied EOB and Merits builds a complete PR-2 appeal — the argument, the payer's own coverage criteria, and your federal appeal rights, every claim cited to a named source. $9 a letter. No account.