Who has to pay after a code 215 denial?

Who owes depends on the details. The letters in front of the number matter: CO (contractual obligation) usually means an in-network provider must absorb it, while PR (patient responsibility) means the plan says you owe it.

How long do I have to appeal?

It depends on your coverage: 180 days for most employer and marketplace plans, 120 days for Original Medicare, about 90 days for Medicaid (varies by state), and only 65 days for Medicare Advantage. Set your deadline clock before you do anything else.

All denial codes · code 215

Denial code 215: what it means — and how to fight it

Denial code 215 (shown on your EOB as CO-215 or PR-215) means: “Based on subrogation of a third party settlement.” In plain English: The plan believes someone else — an auto insurer, a liability policy, or a legal settlement — should pay instead of it.

medium appealability Who owes depends on the details

What they're really saying

“Based on subrogation of a third party settlement.”

The plan believes someone else — an auto insurer, a liability policy, or a legal settlement — should pay instead of it.

Your odds

Worth fighting — many of these get fixed.

Often resolved by proving no other coverage exists or that the settlement did not cover these bills.

Fewer than 1 in 100 denied claims are ever appealed. When people do appeal, roughly 4 in 10 win the first round — and independent external review overturns 40–50% of what reaches it.

How to appeal a code 215 denial

Decode. You just did — this page is step one.
Set your clock. 180 days for most employer and marketplace plans, 120 for Original Medicare, ~90 for Medicaid, only 65 for Medicare Advantage.
Urgent? If this is care you still need, call and request an expedited appeal — they must decide within 72 hours.
Send the plan a written statement of whether any other insurer or settlement is involved. If there is no other insurer, send a signed statement saying so and ask the plan to process the claim. If there is a lawsuit or settlement, get the terms in writing — plans can often recover only what the settlement actually paid for medical care. Do not sign a reimbursement agreement without reading what it obligates you to repay.
Send it certified. Letter plus evidence, keep copies of everything.
Escalate. Denied again? Independent external review — a doctor who doesn't work for your insurer decides.

Do it in minutes, free

The AppealClock tool translates your denial, drafts your appeal letter, computes your exact deadline — and watches the clock so you don't have to. No account. Your medical details never leave your device.

Start your appeal & set your clock →

Common questions

What does denial code 215 mean?: The plan believes someone else — an auto insurer, a liability policy, or a legal settlement — should pay instead of it.
Can I appeal a CO-215 or PR-215 denial?: Yes. Appealing is free and it is your legal right. For this code the odds are medium: Often resolved by proving no other coverage exists or that the settlement did not cover these bills. Fewer than 1 in 100 denials are ever appealed — insurers count on silence.
Who has to pay after a code 215 denial?: Who owes depends on the details. The letters in front of the number matter: CO (contractual obligation) usually means an in-network provider must absorb it, while PR (patient responsibility) means the plan says you owe it.
How long do I have to appeal?: It depends on your coverage: 180 days for most employer and marketplace plans, 120 days for Original Medicare, about 90 days for Medicaid (varies by state), and only 65 days for Medicare Advantage. Set your deadline clock before you do anything else.