Who has to pay after a code 285 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 285

Denial code 285: what it means — and how to fight it

Denial code 285 (shown on your EOB as CO-285 or PR-285) means: “Appeal procedures not followed.” In plain English: Your appeal was rejected on process, not on the merits. Nobody has looked at whether the care should be covered yet.

high appealability Who owes depends on the details

What they're really saying

“Appeal procedures not followed.”

Your appeal was rejected on process, not on the merits. Nobody has looked at whether the care should be covered yet.

Your odds

Strong — this type of denial has real weaknesses.

Very winnable — you usually just have to refile correctly, and you may still be in time.

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 285 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.
Call and ask exactly which procedural step was missed, then refile it correctly. Call and ask exactly which step was missed: wrong form, wrong address, missing member ID, missing signature, no representative authorization form, or filed at the wrong appeal level. Fix that one thing and refile immediately. Ask in writing for the plan's written appeal procedures and for confirmation of your remaining deadline. If the plan never gave you clear instructions, say so — a plan that fails to disclose its own procedure cannot fairly hold you to it, and that argument also supports going straight to external review.
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 285 mean?: Your appeal was rejected on process, not on the merits. Nobody has looked at whether the care should be covered yet.
Can I appeal a CO-285 or PR-285 denial?: Yes. Appealing is free and it is your legal right. For this code the odds are high: Very winnable — you usually just have to refile correctly, and you may still be in time. Fewer than 1 in 100 denials are ever appealed — insurers count on silence.
Who has to pay after a code 285 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.