Health insurance denial & claim adjustment codes

What health insurance denial code 119 means on your EOB

You hit a cap. Since the ACA, annual and lifetime dollar limits on essential health benefits are largely prohibited, so a dollar cap deserves scrutiny.

What usually causes it

• A visit or unit cap was reached.
• A dollar cap was applied to an essential health benefit.
• The accumulator was calculated wrongly.

The documents that decide it

• The plan's stated limit.
• Your year-to-date usage.
• Whether the service is an essential health benefit.

What to do next

If this is a DOLLAR limit on an essential health benefit, it may be prohibited outright. Visit and unit limits are still permitted, dollar limits usually are not.

This page explains what a code means. It is information, not advice — it does not tell you whether your specific claim should have been paid, and it is not legal, medical, or insurance advice. Your plan documents and your denial notice govern your situation.