Health insurance denial & claim adjustment codes

What health insurance denial code 242 means on your EOB

An out-of-network denial. The No Surprises Act may apply depending on where and how you received care.

What usually causes it

• The provider was out-of-network.
• Emergency or facility-based care may still be protected.
• The plan's directory may have listed them as in-network.

The documents that decide it

• The provider's network status.
• Where the care was delivered.
• The plan's directory listing at the time you chose them.

What to do next

If this was emergency care, or an out-of-network provider at an in-network facility, federal surprise-billing protections likely apply.

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.