Health insurance denial & claim adjustment codes

What health insurance denial code 3 means on your EOB

Your flat per-visit amount. Check that the copay tier matches the service you actually received.

What usually causes it

• A specialist copay was applied to a primary-care visit.
• An urgent-care or ER tier was applied incorrectly.
• Preventive care was charged a copay when it should be $0.

The documents that decide it

• Your EOB.
• Your plan's copay schedule by service type.
• What the visit actually was.

What to do next

Preventive services are required to be $0 on most plans. If a copay was charged for preventive care, that is worth challenging.

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.