Health insurance denial & claim adjustment codes

What health insurance denial code 35 means on your EOB

A lifetime cap. Since the ACA these are largely prohibited on essential health benefits, so this deserves a hard look.

What usually causes it

• A lifetime dollar maximum was applied.
• The benefit may be an essential health benefit.
• The plan may be grandfathered or excepted.

The documents that decide it

• The plan's stated lifetime maximum.
• Whether the service is an essential health benefit.
• Your plan type.

What to do next

Lifetime DOLLAR limits on essential health benefits are prohibited on most plans. Confirm your plan type before accepting this.

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.