Health insurance denial & claim adjustment codes

What health insurance denial code 45 means on your EOB

The provider billed more than the contracted rate. For in-network care you generally cannot be billed the difference — this is the write-off, not your balance.

What usually causes it

• The billed charge exceeded the contracted allowed amount.
• The provider is in-network and contractually writes off the excess.
• If out-of-network, balance-billing rules and the No Surprises Act may still apply.

The documents that decide it

• Your EOB showing billed, allowed, and patient-responsibility amounts.
• The provider's network status on that date.
• Any bill you received for the difference.

What to do next

Compare the patient-responsibility column on your EOB to the amount the provider is billing you. If the provider's bill is higher, that difference is usually not collectible.

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.