EOB denial code · PR group
PR-2: Coinsurance — Meaning & What You Owe
PR-2 means coinsurance — you owe a percentage (commonly 20% or 30%) of the plan's allowed amount, after your deductible, up to your out-of-pocket maximum. It's a genuine patient responsibility, but the base matters: coinsurance applies to the NEGOTIATED allowed rate, never the provider's billed charge. Verify the allowed amount before paying.
What “PR-2” means on your EOB
Co-insurance.
Who pays? PR — Patient Responsibility
PR (patient responsibility) — your percentage share of the allowed amount. Confirm the percentage matches your plan (often 20% or 30%) and that it's applied to the allowed amount.
What to do next: Coinsurance amounts are contract-defined, so appeals rarely apply. The real checks: (1) percentage matches your plan, (2) applied to the allowed rate, (3) it counts toward your out-of-pocket maximum, (4) the deductible was applied first as required. If the amount you've paid this year plus this bill exceeds your OOP max, call the plan.
Why this denial happens
- Your plan has a 20%/30%/50% coinsurance tier for the service category.
- The service was out-of-network, where coinsurance is often higher (50%+).
- The billed amount was used instead of the allowed amount.
- An out-of-pocket maximum was already reached but not reflected.
What to do now
- Confirm your plan's coinsurance percentage and deductible structure (summary of benefits).
- Verify the EOB math: percent × allowed amount = your PR-2 share.
- Track cumulative spending against your out-of-pocket maximum.
- If your share seems high, ask the insurer for a line-item breakdown before paying.
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