Expenses incurred after coverage terminated

Why this happens on dental claims

• Crowns seated or dentures delivered after the patient lost coverage, when the plan pays on the completion date rather than the prep or impression date
• Job changes and COBRA gaps between eligibility verification and the actual appointment
• Retroactive terminations, where the employer ends coverage weeks after the visit and the payer claws eligibility back

How to appeal CO-27

1. Confirm the exact termination date with the payer and the employer, in writing
2. For multi-visit work, appeal under the plan's incurred-date definition if preps or impressions happened while coverage was active, since many plans pay on the earlier date
3. If eligibility was verified before treatment, cite the verification reference number; some states restrict retroactive eligibility takebacks
4. If the termination stands, move the balance to the patient promptly with the payer's explanation of benefits attached

How to prevent it

• Re-verify eligibility within a few days of long appointments, not weeks before
• Schedule seat and delivery visits as soon as lab work returns when a patient's coverage is ending