CO-242: Services not provided by network providers
UPDATED JULY 2026 · U.S. PLANS · NOT LEGAL OR MEDICAL ADVICE
The payer processed this as out-of-network care. Networks change and directories lag — this denial is frequently wrong or protected against.
CO-242 at a glance
- Code group: CO — Contractual Obligation — in-network providers generally cannot bill you for CO adjustments.
- Who usually fixes it: You (the member).
- Worth appealing? Yes — commonly appealed.
What to do about a CO-242 denial
- Check whether the provider was listed in-network in the payer's directory when you booked — screenshot it if still there.
- For emergencies and certain surprise out-of-network situations at in-network facilities, federal protections may apply.
- Appeal with directory evidence, or request a network-gap exception if no in-network alternative existed.
Best next read: Out-of-network denials — the full guide (with a free letter template) for this denial type.
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