CARCContractual Obligation
CARC 4: The service/equipment is not covered
Your insurance plan does not cover this specific service, item, or procedure at all.
What this means for your claim
The plan's list of covered benefits (the formulary or coverage schedule) excludes what was billed. You are responsible for the full cost.
What to do next
- 1
Pull your Summary of Benefits and Coverage (SBC) or Evidence of Coverage (EOC) to confirm the exclusion is in writing.
- 2
Ask your provider whether an alternative covered service could achieve the same clinical outcome.
- 3
If you believe the service should be covered based on your plan documents, file a coverage determination request in writing.
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