CARC 51: These are non-covered services because this is a pre-existing condition
The insurer is denying this claim because your condition existed before your coverage started.
What this means for your claim
Under the ACA, pre-existing condition exclusions are banned for most health plans. If you receive this denial, it may be illegal depending on your plan type.
What to do next
- 1
Verify whether your plan is ACA-compliant. If it is, a pre-existing condition exclusion is not allowed — file an appeal and a complaint with your state insurance commissioner.
- 2
Short-term health plans and some grandfathered plans may still apply pre-existing condition limitations.
- 3
Request the specific plan language that allows this exclusion and have it reviewed.
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