Margot Beaulieu

CLM-2024-8701, BCBS, Hysterectomy (58150)

In reviewWith you Denied claims

Billed

$18,500

denied Mar 8

Denial risk

44%

good odds

Appeal window

lapsed

closes Apr 8

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Entered by hand
Mar 8
Denied by BCBS
Medical Necessity (50)
Mar 8
Heron scored it: 44% denial risk
3 factors found, appeal path chosen
Mar 8
Appeal window lapsed
144 days ago
Apr 8

The denial

Medical Necessity, code 50

Patient: Margot Beaulieu, born 1977-03-31
Payer: BCBS
Procedure: Hysterectomy (58150)
Diagnosis: N80.0
Denied on: Mar 8, 2026
Assigned to: Heron

Heron says

BCBS requires documentation of failed conservative treatments for hysterectomy approval. Include hormonal therapy records and diagnostic imaging in resubmission. 44% of similar denials overturned with complete treatment history.

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What I sent

Clinical notes
Operative report

Everything I know about Margot

across every queue

Everything for this patient

Open exposure

$18,500

Recovered

1 denied claim1 prior auth0 underpayments0 backlog claims

AUTH-3298

70553 · Brain MRI with Contrast

58150 · Medical Necessity

$18,500

In review

Mar 8