Bastian Keller

CLM-2024-8620, Aetna, Hysterectomy (58150)

In reviewWith you Denied claims

Billed

$21,000

denied Apr 12

Denial risk

56%

winnable with the right notes

Appeal window

lapsed

closes May 12

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Apr 12
Denied by Aetna
Medical Necessity (50)
Apr 12
Heron scored it: 56% denial risk
3 factors found, appeal path chosen
Apr 12
Appeal window lapsed
110 days ago
May 12

The denial

Medical Necessity, code 50

Patient: Bastian Keller, born 1983-02-17
Payer: Aetna
Procedure: Hysterectomy (58150)
Diagnosis: N80.0
Denied on: Apr 12, 2026
Assigned to: Heron

Heron says

Aetna requires documented failure of hormonal therapy for endometriosis-related hysterectomy. Include 12-month treatment history and gynecology consultation notes. 56% appeal success rate with complete conservative treatment documentation.

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What I sent

Clinical notes
Operative report

Everything I know about Bastian

across every queue

Everything for this patient

Open exposure

$21,000

Recovered

1 denied claim1 prior auth0 underpayments0 backlog claims

CLM-2024-8620viewing

58150 · Medical Necessity

93015 · Cardiac Stress Test

65% odds

Expired

Apr 10