Dmitri Volkov

CLM-2024-8605, Humana, Spinal Fusion L4-L5 (22612)

In appealWith the payer Denied claims

Billed

$39,500

denied Apr 18

Denial risk

63%

winnable with the right notes

Appeal window

lapsed

closes May 18

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Apr 18
Denied by Humana
Medical Necessity (50)
Apr 18
Heron scored it: 63% denial risk
3 factors found, appeal path chosen
Apr 18

The denial

Medical Necessity, code 50

Patient: Dmitri Volkov, born 1976-07-22
Payer: Humana
Procedure: Spinal Fusion L4-L5 (22612)
Diagnosis: M51.16
Denied on: Apr 18, 2026
Assigned to: Heron

Heron says

Humana requires extensive conservative treatment documentation for spinal fusion approval. Include 6-month timeline of physical therapy, injections, and pain management. 63% of similar appeals successful with neurosurgery consultation notes.

No appeal yet

I can draft one from this claim's history

Draft it View the claim form

Open Intelligence, pick this claim, and I write the letter from the denial, the payer's rules and the clinical guideline. You sign it here.

What I sent

Clinical notes
Operative report

Everything I know about Dmitri

across every queue

Everything for this patient

Open exposure

$39,500

Recovered

1 denied claim1 prior auth0 underpayments0 backlog claims

AUTH-3223

27447 · Total Knee Replacement

22612 · Medical Necessity

$39,500

In appeal

Apr 18