Dante Russo

CLM-2024-8791, Humana, MRI Lumbar Spine (70553)

RecoveredWith me Denied claims

Billed

$4,200

denied Apr 7

Denial risk

22%

good odds

Appeal window

closed

nothing left to file

Recovered

$4,200

the money is back

What I did

and what comes next

Claim reached Heron
Imported from a CSV export
Apr 7
Denied by Humana
Not Covered (96)
Apr 7
Heron scored it: 22% denial risk
3 factors found, appeal path chosen
Apr 7
Appeal filed
Tracking APP-2024-1085
Apr 10
Humana approved the appeal
Apr 20
Paid in full
The money is back
Apr 20

The denial

Not Covered, code 96

Patient: Dante Russo, born 1971-01-28
Payer: Humana
Procedure: MRI Lumbar Spine (70553)
Diagnosis: G43.909
Denied on: Apr 7, 2026
Assigned to: Heron

Successfully appealed

Heron says

Humana plan excludes advanced imaging for migraine without step therapy documentation. Low risk, appeal with step therapy records has 85% success rate. Standard submission recommended with attached treatment history.

The appeal

Filed Apr 10, approved

View the claim form

Filed under tracking APP-2024-1085. I follow up with Humana every 14 days until they answer, and the letter will sit here once it is on file.

What I sent

Nothing sent yet.

Everything I know about Dante

across every queue

Everything for this patient

Open exposure

Recovered

$4,200

1 denied claim0 prior auths0 underpayments0 backlog claims