Simone Laurent

CLM-2026-9110, UnitedHealthcare, Chemotherapy Infusion, 1st Hour (96413)

DeniedWith me Denied claims

Billed

$9,781

denied Aug 14

Denial risk

53%

good odds

Appeal window

74d

closes Nov 12

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Imported from a CSV export
Aug 14
Denied by UnitedHealthcare
Not Covered (96)
Aug 14
Heron scored it: 53% denial risk
3 factors found, appeal path chosen
Aug 14
Appeal window closes
74 days left to file
Nov 12

The denial

Not Covered, code 96

Patient: Simone Laurent, born 1966-12-04
Payer: UnitedHealthcare
Procedure: Chemotherapy Infusion, 1st Hour (96413)
Diagnosis: C50.911
Denied on: Aug 14, 2026
Assigned to: Heron

Heron says

Service is excluded under the member's current UnitedHealthcare benefit plan. Verify benefits as of the date of service, plan may have changed mid-year. If non-covered is confirmed, route to patient responsibility rather than appeal.

No appeal yet

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What I sent

Nothing sent yet.

Everything I know about Simone

across every queue

Everything for this patient

Open exposure

$54,542

Recovered

$19,443

6 denied claims3 prior auths1 underpayment2 backlog claims

AUTH-4074

96415 · Chemotherapy Infusion, Addl Hour

73721 · MRI Lower Extremity Joint

73721 · underpaid 27.7%

96417 · Chemotherapy, Additional Sequential

73721 · 35d outstanding

96415 · Medical Necessity

96413 · 85d outstanding

70553 · Medical Necessity

73721 · Medical Necessity

96417 · Medical Necessity

96415 · Medical Necessity

$19,443

Recovered

Jan 2