Simone Laurent

CLM-2026-9111, UnitedHealthcare, Chemotherapy Infusion, Addl Hour (96415)

RecoveredWith me Denied claims

Billed

$19,443

denied Jan 2

Denial risk

57%

winnable with the right notes

Appeal window

closed

nothing left to file

Recovered

$19,443

the money is back

What I did

and what comes next

Claim reached Heron
Entered by hand
Jan 2
Denied by UnitedHealthcare
Medical Necessity (50)
Jan 2
Heron scored it: 57% denial risk
3 factors found, appeal path chosen
Jan 2
Paid in full
The money is back
Feb 26

The denial

Medical Necessity, code 50

Patient: Simone Laurent, born 1966-12-04
Payer: UnitedHealthcare
Procedure: Chemotherapy Infusion, Addl Hour (96415)
Diagnosis: C34.90
Denied on: Jan 2, 2026
Assigned to: Heron

Appeal successful, payment posted

Heron says

UnitedHealthcare denies 55% of 96415 claims without documented conservative treatment. Clinical notes supporting medical necessity were not attached to the original submission. Attach treatment history and imaging before appealing, overturn rate rises sharply with documentation.