Leila Haddad

CLM-2026-9135, BCBS, Chemotherapy, Additional Sequential (96417)

RecoveredWith me Denied claims

Billed

$6,314

denied Apr 29

Denial risk

66%

winnable with the right notes

Appeal window

closed

nothing left to file

Recovered

$6,314

the money is back

What I did

and what comes next

Claim reached Heron
Entered by hand
Apr 29
Denied by BCBS
Not Covered (96)
Apr 29
Heron scored it: 66% denial risk
3 factors found, appeal path chosen
Apr 29
Paid in full
The money is back
Jul 6

The denial

Not Covered, code 96

Patient: Leila Haddad, born 1964-12-23
Payer: BCBS
Procedure: Chemotherapy, Additional Sequential (96417)
Diagnosis: C18.9
Denied on: Apr 29, 2026
Assigned to: Heron

Appeal successful, payment posted

Heron says

Service is excluded under the member's current BCBS 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

I can draft one from this claim's history

View the claim form

This claim is settled, so there is nothing left to write.

What I sent

Nothing sent yet.

Everything I know about Leila

across every queue

Everything for this patient

Open exposure

$31,647

Recovered

$7,415

4 denied claims1 prior auth4 underpayments7 backlog claims

AUTH-4018

96413 · Chemotherapy Infusion, 1st Hour

93306 · 3d outstanding

93306 · 3d outstanding

93000 · Medical Necessity

72110 · 29d outstanding

96417 · 37d outstanding

96413 · Bundling/Coding Error

96413 · Coverage Terminated

93015 · 44d outstanding

72110 · 64d outstanding

96417 · 102d outstanding

93000 · underpaid 23.1%

93306 · underpaid 6.7%

93015 · underpaid 17%

96413 · underpaid 24.4%

$626 short

Recovered

Sep 17