Luis Ortega

CLM-2026-9036, Aetna, Echocardiography, Complete (93306)

In appealWith the payer Denied claims

Billed

$1,099

denied Apr 8

Denial risk

61%

winnable with the right notes

Appeal window

lapsed

closes Jul 7

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Apr 8
Denied by Aetna
Medical Necessity (50)
Apr 8
Heron scored it: 61% denial risk
3 factors found, appeal path chosen
Apr 8

The denial

Medical Necessity, code 50

Patient: Luis Ortega, born 1991-11-04
Payer: Aetna
Procedure: Echocardiography, Complete (93306)
Diagnosis: I50.9
Denied on: Apr 8, 2026
Assigned to: Heron

Heron says

Aetna denies 41% of 93306 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.