Nia Okafor

CLM-2025-9037, Aetna, Chemotherapy Infusion, 1st Hour (96413)

RecoveredWith me Denied claims

Billed

$9,718

denied Nov 19

Denial risk

64%

winnable with the right notes

Appeal window

closed

nothing left to file

Recovered

$9,718

the money is back

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Nov 19
Denied by Aetna
Medical Necessity (50)
Nov 19
Heron scored it: 64% denial risk
3 factors found, appeal path chosen
Nov 19
Paid in full
The money is back
Jan 20

The denial

Medical Necessity, code 50

Patient: Nia Okafor, born 1994-02-22
Payer: Aetna
Procedure: Chemotherapy Infusion, 1st Hour (96413)
Diagnosis: C50.911
Denied on: Nov 19, 2026
Assigned to: Heron

Appeal successful, payment posted

Heron says

Aetna denies 40% of 96413 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.