Tomas Herrera

CLM-2025-9004, UnitedHealthcare, Chemotherapy, Additional Sequential (96417)

RecoveredWith me Denied claims

Billed

$12,770

denied Dec 4

Denial risk

66%

winnable with the right notes

Appeal window

closed

nothing left to file

Recovered

$12,770

the money is back

What I did

and what comes next

Claim reached Heron
Entered by hand
Dec 4
Denied by UnitedHealthcare
Medical Necessity (50)
Dec 4
Heron scored it: 66% denial risk
3 factors found, appeal path chosen
Dec 4
Paid in full
The money is back
Feb 18

The denial

Medical Necessity, code 50

Patient: Tomas Herrera, born 1968-02-27
Payer: UnitedHealthcare
Procedure: Chemotherapy, Additional Sequential (96417)
Diagnosis: C18.9
Denied on: Dec 4, 2026
Assigned to: Heron

Appeal successful, payment posted

Heron says

UnitedHealthcare denies 41% of 96417 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.