Simone Laurent

CLM-2026-9059, UnitedHealthcare, Chemotherapy Infusion, Addl Hour (96415)

DeniedWith me Denied claims

Billed

$13,579

denied Jul 8

Denial risk

62%

winnable with the right notes

Appeal window

37d

closes Oct 6

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Jul 8
Denied by UnitedHealthcare
Medical Necessity (50)
Jul 8
Heron scored it: 62% denial risk
3 factors found, appeal path chosen
Jul 8
Appeal window closes
37 days left to file
Oct 6

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: Jul 8, 2026
Assigned to: Heron

Heron says

UnitedHealthcare denies 57% 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.