Heron

Simone Laurent

CLM-2026-9068, UnitedHealthcare, Chemotherapy, Additional Sequential (96417)

Written offWith me Denied claims
Billed
$13,808
denied Feb 2
Denial risk
59%
winnable with the right notes
Appeal window
closed
nothing left to file
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Entered by hand
    Feb 2
  2. Denied by UnitedHealthcare
    Medical Necessity (50)
    Feb 2
  3. Heron scored it: 59% denial risk
    3 factors found, appeal path chosen
    Feb 2
  4. Heron
    Written off
    Every route exhausted
    May 13

The denial

Medical Necessity, code 50

Patient
Simone Laurent, born 1966-12-04
Payer
UnitedHealthcare
Procedure
Chemotherapy, Additional Sequential (96417)
Diagnosis
C18.9
Denied on
Feb 2, 2026
Assigned to
Heron
Heron says
UnitedHealthcare denies 44% 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.

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

  • Clinical notes
  • Operative report

Everything I know about Simone

across every queue
Everything for this patient
Open exposure
$54,542
Recovered
$19,443
6 denied claims3 prior auths1 underpayment2 backlog claims
AUTH-4074
96415 · Chemotherapy Infusion, Addl Hour
51% odds
Pending
Aug 26
AUTH-4039
73721 · MRI Lower Extremity Joint
70% odds
Pending
Aug 18
CLM-2026-9110
96413 · Not Covered
$9,781
Denied
Aug 14
CLM-2026-7100
73721 · underpaid 27.7%
$884 short
Detected
Aug 2
AUTH-4088
96417 · Chemotherapy, Additional Sequential
82% odds
Denied
Jul 31
CLM-2026-5033
73721 · 35d outstanding
$4,901
Awaiting info
Jul 26
CLM-2026-9059
96415 · Medical Necessity
$13,579
Denied
Jul 8
CLM-2026-5073
96413 · 85d outstanding
$19,165
Not submitted
Jun 6
CLM-2026-9163
70553 · Medical Necessity
$2,806
In appeal
Jun 5
CLM-2026-9157
73721 · Medical Necessity
$3,426
In appeal
Jun 2
CLM-2026-9068viewing
96417 · Medical Necessity
$13,808
Written off
Feb 2
CLM-2026-9111
96415 · Medical Necessity
$19,443
Recovered
Jan 2