My Active Cases

Appeal submitted for Denial #8821 — provider used billing code 99213 instead of 99214. Cited Page 14 of your Aetna policy to prove coverage.

First follow-up sent to Aetna adjuster portal. No response yet.

Second follow-up sent. Escalated to supervisor queue per policy §8.2.

Third follow-up sent. Next action in 61 hours if no response received.

Appeal submitted for pre-authorization denial. Identified that UHC applied outpatient criteria to an inpatient procedure.

Follow-up sent. UHC acknowledged receipt.

Appeal approved. Claim reversed in full. $8,900 will be reprocessed within 5–7 business days.

Appeal submitted arguing experimental treatment exclusion was incorrectly applied to a standard oncology protocol.

BCBS denied the appeal citing internal medical policy MP-001.2.

External review requested with state insurance board. Case escalated to legal team.