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TEST-CLAIM-00061

Synthetic Aetna · Medical Necessity

Needs Clinical ReviewCritical

Denial

CO-55: Procedure/treatment is deemed experimental/investigational by the payer.

Billed
$1,065
Denied
$819
Funnel stage
Awaiting Review
Service date
Oct 6, 2025
Denial date
Dec 27, 2025
Appeal deadline
Jun 25, 2026
Procedure codes: CPT: 80804, 64935, 86983 · ICD: S82.83

Appeal

A draft appeal has been produced.

AI pipeline trace (5 runs)

StepStatusModel · promptConfidenceCostLatency
ClassifierSucceededclaude-haiku-4-5 · v292%$0.00111.9s
Evidence ExtractorSucceededclaude-haiku-4-5 · v272%$0.00264.8s
Policy CheckerSucceededclaude-sonnet-4-6 · v282%$0.00576.5s
Appeal DrafterSucceededclaude-sonnet-4-6 · v282%$0.033636.0s
Quality CheckerSucceededclaude-sonnet-4-6 · v191%$0.015710.0s