Aetna · Illinois
Denied on Bunion correction with fusion (Lapidus) in Illinois by Aetna?The denial, the code, and the path to recovery.
Aetna paid your out of network Bunion correction with fusion (Lapidus) in Illinois below the billed charge, or denied it outright. That gap is what federal independent dispute resolution exists to recover, and we prepare the submission for you.
CPT 28297 covers bunion correction with fusion of the first metatarsal base.
Why claims like this get denied.
Out of network Bunion correction with fusion (Lapidus) claims in Illinois are commonly underpaid or denied for reasons like these.
Denied as not medically necessary
The claim was denied as not medically necessary, common on orthopedic surgery procedures where the payer second guesses the indication.
Downcoded to a lower level
The payer paid a lower level code than the one billed for Bunion correction with fusion (Lapidus).
Anchored to the qualifying payment amount
The payer priced the claim off the qualifying payment amount, which often sits well below the real market rate for Bunion correction with fusion (Lapidus).
Aggressive multiple procedure reduction
Multiple procedure reductions were applied aggressively, cutting the secondary lines below their value.
Bundled into another code
The Bunion correction with fusion (Lapidus) line was bundled into another code, so part of the work was never separately paid.
We do this for you.
When an out of network surgical claim is filed right, federal IDR routinely pays well above the insurer's first number, and most properly filed disputes go the provider's way. We build the submission, your billing team approves it, and you keep the recovery. We do this every day and we win most of the time. No one can promise a specific result on a specific claim, and we will not pretend otherwise.
No outcome is guaranteed. Results vary by claim, payer, specialty, and documentation. Any general figures reflect the published federal record across all disputes, not a prediction about your claim. This is general information, not legal or financial advice.
The window does not wait.
Most practices never file, and the window does not wait. After open negotiation ends you have four business days to start a dispute. Miss it and that money is gone for good. This is the part that costs surgical practices the most, doing nothing.
The pathway in Illinois.
In Illinois, the pathway for out of network surgical disputes is federal IDR for self funded plans and a state process for many fully insured plans. Self funded ERISA plans follow the federal IDR process while many fully insured plans follow a state pathway, so the plan type decides which process a dispute routes to.
- Illinois runs a state process for many fully insured plans. Self funded plans route to federal IDR.
Send us this denial.
Send us this denial. We will tell you fast whether it qualifies and, if it does, we build the submission.
Common questions.
Was your Bunion correction with fusion (Lapidus) claim underpaid by Aetna in Illinois?
If Aetna paid your out of network Bunion correction with fusion (Lapidus) in Illinois below the billed charge, that gap is what federal IDR exists to recover. Send us the denial and we will tell you fast whether it qualifies.
Does federal IDR apply to Bunion correction with fusion (Lapidus) in Illinois?
In Illinois, out of network surgical disputes route through federal IDR for self funded plans and a state process for many fully insured plans. Self funded ERISA plans follow the federal IDR process while many fully insured plans follow a state pathway, so the plan type decides which process a dispute routes to.
How does Sydra dispute a Aetna denial on Bunion correction with fusion (Lapidus)?
We build the federal IDR submission, your billing team approves it, and you keep the recovery. We do this every day and we win most of the time. No outcome is guaranteed, and we will not predict a result on a specific claim.