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Imaging Denial

Humana Denied Your CT Scan?

According to federal data, Humana Inc. denies approximately 14.2% of claims. When patients appeal, about 56% are overturned. Your ct scan denial may have grounds for a successful appeal.Sources: KFF ACA Marketplace Transparency Data, HHS OIG Reports, state insurance department filings. Rates are aggregate averages — individual results vary by plan type, denial reason, and documentation.

14.2%
Denial Rate
56%
Appeal Success
30-45 days
Typical Timeline
$1,000–$5,000
Typical Claim

Based on published government and industry research. Individual results vary based on denial type, insurer, and documentation.

Why Humana Denies CT Scan

Not medically necessary based on clinical criteria

MRI recommended instead of CT

Prior imaging not attempted first

Humana's Common Denial Tactics

Incorrect CPT/ICD coding as basis for denial

Claiming services duplicate prior treatments

Denying rehabilitation services as "not improving"

How to Win Your CT Scan Appeal

Physician order with clinical indication

Evidence that CT is more appropriate than MRI for the condition

ACR Appropriateness Criteria supporting CT for diagnosis

Laws That Protect You

ACA — Preventive screening requirements

State imaging parity laws

Emergency prudent layperson standard

Tips for Appealing to Humana

Verify CPT and ICD-10 codes match the services rendered

Get your provider to document functional improvement goals

For Medicare Advantage, cite CMS guidelines on coverage determination

Ready to Review Your CT Scan Denial?

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This information is for educational and informational purposes only. It does not constitute legal or medical advice. Statistics cited are from publicly available sources including KFF, HHS OIG, and state insurance department data. Individual results may vary. Consult a qualified professional before taking action on your specific situation.

Humana Denied Your CT Scan? Here's How to Appeal | Lysco