So I don’t want to say much in regards to details, but this is the gist:

—Had Surgery in late 2023, everything is in-network, but still had to pay some stuff to meet deductible and maximum out of pocket.

— Get a letter a month ago (in 2025, so over a year later) ago saying that some part of my surgery was not being approved because the request for authorization we needed from your provider wasn’t sent within the required timeframe. Even though this letter was way after my surgery, so weird.

I appealed that, because obviously that is on the provider and not me, and they responded saying that

“We’re upholding our decision because we determined that this service lacked the required pre-authorization and is considered not medically necessary.”

What to do at this point? A 2nd appeal or go through what they call an external review? Other options? They said I can argue my case:

—in person

—on the phone

—via letter

The amount isn’t large and I can definitely live without it, but its more about the principle of the matter then anything where why should I have to pay for something, that I shouldn’t of have.