Blue Cross Blue Shield denying my septoplasty claim after previously giving authorization

Hello,

I am a graduate student at University of Texas at Dallas. I purchased health insurance through the school for about $2000. The insurance is provided by BCBS.

Here’s the story in chronological order:

Earlier this year my pcp referred me to an ENT for a deviated septum. This was supposed to help treat my sleep apnea. The ENT highly recommended the surgery and I decided to go through with it. My provider came back to me a few weeks later saying that the surgery was authorized by my insurance and so we scheduled a surgery date around the end of April 2022. Some time later, I start getting bills in the mail from my provider for ~$6,100 for the surgery. I eventually called my provider to ask why I was getting this bill and they told me that the insurance denied the claim but that they were still in the process of appealing it and that I shouldn’t worry about it yet. I then checked my claims on the BCBS website and saw the denied provider bill ($6,100) and the denied claim from the hospital where the surgery was done, about $29,000. This was all back around May-June. A couple days ago, I got a call from a woman from the hospital who I think was an accountant or something. She told me that the insurance had technically authorized the surgery, but did not specify their exceptions to the authorization. And now the insurance is fighting back saying that the surgery I received was an ‘exception’ or something so it’s not approved. The hospital is trying to argue that it should be the responsibility of the insurance to specify these kinds of exceptions, BCBS obviously disagrees and says that the provider or patient should be responsible for checking that kind of stuff. The hospital recommended that I submit an appeal to BCBS for these claims, which I have just done. BCBS has received this appeal and has let me know that if this appeal is denied then I will have two more chances to submit appeals.

So it sounds like I’m fucked but who knows.

I’m looking for any general advice you guys have. Maybe with how I should be wording my appeal? Whether I should get professional legal help or not. Do I need to be calling my pcp or provider again and asking for help? What documents should I be looking for to support my appeal?

Thanks