Is my provider or my insurance at fault?

Just looking for some guidance on how to navigate this since both my provider and insurance company are pointing the finger at each other and I’m getting frustrated.

I have a PPO plan and pay a copay for doctor’s visits. Every time I go to the doctor’s office, I pay the copay.

And then I get a bill later saying I owe the rest of the visit because it gets charged to my deductible.

My insurance has previously made an adjustment, and now I have requested another as this happened again.

I asked them what I can do to ensure this is billed correctly in the future so I don’t have to keep bugging them. They said it’s the provider using “incorrect billing codes” (which sounds like bs) and it’s on them.

I ask my provider’s billing department and they said they have no say in how my insurance decides to bill between copay vs deductible.

So… who do I call out on this and what do I say? I’d like to not have to ask for an adjustment each time and now I have doubts they ever bill me correctly.

My healthcare is through my employer, so would it be better to go through my HR department and have them get in touch with their rep from the insurance company?

submitted by /u/anewflame
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