Advice for appeal with Anthem Blue Cross (CA)

Coverage for "prenatal and postnatal physician office visits" in benefit booklet provided by my employer (Univ of CA): "$20 Copayment per visit (initial visit only)".

For my first pregnancy (2020), I paid $20 for my first OB appointment and that was it. This time around (born late 2022), I am getting charged $20 per visit and I had 1-2 visits a week, so it's really adding up (high risk). Same doctor, same practice, same high risk type pregnancy, same exact insurance (I know they change coverage from year to year, but the prenatal text in the coverage is the same) across the years. I have spoken to the doctor billing department several times and they said they are billing everything correctly and to take it up with my insurance. I called Anthem (which is actually Accolade) and they submitted to Anthem about the clarification of the billing and Anthem confirmed the billing. So now I have to appeal.

Please give me any and all advice to make my appeal as successful as possible.

Currently planning to include:

service dates claim #s for all service dates The page in the benefits coverage booklet that I quoted above (Accolade said I can only include up to 10 pages in my appeal) explanation that I was told verbally by the Anthem rep that it was $20 "global coverage/ first copay only" for prenatal care at employee benefits fair I don't think I should include how my last pregnancy was billed first copay only, as knowing how these things work, Anthem does not care and that may just confuse things

Edit to add zip code: 92111. Age should not be relevant? But both pregnancies were over 35yo.

submitted by /u/hell0potato
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