Insurance company not reprocessing claims after incorrectly resetting deductible and not refunding incorrect copays or applying credits, out $10K so far

Hi! I am at my wits end and am hoping for some advice.

Last year I ended up in the ER and then had an inpatient hospital stay, I quickly met my deductible for the year because of this. Which, no biggie, my plan was supposed to be plan year. However on Jan 1 my deductible was reset. Spoke to the insurance company and they say its calendar year, HR says its plan year. Turns out, it IS plan year, but insurance company and broker recommended a contract amendment and then they will provide billing credits/reimbursements. However this took months and months for them to come to an agreement, so at first they held all my new claims which made it very difficult for some of my providers to want to make apps for me and made it very confusing. Then suddenly insurance processed all of the new claims, however they did not reprocess my old claims for Jan onward, which to me, if they do not reprocess these, how do they know how much I need a reimbursement for? I have paid a total of just over 10K because the hospital was threatening to go to collections, which was my entire savings. Also just found out that insurance has been incorrectly charging $40 copays for everyone's mental health claims, I am also impacted by this and haven't gotten any money back and none of my claims have been reprocessed. Someone at my work caught the copay error, this makes me worry that the insurance company has made other errors that I am not aware of and am not even sure where to get started to check. I am not sure how to hold the insurance company accountable or if I can trigger some kind of audit? I have A LOT of appointments and physical therapy due to the issue last year so my claims are piling up.

What should my action plan be? Next steps? How can I hold them accountable or how can I take better control/research this situation?

submitted by /u/throwawayinsuranccce
[comments]