Policy includes coverage that insurance says I already used (false) or hospital coded wrong. Advice?

Hello, looking for advice in the US.

Early Fall I did a routine checkup with my doctor and had some blood work done, including a comprehensive metabolic panel (my plan covers 1 per calendar year), and a complete blood count (should also be 1 per year).

My insurance company is refusing to pay for these, saying at first that I already had these services in the last year. This is false, and I believe I’ve proven I haven’t had blood work done for 2 years now (my personal records don’t indicate any & they can’t produce any evidence when I ask for it).

Now insurance is saying that my doctor must’ve coded the metabolic panel incorrectly, and same for the complete blood count, which they’ve denied covering because “maximum amount has been paid”.

On the insurance company’s suggestion, I’ve called my doctor’s office to check and they’re adamant they’ve coded things correctly.

What do I do next? I know I can file a complaint with my state’s board of medicine, but that’s for complaints with doctors, and I don’t consider mine at fault here.

Can insurance just deny and force me to foot a bill they should be covering? I have no coverage advocate that I’m aware of with my job. I don’t know how to take any next steps and would appreciate any advice. Thanks!

submitted by /u/Echo-Honest
[comments]