Appealing the amount I was reiumbursed for an out-of-network service

Hi all,
I recently received reimbursement for an out-of-network service that is very low for the price of the service (it costs about $3000 and I was reimbursed $300). If possible I would like to appeal the amount I was reimbursed.

Here is the context:
The service is a highly specialized genetic test that is only performed at about 5 labs total in the country. All the labs charge about the same rate for the test $3000. To bill for the testing, the labs use the unlisted CPT code 81479 because there isn't a code specific enough for the actual test (it's a custom designed test based on one's individual DNA testing for a single gene).

I have Horizon BCBS (in NJ) but the plan is part of the national network. They denied the claim twice in the first place based on not having a detailed description of the service, but after submitting (and re-submitting) a description from the provider of the test they performed, they did approve it, but just for this low rate.
I don't know if this is relevant, but 2 years ago I had Aetna and the service was in-network and Aetna's in-network reiumbursement rate for the service was the full $3000 at that same lab. I mention this because I don't know if the "reasonable and customary" amount is something that's accepted across insurance companies. So apparently Aetna found the rate to be reasonable, but I don't know if that is something determined by individual companies

I wanted to get advice on what I should include in my letter of appeal to have the best chance of getting reimbursed at a higher rate. (Or if this is a losing battle altogether).

See also  Filed an Appeal with Anthem Blue Cross, and still haven’t heard any response after 60 days. What would be next steps?

Thanks in advance for your help!

ETA: apologies for typo in the title đź« 

submitted by /u/Old_Perspective_6417
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