What to do to successfully appeal my medical bill

The situation is kind of complicated. I called the hospital and the insurance company, but no one would like to take the full responsibility to answer my question, so I'm here to ask, please help me if you are familiar with the system.

I am an international student, so I'm not familiar with the system. I think it's partially my fault for not understanding how health insurance work in the first place but it happened. I have an HMO insurance now, I used to have PPO, so I didn't know you need a PCP to see a specialist with HMO. I went to see dermatology, which is a specialist in the beginning of July. The hospital charged me the co-pay, so I thought ok that's good. About 70 days later, the insurance was denied and I was charged $1300.

I called the hospital they said the insurance company was denying my claim.

I called the insurance company, and they said I need a PCP to give a referral.

So I called the hospital to ask for a referral, they said I need to call the insurance for PCP and then I can get a referral.

I called the insurance company, they said they can assigned me a PCP, so they did. But I couldn't make an appointment before I received the updated card. I waited.

Once I received the card, the PCP was not updated, so I called the insurance again. They probably made some mistakes and promised me they will send an updated one.

So I relieved an updated one, I call the hospital to make an appointment, they said they don't have spot and are going to call me back once they have it. I waited for 2 weeks, they did not call.

I was kinda annoyed, I went to the hospital in person, waited in line, and asked them to make an appointment, and they did. They did have spot but just didn't call me.

I asked them for the referral at the same time and they said I could've call someone to give the referral without making an appointment for PCP. And they gave me a name card who is dealing with the referral.

I called the person, she uploaded the referral, and I thought this is the end, I can get my money back

But guess what, I called the insurance company today and they said it was out of the 90 days range. They said I can appeal it, so I did.

I swear to God, this is the most painful journey I had, and I think this is still not the end. I mean if I paid for that $1300, and then I can know how health insurance work I would have been much more comfortable, but I still don't know how it works and no one is willing to tell me. The insurance company said the hospital has to do that and the hospital said the insurance company has to do that. At the end, no one has to do that, I just had to called the right department for referral, but no one told me that.

So now my question is

How do I talk to the appeal specialist, who the insurance company said is going to call me within 30-45 days, to get my money back, if that's even possible. Do I have to talk to anyone in the hospital to help me justify my medical condition was real and needed the specialist to treat it? How should I go to see the specialist next time, my skin is still in condition. Should I make an appointment with my PCP, and then ask them for the referral, and then make an appointment to the specialist? If that $1300 is not going to come back, can I claim it as deductible? If you read the story I had, what did I do wrong, what I can improve next time if similar situation happened?

Thank you so much for reading these. I couldn't find anyone who's knowledgable and patient enough to answer my questions.

submitted by /u/Constant-Wealth-2339
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