Insurance company screwed up, but they claim it’s too late for me to appeal.

Treatment occured September 2023. It was part of a regular treatment regimen for which I have preauthorization. Dozens of identical claims were aproved and paid off by insurer over the course of the year.

Last month I get a bill out of the blue from the provider for this service that occured over 1 year ago. I was shocked, called the provider, they said the claim kicked back and forth between provider and insurer several times before it was ultimately denied and they billed me.

So I called the insurer, and we figured out that they never attached the preauthrization to this particular claim, and was hence denied. Representative told me to file an appeal. I did. I got letter back saying I cannot appeal because its been over 180 days since my denial notice.

Now what do it do? There is an EOB with denial that is more than 180 days old, but I didn’t even realize it until I got billled by the provider. I have seen these claims go back and forth for months, seen denials turn into approvals, and I never do anything until the provider bills me a number. From my perspective, I asked for this appeal within days of getting the frst bill that ever came to me. From the insurer’s prespecive, I was notified of denial months ago and waited too long to appeal.

The denial is totally incorrect and totally the insurer’s fault. Someone didn’t attach a valid preauth that should go with all these claims. Dozens of identical claims were approved throghout the year, and I had no reason to suspect this particluar service date would be treated differenty. It was not even on my radar until I got a bill from the provider, and for some reason that first bill arrived more than 180 days after the claim was supposedly denied.

I want to file a third-party external appeal, and I believe I can make a very strong case that this claim should be approved and paid for by my insurer. The only thing I have going against me is this supposed 180-day clock. But again, I did not receive a bill for this service until literally a few weeks ago.

Anyone experienced something like this before? Advice on filing an external appeal? It’s a five-figure bill so it’s a pretty big deal for me to get this corrected.