Insurance not covering sterilization at 100% due to “second procedure” – seeking advice

I had a bilateral salpingectomy in November 2024. My insurance covered everything that they deemed relevant to surgery at 100%. However, my surgeon discovered a cyst during surgery and removed it, so now insurance is claiming that I actually had two procedures and is charging me coinsurance on the procedure for the cyst removal, as well as a variety of line items they’ve deemed to be related to that.

I understand that cyst removal isn’t part of sterilization surgery, so I would understand some of the charges, but they’re also trying to charge me coinsurance on the entire amount of the recovery room, for example. That doesn’t seem right to me because I would have required the recovery room regardless, and my stay was not extended by the removal of the cyst. Other things they were charging coinsurance for included drugs, pathology, anesthesiology supplies, etc.

Am I correct in my interpretation of the law? I just want to make sure I’m clear on my situation before filing an official appeal.

submitted by /u/alpacasonice
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