Been fighting with insurance about electrolysis for a year, have a couple claims not paid for and I’m so lost

21 trans man, North Dakota, bcbstx through my employer. It’s a ppo, with some network weirdness going on. I have an insane amount of trouble getting ANY documentation of my benefits, up to the insurance company claiming I have a family plan. I do not have any children, and according to my company documents, i am on a single plan. Their gender care policy states electrolysis is covered as a prerequisite for surgery, which I am pursuing and has a preauth, however isn’t scheduled because electrolysis needs to be done first.

First issue I ran into is while supposedly it is covered, there is not a single provider in the state who offers it. There is not a single one in network, so I ended up at the closest one (7 hour drive one way) in MN. I spent months talking to them at the beginning of the year, was told everything should be in place, but that I would pay out of pocket at the appointment and be reimbursed.

First claim is processed, eob states: amount billed- 480.00 discounts and reductions- (1)480.00 amount you may owe-0.00. 1- we need more information to complete your review. Your provider has been asked to send the data we need. Once we receive the data, we will finish the review and apply benefits per terms of your health plan. No payment can be considered until then. There is nothing more we need from you at this time.

I called them, and apparently the ppo waiver had not actually gone through, and they wanted an npi number. Electrologists are not doctors, they do not have npi numbers AFAIK. More arguing over a week or so, finally got a rep who accepted the tax ID number, who told me I should be good to put in my next claim, and that I could just put both appointments in the same claim

I file the next 2 in the same claim, and this time I get an eob stating, for both appts, amount billed- 400.00 amount covered (allowed) 92.04 amount not covered- (1)307.96. (1)charge exceeds the total number of units allowed when billed by the same provider, for the same patient, on the same date of service. the patient is responsible for this charge

(A) since you elected to receive services from a provider not in our network, you are responsible for the first 5000 dollars of eligible services.

So first off, at a price of 80$ an hour, that’s 40 dollars a unit. 2.301 units is kind of a weird number anyway, but it also doesn’t really make any sense to me that a procedure with an estimated total time of 80 hours, or 160 units, has a unit limit of 2. Secondly, I was under the impression that if an insurance plan does not have any in network providers, they still have to give you an in network rate, and that that was the whole point of the ppo waiver. What am I missing here, does anybody have any advice?