Denied claim for a covered benefit

I 25m have health insurance threw my current employer. It is just my wife and I on the plan

My wife and I have recently started trying for kids and pasted the one year mark of trying. She decided to go to her in network OB and get testing done to make sure she wasn’t infertile. Before they proceeded with anything I checked my benefits and it covers infertility diagnosis, not infertility treatment. So she went ahead with the next visit. The doctor ordered lab work and scheduled an ultrasound to check everything. Labs and ultrasound came back fine, they sent me for testing and it came back fine.

While checking my insurance app I noticed the claim for the visit with the lab work for my wife was denied. And I owed over 3 grand, I called the insurance company and they agreed that If it was indeed a diagnosis it should be covered but since the provider only “coded it as infertility” and not “infertility diagnosis” so we 3 way called the providers billing department. They say that all the coding looks correct so they will send it back for a recode. It comes back again as correct and sent back to insurance.

Long story short is there anything that I can do or say to get them to just change the coding to diagnosis since that’s what the visit was? so the insurance will actually cover it? TIA

submitted by /u/Then-Newspaper-6227
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