Health insurance plan has been ignoring claims for months

I have around 10 out of network claims from 2022 that my health insurance has not been processing. First they told me the diagnosis codes were invalid and lacked procedure and diagnosis codes. Then they told me that they needed medical records from the provider and so the provider faxed those over. Then they told me that they needed to submit the claims for a file audit that would take two months to complete. I called again and they claimed the medical records my doctor had provided were just a letter, and that they needed physical examination records and lab tests, the condition that the doctor is treating is not determined through lab tests or physical examination.

I’m at a loss for what to do, my doctor says she sent in medical records. I have the same health insurance I’ve had for the last 7 years, and they processed claims from this doctor in 2021 and 2020 without an issue. The bills were even in the same format. They’re not even rejecting them, running me in circles. I specifically opted to have coverage for out of network claims and have paid extra for it.

I have other out of network claims that are around $500 per bill and they’ve basically opted to only pay for the cheapest itemized parts of the claim while spuriously rejecting all of the other parts of it without any meaningful explanation of why, leaving them paying only like $40 per bill.

What can I do at this point?

submitted by /u/WhoaBufferOverflow
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