Hospital and insurance company can’t agree on office visits

I recently visited a Cleveland Clinic “Family Health Center” for two standard office visits. I found that under my workplace provided insurance through Anthem, that Cleveland Clinic was in network and the doctor I chose was a covered provider from the plan list of approved doctors.

I went to a visit to establish care as well as a follow up visit to discuss results a few weeks later. I didn’t have any trouble with the billing for the tests and other stuff, but the insurance kept declining the visits themselves, though their staff couldn’t give me a clear explanation why I was denied, and gave me a variety of excuses.

I had paid $25 copays as my insurance requires for each visit at the time of the visit, which is what the hospital requested. After playing phone tag with the hospital system and the insurance, and being given a variety of answers, the insurance finally declared that they refused the visit bills because the visits were billed as “Outpatient professional care” or something along those lines, and that this is particularly excluded from my plan.

The hospital for their part says that this is how they bill all office exams. They insist that Anthem is being unreasonable, and that I should be appealing their rejection of the claims. Anthem meanwhile insists that if the Cleveland Clinic would bill these appointments as office exams, that they would cover them, and that I should ask the Cleveland Clinic about it.

Both sides have told me that they believe my services should probably be covered, but that the other side should be the one to compromise, and both sides then refuse to follow the other sides proposition.

That has me looking at nearly $1,000 out of pocket for what I was told would be two $25 payments. Is there anything I can do? Is the insurance really allowed to list this hospital and its doctors if they really don’t cover any of their appointments due to how they’re billed? Is the hospital really allowed to tell me that services are covered and charge a copay, then bill under a code that is explicitly banned under my insurance plan, instead of the accepted codes I thought they would bill under?

Thanks for any help.