Insurance denied ambulance service from one hospital to another because it was out of network. OOP max is met. Advice on the next steps?

I was directly admitted to hospital A per my PCP's recommendation for potential urgent surgery on my gallbladder. Hospital A kept me there for 2 days, did some tests, and decided that my gallbladder didn't need surgery, but my kidney had aneurysms and needed urgent surgery. Hospital A could not do that type of surgery due to not having a transplant center nearby, so they called around and found out that hospital B, which is 2 hours away, could do this surgery. At 6:30 pm they let me know that I was being transferred between 6:30 and 7:30 pm. I didn't ask if I could go there on my own because I assumed this was an emergency and it would have been covered by the insurance. I was finally transferred by AMR at around 11 pm that night to hospital B. Surgery went well, and I'm recovering at home now.

I've been keeping an eye on my insurance's account portal, and I finally saw the EOB for the ambulance transfer claim. AMR is out of network, therefore insurance doesn't cover the service. My Out-of-Pocket maximum has been met and the majority of the whole event was covered by insurance, except this claim.

I'm now aware that the Surprise Billing Act doesn't cover ground ambulances, so I'm unsure what are my rights and responsibilities here. The location is Florida state (I reside here and both hospitals are in FL as well). The insurance company is Ambetter. Here are the EOBs and their denial codes. The claim number is censored.

1/ Am I still covered because this was an emergency / because my OOP maximum has been met? What are my rights here?

2/ Should I wait to receive the bill from AMR first and then negotiate with them / file an appeal with insurance, or should I file an appeal with my insurance now to avoid losing out on time? I have until the end of April next year to file an appeal.

3/ If I receive the bill from AMR before or during the appeal process with Ambetter, can I tell them to hold on to the bill while waiting on the appeal process?

4/ If the appeal is denied, what are my next steps?

TIA for any suggestions!

submitted by /u/ktt128
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