insurance denied emergency surgery

i have united healthcare/oxford through a company i work for remotely in ny.
i live in pa.
i had an outpatient surgery to remove kidney stones from my right kidney on 9/12.
urologist said he removed all stones and wants me to follow up in six months for the left kidney. 9/20 stent removed.
i had flank pain for weeks after that, right to left and was urinating blood daily. not sleeping. the urologist is unresponsive and downplayed my concerns.
i consulted my nephrologist at one point and ordered a urine test with microscope. found a yeast infection. this was the day before the stent removal. urologist gave me a yeast rx and antibiotic.
10/6 I’m in excruciating pain, my blood is dark brown.
my urologist is not responding to calls, messages or emails for days.
i have my family take me to the ER.

they gave me a shot of toradol? and something for nausea. the pain went down. bp was 170. i was still urinating blood.
a ct scan was done and found that i still have kidney stones on both sides and one of them is borderline obstructing.
i was then told i needed emergency surgery otherwise i could go into sepsis. the facility didn’t have the capability present to operate so i was transferred via ambulance the next morning to another hospital.
i was assured i would not be billed by the ambulance because the onus is on the hospital since they don’t have the facilities.
now i get this. and I’m freaking out. I’m already in 30k personal debt and barely paying that…
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We received a request to cover an inpatient facility admission. We review all coverage requests to make sure services are covered according to the rules of your health plan. Based on the information we have, your admission is not covered.

Your provider should not bill you for the cost of the services you received. If you receive a bill from your doctor or facility that is associated with this admission request, call the number on your health plan ID card.
Member name: redacted
Service Reference #: redacted
Provider/health care professional: redacted
Facility name: (if applicable): St. Luke’s Hospital of Bethlehem Pennsylv Place of service: Inpatient
Next anticipated date of review: NA
Admission date (if applicable): 10/06/2023
Diagnosis: N20.1 Calculus of ureter Date(s) determined not to be medically necessary: 10/06/2023
The clinical reason for our determination is:
You were admitted to the hospital on 10/06/2023. You had pain caused by a kidney stone. A procedure to remove the stone was done the same day. We read the medical records given to us. We read the guidelines for a hospital stay. This stay does not meet the guidelines. You did not have to be admitted as an inpatient in the hospital for this care. The reason is you were watched closely in the hospital. You were stable. You had tests that did not show any problems that needed inpatient only treatment. The records showed that there were no problems with the procedure done. Pain was being managed. You were able to go home later the same day. You could have gotten the care you needed without being admitted as an inpatient at the hospital. The hospital inpatient admission is not covered. We let the hospital know that it is not covered.
Denial code (if applicable): Not Applicable
Claim amount (if applicable): Not Applicable
Information regarding previous requested services:
Number of services approved in previous request(s): NA
New total of approved services: NA
Date service initially started: 10/06/2023
This determination is based on the following information: Observation and Inpatient Policy Administrative 297.1 T2, InterQual 2023, Mar. 2023 Release, LOC: Acute Adult General Surgical.
What this means for you
We reviewed the information submitted by your doctor or facility. According to the applicable clinical guidelines, your illness or injury does/did not meet the guideline for this level of care.
Please see the medical rationale above.
“Level of care” is the amount of medical care or treatment needed for an illness or injury, and where that care or treatment should be provided. When a doctor or facility treats a patient above the recommended level of care, we cannot cover it. In this case, an inpatient facility is providing or
provided a level of care beyond what the guideline recommends.
Note: This is a benefit determination, not a medical decision. Only you and your doctor can decide what medical care you need.
Don’t agree with this determination?
Your provider can speak with a UnitedHealthcare medical director by completing a Peer-to-Peer Scheduling Request Form at uhcprovider.com > Prior Authorization and Notification > Forms > Peer to Peer Scheduling Request Form, or by calling the Peer-to-Peer Support Team at 1-800-955-7615.
You or your representative can also request an appeal. An appeal is a formal way of asking us to review information and change our determination. The appeal rights included with this letter have helpful information about requesting an appeal.
Questions? We’re here to help.
If you have any questions, please call the toll-free number on your health plan ID card.
Sincerely, Morris redacted, MD Medical Director United HealthCare Services, Inc. on behalf of Oxford Health Insurance, Inc. P.O. Box redacted
Copy to: redacted Copy to: St. Luke’s Hospital of Bethlehem Pennsylv
Enclosure: New York Clinical Member Appeal Rights New York Appeal Rights Insert