IVF Benefits and In Network Out of Pocket Max

Hi all. I just want to start by saying thank you so much to all of you for creating this space and for being willing to entertain questions and help myself and others attempt to understand the health insurance landscape.

I have poured hours upon hours into attempting to understand my insurance (they really should have had a class in school on this) and I’m still struggling. I was hoping to get clarity on two points:

Edit: Insurance is UHC if that matters.

My insurance has a generous lifetime maximum allowable amount for IVF coverage. All necessary prior authorizations were approved, we’re seeing an in network doctor and clinic, and we went through with our retrieval two weeks ago. The insurance claims are starting to pop up on my online portal, and there are two claims specific to IVF (each is coded to one of the prior authorization CPT codes that we received) where I am still being charged a coinsurance amount. My thought process was that any of the claims under those CPT codes specific to IVF (and these are specific CPT codes, we’re talking biopsying embryos, etc, not like standard blood work, or something) would not require us to pay any coinsurance and would be paid in full by our insurance and deducted from the lifetime maximum amount. That being said, prior to those claims, we had not hit our in network out of pocket max. Can someone clarify this? Should they have been covered it in full and applied to the IVF lifetimes amount or do we still owe coinsurance? Do we owe the coinsurance amount only because we haven’t hit the in network out of pocket max?

Because of those two claims, and the coinsurance amount we owed, we hit the in network out of pocket max of $2800. After the first claim ($600), we were at $2400 for our in network out of pocket claims. But the second charge, was for $500, which took us a $100 over the $2800. Should they be reimbursing us for that $100 since the in network out of pocket max was exceed by $100? Sorry if that doesn’t make sense, I’m trying to explain it the best I can. If they should be reimbursing us, is there a way to file for reimbursement? I realize that last sentence makes me sound dumber than rocks but I’ve never filed for reimbursement from an insurance company before 😂 😂 😂

Thank you all so much for reading this. You have no idea how helpful it is. It is near impossible for me to speak to a human at UHC and I really have tried. I pretty much only end up getting someone who reads me word for word my plan literature. Which is great, except I can read it myself. So again thank you. You have no idea how much I appreciate this.