NIA denying ECHO more than a week after I had it done

Hi everyone!

I’ve been dealing with palpitations and chest pain for more than a month and finally saw a cardiologist. He had me get an ECHO, which I had on 5/31. The facility told me that they basically get prior auth from my insurance (Ambetter) and if it’s denied (or more info is needed), they will call me to reschedule.

I was never called, so I went ahead with the ECHO. I got my results with mixed feelings. On one hand, everything is ok, but on the other hand, the procedure was performed “suboptimally” with poor visualization in some cases per the report.

Today I received a letter from the NIA and Ambetter dated 6/8 stating my claim for the ECHO had been denied because it was not medically necessary. Looking at my patient portal and Ambetter site, the ECHO was about $3800 (and funny enough, the insurance paid my cardiologist for reading my “medically unnecessary” ECHO but not the procedure itself).

Apparently they need notes showing “changing symptoms” and other exams but I only saw this cardiologist once. So I’m worried there’s nothing that can be sent to solve this issue. I have other procedures he scheduled including a stress test, holter monitor and tilt test (for other symptoms) and now I don’t know if I should risk doing any of them. Who can I trust if I can’t trust my cardiologist knowing whether or not something is medically necessary?

I’m freaking out because I cannot afford $3800 and the ECHO wasn’t even done optimally to boot!

What can I do?