Purchased a wig that was covered 100% but insurance denied

Hi folks, I hope someone can help me understand this insurance denial.

My EOB/Plan clearly states it covers 100% in- AND out-of-network for wigs with the appropriate diagnosis. I received the appropriate diagnosis from my doctor and purchased the wig.

My insurance paid 20% instead of 100% and said it's due to the amount of the wig "Exceeds The Usual, Reasonable And Customary Fees".

I called my insurance provider and they said they would resubmit due to them also seeing the 100% coverage, and I'll have to wait another 30 days for a response.

I get now that like, someone couldn't charge $1M for a wig and get it 100% covered, like, there has to be a limit somewhere. But they can't give a damn ballpark beforehand? I asked 100000 questions before to try to understand what the limit would be, but all any of the reps or my physical EOB would state is that it's 100% covered.

Two questions:

How do I get them to cover this 100%? In the future, how do I get them to give me a damn budget if they're gonna cap it somehow? submitted by /u/pathstothesea
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