UHC Partial Denial for mental health… is there anything I can do?

For context I made this post a bit ago about my mental health claims. I ended up calling and they just had to do what’s called a provider loan since the provider hadn’t been billed before.

The guy on the phone did that for me and told me based on my plan I would have 80% coinsurance. Sweet – that’s what I expected when I picked this provider based on my plan information I received when I started this new job and got this insurance (that out-of-network mental healthcare had 80% coinsurance).

But now it comes back as a partial denial. I should have met my deductible and then had a large reimbursement even with me paying 20%. But now I haven’t even met my deductible because they’re saying they’re not even covering half of the price. For context the price is $165/ session and they are only covering ~$76.

The reason on the EOB states: “This Out-of-network Service Was Processed Based On Medicare Allowed Amounts Or Other Sources If No Medicare Amount Is Available. These Amounts Are Used Even If The Patient Doesn’t Have Medicare. (ND)” The claim code was LG if that helps.

Is there anything I can do? None of that was disclosed in my plan details – I didn’t even know to look for that. I’ve been going to this provider because they’re the only ones in the area who I’ve been able to make progress with (only EMDR therapist in the area) but I cannot afford this. Honestly this whole situation is worse for my mental health and now I’m wishing I never would have gone to therapy.

I rarely use insurance because I’m pretty healthy and this feels so shitty and scammy. American healthcare sucks. Why do I pay so much to my plan every paycheck if they’re not covering half of what my plan says would be covered.

I want to try appealing it but I don’t even know what evidence to provide. I feel blindsided and pretty defeated.