Had surgery on my left foot on February 6. Had a simple bone spur shaved, but my foot doctor likes to shoot some stem cells called Amnicore before sealing you back up, to enhance healing.

I've had prior foot surgeries where the insurance company paid for it, but this time they labeled it "experimental." Which it may very well be, but it wasn't a good look that they paid for it a couple times before with more complex surgeries but this time they refused.

And boy did they ever try to weasel out of this. They hired a company called The Rawlings Group, a third party firm that meddles in your healthcare to try to find a liability to pawn this bill on. Did you fall on someone's property? Was it a result of someone's negligence? Worker's comp? They sent 3 letters, pretending they didn't get my response to the first two.

I escalated to a "Critical Inquires Specialist" who is sort of the last step before litigation. It took going to the BBB and the state Insurance Commissioner to get an English speaker to contact me, because customer support is all outsourced (and I've heard people from the Philippines and India who spoke fantastic English - this wasn't that, this was really cutting corners, I could barley get thru verification and never got a call back from a native English speaker with enough influence to handle an escalation.) Well, this woman did absolutely nothing for me.

They rejected the first appeal and all this “specialist” did was summarize why by restating the explanation of benefits. Four months go by. On the second appeal, where I pointed out they paid for it before, and I'm not like a lot of people they pull this on and get away with, I am prepared to go to court, I've now gotten an updated invoice from the hospital for $806.51 instead of the original $13,694 (where they tried to charge me $12,888 for the stem cells.)

TLDR: Fight back against your insurance company. Bad faith is at the core of what they do. Deny deny deny, sometimes via algorithm without even looking at it. They want you to give up, and many people do, but they accept going in that they’re breaching the contract and a certain percentage will fight til the end and they’ll pay. They regard the ones who give up as making this racket worth it for them. Read your documents, if you can't understand it get a lawyer, and don't give up.