TLDR: any wisdom in the appeals process for a mental health claim when I shouldn’t even have to file a claim (I think??) is so greatly appreciated. Even if it’s just likelihood of approval bc I’m flying blind here!

I’m a Unitedhealthcare PPO member and last year we had our baby yay!! I have had mental health issues all my life, so when I was struggling with post partum, I followed the steps on the insurance card to get treatment. All pre-authorized in network. I just got a claim out of network for $8,700 because the insurance company (after almost two days of me on the phone trying to get to the bottom of it) finally tried saying the hospital isn’t licensed to provide intensive outpatient care. My benefits online also says I’m covered for both so can companies really pick and chose that specifically? A whole ass hospital is in network, except this one little program?

The day I started treatment the registrar of the hospital called my insurance company and they confirmed I’d met my deductible and was totally covered with no out of pocket cost for IOP, PHP, and telehealth. I also called halfway through and a gentleman from UHC confirmed it they have on record. The woman gave me confirmation code. Then today again someone from insurance behavioral health said they were okaying it, 21 sessions Jan 11-Feb 17th but I can’t get through to a human in claims to reverse it.

I can hand write an appeal and get all my medical records and do all this work, but they have all this information why do I have to bend over backwards to fix their mistake. Between the hospital checking before enrolling me in treatment and my checking on the status it feels really shitty. Tomorrow my husband is calling his HR insurance rep and that’s my last hope to not have to deal with an appeal. Appreciative of anyone who took the time to read and offer feedback