[legion]

I had a similar situation two weeks ago. I ended up asking the hospital for the UB-92 (medical claim form they sent the insurance company) so that I could go line-by line through the bill with the insurance company. The hospital balked and ended up calling the insurer themselves to resolve the issue. (In my case, the hospital and the insurer were part of the same company, which made them denying a pre-approved surgery even more bizarre.)

The fact of the matter is the health insurers are staffed with high school dropouts and former psychology majors making $20,000 a year. These are not people who understand medicine. They are often given simplified instructions and they often misunderstand or misinterpret them. This is why you are getting so many different stories--the barely-trained flunkies don't understand how to look at your claim file and determine what is really going on. The trick is to get your claim escalated above the flunkie gatekeepers. Ask to speak to a manager. Ask to have your claim reviewed by a nurse-reviewer. Get the claim in someone else's hands who is probably more competent. Yes, "lawyering-up" can often do that, but it can also often take the process out of your control. I'd say at six months you are quickly approaching that though.