Exhausted my internal appeal option for an adverse benefit determination on an ACA exchange plan. Do I have any options left?

I went to see an ENT for a raspy voice and an unrelated ear issue. The Dr spent like 45 mins with me, examined me, then scoped me to diagnose a polyp on my vocal chords.

I got 2 bills, one for the scope that applied to my surgical benefits (ok).

And a second for the office visit that also applied to my surgical benefits ($370 towards my deductible instead of my $60 office copay benefits).

I exhausted my 2 internal appeals, the insurance company says that when an office visit is billed on the same date of service as a surgical procedure (which they consider the scope) that they apply the office visit charges to my surgical benefits.

I also complained to my state insurance commission, they investigated but did not make a determination. They only said that the insurance company claims to have acted in compliance with their Evaluation & Management services payment policy.

Am I screwed here? I can't really afford $370 right now because I budgeted money for the visit but that was for my office copay + the scope charge which was another $450. Are there external reviews for adverse benefit determinations? Or attorneys that can help without going to court for a small amount? I know the scope is surgical and applies to my surgical benefits but I don't understand why the office visit would be applied to surgical benefits instead of office visit benefits.

submitted by /u/UH2000
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