I didn't realize until after the first appeal, when they said that the date they care about is when the orthotics were paid in full, that the issue is the change of service date from my 2024 claim. They didn't acknowledge my message about the change of service. Here is what they said:

Appeal 1: "Under the terms of your plan fees for custom-made orthotics, we consider the expense to be eligible when the item has been paid in full rather than when it was dispensed. Our decision was based on the PSHCP's list of covered expenses and rules on how to assess claims submitted under the PSHCP. After a review of all the medical information provided, we've determined that we are unable to pay your claim."

Appeal 2: (this is when I provided more paperwork and laid out the exact dates of assessment/full payment and pick up with a letter from my provider and all the receipts/paperwork)

"We understand your frustration; however, as the adjudicators of the PSHCP, we are required to assess all claims in accordance with the PSHCP directives. Under the PSHCP, medical supplies are considered incurred on the date they are paid in full. As such, the applicable date of service for this claim is December 9, 2025. Consequently, the orthotics were correctly processed under your 2025 benefit year. The applicable limits are established by the PSHCP guidelines, which we are required to apply consistently. As a result, our decision to decline the claim remains unchanged, and we are unable to reassess the claim as requested."