Pharmacy Reimbursement with Ambetter (IL)

A couple months ago there were some billing issues with my Ambetter account that resulted in my account being suspended.

It was really weird in that my balance was 0; I’d pay my premiums. However, I guess on their end I still had a balance—the payments I’d made had been credited but not applied. I.e. I had credit for a couple payments worth that was just sitting there, alongside a growing balance.

In any case they got it sorted out for me, and my account is unsuspended. However, I had to pick up my medicine in the meantime, while my account was (wrongly) suspended or in grace period or whatever. I was assured by the CS rep I spoke with that this would be reimbursed as it wasn’t my fault that the account had been suspended.

The medicine had been covered by my insurance up until now. There is no generic and without insurance it’s about $360. So I paid $360 and submitted a reimbursement form on June 28th.

I called in mid July and was told that they’ve no record of it yet, to wait a month and call back about the status.

So that’s what I’m about to do but wanted to see what type of bullshit I should anticipate and prepare for ahead of time. Does anyone have experience with reimbursements and Ambetter? Centene is a name that I know is related in some capacity. I’m not sure how.

I just don’t know if I should assume I’m not getting that money back or not. And I’ve received zero communication after the initial automated reply to my form submission.

submitted by /u/omfgsupyo
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