Unfiled claims, max out of pocket, owed a refund -help?

Saw a provider 3 times in February/March. The first visit was no charge (procedure covered entirely by insurance, claim processed and paid). The next 2 visits I had to pre-pay my estimated portion, for around 2k total. This was all before I met either deductible or out of pocket maximum. Fast forward to May, they have still not filed those claims.

Meanwhile, I've had other visits to other providers that have already been processed and according to insurance I've now met both my deductible and out-of-pocket maximum for the year, but this still doesn't include those 2 visits from earlier. I have now been billed by and owe these other providers around 5k. But I am owed 2k refund by the provider that hasn't filed. Or I would be, once they finally submit their claim and insurance finds that I already met OOP.

The provider is allegedly experiencing a "system outage". Literally can't even call their billing office, it's an automated message saying to please check back next week. This has been the case for at least 5 weeks, but I would assume longer since they still haven't filed something from February.

I have spoken to my insurance, who just shrugs and says they have 90 days to file. I had previously asked if I could file it myself, prior to the other visits that finished off my OOP in order to avoid this situation, and they said no. I have since found where I can submit a claim myself in their online portal. But even if I do that, I'm still stuck trying to get a refund from a provider who apparently can't access billing records.

I think I'm just SOL and will have to pony up the 2k additional or a payment plan until they get their stuff together, but wanted to check if there's something I should be pressing my insurance company to do?

Edit to add location (if it matters) is Texas

submitted by /u/pifumd
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