DME provider incorrectly collected deductible, won’t refund until I submit EOB

I started a new job and was trying to be responsible by proactively declaring that I would be using my employer provided insurance and removing my Medicaid expansion plan that I had been using. In doing so, I was told that I would be responsible for a 20% coinsurance (expected, even though I learned after a call to my state's MCO customer service line that I didnt have to declare my new insurance until my review period in October), AND a $500 deductible which I pointed out was only supposed to apply to inpatient services. Edgepark said I did not understand my benefits and that I would be required to pay the entire deductible and coinsurance over the phone before they made the claim. This did not sit right with me but I was critically low on supplies and they would not expedite the prior authorization and release the supplies until I paid.

I called Edgepark with a Wellmark CS rep and EP said there was no way to process a refund until I submit an EOB and Wellmark has stated that they are unable to expedite claim processing (30-60 days), so essentially, I'm out $500 for a month while I just wait around. Can anyone think of any levers I can pull to get a refund more quickly? I'm really annoyed that they expect me to pay for their mistake.

submitted by /u/BenUrAwesome
[comments]

See also  Is this a QLE?