Medicaid vision provider denying 1-800 Contacts reimbursement

Hello everyone. I have Medicaid health insurance from Amerigroup which includes vision coverage through Superior Vision. I bought contacts from 1-800 Contacts in July. When ordering, my Superior Vision coverage did not appear, but 1-800 Contacts’s website listed Superior Vision as an in-network provider. Additionally they linked a reimbursement form I can file. I never received a formal explanation of benefits from Superior Vision, however I do know from checking their website that I have a $100 contacts allowance. I mailed the reimbursement form and expected to receive a check and have that be the end of it.

Unfortunately, I never heard or received anything from Superior Vision. I called them about a month later and they stated the claim was denied. The representative stated that I used the wrong form and emailed me another one to submit. This form had the same exact information as the one I already submitted, however it had Superior Vision’s logo and a slightly different formatting. I sent that in and the same thing happened a month later. I called to check on the status and the agent stated my claim was denied as I do not have out of network coverage for contacts.

To me this is ridiculous. Firstly 1-800 Contacts clearly states that they work with Superior Vision. Secondly, the contact lenses I use are the exact same no matter where I get them. I submitted an appeal with Superior Vision and a grievance with Amerigroup. The latter called me last week and basically re-iterated the same thing, no out of network coverage for contacts. I asked if the next step would be me complaining to the state, which the agent said yes to. NJ has a “medicaid hotline” which I will call Monday.

I know it’s only $100, but to me this is also a matter of principal. My plan has coverage for $100 of contacts, it shouldn’t matter where they come from as long as the price is reasonable.

I wanted to make this post to see if I have any chance of possibly getting this reimbursed, or if I should just cut my losses and vote. I am not knowledgeable on how this all works, so was hoping this community had some insight.

Thank you!