Anonymous

No Ambetter next Time

Finding a PCP 20 miles away by Ambetter Affordable Care Act Health Insurance itself is frustrating. Any one just do not like wasting their time in holding the phone when called Ambetter Affordable Care Act Health insurance. My biggest regret in 2017 is to select Ambetter Affordable Care Act Health Insurance. I have selected the Plan for all my family and paying the premiums regularly from last 4 months but could not find a PCP till now. The PCP,s are not accepting this insurance. No reputable doctor is accepting Ambetter due to some reasons. Plus I got a bill for my daughter,s cold from minute clinic which we checked before going to the Clinic and which accepts Ambetter Affordable Care Act Health Insurance. It was a surprise to us as we were not informed about this bill before. Now again called the insurance and am still on hold from last one hour. We need a day off from work to settle this issue. Who will pay for this wastage of time.
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Reason of review:
Not as described/ advertised
1 comment
Guest

Doctors and hospitals do not want to accept it because Ambetter is cheap and does not want to pay even an average cost. For example I got a statement from a specialist for $205.00 and Ambetter only paid $9.50.

I was shocked. Every statement received no matter what the medical service has been is the same.

Anonymous

Worst Insurance EVER

This company should not be allowed on the exchange they are IDIOTS! I have never received an insurance card or a prescription card . I spent hours trying to work with them and a pharmacy to fill a prescription. I have had this prescription for years and never had an issue with a "real" insurance company through an employer. These Ambetter scammers won't allow my prescription because the actual tablet is not made in my dosage of 30ml. I have always been able to get 90 pills at 10ml each to cover 30 days. They think that is too many pills and keep insisting I get my doctor to rewrite the prescription. My doctors office has also told them it is not made in that dose. What a BS way to get out of covering what I am paying for. Total SCAM do NOT sign up for this insurance as this is what you get for $500.00 a month!
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Reason of review:
Order processing issue
Anonymous

Worth it to pay more

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I have only dealt with 2 Companies, Ambetter and Blue Cross. There was nothing special about Blue Cross....except by comparison!

Picked Ambetter by price for 2017....this was my mistake. Turns out the Pediatrician we like who has been our Doctor for 8 years is not in their system. We had no idea. The Customer service is so clumsy and cold hearted that I would have spent a good deal more per month to avoid them.

Simply needed additional ID Cards and it was like I was asking something complicated.

Almost as if they were doing me a big favor! If it is at all possible, I would recommend avoiding them like the plague.

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Reason of review:
Poor customer service

Preferred solution: Let the company propose a solution

Anonymous
map-marker Austin, Texas

Ambetter is a fraudulent company.

They have given me lists of doctors who they claim to accept Ambetter. None do. I've spent hours on the phone with Ambetter and it seems like when questions I'm asking are to difficult for them to answer I get hung up on. I've called several of those Drs and when I tell them I have blue cross blue shield they will make me an appointment to see them. But when I tell them I actually have Ambetter then suddenly they aren't taking new patients. I have a brain tumor and need my yearly MRI. My neuro surgeon no longer accepts Ambetter. They gave me another Neuro who is suppose to take this insurance and told me that it is possible that after Ambetter reviews the MRI request they could deny the MRI because nothing proves that my symptoms have worsened and therefore they don't find it medically necessary. When I asked who makes this determination they said they have a couple of physicians who review it. Ridiculous. I found out from several physicians that they quit taking Ambetter because they are not paying on claims. I'm going to call the Texas dept of Insurance and file a major complaint.

When I had a broken foot and after visiting the ER I was referred to see an orthopedic surgeon. Of course they don't accept Ambetter. It took 2 weeks for Ambetter to finally give me the name of a orthopedic who really does accept this plan,, how ever this only DR is located 2 hours away from me.

They still can't get my info right after 10 months. When I call the automated system says that my member ID is not a valid ID. They still have my zip code wrong so that when I call I have to use my current street address with my past Zip Code! Unreal.

Do not purchase a plan from Ambetter!

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Reason of review:
Bad quality
Anonymous

Did not pay 100% preventative per policy

I received a colonoscopy that is preventative that I understood per the policy is paid 100% . (I have a history of rectal and colon cancer my family.) They arbitrarily shoved my remaining deductible of 375.41 to me for the colposcopy but no explanation of what specifically was not covered.

(Yes, I received a EOB but it doesn't show anything to find that out. I called Ambetter and the girl on the phone said she "thought" Ambetter "perhaps" made me pay for the anesthesiologist. Isn't that a necessary part of the procedure? The year before last I had a routine annual physical and that is preventative too.

They made me pay for some of the lab tests as said that since I have, a. low blood sugar, and b. high cholesterol, that I had to pay for the lab tests for that part of the physical. This year I had another routine physical with the same tests, and they paid 100%.

I talked with the ombudsman (person?) on the phone and she really beat around the bush with no real basis other that there are a number of "ifs" in the policy that I can get charged or.

She reportedly processed my complaint, but I never heard anything from anybody. I will drop them next renewal, but in the meantime I am filing a compliant to the state board of insurance.

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Reason of review:
Not as described/ advertised
1 comment
Guest

I would call Ambetter again and try to talk to someone else. Maybe ask for a manager.

Anonymous

Customer Service - Poorly trained

I cannot complain about the insurance itself as other than prescriptions I haven used it -but why does it require 4 phone calls to get something resolved? I had a billing issue - spoke to 4 different people and they each had a different answer. My primary care doctor I tried to change on their website 3 separate times just for me to log on and it would still be some on I did not even know. I chose this company because my dr accepted the insurance. If I have to get the run around each time I call who has the time to sit on the phone for an hour for the incorrect answer. I do not care for this group at all.
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Reason of review:
Poor customer service
Anonymous

Read your Policy

In regard to your comments they are incorrect. The government subsidy you received was taken away by the Health Insurance Marketplace.

This more than likely because you did not comply with their requirements as they stipulated in writing to you. In regards to comments of not finding doctors once you are mistaken. They may not have a huge amount of doctors or OB/GYNS but this out of the control of an Insurance company because the providers are the ones that determine what insurance they will accept. Finally in regards to the medication you did not follow the correct procedure of your doctor sending the correct documentation.

In short of complaining read all documentation that your policy tells you.

Educate yourself before you have a legitimate complaint. The only person to fault is you for your blatant lack of reading.

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1 comment
Guest

What a thoroughly AH response! I hope you don't work for AM Better.

Am Better continually lists providers that do not accept their plan. They do so knowingly in order to present a faux image of great coverage when in fact you may have to drive as much as 25 miles just for a check-up and usually you'll end up with a provider that is well below acceptable on Web MD.

Anonymous

Constant uninformed premium and coverage increases

I am reporting this for my son and daughter-in-law. He is a school bus driver and she is a diabetic on dialysis. My son called to pay his end of April premium of $107.00. The lady said no it had been raised to $384.00. Of course he freaked out and said why did I not receive a notice and how can I afford that. My wife will die without insurance. She said not my problem. As his mother I paid the April bill but I am retired and on a fixed income. I went to pay it for May and actually had a very nice young man who took the payment and then told me that it is raising again in June to $576.00. WHAT, HOW CAN THAT BE. A more than $700 increase in 2 months with no notice. I am upset made and discussed with this whole insurance thing. Any help or ideas would be appreciated. I cannot continue to pay but he also cannot lose his insurance.
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Reason of review:
Problems with payment
Amadou Smb

Ambetter - Health Insurance Review

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Have had numerous problems with ambetter. They never credited me 50 annual credit which was done in October. Called numerous times and was told it would be credited by end of November. They never credited it. This was the last straw. I saw a chiropractor which is covered 100 percent but they put it towards my deductible and my Doctors office has talked to numerous reps trying to resolve this. My plan specifically says (even printed it out) covered 100 percent and it was billed correctly. Im a single mom and cant afford additional expenses but they still havent paid my doctors office and pretty surr they won't. I followed all their rules and paid out a lot more than I could afford every month. I canceled my insurance through them and havent been able to find an insurance that I can afford. Just going to pay for my doctor's visits which will be a lot less for the insurance. I also do not understand why I have to pay a penalty for not having insurance, when the insurance that is offered is horrible. Something is really wrong with this scenario.
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Reason of review:
Problems with payment
Anonymous

They refused to pay doctor

I went to by doctor. They said ambetter didnt pay them. I call ambetter they paid. So i call the doctor again they look it up in the computer ambetter put a check that said paid the amount on the check is 0. That mean they didnt pay anything. I am a pregnant woman and i am sick i have to pay with my own picket to get care.since may 2017. I paid them every month they refused to pay my bills
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Reason of review:
Problems with payment
Cordero Tly

Ambetter in Georgia. Avoid!

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We have the same problem in Georgia. We did not pick the plan, we were "placed" in it by the marketplace when our previous provider withdrew from the state.

We received repeated emails in December saying the premium for January was "overdue" (none showed an account number or member ID), it was paid in good time and then we have never heard from them again. The marketplace web page shows we are covered, the insurers automatic phone system says we are covered but we have no member number and no ID card. Ordering a card on the automatic system says it will be 7 to 10 days and to print out a card on the web site, which you cannot access with a member number...

Our premium is over $1,300 per month for horrible coverage that is essentially in-network only and we have not had access to coverage for half a month. We are going to see if we can find a class action law firm interested in taking on vultures.

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Loss:
$650
Reason of review:
Poor customer service
6 comments
Guest

can not login. I put my information in and it goes to the: Oops.

something went wrong.... Error ID: 1750**** and other stuff!

Guest

This is BS. I paid my coverage on 12/27/2018 today is Jan.

2,2019 and I am getting emails saying that my coverage is not any good due to none payment. I have been with out insurance since sep. 2018 because of a job loss. I have a 9:15am appointment and don't know if I can be seen because of all of this.

I have medication I really need to breath with and my doctor has to see me before he can call in any more meds.

for me. I am very unhappy.

Guest

You can count us into the lawsuit!

Guest

I've been trying to get my ID and welcome packet too. They wasted no time taking their premium

Guest

One month later and no response to messages and emails

Guest

Run, don't walk! The same thing happened to us.

One quick answer/alternative if there's still time: Costco Health Insurance Marketplace had 21 "off exchange" policies from which to choose. (Ambetter policies are not offered.) It's well worth the price of a membership, but you can get free quotes online first. They don't call you or hunt you down when you provide email address and phone. One email.

That's it. https://www.costcoquote.com/

Ambetter's lack of coverage "out of area" and dearth of providers as well as their proud statement that they allow balance billing are a recipe for disaster, really financial ruin.

(Balance billing: Your insurer allows you to use out-of-network providers but pays only the discounted rate that they’ve negotiated with in-network providers, leaving you with the balance. And that cost can be substantial, because the fees insurers set with in-network providers can be hundreds or even thousands of dollars less than what doctors charge directly.)

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Jeena Tdn

No refund

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unless you are desperate don't bother w this one. i've been waiting for my refund for 4 months.

everytime i call they come up w brilliant stories n excuses. every time i call i had to stay on line for minimum 90 minutes. as i'm writing this letter they put me on hold for another 20 minutes. i'm not sure if i will get money money back.

forget about the services. I'm still on hold. When I've reached the manager about a month ago I thought I'll get my money back. He sounded sincere enough but today he won't even answer my call.

I really don't know what to do. About a month ago the manager P ( I don't want to reveal his last name which starts with a letter P) said the company will make a direct deposit to my bank account which will take between 2 to 3 days. I've waited for a week. NO DEPOSIT.

I've called him back. This time he said the company policy is mail the physical check for the refund. He said wait for a few more day to receive the check by mail, a week went by. I called today and the rep who answer the phone said the company sent the e check to my email.

I've told the rep I didn't receive any and her story contradicts to what the manager said. I don't know whose lying but somebody is. See what happens from now on.

If you're curious about the story shoot email to me. I'll give you the follow ups.

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Loss:
$1500
Cons:
  • Way the company handle the business
  • No reliable way to contact them
Reason of review:
Other issue

Preferred solution: Full refund

3 comments
Dellia Hfm

Having same problem for 4 months. Canceled back in Jan, in Mar they took $564.

Out of my account. Called them 10 times atleast. Everyone is very nice and wants to help. Always ends with "will be in your account within 30,10,05 days ect...

But it never is.

So I call back and I'll get a completely different reason. Now I'm suppose to call back Wed.

Guest

I am having exactly the same problem, chasing up a refund for the past 2 months. The agents seem sincere enough every time I call, but I am still no closer to getting back my $590.

I keep being given differing times for how long it takes to refund - 5 to 7 business days, 4-6 weeks...

depends on the agent. Frustrating beyond belief.

Guest
reply icon Replying to comment of Guest-1282352

The exact same thing is happening to me!

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Anonymous

Ambetter - Affordable Care Act Health Insurance Review

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I, Glenda Wilson, Member #904409**** made the Payment of $122.01 via Ambetter Insurance phone system on March 9th took a Double Payment of $244.02 from my account on March 10th without my consent. *Today is March 21st Ambetter Insurance HAS NOT CREDITED THE MONEY BACK TO MY ACCOUNT. I have called and spoke with their Customer Sèrvice Reps. almost EVERYDAY they give me excuses & lie about when they will credit my account. In my opinion Ambetter Insurance is DISHONEST. I have contacted my Lawyer.
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Reason of review:
Problems with payment
Anonymous

Ambetter - Health Insurance Review

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Run!!! Do not get this insurance!!!

I have had the insurance for three months, and they still have not provided me an insurance card. I have called 11 times and they keep saying they will send it for the last three months and still have not. I am pregnant and my OBGYN needs the actual card but I don't have one. I got sent away today from getting my blood drawn because they need the actual card and not just the number.

I called Ambetter and they won't fax or email a copy of my card to the lab leaving me with no medical services provided despite paying every month. They are a scam, do not get this insurance..

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Reason of review:
Poor customer service
1 comment
Kanani Jkj

Ambetter was horrible with my tests that were run. First the specialist stated they take Ambetter insurance & they were listed as "in network" come time for my tests to be paid & I get a letter for 4300.00 worth of tests that my specialist lab(in his office) were "NOT IN NETWORK" Let's turn them into the Missouri Insurance fraud complaint dept & other states as well.

Anonymous

Ambetter - Health Insurance Review

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I paid my bill they are saying I didn't An I went to get my medicine at the Walgreens they said I had no insurance I had to pay for medicine this is not the first time so this is Getting annoying . This company want talk to you they give you the runaround . They want pay but 64 dollars on a 2000 dollar hospital bill there the worst insurance company if telll a dr office you this insurance they tell NO we don't take that An hang up like you are a peice of trash a
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Reason of review:
Problems with payment
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