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.
Product or Service Mentioned: Ambetter Health Insurance.
Reason of review: Not as described.