Ambetter
5.5
Overall Score
This company may not service all states.
See states serviced
LAST UPDATED: May 14th, 2024
3 Things to Look for in a Health Insurance Company
- Plan Options — Look for an insurer that offers the kind of health plan you need. Some insurers specialize in specific types like Medicare.
- Extra Benefits — Look for the extra perks offered by the insurer with your plan like a fitness program or reimbursement. While not a dealbreaker, these benefits are worth noting.
- Claims Experience — Look for insurers that offer a good claims experience compared to others. Reading customer reviews can give you a sense of how well an insurer takes care of its plan members.
Ambetter insurance specializes in health insurance plans on the Health Insurance Marketplace in twelve states. These plans are also sometimes called Obamacare plans. Ambetter health plans are operated by the Centene Corporation. If you're looking for another kind of plan or don't live in an Ambetter service area, you'll need to consider other health insurers.
Attention: Ambetter is a very unpopular health insurance company.
It has received a 1.4/5 star rating from reviews left on Best Company. Roughly 87 percent of the Ambetter reviews on Best Company gave a 1-star rating. Complaints against Ambetter include poor customer service, difficulty with pre-authorization, and high costs for limited coverage. Most customers do not recommend buying healthcare coverage from this insurance company.
View Ambetter Reviews and Complaints
Ambetter health insurance's covered services include preventative and emergency care, therapy, behavioral health help, medications, maternity, and hospitalization. It is an on-exchange health insurance option in the Health Insurance Marketplace.
Health Insurance Marketplace plans offer comprehensive health insurance coverage. For health plans to be on the Marketplace, they must be a qualified health plan that covers the essential health benefits listed in the Affordable Care Act.
To enroll in Ambetter insurance, you need to apply during Open Enrollment. The Open Enrollment period for 2021 healthcare coverage runs from November 1, 2020 to December 15, 2020. If you missed the enrollment period, you may qualify for a Special Enrollment Period after December 15, 2020 if you have a Qualifying Life Event.
The Good
- Health Insurance Plan Options
- Helpful Online Account
- Member Perks
- My Health Pays™
- Dental and Vision Coverage
Health Insurance Plan Options
If you're looking to get an Ambetter plan, you can view health plans by first selecting the state you live in and then selecting the type of health plan tier you're most interested in. From there, your options open up to several different plans with varying prices and benefits.
Ambetter Health Insurance Marketplace plan options include: Ambetter Essential Care (Bronze Plan), Ambetter Balanced Care (Silver Plan), and Ambetter Secure Care (Gold Plan).
Each plan offers insurance coverage for the essential health benefits listed in the Affordable Care Act, but the cost-sharing rules for medical expenses are different for each tiered plan option.
Members with Ambetter Essential Care pay lower premiums but have higher out-of-pocket expenses.
Ambetter Balanced Care, the Silver Plan, offers higher premiums and a lower out-of-pocket limit.
Ambetter Secure Care has higher monthly premiums, but the lowest out-of-pocket expenses of the three plan types.
For specific coverage and cost information, including the deductible, out-of-pocket expenses, and premium costs, you'll need to work with Ambetter directly. Depending on your income, you may qualify for a tax credit subsidy on your monthly premium.
Helpful Online Account
Each Ambetter member has access to an online portal through which they can make all of their payments, view healthcare plan benefits, and take care of logistics like obtaining a member ID card. The member portal offers extra features, too, such as providing reminders for members when they are due for another doctor's visit or allowing them to take a health risk assessment to determine which steps they can take to live healthier.
Members can track their claims 24/7 through the online portal, as well as connect with member services at any hour of the day.
Member Perks
Ambetter provides more than just logistical tools for members. Many of the extra features it offers also send the message that Ambetter wants members to get healthier and stay healthier. These tools include a 24/7 nurse hotline that members can access for questions and medical needs.
There are also health-promoting programs to support members with dealing with behavioral health and maternity and newborn care. Ambetter offers 24/7 Nurse Advice Line and integrated health management to enhance members ability to get the most out of their medical care.
Ambetter also offers telehealth access with some of its plans. With telehealth, members can have phone or video access to in-network providers for non-emergencies.
My Health Pays™
My Health Pays™ is Ambetter's rewards program to provide incentives for members to live healthier with better habits. You can earn money for taking a survey provided by Ambetter, getting a flu shot or having your wellness exam. This money can go toward your next premium. Members can be reimbursed for gym membership payments as well. This rewards program promotes health and well-being among Ambetter members. While this program is great, it's only available in some of the states Ambetter services.
Dental and Vision Coverage
Dental and vision coverage are available with Ambetter, but the benefits and availability of each are entirely specific to the state you live in and the type of health plan you choose.
Dental benefits, for example, is not available in Texas, but vision insurance is. Dental coverage includes exams, cleanings, and screenings, overall, and vision benefits include yearly eye exams and glasses or contacts. Those seeking vision coverage and dental benefits in addition to health insurance can find options through Ambetter.
The Bad
- Poor Customer Reviews
- Access to Plan Information
- Limited Service Areas
- No Mobile App
Poor Customer Reviews
Ambetter has received an overwhelming number of 1-star reviews on Best Company. These Ambetter reviews mention difficulty getting medication and treatments approved for coverage, issues with claims that were difficult to resolve, frustration with customer service, and difficulty finding an in-network provider.
With such a high number of 1-star reviews, you'll likely be better served choosing another insurance provider if you can.
Access to Plan Information
It's somewhat difficult to access specific information about the types of health plans Ambetter has. Its website primarily just explains the metal tiers (gold plan, silver plan, and bronze plan) as well as how essential health benefits are covered by every plan.
To find out what kinds of plans these are, such as Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO), not to mention what prices and benefits you qualify for (like out-of-pocket expenses, copayments, deductibles, covered services specifics,and if you need prior authorization for certain medical services), you'll have to contact a representative.
Upfront, it's important to know that Ambetter is part of the Health Insurance Marketplace (HIM). It's Centene's option for HIM plans, which are intended for people who don't have health insurance and maybe don't qualify for typical plans.
Ambetter only offers Marketplace plans. If you are looking for another kind of insurance plan, like a short-term health insurance, Medicare, or Medicaid, you'll need to find another insurance carrier.
Limited Service Areas
Ambetter plans are available in a some states. These include Arkansas, Florida, Georgia, Illinois, Indiana, Massachusetts, Mississippi, New Hampshire, Ohio, Texas, Washington, and Wisconsin. If you don't live in any of these states, then you'll need to consider another insurance provider.
Even if you do reside in one of the states they service, make sure to check the location of their in-network providers (e.g. a primary care physician, specialist, etc.) for your state to ensure they have an in-network provider near you.
No Mobile App
Unlike many of its competing insurance companies, Ambetter doesn't have a mobile app. Some companies provide this for enrollees to access their accounts right from their phones, making communication and logistics much easier. Ambetter hasn't provided this yet, making account management slightly less convenient than with other companies.
The Bottom Line
Ambetter should be somewhat of a last resort when choosing an affordable health insurance company. While its plans all have decent health coverage for preventative care and some vision and dental benefits, it is difficult to access full details of its various plans. Data points such as the annual maximum out-of-pocket limit and co-pays are difficult to find on the website.
Plan cost and deductible levels vary among plans. Availability depends on location. Cost is also affected by the number of people on the plan and some demographic information, like age.
While Ambetter's plans offer comprehensive healthcare coverage, it's important to review customer reviews to get a sense of Ambetter's quality — health plans, value, cost, and customer service — and compare Ambetter to other health insurance companies before making a final decision about signing up for an Ambetter plan.
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Julissa Nicole Tampa, FL
My name is Julissa and I just want to say that there is majority of customer service reps who are horrible, but there is hope and I truly appreciate Tiffany a customer service rep, she was super understanding I called on 3/6/24 approximately around 5:30-6:00pm eastern time and I really wish i had the chance to do the survey bc she truly deserves it she took a look into my account and in no way shape or form had an attitude or hesitations, she truly cared about my issue i was having and she took her sweet time to help me figure out my problem. It was confusing for the both of us but because of her patience it made me feel like we had a connection bc of her kind heart of helping me I felt like i can trust her with everything I was going through she even reached out to her team which they 3 of them responded 1 of them mentioned about what a co-pay assistance was, another one mentioned about getting into Sales Marketing which so i can get a better plan and another one advised to her that yes what she told me about my problem about i can pay no matter how i pay my maximum, so the fact that she had to triple check with what she already knows means that she really cares for us. She was very honest with me in regarding to coming into an understanding, I am not great in my grammee and she still tried her very best she can to help me get to my answer bc i realized i myself did not make sense so re word it and she knew exactly where I was coming from and she truly opened doors for me. She really saved my sanity bc i was so stressed about my my medication issues and she was such a blessing I am very grateful that she came through and i really want Ambetter to see this post bc she was truly amazing she should work for a better company at that! And I want to make it known that in our conversation iver the phone she mentioned she was 27 so If you guys ever reach Tiffany from Ambetter give her her props! Im trying to be specific as i Can from our conversation.
2 months ago
Belinda Priest
I chose this insurance because they said my doctor was in network. When I went for my appointment I was informed by the office they did not accept my insurance. While waiting to be called back I called Ambetter and was told by Ambetter that yes my doctor was an in-network provider. I think they just list everyone as in-network even if they aren't just to get you to sign up for the insurance.
I am lucky my doctor will work with me and treat me as a cash pay customer.
4 days ago
Morgan
This health insurance is the worst health insurance that I have ever encountered in my life. I have multiple medical issues to say the least I have been out of work this past year and last year I only made $13,921 however I go to a clinic as I am a recovery addict from pain meds that were prescribed to me by my rheumatoid arthritis doctor no I didn't go out on the streets and get drugs just so you all know I was prescribed pain meds and that was unaware that your body could become addicted to them the only way I could find to get off of them was to get on a thing called methadone so I have to go to the clinic in Tallahassee Florida 7 days a week to get my dose you can't take your doses home until you're clean and then you can only take one dose home a month so yeah I have a couple days since I can take home does this build up as much as you can take home based on how long you've been clean anyways my point that I'm trying to get at is this I have to go 7 days a week to those well I go 6 days a week and I have one take home cuz I've only been in sobriety for about 6 months now this is the issue I'm out of work this year I am actually trying to get back into work but I'm having trouble finding a job that will let me work without being able to use my hands because my hands don't function properly part of the reason I was on pain meds in the first place had I known about the dangers of pain meds I would never have taken them for my ra doctor the first place anyways so today I get called in by the insurance lady at our clinic saying you $58 I say what do you mean I owe $58. My premium is zero I told her I know I'm 100% in the poverty level I don't understand why I owe anything she says well ambetters changing their co-pays now that's not your premium that's your copay and I said what do you mean is that $58 for the month just like I really don't know that's just what you owe right now well I did some calling and it's actually $58 a week that I have to pay plus for one urine screening a month I have to pay $58 for that those are my co-pays so it's $300 and something dollars a month for my co-pays to go to this clinic when it was zero before so overnight they have taken people that are way into the poverty level and are now charging them $300 and $30 a month and co-pays that is crooked and evil and if I have anything to do with it I will be fighting this all the way to the legislation because what's the point in this type of healthcare I mean it's already a crappy healthcare as it is I can't find a doctor and I've got multiple issues I've got lymphedema I've got ra I've got fibromyalgia I have hypothyroidism I have a chronic heart condition I potentially have diabetes don't know yet I have hypoglycemia I have a hernia in my belly button I have carpal tunnel syndrome in my arms I have deep venous insufficiency in my legs I have an ulcer on my leg that caused by deep venous insufficient that hasn't close up for 4 years and I can barely walk on my right leg my fingers are numb consciently burning and I can't hold a pen for more than 2 seconds before I have to try and stop the pain in my hands therefore I have to get health insurance but here's the thing last year the cutoff was to even get even to qualify for ObamaCare you had to make $13,800 I made $13,921 last year I was 100% in the poverty level this year they've moved the cut off up to 15,480 I'm still in the poverty level cuz when I start working again which I will have to somehow or another I've got to make at least $15,580 or 480 whatever I said to qualify at the low end how on Earth are they charging somebody that right now only made $13,921 $300 a month $330 a month in copays to go to one clinic now I understand we have to go every single day but they're not realizing that I guess I guess but I've seen them do such crooked things to so many different people had so many different financial levels at this clinic that it blows my mind and how the CEOs are just sitting up there making Bank off of us just makes me sick I will be fighting this all the way to the top.DO NOT GET
AMBETTER. I was forced to get me and better because I was the only thing my clinic took I was actually on Capital health plan before him better Capital health plan is the best plan I've ever been on if you're in Florida I recommend Capital health plan and they do work with people with lower income my premium would have only been $11 a month with Capital health plan I'd rather pay $11 to 80 something dollars a month premium for Capital health plan then pay a dime to him better cuz it's crooked. If I could give these guys a negative I would am better you need to do better I can't believe the amount of money you're trying to take from people that are struggling to keep a roof over their head food on their table clothes on their body and are trying to do the right thing in their lives as well good one real good one!!
1 week ago
Lauren Cotter
I'm going to be courteous and give them 2 stars even if that's pushing it. They went as far as terminating my coverage, when I'd been using it for months without even knowing! My concern is, since I've received care in that time, was it paid for or am I going to be getting a number of high bills?? Totally ridiculous! They even enrolled me in the gold plan and then disenrolled me, again, not telling me this was happening. I had to find out through a phone call from a service provider my coverage had been terminated and last few appts had not been covered. I'm like, what??
Very few if any of the member services 'agents' speak English well, and after being on the phone with member services for just shy of an hour, getting transferred from one person to another, I was finally told my coverage hadn't been terminated, I'm just now with another insurance company! So here I am thinking I' have no insurance at all, when in fact I do. Ambetter really needs to get their act together. Far too few doctors to choose from, options are very limited. More services not covered then are. As others have said, some doctors are mistakenly listed as in network when they're not in network. Many more cons then pros when it comes to Ambetter. Really, they ought to change the name to Amworst!
More than once have I had my plan changed with no notice. I'm glad to get away from them and their incompetence. Good grief!
1 month ago
John Leitgeb
The employees do not know how to communicate with each other. I have been needing basic blood work to test for cancer since January and it is now currently April. Ambetter still doesn't have their team together enough to get simple blood tests processed so I can get them done. My doctor's office is stating the insurance company is giving us incorrect information which seems to be correct given the extreme runaround we have received. There's a case manager who openly stated it is not their job to help us out with this information and only did so once a grievance was put in. The case manager feels as though they are acting with petty intent to create problems and delay my medical care. It has gotten so bad that ambetter has even told me it is my responsibility to verify that the lab billing codes are correct.... As if I'm an ambetter employee that can understand any of that. Meanwhile, the SWAT team provide emergency care because of the delays that has happened and a case manager is on the job and somehow it's more my responsibility than theirs.... Obviously I have no clue which billing codes are correct and no way of finding that out. But the fact that I was asked to verify this with two specialists that are supposed to be helping me just shows the lack of support and professionalism by this insurance company. On top of the fact it's taking 3 months for them to be able to figure out how to get me basic blood work.
1 month ago
Tracy A Stock
Worst insurance ever. I had double mastectomy due to 2nd time breast cancer. They had no plastic surgeons in network in Columbia Missouri. I called Ambetter and was told by the rep to write a letter and I would be reimbursed. Well, after submitting the same information at least 4-5 times, I kept being denied for out of network. I finally turned it over to the State Insurance Dept and not much has come of it. So far I've only been reimbursed about $1,000 and they owe me over $8,000. There's one claim left and it was for the original surgery. I noticed on claim status now that they show it being from a provider in a different state and that the claim was just submitted in Feb 2024 and my surgery was in August 2023. I call them and they cannot even find my claim under the number they have listed on line. I have never dealt with a more idiotic bunch of people in my 56 years on this earth. I could write a book on the problems I've had with this company. DO NOT EVER USE THEM AGAIN!!!!!
1 month ago
To Co
I am filing a complaint because when ambetter health insurance and marketplace insurance told me there would be no copay nor any premium charges so i signed up but it was a lie because when i filed my taxes ambetter sent a 1095 and stated that i owed them a premium of $1795. So i had to pay it even though i never used the insurance. They lie to people stating it is all free and you will never have to pay a premium or copay just to get you to sign up but ambetter and marketplace get your money by sending a 1095 to the irs at the end of the year. I was told by my tax guy they scam many people and others have the same experience as i have had. I am warning consumers that they will charge you $587 per month and you wont know until you report your taxes for the new year and find out they sent a 1095 report to the irs and that credit woll count against you. It will be taken out of your refund.
1 month ago Edited April 2, 2024
AmbetterIsTerrible Nashville, TN
This is the worst healthcare insurance I've ever had. Do not get it. Every PCP listed on their site that is supposed to me in my area is no longer accepting their insurance or no longer in service or actually dead. I'm not making this up.
After calling repeatedly and getting my case escalated, I tried to get them to switch my insurance over. They supposedly did "an investigation" and sent a letter to me with the names of 2 radiologists!
Does Ambetter even know which physicians do which kind of work?
The customer service is obnoxiously terrible. Their knowledge base is extremely poor. As I mentioned their information on their site is outdated. Their network basically doesn't exist in Nashville, TN. They're basically stealing money by charging for insurance that they are not providing.
DO NOT get Ambetter. It'll be a terrible mistake.
In fairness, I will admit that my prescription drugs are cheaper on their plan than my previous one.
2 months ago
Southern Coffee Moments
This is one of the worst insurance companies I have ever had. I would look somewhere else for better service. This is not the place for any living person. I cannot get my prescription that I need unless I pay for it. When it supposed to be free. So I am going back to what I had before. If it's not broke, don't fix it. Leave well enough alone. The company is headed for a downfall!! Do Better or SHUT Down!!!
2 months ago
macoe davis
I wish I could give less stars, haha! Poor communication skills. Stole money from us because they drafted from our account more than once in a month and won't send a check back. Have to call them too many times to get a solution to a problem...oh wait, did I say solution? I meant NO SOLUTION to a problem. The "reference" numbers are a joke. Don't bother writing them down. All for show. If you don't want an unpaid internship where you call your insurance everyday to sit on a phone with an automatic answering machine, DON'T SIGN UP FOR AMBETTER!!! Definitely switching carriers.
2 months ago
Waylon R Lambert
Ambetter is a joke...For example, I just called with issues, and I spoke with a "customer service rep" who didn't have a working phone...Yes, you read that correctly...A phone CS who didn't HAVE A WORKING PHONE...I was transferred and the next rep justified the fact that the first didn't have a working phone by saying "Things don't last forever..."...This exchange is so symbolic of just how pathetic Ambetter is...It took 4 months to get my auto draft set up, and in the meantime, the company sent a letter saying that it dinged my credit report for not paying my premiums...When I thought the premium was on auto draft...This entire company is just an excuse for rich folks to prey on poor people...I had surgery and wound up paying more than they did for service...Yet, they got over 700 bucks a month from the govt for my coverage...I wonder whose pocket that cash wound up in...Do yourself a favor and run as fast as you can away from Ambetter...The company of non working phone phone reps...It's almost surreal...
3 months ago
Andrea Podolski
I have been trying to get a refund for initial payment as I was in a fragile mental state from a recent health crisis. I got this call for Insurance, he said I didn't have much time and I need to get a supplemental provider. This occured on December 8, 2023 as I was getting assistance with my affairs the case worker told me that I didn't even need what the representative repeatedly told me I needed it. So on January 2, 2024 I cancelled this policy and asked for a for a refund. I called 4 more times on the fifth call the representative Rebecca told me, I wasn't getting a refund because I was covered in January 2024, not so I cancelled it as soon as their Holiday break was over 01/02/2024 and I could speak to someone to cancel. I feel I was conned because the representative knew my current health state was compromised. I'm so disgusted with this company with their manipulative ways. I was treated awful while trying to get a refund. I'm still recovering and this kind of stress was the last thing I needed. I cancelled it, I never used it, all I did was get conned. I would never recommend this company for your health care after the way I was treated. Also, on the sixth call after sitting on hold for ever when I asked for a representative to speak with so I could ask for the supervisor since Rebecca refused to let me speak to the supervisor on my fifth call, I was hung up on!!!
3 months ago
Sherrick Thuesmunn Seattle, WA
AVOID THIS INSURANCE. It seems like a scam company, but I think they're actually just completely incompetent.
I'm currently going through my second denied claim appeals process. The first time, I used their website to find an in-network doctor, and went to that doctor. When the claim was denied, they told me the doctor was out of network. Their website is completely inaccurate. But this inaccuracy isn't just a one-time thing, it seems like around 50% or more of the info on there is outdated or inaccurate. I initially tried to set up an appointment with the doctor Ambetter had automatically designated for me as my primary care physician, but when I called the office number listed for that doctor, they told me that doctor hadn't worked there in years!
So I tried again to get a PCP, and this time I went through the process on the phone with an Ambetter representative. They walked me through everything and we made sure the provider was in-network and near my home. After going to my first routine office visit with that provider, however, I got a $700 bill from their office! I checked online and my EOB said that the whole claim was denied, and they put a reason that was very cryptic. I called Ambetter to explain the claim, and they honestly had no clue what was happening. They couldn't explain it at all. I called the doctor's office, and they explained to me that Ambetter told them the claim had been denied because I went to see a PCP different from the one they had on file for me as my approved PCP. But it was the same person!
Ambetter will give you cancer. Only sign up with Ambetter if you hate your life. I now find myself in the unlucky situation where I am actually just not going to the doctor anymore. Of the three claims I've made since starting with them, they've all been denied for different BS reasons. I've appealed two of them, one is being processed while the other did result in reimbursement for me. The third was small enough that I didn't deem it worthwhile to spend the requisite 10 hours on the phone with support and all the stress the process entails.
So now I can't switch my health coverage since open enrollment has ended, but my insurance is so untrustworthy I can't really go see a doctor unless it's an emergency. The only reason I haven't canceled is I need my monthly medications and in case of an emergency. Heed the warnings of others: STAY AWAY!
3 months ago
Leah Haynes Keller, TX
This company somehow obtained my info and had started sending me Bills/ invoices after I was n an accident and already covered with my states insurance Medicaid, Granted after I became 21 in November and they are somehow claiming they paid some of my medical bills from an accident i was in!! I only found out about my SUPPOSED membership through my contacting them and them telling ME I did sign up to become a member and I am VERY AWARE I have NOT signed up for ANY IAMBETTER anything!! They've sent a bill to my lawyers with my name as well as a person named Antonio M!! and this is in FACT the hold up for my financial payout!! I MAY sue them next for this unwarranted confusion, it fells like someone who works for the ER also moonlights for obtaining injured soon to be uninsured victims, because how else did they obtain my personal information and to mix it up with Antonio M' is CRAZY!!
3 months ago
Catherine Scanlan Seattle, WA
I've read many of the reviews and agree with many and disagree with a few. I've never had a problem with Ambetter paying my claims, as long as I am enrolled according to them. Earlier this year, January-February timeframe, I went to pick up my insulin and it was over $1,000, when it was supposed to be $25. They said they cancelled me because I hadn't paid my premiums for several months, which I had. After hours on the phone, I paid what they said I owed and they reinstated me. After sending them front and back of cancelled checks, they gave me a credit on my account. Today, I was checking on a prescription for insulin that my doctor said they submitted 11/29/23. The pharmacy initially said they hadn't received, it. I called the doctor who called the pharmacy and they said it was a problem with my insurance. I called Ambetter and they said it was a problem with the exchange. I called the exchange and they said that I was eligible and enrolled through 12/31/2023. Apparently, when I renewed for 2024, Ambetter put in a start date of 1/1/24, which somehow cancelled my insurance for December 2023. After several hours on the phone in a 3-way call with Ambetter and the exchange, they said they would fix it. The problem is I am out of insulin in a few days. It is the weekend so nothing is going to happen. However, insulin doesn't stop for the weekend. I am beyond upset. I have Type 1 diabetes and will literally die without insulin by the end of the month until the new insurance takes effect on 1/1/24. As it is, it looks like I will have to go a few days without it even if they reinstate it as promised and can't go to the hospital without insurance. I shouldn't have to spend hours and hours doing some else's job and fixing someone else's errors.
5 months ago
Har Tol Lucedale, MS
I don’t understand what all this noise is about! I would say that most of these 1 stars are just not getting the understanding needed from their agent that signed then up or if they just went in and just chose the cheapest plan themselves! So with that being said my agent explained how the insurance works and helped me with the best plan for my area. All plans did not work for me and I listen and went with the one she chose for me and I never had a minutes trouble with my plans! I’ve been with Ambetter for 5 or more years and NEVER had the experiences that I’m hearing here. So far Ambetter has been far more than just insurance, it has been a life saver for me!! I say find the best plans in your area and leave Ambetter to continue to blossom in it’s good here. Molina, Cigna and the other great affordable plans are great as well in the areas they serve.
2 years ago
Just another biller Kodak, TN
I am a medical biller and certified medical coder and have worked for providers for over 20 years. To those getting billed by the provider for lack of auth, change providers! Those bills are not your responsibility! Do your research on what you should pay. NEVER PAY THE PROVIDER BILL WITHOUT MATCHING IT TO YOUR EOB (Explanation Of Benefits) from your ins company. If it's not the same amount, send a copy of the EOB with your payment.
Ambetter requires providers and the staff to do their jobs. Documenting medical necessity, submitting records supporting the diagnosis and treatment plan. I will say that once a claim or procedure is denied and multiple hands touch it, getting it approved or paid gets tougher. Providers need to do it right the first time. Providers have the ability to upload supportive documents online directly to the denied claim or auth. It is usually resolved within a few days. I actually liked working Ambetter claims because they were so easy! Even if a provider missed an auth, Ambetter would approve retro auth requests IF they were done in a timely fashion. From my experience, most of the complaints I have read are most likely from:
PROVIDERS SIDE:
1. Not enough office staff to support the patient base.
2. Untrained medical scribes or physicians that are responsible for documenting medical necessity. And yes, mds, nps and all others contributing to the medical record must know what is needed to get paid. I have attended many trainings and I can count on one hand the number of physicians that attended. The ones that did, knew exactly what they were required to do in order to get a test or surgery approved and paid.
3. Untrained billers/collectors that do not know how to get the claim paid.
4. Not educated on what the step management is for authorizations (ex: the small test, the next test, then the advanced radiology) Not going straight to MRI.
MEMBER SIDE:
1. Not understanding your medical policy. 2. Going to out of network providers.
3. Not looking at their EOBs and matching them to the providers bill.
Overall, Ambetter requires the provider to DO THEIR JOB! As they should, in order to provide care to their patients who entrust their health and life to them.
2 years ago Edited December 6, 2021
Dali Dallas, TX
If you follow the rules of using in-network providers for both diagnostics and physicians, there will be no surprise billings. I made sure my primary care physician on paper was affiliated with a local community hospital so that I’m covered and in-network in case of an emergency. I have never had a problem getting authorization for drugs, but sometimes the pharmacies will actually lie (not Ambetter’s fault) and tell you,”It isn’t covered by your insurance,” when all you needed was a pre-auth. I always check with Ambetter directly. I never trust the doctor office staff nor the pharmacy staff to sue the due diligence. I guess I’m cynical that way, because I used to work in healthcare. I think it’s easy for people to blame this insurance company, and usually people only take time to write reviews when they are angry. If you follow the rules of the Ambetter system, and make sure you use in-network providers, you won’t have to deal with appeals over billing later. Work smarter, not harder folks! Also, being kind to customer service goes a long way. I mean, I had a lengthy convo with a rep who was absolutely outstanding and sweet. She took the time to explain how everything works, because healthcare gets complicated with deductibles and all, and even I needed some questions answered. I am so happy that I chose Ambetter and not a cheaper company, because you really do get what you pay for, right?
3 years ago
Kristin Slink Atlanta, GA
I honestly couldn't say anything bad about Ambetter and feel compelled to write a review based on its one star rating.
Disclaimer: I live in Atlanta proper, so I have Emory locations all around me. Access was easy and although scheduling my annual appointment wasn't instant (several months out) I have very limited needs, so this worked for me.
I am not going to boast about the price, but compared to the other offers, it was pretty reasonable. I will not comment on the overall status of government healthcare. I don't understand how we are supposed to afford it, but this is not the fault of Ambetter.
When I was offered benefits through my employer and had to cancel my plan, the person who helped me was extremely polite and helpful. I was able to submit a request to refund my recent payment and she went through my account to remove my cards so I wouldn't get an auto payment. No issues at all. Very happy.
Give them a chance!
4 years ago
Heidi Turner
I love Ambetter! My place of employment is now offering Insurance so I'm going to loose coverage since I'm in with Markplace. Ambetter has been great! I don't want to switch. They approved without even hearing the arguement I was ready to take on, a very expensive liver medication that I had been trying to get for years. It was even delivered to my door step. They have also approved all my husbands medications which are also very expensive. Our co-payments are low and they cover our family of four at a reasonable price considering the market. I'll be so sad if they say I have to get the company insurance at renewal.
4 years ago
CinderUgly Maple Valley, WA
I don’t understand all the bad ratings going towards AmBetter’s medical insurance, I can only attribute that to people who aren’t looking at the plans being offered more closely and choosing the wrong plan that don’t fit more true to your health. Also, most of the time, it’s either the doctors office or the hospitals that are the problem. Billing procedures not pre authorized, care under doctors that are not covered on your plan, billing incorrect codes, causing problems with out of network charges to appear. I took months looking at plans for me and my husband, and came across AmBetter, under ACA Plans. If it’s about your health take the time to READ your plan, the whole plan! I took my age 50+ & husband 60+, and the type of Health plan I was hunting for. ****1.) Most Important!!! It had to cover a total catastrophic event, (stuff happens) what type of plan would cover that and not put me in the poor house, with affordable deductible & affordable out of pocket, or preferably one that combines both, so deductible & out of pocket are one total, with copays that goes toward that? 2.) Very Very Important- Once my affordable deductible is met, what do they cover 100%??? It has to be 100% after deductible is met... not this 20/80 garbage. So make sure it’s 100% after you’ve met your deductible, and once that’s met you best take advantage and get things done that you’ve been holding back, because they weren’t an emergency, but should be done, such as; colonoscopy, prostate exams, breast exams, health check & bloodwork (most plans cover this for free, because it’s considered preventative maintenance). We are fairly healthy, or I should say we don’t see doctors very often, so paying maybe once or twice at the doctors office yearly is... normally affordable. Mine was all about catastrophic events that could happen and a lower deductible with co-pay that goes toward my deductible and my out of pocket costs were my main goal, not to go broke. 3.) who are the Hospital’s they sponsor... are they close and who are their doctors? Then look up those doctors (people review them online), theres always one with high stars you can review. 4.) If you can... find on the same plan, “ No Referrals“ for seeing any doctor you want to visit, (not always available, very few available) my didn’t offer that. 5.) “NEVER, NEVER Let a doctor or procedures done to you WITHOUT prior approval from your Health Insurance!” I can’t repeat that enough! That is a must, never waver! That’s why I always know where my hospitals are under my coverage, there is always doctors in emergency covered under your plan, if you use hospitals under your plan.. If you are coherent, ask for procedures to be preapproved by AmBetter or any insurance company for that matter, and that the people that are doing the procedures are covered and registered with a Ambetter or what ever Insurance your using. Normally, there is a person on staff that her/his responsibility is to make sure things flow with getting all of this pre-approved while your in emergency. Take huge advantage of that, you’ll need it. “(Always have someone, loved one or who ever is your emergency contact knows your plan, in case of being unconscious when arriving at the hospital). “ 5.) keep in contact with your insurance and write down who you talked to and a reference number, if you need it for fixing a billing problem. Ambetter agents are very helpful, and if you get one that isn’t understanding or not getting you where you need to go, don’t feel intimidated to ask for someone else, with new ears. That’s their job. My plan had dual as one total; deductible/out of pocket $5100 total deductible, with copays that went towards that deductible. I had a TIA stroke this year, went into Emergency on my own cognizance (catastrophic event) hit my deductible of course, but I was willing to pay the $5100, and had set aside most of that amount just for this reason. My plan covered 100% of ALL charges after deductible was met. Xrays, MRI, CAT Scans, neurosurgeon visits and months of testing to determine what happened and it turns out it was a TIA stroke. This was part of my policy. The costs that I would have been billed were unimaginable... at the cost around $70k, then all was said and done, cost me $5100. So what I’m trying to say is that looking for catastrophic insurance over conventional insurance is ten fold in the long run for people over 50. Now I’m up for renewal for same policy plan, but now the deductible is $5200+ Soooo... now I have to wave if I can afford that new increase or find another plan. I’ll probably stick to the same plan, since there is always financial help if needed... still that’s a far cry from paying $70k to only paying $5100. So AmBetter does have great plans out there, but like anything... do your research, know what your looking for and READ your policy, always get referrals if needed, a MUST get pre-approved procedures prior to having them performed, and always make sure that all the people providing your care are sponsored by your insurance, and if you have questions, speak to an agent. keep in mind that ALL medical insurance company’s now required you to be responsible for your own care under their policies, and all require you to make sure you know these procedures and most of all using ONLY in-network pre-approved procedures and pre-approved doctors are used under your plan. Hope all that made sense, even if I did repeat myself. Good Luck!
4 years ago
Wayne Jackson Douglasville, GA
My experience have been good, got the insurance for my wife, she had to spend one night in the hospital and the total bill came to over $14,000, Ambetter paid all of it. Never had an issue finding a providing. I live outside of the Atlanta and do no have issues find a provider. If you do not live around a large city then you will most likely have issue finding a provider in your area. Also make sure you call all of your Doctors that you wish to stay prior to signing up. I worked in the Ambetter Call Center, the Provider list that they have is not up to date. Do your homework prior to joining and everything will work out.
4 years ago
LD Darien, GA
I was scared to get the Ambetter from Peach State Health Plan after reading all of the bad reviews on here but it was all that was offered in the Marketplace for my area. I have been very happy. I have had their insurance for nearly 6 months and they have paid everything promptly with no issues. Of the nearly $6000 we have only had to pay a little over $100. I have had no problem finding doctors, although I must say they all have to be affiliated with the local hospital. Sure, I'd rather have better choices but I really did not expect more. I have been happy with every doctor or NP I have seen, especially my NP. I have no problem with their website either, including earning rewards on the visa and using it to pay my phone bill. We have not had health insurance for many years and this has given us peace of mind. I have not had to call them but I did message them on the portal a few times and got a quick response. It would be better if they sent an email saying they had replied though. I had to keep checking the message box. We thank God our health has been cleared except for a few small issues, thanks to Ambetter.
4 years ago
Brittany Lawrenceville, GA
I have had AmBetter since July 2018. I have read the majority of the hundreds of these reviews and it seems as though folks either didn't have other options and also didn't do adequate research about whether the physicians, hospitals and urgent care centers that they prefer were covered by the AmBetter plan they were considering. I went with an AmBetter 4 (which is a Silver plan on healthcare.gov), I have a low deductible ($600) and 100% co-insurance after my deductible is met. I pay $0 for my medications and since I am self-employed, I actually pay the full amount of what this insurance premium is per month (roughly $400/month.) I have on-going health issues that they haven't penalized me for, I have received all of my 3-month prescriptions without issue as well as over 15 other Rx's that are monthly. (As I said, I have seriously, life-threatening, on-going health issues.) I just spent 8 days in the hospital being discharged on 03/30, today is 04/07/19 and ALL of the hospital bills ARE PAID IN FULL. Again, I did extensive research before selecting AmBetter as my provider. I am very pleased with them and have zero complaints. Again, I pay my premium on time, researched my physicians before selecting their insurance and understood what type of plan I was selecting. Doing your research instead of expecting someone else to do it out for you is the truth behind the majority of the complaints in all honesty.
5 years ago
Kaye C. Marietta, GA
My experience with AMBETTER for the 2018 year has been GREAT. My husband has been to the ER three times and hospitalized one time. All the bills were paid promptly. We both have had a lot of doctor visits and several diagnostic procedures without any problems at all. All of these extremely negative reviews are terrifying and scary as it is time to pick a company for 2019. I only had two choices form 2018, either Ambetter or Kaiser and Kaiser is a true HMO so that was out. The reason I pick AMBETTER is that All the hospital systems in the Atlanta area were included: Emory, Piedmont, and Wellstar. When I have searched for doctors, there any dozens for each specialty. I don't know if my great experience is driven by my location and the fact that we are in the metropolitan Atlanta area or not. Good luck and Good health to all.
5 years ago
Laverne Williams Irving, TX
I am a healthcare reimbursement professional with may years of experience, I file claims for various physicians, code medical records and perform physician credentialing. Currently, I do not qualify for AmBetter health plans but anytime I have needed to call to verify patient benefits, check health claim status or get an authorization for services or just so I that can help redirect a patient appropriately, every customer service person I have spoken with at AmBetter has been helpful, courteous and professional. Answering all of my questions with care and great attention to detail. As a patient, its better to allow your doctors office to handle things for you but try to be clear when attempting to get answers from your insurer. But it is the insured parties responsibility to personally understand their own insurance like what's covered and what is not, and how much will this cost me? before you leave the doctors office. For physician offices you really should let the right people handle credentialing, people with experience. AmBetter is a great payer of claims and fast; as they keep accurate records and when they recoup because someone made a mistake in claims processing its always been accurate without the chatter like some others, "because we can". Thanks AmBetter you are doing a Great job and you are easy to work with.
5 years ago
Viktorija Kang Henderson, NV
So far everything has been great. The only reason I am writing a review is to balance a little bit the stars because majority of people gave 1 star. I am a scholar and I can tell that all the reviews are always very biased and subjective. Most of the time people leave reviews when they are extremely unsatisfied or they are extremely satisfied. What about those who are in the middle? I live in Nevada and I found primary care doctor and pediatrician for my child within 5 minutes on their website. The plan I have has a good price and very good coverage, more than I could ask. I have called customer service and I was helped promptly. The person I spoke to was very nice and professional. I would never have written the review if I hadn't seen so many terrible reviews. Imagine how many other satisfied customers have not left a review? I just don't want people to not get good prices insurance because of other people's personal experience. Just look at the coverage, the price, and compare with other insurance companies. Choose what fits your needs, not what the "stars" say.
5 years ago
Kenneth Newman Spring, TX
This is the worst insurance company anyone can have from poor communication skills from customer service to not covering anything, to finding doctors to accept this insurance is joke. What a scam. For govt to subsidize this fraud is even a bigger scam.
2 months ago
John Seattle, WA
Ambetter denies claims saying preauthorization was needed even after saying it was not needed over the phone. There customer service is awful. Of shore call center where the people are difficult to understand constantly put you on hold and just want to get you off the phone so they can move on and not help the next person.
2 months ago
Michelle Little Rock, AR
DO NOT GET THIS INSURANCE!!!
they will hang up on you, Deny every pre-authorization your Dr sends over and offer zero assistance to diabetic patients. Absolutely pathetic. They could not care less if you died. Stay away from Ambetter!!!
2 months ago
jeffrey hill Matawan, NJ
I wish I could leave zero stars. BEWARE OF THIS COMPANY. DO NOT DO ANY SORT OF BUSINESS WITH THIS COMPANY. I have been in a battle for over a month for a refund. Hours I’ve spent on the phone trying to get my money back. I signed up and payed twice for the first month - accidentally bc of simultaneously signing up and paying with autopay. I keep getting sent to different people who are the opposite of helpful. This company has robbed me of $551.24 and will not return my money. Stay as far away from this company as possible. BUYER BEWARE
3 months ago
Eric Perry
Been insured for just over a year so I call for my 1095 form for my taxes and got the run around,so I got transfered three times and the final transfer was a no help recording.I will cancel first thing in the morning and very unhappy by the lame service I received ,the last person I talked to was speaking over me and was of NO Help....Will not be back
3 months ago
aria manolakaki Odessa, TX
When shopping for insurance, my specialist doctor was listed in network with ambetter and specialty drugs were covered after I purchased their insurance and went to my specialist They told me at his office that they do not work with ambetter. They only cover generic medications no specialty drugs are covered.
Getting a customer service agent on the phone is horrible it is impossible to communicate they do not speak or understand English
3 months ago
Enya Bradner Redmond, WA
The worst health insurance. I was called by a facility to set up primary care, but the earliest appt for “new patients” was 3-4 months down the road. Had an health situation and needed to go to a clinic for immediate attention. Got turned away from THREE clinics because they wouldn’t see me with Ambetter insurance. All the clinics Ambetter contracted with were 20-200miles away and NONE were open on weekends. Apparently with Ambetter, you need to only get sick on the weekdays and be able to drive hours for “immediate” care. The worst money I’ve ever spent.
3 months ago
Laura “Vanilla” Jamison
Yes, I am leaving a 2nd review because this is beyond ridiculous. NO ONE can tell me WHY I have to contact THEM to verify MY information and now they are claiming on their site that my insurance has lapsed even though they aren't letting me know why and they did send me my membership cards and I know they will tell me to contact them AGAIN when I should NOT have to go through all of that JUST FOR A SIMPLE ANSWER. Screw this company, you have lost a customer, I don't even want to pay y'all a cent if this is how you treat your customers!!!
3 months ago Edited January 24, 2024
Brian Wall
This is literally one of the worse insurance companies I've ever dealt with and you should avoid them at ALL cost!! They are horrible in all areas including coverage for services received. My wife was covered by them and we chose to cancel the plan due to financial hardship and horrible coverage. Once I cancelled the policy and turned off auto-pay the illegally debited by account for two months of premiums, which is theft! We cancelled the policy prior to them doing so and completed the process they suggested to receive reimbursement for their illegal act. It's now been over 60 days (reimbursement should be received within 7-10 days as per their representative and it hasn't been. We have contacted them multiple times with no resolution. In fact, whenever we DO contact them they continue to give bogus reasons for why we haven't received a reimbursement for $436.58, which included "you have an outstanding balance" of one month's premiums. When asked which month that would cover they were unable to clarify. These folks are a bunch of crooks and only out to take advantage of people even if it requires illegal actions. I've filed complaints with the insurance department AND the better business bureau as I believe these two entities are there to represent the people in such situations. If Ambetter is in the mix to consider, shop elsewhere until you find a company that is now owned or operated by them!!
4 months ago
Tiffany Cochran
I feel like I'm talking to a 1 year old when I call customer service. It's hard to understand what they're saying and the words I DO understand make no sense! I'm pretty sure SHE didn't understand what she was saying. I saved up my points and had them put on pre-paid visa. It arrived about 4 weeks later. I go to Walmart to buy some FOOD and my card was declined. SO EMBARRASSING! I call customer service and the customer service rep tells me, "Mam, you can spend your card on a bill, rent and phone but can only spend on food at a Walmart in Georgia"...I LIVE IN OHIO! So all the commercials about them talking about the rewards IS A LIE. You CANNOT withdrawal cash. You CANNOT spend on groceries (in your state). You CANNOT use the prepaid Visa card on things you need. So if you're thinking about getting the card I hope you live in Georgia.
4 months ago
Holly Myers St Louis, MO
I enrolled in Ambetter for 2024 in early November. On 11/13 I long into the enrollment portal to check on something and I see that the status says "cancelled" so I call customer service to see what that's about. The lady insisted multiple times that I was currently enrolled and it was not cancelled, and everything looked fine when I created an account for the member portal so I took her word for it. Then a couple months later in early January I tried to log into the member portal a few days in a row but I kept receiving an error message. So I called about that and they said the reason was because my coverage was CANCELLED VOLUNTARILY which it sure as hell was not. Never received any sort of email about this supposed cancellation and never got reimbursed the $680 premium I paid to enroll. So they transfer me to someone else to look into this more and get my health coverage reinstated for January. But then that person says that the notations for the call I had with the customer service said I had cancelled my plan at that time. They said they would open a case about it and someone would call me in the next couple of days but they said that it might not work out since that dimwit notated that I had cancelled my coverage. Since open enrollment is still available for a little while I may just cancel for real and go with someone else as long as they give me my $680 back. DO NOT RECOMMEND based on customer service alone
4 months ago
John Smithers New York, NY
Ambetter from WellCare of New Jersey. I WOULD NOT UNDER ANY CIRCUMSTANCES ENROLL IN THIS HEALTH INSURANCE COMPANY. Their customer service is absolutely terrible. Their customer service is in India and I could not understand what their customer services reps were saying to me because their English was incredibly poor. They sent me a letter saying my insurance was going to be cancelled and no one at Ambetter from WellCare of New Jersey could explain why my insurance was going to be cancelled. Every time I contacted them no one could answer me. I was terrified that they were going to cancel my insurance. In New Jersey, insurance companies are required by law to send out a letter about re-enrollment and any possible increase in the premium. This company never did that. I believe this company is operating in violation of the law in New Jersey. The New Jersey Insurance Commissioner's Office should investigate this company and shut them down for not being in compliance with New Jersey law.
4 months ago
Melinda McCarthy Hawkins, TX
Outsourced customer service with poor communication. Hours on the phone to try and get to a complaint department to no avail and resorted to filing a complaint with Texas Insurance Department and finally got an unsatisfactory response from Ambetter. They quoted my monthly premium for 2024 at $113. I checked Healthcare.gov and the premium was listed at $299/ month. When I contacted Ambetter they confirmed that the premium would be $299/ month. Had I not done the checking of premiums I would not have know until after open enrollment had ended and been stuck with the $299/ month. Their response to the complaint was to blame Healthcare.gov with doesn’t make sense they are the ones that listed the correct premium. How can Ambetter not know the correct premium they are charging? They have very limited in network providers . They have denied claims for my yearly dental cleanings saying I have to get all the paperwork work with codings from the office, fill out the forms and send them in since the dentist isn’t in network. There are no dentist in the area in the network. Their policy states they pay the same for in network or out of network for dental. They just don’t tell you you’ll have to do a hula dance to get reimbursed. I’m not a coding expert have no idea what they want and I would have to drive an hour to the office to get the paperwork. I gave up and just pay out of pocket even though I’m supposed to have dental coverage. The also denied a CT requested by a surgeon for a hernia repair. It’s been appealed and the surgeon send additional noted to justify and they find another reason to deny. Amazing that these denials come right as I have met my out of pocket maximum. Mean while the hernia gets bigger daily and my guts and literally falling out. Yes the insurance is cheap but you get what you pay for and I definitely would not recommend Ambetter.
5 months ago
Chloe wood-henrickson Olympia, WA
Worthless insurance plan. They do not have a single in-network urgent care in my city. I live in an urban area walking distance from 10+ urgent care clinics but instead I had to ask a friend to drive me 30 minutes to a clinic that was in network. If no one could have driven me then I would have paid an extra $80 for the cab fare both ways. Its a lot to try and figure out when you're already in the midst of a medical crisis. Another time I waited 6 months for a dermatologist appointment. I had a rash the entire time and it left permanent scars on my skin because of the delay in treatment. I also had a stye in my eye this year and Ambetter does not cover a single ophthalmologist in my state, so I could not have the surgery to remove it, and once again was left with permanent visible damage. An insurance plan this neglectful should be illegal, it is basically no more than a cheap scam.
5 months ago
Martin Milner Hernando, MS
Ambetter Health Insurance review
Good at claims payment. Very poor customer service, you are directed to a third world call center, not an Ambetter employee , very loud and busy background noise. Reps don’t speak fluent English, nor do they understand your fluent English. If they can’t understand or address your needs/inquiries, they eventually just hang up on you and you have to call them back and start the process all over again……
they put the CUSS! in customer service.
5 months ago
Blink Drive Roanoke, TX
Ambetter insurance is not a scam. However, every phone call made to them results in an endless loop, typically lasting at least one hour, before you can speak with someone, and even then, there is no progress. Seriously, we called them for 10 consecutive days, averaging one and a half hours each day, yet nothing was resolved.
I just want them to approve my Primary Care Physician (PCP) and assign me to any in-network specialist. Their call center is unprofessional. Even if you ask them something as simple as the current date, they still put your call on hold to get the answer from their manager. It feels as if they might as well hire stupid robots instead of real humans to work there.
My wife got pregnant for three months. They are helpless since day one till now.
5 months ago
Quinn Ales Chesterton, IN
I'm from Indiana so I don't know if that makes a difference, but I've never had an issue with Ambetter. I had more headaches with BCBS. Honestly the only thing that has been annoying in the last 4 years was that they didn't want me to use name brand Vyvanse for my adhd but instead preferred adderall xr...not a big deal. I'm happy with them. Just sucks insurance is so expensive these days across the board. I pay $1300
2 years ago
Jason Walker LaFayette, GA
I have been with Ambetter as a patient / customer for nearly a year. While I totally comprehend the opinions and troubles of others and the number of one star reviews, I have been thoroughly pleased after leaving my workplace and losing excellent company insurance.
Ambetter fortunately had my providers on their roster and I've had absolutely no trouble with accessing care or prescriptions.
Perhaps I'm a rarity, but I'm really happy with Ambetter.
I'm a Georgia resident and acccesed my Ambetter plan through Marketplace during open enrollment.
2 years ago
William McNeel Columbus, MS
Its been pretty good for me on my first year of coverage with them in 2022, depending on your plan, I have a zero deductible plan and generally this pays in full for my doctors visits and I also like the $10 Urgent Care visits and it pays for medicines for like illnesses in full and lab work at my doctors office. I personally really don't get sick much or go to the doctor very often. I also like the teledoc call in doctor that comes free with this coverage basically unlimited call in visits. The only dislike(s) I have so far is that my doctor prescribed me Ozempic and they refused to cover it even with filling out PA (pre-authorization) and had me take their recommendations of other medicine for 3 x months only to still deny me. Also its not any good if you go out of your state to a doctor. so if you are from mississippi and get sick in Alabama or Florida and need medical attention you best get back to mississippi to be treated. Also not sure how good or bad it'll ever be for hospital stays or surgeries just yet, I know my sister is on this coverage, as am I and even our local hospital in our home city is not in their coverage network and she got hit with a $1,500 bill that they refused to pay for going to the ER... so you have to be extra careful where you go to make sure its covered and in network. I would recommend knowing in case of a medical emergency where you want to be taken to and treated at.. That also goes for specialist and dental work also. Be sure to call ahead in advance and verify with doctor(s) before going and do not trust what the ambetter website list as approved providers. I had an appointment with my long time (local) dentist and even noticed he was on their listed of accepted & approved providers only to find out on the day of my appointment that they do not accept ambetter or evolve dental coverage. Even told me it was a down right awful insurance that they don't ever pay claims is why they quit accepting it. I was able to find another dentist in my area that accepted my coverage but he wasn't nearly as good of a doctor as my long time dentist. Also I have noticed that specialist that do accept ambetter generally put you on the back burner. example I have had a bad ear ache called an ear nose and throat specialist and they booked my appointment almost a full month out!! I'm like i need treatment now not a month from now but ended up keeping my appointment.. I'm not sure on that myself that my dentist told me about them refusing to pay claims to doctors.. also my primary physician tells me its a horrible last resort insurance to have. He said I do not have insurance with this insurance, but overall I haven't had any issues with them not paying anything so far although I haven't had any XRays or much lab work done. Even the tech lady at Walgreens says I have good insurance so I'm not really sure who to believe on that. Also if having test as I've learned with united healthcare I would still call the insurance company to verify if the procedure, surgery and pre-surgical testing that needs to be done to verify if it needs to be prior authorized and don't trust hospitals or doctors or specialist to do this for you...
2 years ago Edited November 3, 2022
Smileeys Hattiesburg, MS
I wish more people would write the state and general area they live in for these reviews because it seems to make a difference. I live in South Mississippi and Ambetter has overall been a good insurance for me. I work part time and would be on disability or unemployed if I didn't have a wonderful employer who allowed me to go from full to part. However, I am no longer eligible for health insurance through work so I had to go to the marketplace. I actually have better insurance paying very little than my work family does. They have united healthcare and have had so many problems. I am one of the ones the affordable care act has helped tremendously.
One thing I really like about ambetter is they have a rewards system that is not hard to do. You get points for flu shot, answering simple questions, watching health videos, etc. I was able to earn $250 this year easily that I paid my electric with. There are only certain bills you can pay or they have merchandise you can get.
CVS quit taking my insurance this year but I went to another pharmacy that I discovered I like better. I pay zero dollars for my medication (I take 9 a day) and copays for primary and specialists. What plan you get depends on your income, though. We are a family of four with income around $36,000 for reference.
The bad is that they require pre authorization but that's any insurance. They have denied some but then approved it later all except for one. My neurologist really didn't like my insurance and kept telling me they wouldn't approve this or that and I quit seeing him. Probably should have stopped sooner really because that wasn't only problem.
I haven't had much contact with live customer service so I can't offer much insight there but I'm often called by automated service to check in with me or tell me about new info. It's equal parts annoying and helpful. They also keep calling to tell me they've noticed I'm not taking my heart medication right but don't say what it is. I don't take heart meds but do take blood pressure meds. Anyway, that's just mildly annoying.
On my plan they do not pay for pain management and regular doctors pretty much can't prescribe anymore so that is difficult since I'm in pain almost constantly.
They have telehealth and 24 hour nurse's line but I've never used it.
3 years ago
R. M. Boca Raton, FL
Overall, I like Ambetter 1000x more than past plans I've had, like Humana and BCBS, which were outrageously pricey AND retroactively denied coverage for life-saving treatments, leaving me over $30K in debt. Of course there are pros and cons to every plan, but I stick with Ambetter because the positives far outweigh the negatives. So, for the good: it's affordable, I've had good customer service experiences (once they accidentally denied a claim, saying it was out of network, but quickly corrected this after a phone call), my copays aren't bad (this is important as I'm chronically ill and frequently see multiple specialists), they have a free health coaching plan, and I absolutely love the providers I found. I noticed that the providers' actual billing staff cause most of the billing errors, not Ambetter. The bad: Providers are hard to find, and while copays (like $8 for a PCP visit) are low, coinsurance is NOT. While they've allowed me to receive stellar mental health care, the same can't be said for my back. They required 5 weeks of PT before authorizing an MRI, with me paying 40% out of pocket for each session (I met my out of pocket max, so MRI was 100% covered). Meanwhile, they denied a back brace and stopped covering the pain medication I need to function. The MRI showed a mess: disc bulges, stenosis, degeneration, and bone spurs (and I'm in my 20s). Ambetter initially denied epidural steroid injections. HOWEVER - I've had a LOT of luck with providers winning appeals. My pain med is covered. My injections are authorized as far as I know (they wanted 5 weeks of PT, but I told them I'd done that, so they fixed it). I love all my providers. Yes, some stuff is a real hassle, but I'm very satisfied with Ambetter.
3 years ago
Meagan Mueller Chattanooga, TN
This is my second year as an Ambetter customer, and I plan to renew my plan with them for 2021. The coverage is better than any employer provided health insurance I’ve ever had, and at an incredibly reasonable price. The customer service reps are always helpful and usually go above and beyond to help, most of my prescriptions and doc visits are 100% covered or have a super low co-pay, and there are plenty of doctors and nurse practitioners in their list of providers.. I don’t know what the complainers are expecting, but this health insurance company is doing a great job.
3 years ago
KAREN M HARRIS Kansas City, MO
I lost my insurance 3 years ago. Never been without insurance. Bad luck happened to me and I had to have eye surgery. The only good thing that came out of that bad situation is a girl told me to call ambetter
I did and I am very thankful. They have been wonderful. Had 2 more eye surgeries that same year that they paid really good. I'm low income so I qualify for a subsidy. I just can't say enough good things about ambetter.
4 years ago
