Ambetter

The policy was unusable. When I signed up for the plan, it showed no deductible before payment, when I ended up having to contact them, I was told no it actually had a 6800 dollar deductible. I ended up cancelling it on June 8th, not only did they not pay for anything, even though my coverage was supposed to be from June 1st to June 30th. I was not able to use it for medications as they wanted $80 dollars for a 90 day supply of generics, all of which were 40 or under on GoodRX. I ended up calling July 2nd to request a refund. The first cs rep I spoke to told me he was looking into it, then ended up instead transferring me to the healthcare.gov cs, who turned around and told me I needed to speak to Ambetter regarding it, as they are the ones I paid directly. I was also informed on that call, that I did not have a policy with them, as I was looking at it on my phone. I ended up calling back, and being send to the escalation team, and the rep I spoke to on that all assured me I would receive a refund within 3-5 business days. When this did not happen, I called again and was told they had no record of this, even though I had a reference number. The first rep called Marketplace CS on a three way call and nothing was resolved, so I requested to speak to someone on the escalation team, who also did the same thing. At this point having been on the phone for about an hour, I requested to either speak to someone above the rep, or someone else who actually knew how to do their job, the cs rep refused to do so stating that I would nee to call back and start the entire process over to speak with someone else. I am very unimpressed by this company. The customer service team is total crap, and while I hate to say this, it is very hard to understand half their reps, you can tell that they obviously outsource to other countries, with a lack of adequet training as none of them seem to be able to do their job, and will tell you anything and everything to get you off the phone. I spoke to about five different reps, and was told something different every time. I would avoid the at all costs, they are shady, scammy, and will do anything and everything not to cover what the plan states it will, and when you try to do something about it, they will give you the run around to pocket your premium for a plan that was completely unsuable.

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!!!!!

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.

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.

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...

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!!!

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!

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!!

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!!

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.

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

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.

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.

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.

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.

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.

I've never written a negative review but I feel so strongly that I don't want anyone else to go through the stress I went through with them, so here we are. I enrolled through the marketplace with Ambetter, paid several months worth of my premium, yet never received a welcome packet, a member ID, a way to create an online account, nothing. I probably spent over 10 hours with their TERRIBLE customer service who clearly has no idea what's going on trying to get this issue resolved so I could simply make an appt with a PCP. The few times customer service was willing to transfer me to their escalation team, the call dropped every time. I was never able to receive medical care, and the only resolution I got came after I filed a complaint with my state's insurance commissioner (which I highly recommend you do as well if you have issues with them). I couldn't IMAGINE having actually received medical care and having to contact them with an issue or concern. AVOID AT ALL COSTS.

I am pregnant and have been trying to get prenatal Routine labwork done for 2 weeks. It took me 3 phone calls to figure out that all labwork needs a preauthorization, whether routine or not. The people on the phone have heavy accents and don't seem to understand what I am trying to say, they keep reading screen prompts that have nothing to do with why I'm calling. Then it took my provider more than a week to hear back, and I had to call member services again, upset, and stressed out while pregnant to advocate for myself to be able to get the bloodwork covered. Today, I am still waiting for the preauthorization, and my appointment is now 2 business days away. So I will get my ultrasound and first OB appointment without even having my bloodwork confirming my pregnancy or any of the routine things they check for. This is absurd, all this money I pay through the marketplace and I can't even get the prenatal care that my baby deserves. Yes, I selected this insurance because it has no deductible and a lower OOP max, and chose to pay more monthly to have those things. But when I chose this I also thought that my care would be covered and I would not be spending hours on the phone trying to advocate for myself.

Horrible. Do not use them. Took payment but was not applied to account. Called customer service ( could not understand any representative as they speak broken English) they took another payment and then had a credit on balance. Went to use it and was denied. Spent 3.5 hours trying to get to the bottom of this only to be told to call back in a week. Is all they can do is put a ticket in. Asked to talk to supervisor, was told they were one. Asked to talk to their superior then told there was non!! So can not fill my prescription because I now have no insurance and with out insurance it costs $1600. And this prescription is vital for my health.

I have been battling with this insurance company for over two months for a pre authorization diabetic medication. First, I was told my diabetic medication wasn't a medical necessity, despite hitting the required A1C numbers. Then I was told I haven't tried a different medication first for 3 consecutive months, even though currently I have been on that medication for 9 months. Now they are blaming my doctor. I have been without my DAILY injection for over a week at the time of this review, despite consistently attempting to get the prior authorization approved for future doses since SEPTEMBER 1, 2023. It is the end of day, writing this review NOVEMBER 14, 2023. This is BEYOND ridiculous. I wish I could give 0 stars. A customer support agent called yesterday to see if my prior phone calls with the company had been resolved, I told her no, then we continued to go right back through the entire process again with the conversation ending with no new information, no medication, and irritation.

Sadly, I HAD to give 1 star because they don't allow ZERO stars. They have managed to screw me out of $400 and I can't seem to do A THING about it. I have contacted BBB, filed a complaint, they stepped in as mediator but SCAMBETTER says they can't share info because of customer privacy ... they are a multi-million dollar business ... I have jumped through all of the ridiculous hoops for their bogus "My Rewards" card ... and it has been over TWO MONTHS since redeeming my points and SEVERAL CALLS, GRIEVANCES, AND EMAILS, and here I sit ... still waiting! I will be carrying in insurance elsewhere, at the beginning of the year and they say ... if they don't get their "glitch" 🙄 ( I SAY SCREW UP) fixed in time, I will not get my $400. I am beginning interactions with my state Attorney General's office and State Insurance Commission. The number of HOURS I have put in, trying to get them to STAND BEHIND THEIR "GLITCH" HAS BEEN CRIMINAL!!!! Only to be told, REPEATEDLY, that I will not be able to use the card, after I leave, at the first of the year. I have called "The Marketplace" for help .... NOTHING! I have called the "My Rewards" people ... NOTHING! We'll see if BBB can help but SCAMBETTER hides behind this whole "client privacy" BS ... and won't disclose information. I said, give 'em (BBB) 100% access! Don't hide behind some sort of bogus HIPAA proclamation!!! SCAMBETTRR SUCKS! CUSTOMER SERVICE CAN'T DO A THING!!! THEY ARE CLUELESS!!! And this (above) isn't even all of their screw-ups!!! ... oh, excuse me, "glitches". 🙄 I have been in tears, on MULTIPLE occasions, while dealing with them!!! A-holes!!!!!

They cancelled my auto pay without warning. They overestimated the amount for treatment I was receiving, but when that amount turned out to be less, I STILL had to pay the balance out of my own pocket - for an ESTIMATED AMOUNT!! Furthermore, I received NO communication whatsoever about this - no letter in the mail, no email, no phone call - no nothing! Their website is outdated. Most if not all of the doctors listed are either no longer practicing or don’t take Ambetter insurance. Every year my premium has gone up considerably, but I don’t get what I pay for in the least. Lastly, customer service is a complete and utter joke! Imagine hearing barking dogs and screaming children in the background while you try to get answers from people who clearly have no clue what they’re doing. This company should be investigated for deception and fraud.

Absolutely a scam. They appealed to me at first because they claimed to offer 'coverage' of the current providers I was seeing. Come to find out, not a single doctor that they claimed to cover was actually contracted with them. Not a single doctor of any, ANY, discipline, that they claimed to cover was actually contracted with them. Not even the literal PCP they assigned to me. Not a single clinic or hospital near me either. 100% a sham of an insurance company, misleading consumers either deliberately as a scam or accidentally out of monumental incompetence. I even spoke to a telehealth doctor for help, and they told me that Ambetter is notoriously bad for misleading patients. Never, ever, ever sign up with this insurance company.

My experience 1 month of having ambetter: They will take your money. 540 USD exactly for my wife’s plan. They will continue to admittedly deny you ever paid, and continue to send you the bill despite living in 2023 and being able to see a 540 deduction from ambetter. You will get the absolute worst customer service representation you will ever experience in your entire life time. (Broken English, contradictory statements, and flat out lies about information that later turns out to be intentional) For 500 and being brand new, how does the United States government have this business listed on the market place. I’ve never left a review for a company in my life, but I felt I am morally obligated to make sure nobody else has to deal with this legal scam.

I’d give zero stars, they treat you like your stupid and they screw you over, it feels like a scam, and their rewards card doesn’t even work, I would NEVER recommend them to Anyone, also they put a block or something on me refilling the medication that I need to actually stay alive, luckily my pharmacist is amazing and helped me to get them with good RX pricing without having to use Ambetter, this company has been nothing but rude and unhelpful, you shouldn’t be paying. For something that is against you when it’s supposed to be helping you major disappointment and they won’t even pay for anything even though I have already reached my deductible and they are supposed to cover 100% of it …. Stay away from them they clearly don’t care about you

Be aware that when you sign up for Ambetter's autopay, they will inconsistently deduct your bank account. You will think that everything is being handled because you made the responsible choice, until you are refused service in your doctor's office being told that your insurance has been cancelled. It turns out that somehow it is my responsibility that Ambetter's autopay is not working. Ambetter did not make me aware that there was an issue, nor did they take responsiblity or fix the autopay issue. This happened to me 3 times! The stress and hassle is not worth the savings of a few extra bucks.

Ambetter is not cheap by any means but they always done what they said in the past. I paid our premium August 15, 2023. They cashed the check but they are telling me that they didn't receive my payment. I have the returned check in front of me. They are also saying that since my husband had an increase in his pay that we owe an additional $92. They are saying that this is for the premium from August 1-7...they have been paid for all of July and the check I sent in August was for our new monthly premium. They are just trying to double dip and get more money from us. I am cancelling them as soon as I can get someone to give me my premium back. I have done called 5 times trying to get this issue resolved and like all of the other reviews, I am trying to talk to someone in a foreign country. I am a cancer survivor and I have an oncologist appointment tomorrow and Ambetter is saying my policy is suspended. This is total BS. As soon as I leave this review, I am filing a complaint with the BBB. STAY AWAY FROM AMBETTER.

No healthcare providers in WA state accept Ambetter. Some of them have never even heard of it. No mobile app and their website is a joke. "Find a provider" is useless - don't waste your time. If you start calling the doctors on Ambetter's "covered providers" list, you will find that they either don't take Ambetter or are no longer practicing. I have to assume the data is either completely out of date or false. I have their Silver plan, and I can't find a single doctor who can make a referral for any x-rays, specialists, or physical therapists, let alone the MRI my doctor thinks I need. My doctor called me after my visit to let me know that she couldn't even give me a referral in good conscience, because I would end up paying out of pocket for 100% of everything. I'm paying expensive monthly premiums, and the only thing they pay for is co-insurance on prescription medications. It's an absolute joke. Whenever I try to switch to a different plan, the health insurance marketplace in my state shoves Ambetter in front of me. Oh -- and they don't release any data, so you have no idea what they might actually cover. It's a guessing game. I don't know how it's legal for a health insurance company to offer zero transparency, but that's what you get with Ambetter. I'm switching to literally anything else as soon as possible.

Horrible experience with this insurance company. I have a really bad back. They are trying to require me to go to physical therapy BUT they know it just hurts me worse! My Dr ordered an MRI but they declined to allow it. I now live in constant pain. When I attend therapy I'm laid up in the bed for almost 7 days- just in time for another therapy appointment. I tried to call and ask if there's anything else I can do to "earn" the MRI that I need so bad- they tell me that can't tell me anything! (Their imaging department). My Dr even tried a peer to peer and it was still denied. HORRIBLE COMPANY! Maybe it's time to contact a lawyer!

I have structural spinal damage and a hamstring that is partially torn off the bone. I have an issue with my hip and all of those conditions require surgery. The MRIs for my low spine and hip were denied by Ambetter even though I had MRIs as far back as 2015 that showed the damage and a lengthy history of Physical Therapy and a wide range of medications for my pain over the years, Ambetter required that I start over, repeating medications I had already tried that were ineffective. Meloxicam and Gabbapentin is what Ambetter would approve, and not something new (Lyrica). I ended up scrounging up the money to self pay for my back and hip MRIs and even further damage was found, that was at the begging of this year. Currently, here we are 7 months later and now I have developed a wide range of neurological issues that two of my doctors have said are suspect for MS. (Multiple Sclerosis). I am in pain constantly. I have been now for over half a year and it never lets up. I have had several episodes that were being labeled as chronic pain, similar to this, over the past several years but Ambetter has refused to approve my most recent physicians order for an MRI of my brain to see why I have had an ongoing headache for 3 months, deteriorating vision, stiff and sore neck, very sore hands, burning sensation and electrical shock sensation in my wrists and hands, I woke up this past weekend with a crooked finger that is now stuck that way and there was not injury and my hearing is muffled and my ears feel like they are being poked inside by something sharp. I have been recommended to a neurologist by three ER doctors, my eye doctor, my pain management doc and my primary care physician. Now, here we go, on the 16th of June I saw my doctor for just the headache, neck pain, dizziness and ear problems. For those symptoms alone and based on her assessment and exam she felt that an MRI with and with out contrast of the brain was important for my health and wellbeing. She ordered that MRI that day. On Monday, the 17th of July I received a denial letter from Ambetter saying a brain MRI was not appropriate for my symptoms. It also stated that the Dr. who was responsible for the evaluation of my symptoms was a Gastroenterologist, stomach and intestinal specialist. I called NIA, the new imaging association who Ambetter now uses to decide if we will receive appropriate care or not. I called AmBetter and spoke on a three way call to an Ambetter supervisor and an NIA worker. It did not go well. I have called Ambetter almost every other day for a month and my symptoms that are new are very serious and painful. The longer Ambetter denies my care the worse I get. So, I once again am scrounging around and freaking out about financial obligations. Yes, I’m going to self pay, once again. But I will tell you this and it’s important if you want to know what you can do to fight Ambetter and other crooked health insurance companies. The denial letters we receive have instructions and “requirements” that we must meet in order to file an appeal or a grievance with Ambetter. There is also the option to just skip that step (and if you are not feeling well and dealing with Ambetter is making you feel stressed out and worse, ask your Dr. or a good friend or family member to help you or to do it for you). Also, there is an insurance commission in your state. They are separate from Ambetter and that’s who I will be calling. You can file your grievance or complaints with them, don’t bother doing that with Ambetter. It is a waste of your time and energy to deal with them. Most importantly, invest your efforts in seeking the option of an External Review. That’s what I’m working on with the expectation that an actual NEUROLOGIST will be assessing my symptoms, per my request because that is the appropriate approach. My MRI of my brain is next Wednesday and I’ll pay for it, however I still intend to follow through with my commitment to hold Ambetter accountable. I’m stuck with them till the end of the year and I’ve got a lot that needs to be fixed health wise. I refuse to let them continue to bully me and I encourage you to do the same. My intention here with my actions are not to get the MRI approved, or reimbursed. They make our lives harder when we are already having struggles. So it’s really just me at the end of my rope with these fools. And I really must advocate for myself, so I will and I encourage you to do so too. If you have a lawyer who knows something about health insurance laws you can see if you can catch Ambetter breaking the law. You can research all that too if you don’t have an attorney. Its all out there. I’m just one person and I know my efforts are small so I really hope that you might benefit from my experience and suggestions.

I don’t know how they can even be called an insurance company. They have incredibly limited providers, two urgent cares in the plant for all of Seattle and surrounding area.y husband has arm surgery. The paid for the doctor but none of the additional staff that assisted! They said they weren’t in the plan. I guess they expect you to get a list of surgery team members and put it together yourself. RIDICULOUS! It also took seven requests and 6 months just to get our insurance cards. This is just a few of multiple examples. Customer service is a joke. The system is so poor that they either can’t hear you or the call gets dropped during conversation. They don’t call back. You have to start over. They suck! No matter the price it’s not worth it. You’ll end up paying more in the long run.

Do yourself a favor and DON'T FALL FOR THIS COMPANY'S PLANS. They use overseas customer service reps who DON'T speak English well at all; you can not request a native English speaker - they just tell you to hang up and try again. I am of the opinion that there ARE NO native English speakers there. As well, their CS reps are not well versed in how to use the plan. I am currently signed up with their Gold plan with the virtual PCP - which, according to the website, there is $0 copay - until you actually make an appointment and guess what? It'll cost me $75 for an appointment. What a crock of crap! The plan supposedly gives me PCP appointments at $20 copay but guess what? Nope. You gotta pay full price and hit your deductible before that kicks in. It's a farce from Day 1. Can't wait 'til open enrollment to get out of this plan.

Absolutely terrible insurance company! They used to be better. The customer service department is poorly trained. It usually takes several representatives to answer any questions and the calls are long because the reps do not know how to answer questions. The network of health providers is small and the coverage has declined this year. Last year, a colonoscopy was covered yearly and this year it is covered every 10 years unless you are at high risk! The premiums have risen this year, but the coverage is lower. They do not cover some basic preventative care such as mammograms for younger women. I DO NOT RECOMMEND THEM!

If I could give a 0 stars I would. They took a payment over the phone for 2 months then they took it out again 3 days later then said they had no record of it. Told me I had to wait 72 hours and call them back. Waited the 72 hours called back and they asked me to prove that that they took it out twice so I emailed them screenshots of the transactions while I was on the phone with her. She said she put in a refund for me. I canceled my insurance with them. Called back 2 weeks later and they are telling me I never requested a refund and would I like for them to. I asked if it was their policy to keep overpayments on customers who have canceled and she said no. I said well of course I want a refund. Said it would take up to 30 days. THESE PEPLE ARE THIEVES!

If I could select less than one star I would. AMBETTER is the worst! Do not waste your time or money. This company definitely has proven they are for profit only. They offer lier monthly premiums but you pay hirer cost for medications and Medical office visits; including, Tele- med calls. If you need specialty care ; you can just forget it. You’ll pay dearly. A day late with your premium and all cost are on you. Even if you have diagnoses that will cause you additional harm or risk of death, this company does not care. Customer Service Reps are incompetent, and reaching a English speaking person is off limits. I can go on forever telling about the greed and horrible service this company provides. PLEASE DO NOT WASTE YOUR HARD EARNED $$ WITH THIS ORGANIZATION!! YOU’LL REGRET IT! They do not care about providing better care or services to anyone. But they will gladly take your money.

Horrible! I had severe pelvic pain and had no choice but to visit an urgent care facility that wasn't in their network thus paying out of my pocket. No problem. The Dr suggested I get a Cat Scan "Stat" to figure out what was causing my debilitating pain. I decided to go through Ambetter in order for them to pay half the cost. I spent 4.5 hours total on the phone calling over and over again trying to get them to authorize the service. Nobody could even figure out how to get a Pre Authorization form to the urgent care office. It was insane! After all that time, I learned that Ambetter will not authorize the service unless I see their doctor first, even though the Dr at urgent care stated it was urgent that I get a Cat Scan. Needless to say, I was extremely frustrated and felt no choice but to go through with the Cat Scan without going through Ambetter and I paid the full price on my own. A month later, I decided to make a gyno appt. I called 9 doctors listed on their website. 6 of them are not actually in the network even though they were currently listed on the website, one was for emergencies only and one didn't work at the office listed. The other three weren't accepting new clients or had a wait time of 2 months out. Their website is incorrect. This has been a waste of time and money for me. I had my membership for 5 months and I wasn't able to use one single service.

I hardly write bad reviews, but I really dislike my coverage with AmBetter. The website is unbelievably glichey, same with the customer service. I've never gotten anything resolved on the first try, and have actually just given up on getting help multiple times. The rewards card doesn't work. I can't log into the site half the time. And I'm in the insurance industry and help people with their coverage, but I have a hard time finding answers to my own coverage. None of the doctors I want to see with good reviews are in network. They don't cover a lot of preventative or alternative care. Just don't do it.

I would rate this lower than one star if possible. Customer service is off-shored which makes communication difficult at best. I needed to know who in my area was In-Network as a Durable Medical Equipment provider and was given the names of four companies. This is after two seperate calls trying to explain what a Durable Medical Equipment provider was. I called all four providers and they all told me they do not work with Ambetter. I called back and was given another name to call. They explained they did work with Ambetter but only for members located in Michigan and I am in Florida. I am paying for insurance but cannot utilize the coverage, what a SCAM. Please do not sign up for coverage with this company, you will be sorely disappointed if you need coverage.

I have had Ambetter for all of 2021, 2022, and now for 2023. Something has shifted over at Ambetter. During my first two years of coverage, I was amazed at how good it was and I raved to all kinds of people. Sure, I had to switch to some new physicians, but that part turned out very well. The problem in 2023 is that my prescribed meds are consistently being turned down, even after my physicians appeal the denials. We are not talking about expensive drugs here. If there is no generic available, Ambetter will deny it even if it's only a hundred dollars. I have a lot of conditions for which I'm on maintenance drugs. These meds, even cheap cheap generic ones, are now not allowed to be filled for ninety days. Why??? Now I feel like I'm at the pharmacy every week just to keep my meds on track. This makes me feel like a sick person, which maybe I am, but I like to pretend I am well. Another thing, which is a big giant thing, is that my premium went up 30-40 percent and my deductible and out-of-pocket more than tripled. TRIPLED! My out-of-pocket is now approximately 30% of my annual income. Not sure that part is exclusive to Ambetter because all of the companies seem to be even more costly. I don't qualify for other gov benefits because though my income is low, I have assets (retirement funds). I'm only 57, so this is not a good time to begin draining my retirement, but Ambetter is leaving me no choice if I want to do anything, like EAT. So much for "affordable care". I'd recommend choosing a different insurance company, but I am completely priced out of that option. Ambetter is the devil I know. Unfortunately.

Absolutely one of the cheapest “insurance” companies out there!! But! Only After I qualified for a discount on my premium after getting married last year! When I was paying a whopping $ 680.00 a month they paid for Everything! Every test! Every treatment! Everything! Now that I’m receiving the discount; they won’t pay for ANYTHING! And I’m not being ridiculous or dramatic; I have several autoimmune diseases and they paid for a particular medication for a year and a half, my doctor RENEWED my prescription for the same medication I was prescribed prior to the discount and now they won’t pay for it, if I want it, I have to pay out of pocket!!! What the frick do I even have insurance for??!!?? They are also denying nearly ALL testing from my specialists as well!! I used to believe they were one of the best; definitely NOT!!!! Stay away!!! I am switching as soon as I can!!!

Arizona Complete Health by Ambetter should be shutdown!! They recently turned my wife down for an MRI of her back that she desperately needs. They said she needed to do Physical Therapy for 6 weeks, which she did. They turned her down again! You'll NEVER guess what type of Doctor reviewed her case to determine if she needed an MRI ?? You're probably thinking it's a Doctor with a background in Orthopaedics, Nuclear Medicine, Radiology, Back Surgery, etc. WRONG!! The Doctor who reviewed my wife's case has a specialty in Pediatrics! Can you believe it? All this, to turn down an MRI that costs $300.00. What I have just related is indicative of how they routinely treat their patients. It's also no wonder that many Doctors don't accept Arizona Complete Health by Ambetter. I'm sure they treat Doctors as badly as they treat their health plan members. Let this be a WARNING to anyone considering buying this Health coverage: DO NOT USE ARIZONA COMPLETE HEALTH BY AMBETTER!!! It's dangerous to your health, and a complete waste of your money. I could go on and on, but I've said my piece, and I'll leave it at that.

My plan is great. The kicker is that my account is suspended for lack of payment and yet there is an account credit for 2 months. No one can get this resolved. The letter I received in the mail said I have 3 months until my account is cancelled and yet my daily breathing medication isn’t being covered during this “glitch” period. I cannot get anyone to explain this either. I have a case manager who hasn’t checked in with me. I was told someone would be calling me back today and emailing me about getting my prescription authorized. That never happened. I have payment confirmation numbers. I have reference numbers. And 3 weeks later, still no resolution. I will say I have had some great customer service (and some terrible). But if you cannot get IT to figure out why my PAID account is suspended, what good is lip service?

I enrolled in Ambetter Health Insurance (Florida) just this year. Ambetter lists practitioners on their website as being part of their Network, then when you ACTUALLY CALL these practices/doctors, they actually DO NOT participate in Ambetter's network at all. I called SIX different doctors' offices (one Internal Medicine doctor and 5 different Orthopedists) that were listed on their site and NONE of them participated in the Ambetter Network! Secondly, whenever you call customer service, you get agents from non English speaking countries who (a) have very mediocre command of the English language, (b) have limited communication skills and are often very difficult to understand and (c) are not very effective at assisting you at all. I had to call back FOUR different times before I could get my issues resolved. The only reason I got it resolved the fourth time is because I insisted that they transfer me to an agent in the US. Makes me wonder what kind of criteria they use when hiring foreign customer service agents. Overall, I am extremely dissatisfied with this Insurance and if I could give it a lower rating, I would.

Horrible.. horrible customer service and insurance provider. Switched to them on Jan. 1st 2023. Worst mistake I ever made. I have yet to have a single visits approved by Ambetter of North Carolina. I’ve called over 40 times and get someone overseas that either I can’t understand or hangs up on me. I’ve been on 3 way calls with the Marketplace and Ambetter and still nothing corrected. They claim it is, but it never happens. Their member website has invalid dates and entries throughout, so it’s worthless. I can’t even get them to email or mail me a bill. I have 9 more months to go with them and then I’m done. Please reconsider if you plan on moving to Ambetter. ITS JUST NOT WORTH IT!!!!!!

A NIGHTMARE!!! DO NOT CHOOSE THIS COMPANY WHEN YOUR LIFE DEPENDS ON IT!! We JUST chose Ambetter of NC for our healthcare and so far it has been HORRIBLE (to say the least) dealing with their customer service people! My son has needed a replacement for an antibiotic for a recurring strep infection that has caused him to miss numerous days of school. One of the bottles was spilled leaving us short. I had to call this company about 4-5 times and on only the 5th try did I FINALLY get someone that I could understand and understood me, and got the job done!! She told me there were no notes taken except for one time when I called. Unacceptable!!! And now we are stuck with this insurance for the year! :( Not off to a good start at all! I also want to add on my very first phone call the rep had roosters loudly in the background and a child talking during the phone call. I get people work from home but most of these calls went to people I could hardly understand or communicate well with (they didn't seem to understand me) and didn't know what the heck they were doing! I'm dreading dealing with this company's customer service when I have to again! Just avoid signing up with them!!! I wish we had! :(

Absolutely the worst insurance company I have EVER dealt with in my ENTIRE life. Switched to Ambetter and paid my first premium in December 2022. Had questions about discrepancies between Ambtter's website and Healthcare.gov. Ambetter customer service was USELESS. After hours spent in phone calls and being shoved from one operator to the next, we were basically told we'd have to wait until Jan 1st, 2023 to see the updates on Ambetter's website. January rolls around and NO CHANGES. Yes, bait-and-switch! Strike 1: HORRIBLE/unknowledgeable customer service that barely understands the English language. Strike 2: Ambetter NEVER sent my Insurance ID card nor a welcome packet. Strike 3 and my biggest gripe: Healthcare.gov showed a $0 copay for generic prescriptions before meeting the deductible. However, Ambetter changed the rules mid-game and decided that I need to pay my ENTIRE DEDUCTIBLE before getting ANY coverage for ANY prescriptions! YOU'RE OUT, AMBETTER! Thankfully, I caught on to their underhanded tactics before the second open enrolment deadline of Jan 15 and was able to switch back to Medica. Bottom line: Ambetter gives no indication of caring even a tiny bit about its members and misrepresents the actual benefits offered to Healthcare.gov. THUMBS-DOWN, NEGATIVE STARS, & a GOLDEN RASPBERRY AWARD for Worst Insurance Company.

Premiums are lower than most. But, you get what you pay for. Terrible customer service. I finally asked for a supervisor and she could not even get that. I called to ask why my claim was not paid in full. I had 100% coverage after deductible was met, and it was. They did not pay 100% of my ambulance claim and I wanted to know why. She asked several times what was the date of claim, what was amount, etc. Finally the last time she asked for the billed amount, I got mad. I’ve trained customer support staff for over 30 years in various positions. I skied what the problem was. She said her computer was having difficulty. I asked her why she does not write down information from the customer so she doesn’t have to keep asking. She said they re not allowed to use pencil and paper! I’ve never heard of anything so stupid. And, they need to provide ENGLISH SPEAKING SUPPORT PERSONNEL! DO NOT GET AMBETTER INSURANCE. WE LEARNED OUR LESSON AND WENT WITH BLUE CROSS. I believe Ambetter does not fully train their staff. Most likely they don’t train them because they don’t speak the same language. AMERICAN COMPANIES NEED SUPPORT LOCATED IN AMERICA. ENOUGH IS ENOUGH.

IF I COULD GIVE THEM LESS THAN ONE STAR I WOULD! I'VE ONLY HAD AMBETTER FOR 11 DAYS AND I WISH I WOULD'VE NEVER LEFT MY PRIOR HEALTH INSURANCE CARRIER. MY SON HAS CROHNS DISEASE AND NEEDS HIS INFUSIONS VIA IV EVERY 8 WEEKS OF HIS LIFE, DOCTORS OFFICE HAS FAXED 7 TIMES THE AUTHORIZATION REQUEST, HAS EVIDENCE THE FAXES ARE GOING THROUGH AND YET AMBETTER STATES THEY HAVEN'T RECEIVED ANYTHING AND DO NOT HAVE THE AUTHORIZATION READY. I'VE SPOKE TO CUSTOMER SERVICE, SUPERVISIORS AND THEY ALL ASK FOR MY CALL BACK # IN CASE I SOME HOW GET DISCONNECTED, WELL GUESS WHAT I HAVE GOTTEN DISCONNECTED 3 TIMES A NO ONE CALLS ME BACK NOT EVEN THE SUPERVISOR! SO SAD....

1-4-2023 We did our homework before choosing Ambetter for health insurance. However, we did not find out how terrible this company was until we were fully signed up. First, calling customer service is useless, you are put on hold and never gotten back to. You are given wrong,completely false, and incorrect information at every call, if you can get any information at all. Hours and hours of phone calls with no correct answers to your questions or concerns. Before signing up we checked on line and were told verbally that our family doctor was in network. However, after signing up we were told our doctors group were ALL considered SPECIALIST and we were not allowed to keep our doctor. MAKES NO difference what their website says or what you were told before you signed up. Terrible, Terrible company. It's not like they are a cut rate insurance company. For one person in our family, Ambetter was being paid around $1300.00 a month for health insurance. Not only that but the first $1500.00 of medical expenses came out of our pocket. Only then did Ambetter start paying for any medical expenses. How can such a terrible health insurance company be allowed to operate in the USA? We cancelled our policy with Ambetter and went to another insurance company. We are paying much more, out of pocket, for the new health insurance, but we felt like we had no choice but to do so. You cannot believe anything Ambetter says on their website or information they put forth. say or tell you.

Signed up with them through a healthcare .gov agent due to finding the low pricing attractive. Only to find out after calling around my area that same day that their website listings of practices who they stated would accept their insurance was completely fabricated and/or out of date. As almost every single of the 10+ ones listed in a 25 mile radius I made an inquiry to confirmed they would *NOT* accept Ambetter insurance, and/or hadn't accepted in quite some time. Filed a cancellation and refund request direct through both healthcare.gov and Ambetter, which on both ends was acknowledged and accepted. Followed up by a switch to different insurance company who's accepted location claims on their website was legit. After a very extensive information gathering session with an Ambetter rep on the phone I was assured everything was squared away, and that after confirming my cancellation with healthcare.gov (which I did) I could expect my refund in 5-10 business days. Fast forward 10 business days latter and with no issued refund. Called in to Ambetter again and was told there was absolutely no record on their end of my refund request. Proceeded to go through the extensive information gathering process again, including a direct 3 way phone call to a healthcare.gov rep who confirmed direct to their rep my earlier cancellation/refund request. After which i was again assured my cancellation was squared away and that I could expect an issued refund in another 5-10 days. Fast forward another week latter and I get a follow up email stating I was now eligible to sign up to their website to access my account. Found that strange so called back in to Ambetter a third time to inquiry about my refund status, and was again told for a 3rd time that there was absolutely no record of my refund request, but that they would be happy to file a request for one. Borderline criminal behavior experience as far as I'm concerned, and which basically forced me into having having to file a charge dispute with my credit card company to end the blatant run-around. Would give Ambetter a zero star recommendation to anybody looking to pick them up if i could.