Ambetter Insurance is health insurance. Its 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 from Sunshine Health and Superior HealthPlan. It is operated by CeltiCare, a subsidiary of the Centene Corporation.
Health Insurance Marketplace plans are intended for people who do not have health insurance coverage, and only certain customers qualify for coverage. Thus, Ambetter health insurance is somewhat of an exclusive health care plan insurance company.
To enroll in Ambetter health insurance, you need to apply during Open Enrollment. Open Enrollment for 2019 health care coverage runs from November 1, 2018 to December 15, 2018. You may qualify for a Special Enrollment Period after December 15, 2018 if you have a Qualifying Life Event.
Ambetter enrollees are given access to an online portal through which they can make all of their payments, view health care 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.
If you're looking to get an Ambetter plan, you can view their health plans by first selecting the state you live in and then selecting a metal type for the 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 plans available include: Ambetter Essential Care (Bronze Plan), Ambetter Balanced Care (Silver Plan), and Ambetter Secure Care (Gold Plan).
Ambetter Essential Care has lower premiums, but 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. In some cases, premium subsidies may be available through the Affordable Care Act depending on how your annual income compares to the Federal Poverty Level.
Members can track their claims 24/7 through the online portal, as well as connect with member services at any hour of the day. The subsidy estimator in the online account also helps members see how much they would receive for reimbursement for a treatment with their benefits.
Ambetter provides more than just logistical tools for members. Many of the extra features they offer also send the message that they want their 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 such as the StartSmart for Your Baby program, which provides support for expecting mothers. Ambetter has support for members coping with behavioral health issues, chronic illnesses, and similar struggles.
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, and this money can go toward your next premium. Members can be reimbursed for gym membership payments as well.
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've signed up for. 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.
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.
Up front, it's important to know that Ambetter is part of the Health Insurance Marketplace (HIM). It's Centene's option for HIM plans, which is intended for people who don't have health insurance and maybe don't qualify for typical plans.
In HIM territory, Medicare isn't an option. For example, if you qualify for Medicare, that's the legal option for you to get rather than taking advantage of Ambetter plans. Medicaid and CHIP are HIM plans, too. Ambetter has PPOs, HMOs, and EPOs. However, they don't offer Health Savings Accounts (HSAs).
Ambetter plans are available in a select few states. These are Arkansas, Arizona, Florida, Georgia, Illinois, Indiana, Kansas, Massachusetts, Mississippi, Missouri, New Hampshire, Nevada, Ohio, Texas, and Washington. If you don't live in any of these states, then obviously Ambetter isn't an option for you. Even if you do reside in one of the states they service, make sure to check the location of their in-network providers for your state to ensure they have an in-network provider near you.
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.
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I am native American and the marketplace suggested this is the best insurance for natives that have health benefits from the IHS services. However after a year of having the insurance and it's coming to an end on December 31, not once did Ambetter assist in any payment of any service I received in the last year. All i ever received this past year was denial after denial I would never recommend this insurance to anyone, nor would I suggest any Native American to take this insurance. It was a money pit and not worth the cost I paid.
They don’t care about you in the least. I had them last year. My bank card number was stolen and used for $12,000 in phony charges. I stopped the card and ordered a new one. Visa said my bills would transfer. Ambetter didn’t. It skipped 1 payment and they cancelled my policy. I called and asked if I could back pay them they said NO. I asked if there was anything I could do. They said, NO. I said this sucks. They said, I know it’s compam policy, it happens all the time. Goodbye.
I still got high bills, they charge you for being over weight, and high deductible that i had to pay towards at prenatal appointments, this is not a good insurance for expecting mothers.
I'm on Affordable Healthcare Act in which I have a premium and the government kicks in $1,300 a month. I can't even get an ID card to go to the doctor. this is an Arizona I was in Montana before and had great insurance. This insurance company is a joke
My husband and I live in North Las Vegas and we are very satisfied with AMBETTER.
I wasted many hours with them on the phone. It appear that their strategy is to wear you out by wasting your time trying to find 1 actual provider out of the many providers that they claim that are in network according to their website. During a call, Ambetter might help you search for providers, keep you on hold during their lunch break, waste 4 minutes on every call to run you through a long menu before speaking with someone, give you a list of providers that do not take their insurance, refer you to somebody else and finally RINSE AND REPEAT. START VERY EARLY IN THE YEAR, IF POSSIBLE, WHEN SEARCHING FOR A PROVIDER. Don't waste your time trying to pick the best provider yet. FIRST, just confirm that the provider actually takes Ambetter insurance AND that someone has successfully filed an Ambetter claim with them for what you need to have done. Talk to the person that handles the insurance claims at the doctor's office just to be sure. And then, ask them again 2 more times to be sure. If you are lucky, they are correct. Record all calls to Ambetter, if possible, and use an internet phone service that keeps track of all calls numbers and call lengths. After wasting months with them, I filed a complaint with the Texas Insurance Board. Two weeks later, THEY CALLED ME BACK TO HELP FIND A PROVIDER. The provider I chose was one that was on their website for quite a while, but they only recently signed a contract with them. Surprise. My health problems have all been taken care of by a very good provider. I was very lucky! Best of luck to you! Hope this helps somebody!!!
This insurance company is so bad they hardly cover anything and they deny most claims even though it’s expensive. And most important of all only few provider accept this plan in Houston,TX and sorrounding counties and most of them start rejecting it after a while
If I could give it 0 stars I would. There are no doctors in the Dallas, Texas. They won't let me go off it and pick another insurance provider.
Having Ambetter has been really frustrating. I can't do a number of things that they say we can easily do. Some of these include...1. getting a hold of them on the phone when needed. 2. finding a provider online. Whenever I search it says that there is no one in our area even though there is. What I liked about Florida BlueCross was that it was the exact opposite and they were very reliable.
No urgent care providers in-network withing 50 miles. Run!!! Better off putting the money paid in premiums in the bank. They'll deny your claims. Denied MRI for my hip (that was fractured) and wanted pain meds and PT for 8 weeks first. Because I was unable to access care, I requested a refund of premiums. They agreed and then kept my money. Reported them for consumer fraud in TX, but they lied and I would have had to fight the determination and by then, I was worn out. They are the WORST! So bad, that I didn't get coverage this year because I felt so scammed.
Ambetter is a huge headache when trying to help a parent to at the very least enroll. Ambetter sent an invoice that was not received due to being out of state and mail was not collected properly. Ok...our fault. Then sent another invoice that included the first invoice and a new total that included a price difference for a new health bracket that he qualified for. Ok... no problem. The invoice was mailed with a ck to cover the total right away. A couple weeks later a letter is received stating that the application for the ins. was not processed due to the lack of payment of the first invoice. Umm...the first invoice was paid with the revised invoice. A week later another letter comes stating that the coverage that was applied for is not longer available, so if you don't contact us then we will just enroll you automatically into something of their picking that will actually be better for him. Okay no problem. 2 days later a ck and a letter stating that the actual ck that was received was an over payment of the invoice and because you didn't pay that first invoice that was not received, you get no insurance and have to start all over again! I spent several calls and hours on the phone between Ambetter and Marketplace in reference to just getting him enrolled and why the ck was sent back and denied all together. One pointing the finger at the other and it's beyond words that I can actually post on here. So if you are helping a parent or trying to get this insurance yourself look elsewhere or if you have to go with them keep a close eye on them and write down everything you can about your call if you have to talk to them. Oh and for those trying to help out a parent or member, they say you have 24 hours of authorization from the member. Nope. You have until 10pm central time that day. As for question #4 below, It shouldn't matter if you are a paying customer or not.
This is the worst insurance company! Invest your money somewhere else. Horrible costumer service, they laugh at you, and they won’t resolve anything, and won’t leave you speak to the manager or supervisor. They deny claims , and would also take money from your bank account to renew your policy without your authorization. Run away from this company!!!
Ambetter is a good company. They're prices aren't too bad, and they contact you personally to inform you when certain preventive care is needed. The only thing I have a problem is with new medications. I have severe migraines, and finally an injection that reduces migraine days to at least half of the migraines per month has been aporoved by the FDA, but it isnt covered. I can't afford to pay my Ambetter premium every month, plus 575 every month for the shot I need!
Every interaction with Ambetter has been a nightmare. You have to contact customer support anytime you need to do anything online because their website is so bad. It seems that anything that might cost them money is burrowed deep into the darkest corners of their site where you would never find it without guidance. In addition, customer service does not respond in a timely manner and is never very helpful. Right from the start I knew they were shady when I signed up for one price and SURPRISE, next month my bill is 20% higher! Not to mention the health providers covered are poverty status. This company preys on people that don't really have any other options. That way they can charge whatever and treat you like garbage. DO NOT USE AMBETTER!
Ambetter told me to have a mammogram for prevented health maintenance. They said it’s free to me. I got it done by a provider in Ambetter network but Ambetter has yet to pay the provider and it’s been eight months. The provider said they have thousands of Ambetter patients that have not been paid on. I’m switching to Oscar Insurance.
Absolute trash. Have been trying to appeal coverage for prescription and have made 20 phone calls totaling over 7 hours or phone time with them and no resolution. It has been 22 days of trying to get my medication covered and they claim that an expedited appeal only takes three days.
Complete waste if money every month. Living outside the perimeter of Atlanta there are only 2 insurance plans available. Kaiser HMO and Ambetter. Refered to as AmGhetto. Our premiums are what a typical mortgage payment would amout to. Nothing is covered and no top rated providers are accepting it...not even the Walmart Care Clinic will take it. We consider ourselves "self pay" in order to get a reduced rate to see quality docs. Thankfully nothing catastrophic has occurred because I have a feeling our local hospitals would not accept the plan. Soooo.... forced to buy an expensive and useless plan through the marketplace that no one accepts, where we would have to spend nearly $12k in premiums and deductible per year before they pay the 1st $1 in reimbursement. Yeah that makes sense. I want my individual plan prior to Obama care back that was reasonably priced, that everyone accepted, and covered everything.
How does a company like Ambetter (Centene) even get approved for the 2019 ACA Healthcare.gov exchanges? They should change their name to AM(not)Better, haha. I had them for 6 months, and they almost 're-enrolled me', no doubt in search of that government money but by then I had chosen another company...good to run as fast as you can away from them. The 1st problem is their doctor network does not really exist, I could never get the website to work, and never got a real doctor and they keep upsetting providers one after another...we had to pay for emergency services at Dignity Health, at first approved, then later changed when the provider Dignity Health REFUSED to do business with Ambetter (haha usually the other way around)...this is a common tactic for this company they want your money, market their name well, but they they don't want to pay or provide good services. I was so HAPPY to receive a letter from Ambetter that I have been denied 2019 Insurance...good riddance hahaha.
My daughter had emergency situation and joined her in the near by emergency room, ambetter have contract with emergency which is more than 100 miles. We have called ambetter for pre-approval since its out of network and more than 100 miles, she is agreed. Later I was by customer rep that I need to pay deductible then rest of them they will cover. After hundreds of followups (almost 2 years) surprisingly they don't cover anything with strange disclaimers. AMBETTER IS A FRAUD.
Why aren’t the specialists or all participating providers not updated? Why is old information still in the out of date system ? Why are there different tier systems for the member vs Ambetter locater ? Why don’t I have access to the same information in the member system? Why do I have to call to find a provider When it takes a minute on line if updated ? Why do I have to work so hard to find a provider and continue to pay for this insurance ? I answered my own question.....
I have a medical professional within their network and they keep denying she's in their network. When I first called, they said she was in the network, so I went to see her. Then I got a letter from Ambetter saying she's not in my network and they denied the claims. So I called again and they said she is in my network and refiled the claims. Then I got another letter saying they denied again, not in network. It is now the end of the year, the plan is expiring and they still deny these claims.
If you want to have your tests, procedures denied....ambetter is the perfect choice. Ohhhh and pain MGMT..they approve then re nig and deny pre auth Oh and the best part... getting repeatedly hung up on.... Be. Sure to get the agent name at start of call.
THE ISSUES I HAVE WITH AMBETTER IS THEIR IN NETWORK PROVIDERS ARE FEW AND FAR BETWEEN. AMD WHEN I CALL MY SUPPOSE TO BE AGENT HE SOUNDS LIKE HE WORKS FROM HOME AND JUST ROLL OUT OF BED EVERY TIME WHETHER IT IS DAY OR NIGHT. THEN HE ENVER HAS ANSWERS FOR ME SAYS HE IS NOT MY AGEENT THEN GIVES ME HIS SONS NUMBER WHO IS SUPPOSED TO BE MY AGENT ACCORDING TO THE DAD BUT THE SON SAYS HIS DAD IS. SO CONFUSING - I JUST WANT ANSWERS AND GET NONE.
I am in Missouri and have had excellent health care coverage and customer service provided by Ambetter.
This is the worst insurance You can find I live in the suburbs & they sent me to Doctors in the south side of Chicago (the hood ) 11/2 hr from my house just to see a doctor then a problem to pay the providers then when I go get my medicine the card isn’t active I’m not in the system .the list of there providers when I call them none of them take ambetter. This is the most sleezy insurance I have ever come across if u want an insurance that doesn’t pay that u have to call then also call the market place over and over again and fight all the time this is the insurance for you
The worst insurance experience ever! Unable to get a person on the phone. Only thing they were worried about was making sure you paid your premium. When my wife turned 65 and went on Medicare, we quit Ambetter verbally and in writing, but still received past due notices for four months after! One arm does not talk to the other at that company!
Ambetter insures me and I went to an in network hospital emergency room. Problem is the ER Dr. was out of network. Even though I have 2 separate copies of my plan and my insurance card issued by Ambetter, all stating zero$$ after deductible with exceptions =-NONE- for IN and OUT of network they are refusing to pay the full bill. I would give Ambetter — stars if I could because they are deceptive and DO NOT pay legitimate claims that are supposed to be covered as found in writing in black and white. I would never recommend this company to anyone.
My daughter has Crohn's and has had 8 remicade infusions this year at Dayton Children's, all were pre approved and it still shows no payments made, all payments are pending. First treatment was in February, When asked, they say they are still in negotiations, in negotiations since Feb?!?!?! They also refused to pay a bill to Cincinnati Children's (out of network) By the way, Cincinnati Children's is the number 1 children's hospital in the country, but they are out of network?!?!?! I urge everyone to bombard their advertisements on Facebook with their complaints and concerns, I did that and was messaged right away. Their member services contacted me, it was obviously no help, but social media is one way to let the world know about them and also maybe get them to act. Another fun fact, they have to give the Ohio Department of Insurance's phone number on their website, when you call that number you get a survey company that wants to give you a "free" cruise. I dialed a couple times and so did my wife to make sure we didn't misdial.
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.
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.
Terrible service, terrible policies. They refused to pay legitimate claims, resulting in Collection agencies filing claims against me and ruining my credit rating. DO NOT trust Ambetter with your health insurance.
I have been trying for 3 weeks to find a neurosurgeon with Ambetter, all the ones listed are no longer with Ambetter. I was told that I was referred to a member advocate to find a neurosurgeon that would take my case, my neurologist suggested a Dr. in his area but he would not work with Ambetter. I have been on the phone for 4 hrs. today with supervisors trying to find out why no one has followed up on this. When trying to follow up on this for the 3rd time today. I reached an advisor who told me that open enrollment started today and I should switch insurance. This company should not be allowed by the Florida Insurance Agency to sell insurance in the state of Florida.
Ambetter couldn't consistently provide access to healthcare for my two year old son. Earlier in 2018, I was prompted to alter my current plan to include my 2 year old son. The process to include him was fraught with error and employees who meant well but really couldn't help. I spent hours on the phone with membership services and enrollment, bouncing back and forth because no one knew the number of the appropriate department that handles modifications to existing accounts. And I really mean NO ONE. Not the membership/customer service reps, enrollment department, managers, supervisors, and not even the director. Well at least I'm sure that is what they are trained to say. To give you an idea of how bad it actually is, I spent over 3 hours on the phone today because my 2 year old son's coverage was mistakenly voided, without any notification, even though all bills were paid on time. YES, THIS REALLY HAPPENED TO ME TODAY. When I called and pressed the issue asking why was he dropped from coverage, the membership service rep claimed that they can't drop anyone without that change coming from the Marketplace. Thus, I contacted the Marketplace to see if any new direction came from them. Nada, NOPE, ZIP. That was and outright lie. According to the Marketplace, their last communication was dated, May of 2018 and it informed Ambetter to include my son in my current balanced care plan via a completed escalation. It clearly laid out retroactive starting dates, insurance rates, who should be covered, etc. That information was transmitted to them on more than one occasion, dating back as far as March of this year. Nothing indicated that my son should be dropped on Oct. 30th, as the customer service rep suggested. I contacted Ambetter membership services again but this time I did so via a three way call. A supervisor from the Marketplace accompanied the call. This Marketplace supervisor actually said and I quote, " We've been getting nothing but the run around for nearly 2 hours." Eventually, and perhaps by error or overwhelmed by the complete drudgery of it all, she quietly disconnected as well. This is all truth. I don't have a history of any particular bad luck and I am by anyone's standard a good person. Personally, I don't bear any malice to the folks that work there. They really tried to help but they weren't given the appropriate venue to succeed. That's what Ambetter is. The part that really doesn't any lick of sense is that the only person who was penalized by all this was a 2 year old boy. Prior to this fiasco and by fiasco I mean my experience with Ambetter, I never had any problems like this. If you have kids ... don't walk away, run.
My rating would be zero stars of i had the option. TERRIBLE. My recommendation is to avoid it at all cost. I recently had to look for a specialist. I called 3 separate imes. Each time they would give me contact information on two to three doctors. When I called each one of the doctors in the list, the doctor would do not accept the plan or the doctor no longer worked there. When I lost my patience and called a fourth time they transferred me to another office where they said they would find a doctor and would make a contract with him/her to take me. I waited for a day and a half and finally went to see a doctor and paid out of pocket. This insurance is the same as not having any.
Horrible coverage in Central Texas! They list a lot of Dr but if you really look, the are pediatricians not accepting mew patients. Meanwhile the primary care physicians that do accept it are the bottom of the barrel in quality. This company should not be allowed to exist. Terrible customer service and they deny everything. Total joke .
They seem to have a policy of rejecting preventive care claims for which they are 100% responsible to cover under EVERY health plan. They blame the providers and the truth is that both parties are responsible yet ambetter's claims department does nothing to rectify the situation
Almost none clinics accept Ambetter insurance including convince clinic. This is the worst health insurance I met.
The worst insurance company of all time. Everything I read here is true. No one takes it, even if they say that do on their website when I call them, they say they do not take the plan. I am paying an insane amount for my premium each month and they don't cover anything. I just gave birth to my baby, and if I had gone through the hospital without insurance I would have paid 1/2 the amount that I owe now. This insurance company is a fraud.
I would give a 0 if possible. My insurance was dropped because my husband started Medicare. When he called to remove himself, there was no mention that my and my two dependent children’s coverage would be cancelled. When we found out it was canceled, we got myself set up on a new policy. They never mentioned that they were not going to still use the same credit card for the payments, so then my insurance was invalid for a little while because no payment has been made. When I found out about this, I contacted the insurance again and added the credit card back onto the insurance for payment. I then received when we found out it was canceled, we got myself set up on a new policy. They never mentioned that they were not going to still use the same credit card for the payment, so then my insurance was in valid for a little while because no payment had been made. When I found out about this, I contacted the insurance again and add a credit card back onto the insurance for payment. I then received two bills - dated one day apart. I don’t even know where they pulled the numbers from her for the bill and there was no explanation. The amount was over twice what my policy is. The bi I don’t even know where they pulled the numbers from for the bill and there was no explanations. The amount was over twice words my policy is. When Bill was dated a day earlier than the first and said that the first bill had not been paid so there was a penalty. Medicine that cost me zero dollars just a month ago now cost me $24. Now when I called two days in a row to find out why I had to pay for this prescription and why I receive these bills, their whole system is down and they can’t figure out anything.
Ambetter called me twice to inform me that since I am over 60, I should get a colonoscopy which would be an insurance covered procedure. They did not tell me that if a polyp was found they would refuse to pay for the procedure. I had the colonoscopy, a polyp was found and now I have a very large bill to pay which was a totally unplanned expense for me. The doctor was demanding his money so I had to pay him with a credit card and will have to quit taking blood pressure and cholesterol medications and quit checking blood sugar until this is paid off. There is probably no reason to see a doctor if I can't afford the meds, so I can save the physician co-pays as well. Fortunately, I don't have to worry about dying from colorectal cancer and with any luck I won't have a stroke before I can get back on my meds. The polyp was very small and was unlikely to have ever caused me any trouble. I wish that I had never let the Ambetter employee talk me into getting a colonoscopy, as I am now in a worse position than I was at in the beginning. I have appealed this decision but it will take months for them to decide.