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 88 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.
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 2020 healthcare coverage runs from November 1, 2019 to December 15, 2019. If you missed the enrollment period, you may qualify for a Special Enrollment Period after December 15, 2019 if you have a Qualifying Life Event.
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 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.
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.
The subsidy estimator in the online account also helps members see how much they would receive for reimbursement for a treatment with their benefits. If you qualify, the subsidy lowers what you pay for the monthly premium charge.
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™ 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. 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 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. Those seeking vision coverage and dental benefits in addition to health insurance can find options through Ambetter.
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 be better served choosing another company if you can.
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.
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 Ambetter may not be 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 (e.g. a primary care physician, specialist, etc.) 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.
Call our recommended rep over at Ambetter below.
I’d put zero star if I could. Worst insurance ever. Went to hospital in ambulance for possible heart attack. Was told to see my cardiologist ASAP. My cardiologist wanted to preform a stress test. Ambetter DENIED. I repeat denied a stress test to find out if my arteries had blockage. How sorry is that for a health Insurance Company!!!
After calling 25 different doctors, listes as "in network" through the Ambetter website. NONE of them actually take Ambetter insurance. This company is fraudulentl! There is a class action lawsuit filed in 2018 and is currently in progress. Drop Ambetter asap and get in on that lawsuit! They should have been taken down years ago.
The customer experience with Ambetter was clearly the worst in my role as a consumer. The EFT payment schedule was incorrectly programmed resulting in a premature cancellation of coverage that had to be reinstated. Then, their customer service reps gave nothing but inaccurate information. They advised my dentist that we had an $8000 deductible and then advised my dentist they did not cover routine fillings. My dentist refused service on this basis. The staff at Ambetter is both incompetent and uninspired. They have no business advising policyholders on their insurance products. This company should be prohibited from writing insurance in any state.
Aaron & Ashley Trincado
If I could leave ZERO stars I would. I was with Ambetter part of 2019. I got a bill from a provider from something I got done back in July. I was covered in July. I paid what I owed based on my plan. Ambetter was supposed to pay the rest or so they told me. But they DID NOT. Then I kept getting billed for the same thing. Ambetter kept telling me that they would take care of it. This happened multiple times. I kept calling Ambetter again and again so try to solve this issue. Now they are denying me apparently and are saying that I have to pay the full amount! It's just RIDICULOUS! No straight answers from Ambetter. No explanations. Nothing. Awful company. Awful service.
Ambetter is horrible. You will spend hours on the phone with them over weeks, trying to get a simple prescription authorized for refill that you have been taking for years, because suddenly they will deny payment for it. Not a controlled substance, just a generic anti-inflammatory for osteoarthritis. I truly believe the company is run by mean spirited people! I would give them zero stars but you have to click on at least one to complete this form. I am still jumping through hoops to try and get my generic Celebrex paid for. Been 3 weeks!
Health insurance ran by circus clowns. Ambetter loves taking money from their customers and they make it almost impossible to get approval for any procedure that is above a basic checkup. They continually deny any procedure, regardless of what type of physician (general practitioner, specialist, surgeon, etc.) requests it. On their website, they list a ton of doctors in any area of practice you can think of. However, this is a fraud as well. A majority of doctors, who Ambetter list as in network, refuse to accept the trash known as Ambetter. After fighting alongside my doctors against Ambetter trying to get required & necessary procedures approved, I understand why most doctors will not accept this lousy insurance. Ambetter requires everyone who they deal with jump through so many hoops that it is impossible for the doctors to make any money. Moreover, Ambetter is only concerned with the money which they can swindle from their customers with no regard to the health, betterment or required & necessary needs of the customers who are making this company filthy rich. In my opinion, the name of this company should not be Ambetter. A more fitting name would be Amworse.
I am begging you, if you have a choice, do not choose Am better. They do not care about their members or their health. I had a breathing emergency due to asthma. Rather than helping to get the medication I need, they would prefer I go to the ER, I guess so they can deny that claim. They would prefer I sit in an ER waiting room and have the possibility of being exposed to the Corona Virus. Since I am having breathing issues this really makes a lot of sense. I will never choose this company again. This is only one of the many incidents have experienced.
Horrible service from customer service, already called 6-7 times for the same issue and they just say to call the Doctor, call the pharmacy. The point is they just don't want to pay for the medication!! Just want your 💰.
Maybe it depends on where you live. So far my experience with Ambetter in Georgia has been very good. I can't image how I would have paid for $400 plus a month health insurance right now. Plenty of primary care doctors and specialists here that take it at Wellstar and the quality has ranged from so-so to excellent. (I am in the surrounding suburbs of Atlanta). I haven't needed to get ahold of them for anything yet so I can't rate that accurately.
Bad experience. No primary care physicians available. The ones that were in their network discontinued accepting this insurance because physicians were not being paid.
This company is the worst insurance company I have ever had. They fight every prescription. The Dr.s listed on their site, most don't take their insurance. None of the dentists in my county take their insurance. I've only been with them three months and they have cost me many hours of trouble. Pay the extra hundred bucks and get a good insurance company policy. Ambetter isn't it.
What a nightmare with this SORRY company! We just purchased this policy a few months ago. Went online on Ambetter website to look for a Arthritis specialist in our area they covered. The closest one they had was 2 hours from my house! So we decided to go on my day off work. We drive 2 hrs, gave the office my card, they said” we don’t take this insurance! ARE YOU KIDDING ME?!?! We called ambetter, and all they said was” sometimes these doctors come off our list and don’t tell us!” BS!! Don’t waste your money!
I called the market place looking for a good health insurance. The next day I received calls after calls from different phone numbers, non-stop. Then in few days I received a bill from Ambetter for my first payment of my plan. I ignored it since I didn’t apply to any health insurance.. then the next month Ambetter sent me again another bill and so with the next month. I got tired and called Ambetter. I told the lady I didn’t apply and she said she cancelled it. And transferred me to another phone which she said the market place so I can tell I didn’t apply for Ambetter which I also told that I didn’t apply and they must cancel it.. which they both said they did cancel it. Then why still I am receiving a bill every month? This health insurance is fishing people by their tricks. You don’t drag people to buy your insurance, you have to wait if they choose you!
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!
Hot happy...when you need to get specialty help from outside of the network because in their network does not have the medical ability to take care of special needs for medical needs of their clients...they need to look into getting the Seattle cancer care alliance under their umbrella. And the University of Washington hospital in Seattle under their umbrella. That's where all the specialties doctors are for multiple diagnosis and blood diseases and cancers.....because when insurance company only lets you go to certain facilities and you need facilities outside they say they will cover but you have to beg borrow and still and get doctors and doctors and doctors on phone calls to prove your case to get referred to see a doctor like at the University of Washington hospital..and you have no choice but to be under that network which is in Wenatchee Washington You're very limited to facilities in Seattle one hospital... This bill is almost criminal to the patient..very unhappy and can't change insurance because of our location where we live. And you're not allowed to have more than one insurance company.... Sorry for all the patience and spouses that are suffering like us just to get the best medical care.....
I'm happy with the doctors, but the company nickle and dimes you till you can't get healthcare. Even lab work costs for every single blood test done. My last insurance had a $5 copay for all lab work. I just got a bill for over $90 for routine work to monitor my T3 & T4! My breast ultrasound cost $200. I'm affraid to get any more.preventive work till I switch insurance companies in 2021. DO NOT CHOOSE AMBETTER. It isnt better.
Total scam, they don’t pay for anything!! Don’t waste your money
When you finally reach a working phone number for the doctors that are listed on their provider list virtually every one of them says that they are not contracted with Ambetter. This is worthless insurance. We are running out of our maintenance medications and are going to have to just find a doctor and pay cash out of network to get our blood pressure and cholesterol medications. If you call customer service they give you places....but when you call the place they say they are not contracted with Ambetter (seemingly smart on their part).
Billing is terrible. We are set up on automatic payments from our credit card. Ambetter uncharged us for a month, then suspended our policy, stating we did not pay. It was not our fault they charged the incorrect amount. As a result, a procedure had to be canceled and has to be resubmitted for approval, and two doctor appointments were canceled as well. When we tried to straighten it out, they overcharged us $1600 and refused to issue a refund. We got this plan through healthcare.gov, so I'm wondering if we can cancel and get another company. We've had BCBS for many years with no problems. We should have stayed with them but were trying to save money.
I was hoping to choose a different Obamacare provider this year but Ambetter is the only option that includes both major hospitals in my city in their network. That's the only positive thing I can say about them. Their website makes it easy to pay but hard to do anything else. Lists of specialists are out of date and calling customer service is an exercise in futility. Referrals from your doctor can take weeks or months because so few specialists accept this lousy insurance. And once you finally find one, you will pay high rates out of pocket. It took two months worth of rejected referrals to finally find an in-network physical therapist and I found out the day before my first appointment that my cost would be $100 per session. I chose to go elsewhere for less, even though it won't count against my $7,000 deductible. I did the same thing with a medical device -- Ambetter wanted $1200 and I bought one privately for $650. So I am spending thousands for premiums and thousands out of pocket that doesn't even pay down my deductible. It's blackmail. It's craptastic, catastrophic insurance that meets the ACA guidelines on paper but, as a practical matter, is almost impossible to actually use.
Call center hangs up if they don’t want to handle the situation? Supervisor do not do what they say they will. They scam you and ask you to give them money by a certain date but your not even in the system yet because it takes 1-2 weeks!!! So if you need health insurance a week or 2 after signing up you will not be able to receive it. Complete scam!
This is a fraud insurance company, I regret signing up for it!! It said I would only have to pat $50 for PCP visit and I am paying almost $64 and $20 for medicine, Almost $30 for thyroid meds and over $200 for my husbands toe infection cream plus I pay them money every month. worst mistake ever, I also have emphysema and Dr. prescribed 5 days of antibiotic but they would only approve 4 days, this is going to be bad insurance for anyone that has chronic illness
Stay away from this company please! Their customer service is poorly trained, never get our issues solved. Totally a fraud company. We've been trying to cancelled our membership several times but they never did. Like some of the people here said, if there is a zero star we definitely will put zero. Hopefully, we're the last people whom they've taken advantage from.
There Customer Service is Wonderful I've been very pleased anytime I have needed help in the past there has always been someone to help me on the first try. And for that I am Thankful For
Peter M Rosenfeld
Zero Stars. They charge high premiums, then don't pay claims, leaving you stuck with collections of bills they refused to pay. Very unethical and fraudulent company. They ought to be put out of business.
Ambetter of North Carolina has been a nightmare. I used to own a large business which provided over 400 employees with healthcare coverage. Typically when changing carriers there can be a few bumps but Ambetter has been almost impossible to deal with. People at the call center are nice enough but have no ability to really help. We have three family members on meds for multiple years. Ambetter denied coverage even though they said the meds were covered when we were choosing carriers. Our doctor has sent pre-authorization forms in but they Ambetter had no record. How can you be HIPPA comment if you lose authorization forms?
I would give this so called Ambetter a zero if I could. My husband is diabetic. When I unrolled in this plan I wasn told they covered his $1100.00 med. I said great. So I enrolled and went to get his prescription filled. Well I get a letter in the mail and saying. Now mind you the pharmacist made this final decision. Well wont cover this med because his A1c was not above a 8,5. Well the reason why it wasn't is because he was on this med that lowered his A1c for 3 months. Got free samples. But I dont get how a pharmacist can make a final call on what my husband needs. That is why he has a doctor. Also he is on metformin. The pharmacist says he cant be on both tyoes of meds. Are you serious. So I pay a monthly premium for nothing. Cause there are no doctors that wont take this insurance. So I might as well pay out of our pocket. Totally rediculous. So very frustrating.
I signed up for this insurance company effective January 1st. Got messages to pick a primary care provider. I did but it was not updated in their system. When I called, the customer service person said it wouldn’t be effective until February 1st! So it takes their system weeks to update a doctor’s name? They cashed my premium right away. Sounds like a scam to me. They did give me a reference number to use, but when I called my doctor’s office I was told Ambetter would not pay until the doctor was updated in their system so I should wait until Feb. 1st. So they got $700 for January for nothing.
We signed up for the MyHealthPays card through Ambetter in the fall. It is a prepaid debit card. We were able to use it at Walmart with no problem. We tried using it recently with no luck, so called Ambetter...they reactivated the card, we tried to use it again, same thing. So then we tried to pay toward our premium, that didn't work. After a gazillion phone calls, we were told that Walmart didn't renew their contract & we can't pay our premium because we live in Arizona...and the card says "Ambetter from ARIZONA Complete Health"!!! They should be called "AmWORST"!!!
I think it must depend on what state you are in. I have Ambetter Arkansas and I love it. I do receive a subsidy so I don't pay a huge premium. I also don't have any major health problems, They are excellent for routine care, chiropractic, mental health etc. I do not have dental. So far they have covered everything without any issue.
KAREN M HARRIS
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.
Doctors listed on the website are not on the plan! Most of the numbers for the doctors are not correct or working numbers. I was on the phone with Ambetter for 52 minutes. I could not find a primary care doctor on their list after calling over 42 of them listed in the Dallas- Fort Worth Area that would take my plan. Even after 52 minutes on the phone and Ambetter calling doctors they were not able to find me a primary care doctor. I pay close to 2,000.00, a month for insurance. The plan says you do not need referral yet all the doctors I have contacted said they need a referral from the doctor yet you can not find a primary care doctor. I feel like this is false advertising and I feel the State of Texas should get involved and a class action suit should follow this scam. Texas Attorney General's Consumer Protection Hot Line at 1-800-621-0508. Because you deserve better than Ambetter!
What a horror, our insurance increased 400% so our only choice was AmBetter. They promise dental benefits up to 1000 in SC but NO ONE takes their insurance EVEN THE NAMES THEY GENERATE FOR YOU AS NETWORK DENTISTS. I called for assistance after the dentist AM BETTER sent me to refused to serve me, I spent 90 minutes ( mostly on hold) with sub par representative who "found me another dentist within the plan" but that dentist declined to take me too. Then I spent ANOTHER 90 MINUTES trying to get that resolved. They put me on hold and never came back on the line. I gave a denral emergency and no one can help. They only pay a small % of tge ER so an ER room visit will cost me 1000.00 The next day I tried again, was asked if I wanted more names. I asked for a supervisor and was put on hold for over 35 minutes. No supervisor ever responded. I checked our benefits for urgent care and the closest urgent care is 100 miles away. Sorry, they cant help. DO NOT SIGN UP FOR THIS COMPANY.....THIS ISNT INSURANCE IT IS A SCAM. They denied my husbands RX even though the " website" includes his medication as pre approved. They wont assist or repond to help getting the RX approved. Can we file a complaint with a governnent agency? PLEASE DONT TAKE THIS INSURANCE
Michael Le Monier
Most poorly run insurance company I have been associated with in the past 50 years. This company is stone age in terms of technology, constantly blames their members for their own internal failures and denies claims to see if you will fight back. I would suggest run away if you have any options.
They have changed my medication from what works to what doesn't work over the price they care only about money
This insurance marketplace should be investigating this company for not meeting their standards. This company is so TERRIBLE I decided to forego having insurance for 2020 as they are the ONLY insurance available on the marketplace for the area I reside in. The doctors and hospitals will NOT work with this company (will not contract with them) because the insurance company will not pay the same amount to the doctors and hospitals that all the other insurance companies pay--this company wants too good a deal for themselves, (a better deal/contract to pay the hospitals/doctors LESS THAN their competing insurance companies pay) so rather than form proper coverage areas, they simply provide their insured patients with very, very spotty coverage (INVESTIGATE THEM Health Insurance Marketplace) forcing people to drive hundreds of miles for specialists, and giving them one single choice of primary care physician per town. I was told by one of the major hospitals in my area, at the beginning of 2019, that I would have been better off having NO insurance company, rather than this company, because they had programs for low income uninsured individuals that would have given me more options at a cheaper price. But because I had this terrible insurance, even though it was inadequate, I could not qualify for the hospital's low-income program. Better no insurance, than lousy insurance, if you have limited income. After one year of fighting with this company constantly, finding their directories to be downright FALSE, and their coverage so spotty its all but useless--I decided I'd rather pay out of pocket than ever deal with them again. I'm calling around right now finding various doctors with the lowest prices for uninsured patients, along with online prescription programs versus local pharmacies and will have a game plan ready in case of emergencies. I'll be putting the money aside that I would have been paying this lousy company (for next to nothing coverage) and use that for any doctor visits I may need. In addition to the lousy coverage area this company has, (because none of the doctors or hospitals want to deal with them) and a directory you absolutely cannot trust, you have to pay 25% co-insurance IN NETWORK using their marketplace plans. They should be investigated by the Health Insurance Marketplace-- there is no way they are meeting marketplace requirements, I had two companies before them, HUMANA & BLUE CROSS, both through the marketplace and both were a million times better with proper coverage and correct directories.
I would give Ambetter a zero star if the option was available. My rates were around 1800 for my two children and I with 7,500 individual deductible and 15, 000 for the family. This company refused to pay for anything. My daughter who has asthma and was hospitalized multiple times as a child was denied having her inhaler covered because they deemed it unnecessary. They are also denying acne medication even though my son has acne and a prescription from a dermatologist. I am switching to hometown health with around the same premium, way better coverage and a 500.00 deductible. This insurance companies only goal is to make money off of people who can actually pay for health insurance and to deny covering everything. Some of our local doctors now refuse to even bill Ambetter because the companay makes it so hard to get reimbursed.
Great insurance for a HMO plan never had any problems with customer service or getting things done that needed to be done.
The worst health insurance company ever. Really expensive and they cover nothing. Actually not sure if any company is good or not with our health care system as it is. Completely inefficient for the working man. I am a hard working motivated person without a company sponsored health care insurer. I have chosen after 3 years to not be on insurance this year. Too expensive and too little to cover.
Horrible. My husband has a heart condition and Ambetter routinely denies basic tests and procedures that could make a difference between life and death. They also frequently deny routine medication. Ambetter simply doesn’t care. Around our house we call it Am”worse”
PLEASE DO NOT CHOOSE THIS HORRIBLE INSURANCE COMPANY. This insurance company's goal is to steal your money and give you NO benefits, especially not any diagnostic tests/scans/imaging.. Last year, they denied a CT scan for 9 months, even after 3 doctors requested it, and even after 2 "peer to peer" interviews with my doctor, they still denied the CT scan. Ambetter's doctors that do the "peer to peer" interviews with the patients doctors completely disregard the patients doctors and THEIR POLICY IS TO AUTOMATICALLY DENY REQUESTS FOR SCANS. The only scan they will approve without a fight is an ultrasound, and that is because an ultrasound is low cost for them. Unfortunately, ultrasounds don't show MANY problems that require diagnosis by a CT scan or some other scan. This time, I waited their 15 days required before the CT scan, only to be told that they denied it. Then they denied it again after an interview with my surgeon. This same thing happened last year. Ambetter denied the CT scan after numerous requests from doctors for 9 months, and by the time they approved it, I had to have emergency surgery because they had denied the diagnostic imaging for so long, until it became an emergency situation.
My account became locked (the portal I use to pay my premium). After spending almost an hour on the phone with a customer support representative, I was told to try logging back in tomorrow and call back if it still didn't work.
Denies most all but the basic office visit. Headaches. Phone conversations end with no results.
Ambetter has been a hassle free insurance company that was the most affordable out of all of them. I have never had issues with doctor visits, ED visits, or prescription drugs. They are always very pleasant customer service wise and I actually think the website is getting better. My only complaint is finding a provider is a bit difficult and obviously you are very limited on who you can see, but the cost of the insurance is so low that I am okay with that.
They are terrible. I have the dental plan. Needed an Endodontics. They have one in a 200 mile radius of Atlanta. Made appointment, paid deposit for appointment, doctor didn't show up. Couldn't make another appointment, so I called Ambetter. Spent 1.5 hours with four different people on the phone. First they told me I could go out and find an Endodontic and get them to accept Ambetter terms, I said fine, I will charge Ambetter my consulting fee to do their job. They said no, so they tried calling doctors to see if one would accept Ambetter terms. None would - that tells you something. I asked them for an email, giving me the names of available Doctors and she said she couldn't do that (the person the day before did). She would let me ask why not, and quickly sent me to hold and never came back. I think I will go and get the work done and then take Ambetter to small claims court suing for the medical, time lost from work, and travel costs. Like my son says "they suck"
I'v never been happier with an insurance company. Ambetter has come through for us MANY times.
Ana Maria Hudtwalcker
This is the worse Health Insurance company. I have a lower back pain issue for many months and got this insurance in hopes of finally getting better without going to the hospital. However, their list of providers are very poor and of low quality. Most of them have bad review online, and when you finally have a decent doctor they have a long waiting list for an appointment. So far, many of the treatments or medication the doctors try to prescribe me have to be first approved Ambetter. Really!! Even when they get all the information from the doctor, they still don't approve and you are left untreated. Please, unless you are just worry about minor illnesses, like a cold or the flu, do not get this insurance! They are really bad and omit information regarding the details of your plan
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.
I am currently a member of the Gold plan. I pay all my premiums, have met my deductibles and maximum out of pocket. Now they just deny everything! I have sent appeals and am now contacting the Department of Insurance in Ohio to lodge a complaint. They will not even tell me what criteria was used to make the denial even though by law they are obligated to.
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!