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Ambetter Insurance from Sunshine Health and Superior HealthPlan is the Health Insurance Marketplace (HIM) option operated by CeltiCare, which is a subsidiary of the Centene Corporation. HIM plans are intended for people who do not have health insurance coverage, and only certain customers qualify for coverage. Thus, Ambetter is somewhat of an exclusive health care plan. Open enrollment in the HIM is closed. You may qualify for a Special Enrollment period if you recently had a Qualifying Life Event.
Ambetter enrollees are given access to an online portal, through which they can make all their payments, view their 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. There's also a section for member news alerts and, of course, social media accounts with Ambetter that members can connect to.
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. Ambetter health insurance plans available include; Ambetter Essential care (Bronze Plan), Ambetter Balanced Care (Silver Plan), and Ambetter Secure Care (Gold Plan). The higher metal the health plan, the higher the monthly premium but less out-of-pocket expenses. In some cases, premium subsidies may be available. From there, your options open up to several different plans with varying prices and benefits. Members can track their claims 24/7 through the online portal, as well as connect with member services or a nurse hotline 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. Admittedly, many of the resources available to members do not extend far beyond the basic ones supplied by other health insurance companies. Nonetheless, Ambetter's online portal and customer service mediums do make members' experience more convenient and secure.
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 as well. My Health Pays is a rewards program offered by Ambetter, and through it members can be reimbursed for gym memberships and even earn back money for getting a wellness exam or a flu shot. This money can then be used toward a copay or monthly premium down the road.
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.
Customers have 24/7 access to a nurse and can contact this healthcare professional for sudden medical concerns and other questions. Round-the-clock support like this adds reassurance to members' experience.
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 plan you've signed up for. Dental coverage, 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. Their website primarily just explains the metal tiers for their plans, as well as how essential health benefits are covered by every plan. But 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, 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, because if you qualify for Medicare, that's the legal option for you to get rather than taking advantage of a plan like Ambetter's. Medicaid and CHIP are HIM plans, though. Ambetter has PPOs, HMOs, and EPOs. However, they don't offer HSAs. They've divided their plans into three metal tiers: Bronze, Silver, and Gold. All three of these tiers cover "essential health benefits," Ambetter's term for services like preventative and emergency care, therapy, behavioral health help, medications, maternity, and hospitalization. But the difference in the tiers comes in the costs for premiums and out-of-pocket expenses (coinsurance and annual deductibles). Bronze plans have the lowest premiums but the highest out-of-pocket costs, and Gold has the highest premiums but the lowest out-of-pocket costs. Silver, of course, is the in the middle of those two.
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 Washingon. 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 affordable care professional near you.
Unlike many of its competitors, Ambetter doesn't have a mobile app. Some companies provide this for members 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.
Ambetter has received hundreds of negative reviews (seen below). Many reviewers have cited Ambetter's poor customer service and lack of in-network providers as their reasons for being unsatisfied with its services. While most companies receive negative reviews from time-to-time, we would strongly encourage you to read the consumer reviews below before deciding to choose Ambetter as your health insurance provider.
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Ambetter refuses to treat my hepatitis C because I don't drink my liver shows little damage although my blood work shows F4 of the virus in my blood I was told I must be on a journey to be treated
BUYER BEWARE!!!! I pay my premiums on time. Every month. But when one of my healthcare providers submitted her claim nothing happened. She is one of their providers. So I called several times. She called several times. We both verified that she was using the correct form, the correct numbers, the correct address to send the claim in. So she resubmitted the claim. After 6 months, still no payment. When I've called I keep getting excuses, usually they try to tell me that the problem must be with the postal service. I"m REALLY tired of their runaround. Today this provider told me she can't continue to see me because she's not getting paid. She said she won't even take people with Ambetter insurance anymore because they don't pay their claims. I filed a complaint with my state insurance commission. These people are horrible- I manage to pay my premium on time every month so I'm holding up my part of the bargain but they're not hold up theirs. They need to stop making excuses and FIX THIS!!!! I'm done being nice about it. I'm going to write negative reviews on every healthcare bulletin board I can find because people need to be warned about Ambetter Insurance- BUYER BEWARE!!!!!
The list of primary care providers is not accurate! i have called the first 40 doctors listed on the ambetter site. None of them take ambetter insurance ! customer service doesn't help.
Ambetter is Medicaid. If you have Medicaid you are concidered poor/ low class. Many low income clinics will say “accepting new patients but not taking Medicaid/Medicare payment”. Health insurance is a great USA scam. Ambetter is a peepoor excuse but a good revenue for Big Pharma. It costs a clinics door $3000 an hour to stay open and Medicare makes us probono patients. No one wants us and Ambetter is just another Medicaid symbol we wear on our arms so medical staff can judge and deny us. Remember: Medicaid/Medicare is to label who is worth saving and who is worth dying.
Ambetter commits fraud regularly. First, they decided that $8,900 is less money than our $3,000 deductible so we owe everything. They don't comply with federal regulations to provide breast pumps to mothers. They then reprocess your claims to put some money toward co-insurance instead of the deductible so you owe more money and they owe nothing. This isn't how insurance works. They work the Better Business Bureau automated system, saying they're looking into it and then because you don't respond BBB closes the complain. They claimed because my deductible changed after my son was born that his deductible wasn't met. This doesn't even make sense. Ambetter scams health care providers, too, so it's difficult to find one that even accepts Ambetter.
The worsest health plan that I ever had. Do not be accepted in any providers, pharmacies nor clinic or hospital. Irresponsible at 100% you call for help to find a provider and they always say the same thing "we'll call you back during the next 5 days" and never call back. They are #1 to bill you but not to pay for the health needs. Im was recently pregnant and I had been waiting for them to indicate what they are going to do to provide me an OBG cause theres not providers in the entire area of Dallas and nears city that accepted this insurance and nobody took responsible for that. Every time I called they said the same "we are going to evaluate your case and see to assign you a provider out of the network for your prenatal care" never they did it. So not choose this insurance for you or your family. Im not recommended to anyone.
Ambetter by SilverSummit is by far the worst insurance We could have ever possibly chosen for my husband and myself. First of all, even after paying a deductable in full, I am still getting sent bills in the mail that I have to spend hours on the phone disputing, only to get dismissed and pawned off to unqualified people. They don’t have accurate book keeping at all. All their numbers were off. When I filed a claim with them to fix this, they only put one charge on thit claim and not all the charges that they promised would be dealt with. So I’ve had to call again, only to get on the phone with a slow representative that sounded unconfident in what they were doing. Also, even after you are done paying the deductable, you will die before they approve life saving procedures and tests like mri. My husband now has permanent nerve damage down his leg and foot, because our insurance refused to pay for MRI and pain/steroid injection at the time he could have prevented it. They insist that he has to do 2 months physical therapy first. So we took him to see a Physical therapist and they won’t even touch him because they were never able to examine an mri to know how to properly handle him and they could see that he was in a lot of pain. Huge waste of time and money. They will not pay for the healthcare on time. We think it’s because once you get mri, they know they might be having to pay for surgery so they will take forever just to even review your case - over two months of my husband in the worst pain of his life, just to get a denial. Also, top to bottom, they only pay for what they want to pay for. I was prescribed a medication that they would not let me fill unless I tried a cheaper one for 2 months first which was ineffective. They will try to avoiding paying for the healthcare your doctor thinks you need, and make that decision for you what u can take. We have been going through this so Long that we went broke and now qualify for Medicaid which will actually pay for an MRI. So we now live with regret for ever trusting Ambetter. But are thankful that Uncle Sam can help us out. Ambetter should be shut down they are the worst. You’ve been warned!!!
Here in NV, this company is very inefficient. Materials are never sent timely, the website does not function properly, the medical network is very weak, the provider search feature is innacurate, the EOB are not posted timely, the communication portal is not followed up upon timely or with solutions, the advice from the help center is inaccurate and the prior approval process is lethargic at best. Other than those things, they don't seem to care too much to fix any of it - and oh boy don't point it out to them. And we get the priviledge of paying ~$1,400 a month. Lucky us.
They stink! They deny any authorizations so I am forced to pay out of pocket for everything and because they deny the charge the money I am forced to pay out of pocket doesn't go towards deductible. I will pay 6 more premiums and I am switching insurance companies!!
I started coverage with Ambetter on 5/1/18. Since then, I have had to call them 3 times. Each time, the representatives I have spoken to have been unable to assist me with questions. I requested a supervisor and had to wait in excess of 15 minutes to speak to them and then they could not assist me either. All they did was refer me to my bank where the payment was made.
Beware this is the worst company, can't talk to anyone but a dumb customer service who doesn't help at all. paid my premiums on time and they said I have never paid a premium my bank has called and faxed over proof still they won't help they suspended my Insurance, I call everyday and get told the same crap. STAY AWAY DON"T WASTE YOUR MONEY AND TIME!!!! THIS IS A NIGHTMARE
My daughter has to have ins and this is the only she can afford and now she is trying to find a allergist in the whole Houston Tx area and there is only ONE. What does that say about this ins co.
Benefits are terrific but, the rewards pays card... I had my hip surgery October 2017, I was going to use the card for my electric bill and November, after 8 months I was finally able to activate it. Between October 15th and January 21st I Must Have Spent at least 3 hours on the phone with these people until I finally gave up just this morning I thought hey I'll give it a shot. I finally got my benefits, the people on the phone with ambetter their representatives had no idea how to activate the card put me through multiple people and then finally hang up each and every time although they did ask for a call back number in which they never called back they were very uninformed
The market place first off mistold me the benefits of this plan. And will not change it. Ambetter can’t override them. So always check and confirm with Ambetter before choosing a plan. I am not at all on a plan that is beneficial to my needs. My other half is a pharmacist and we both know a lot of insurance plans. Ambetter is not clear on their plans, their representatives are long winded talking you in circles only to find out that they can’t do anything to help you. Read the fine print. For me doctors visits and specialists aren’t covered to meet my medical eductible. Only lab work and certain general doctors are. When you get a bill for lab work it’s then you find out that that’s the only thing they cover outside of a general physician after you meet a high deductible. READ THE FINE PRINT AND GO OVER IT WITH MARKETPLACE AND AMBETTER BEFORE YOU CHOOSE A PLAN!!!
I paid one month in advance and they sent money back. My son had been in hospital for a couple of weeks and I wasn't paying attention to bills. Six weeks later, my policy got cancelled as they said I couldn't pay in advance. .Then, I found out my policy doubled because of a mistake. I called the company because I was out of meds. One day they said I owed a certain amount. Then I ended up calling back three times and every time they said I owed a different amount. Today, I can't afford it and will most likely die because I can't afford to get them money.
Ambetter is health insurance like tying a string around yourself in a car is a seatbelt--it might resemble the real thing, but it's probably more dangerous than nothing. I got Ambetter because I was sick, uninsured, about to travel and terrified. Suffice to say I am lucky that my health held up and I didn't need to use them at all. 1. They have no gastroenterologists covered in CHICAGO--so if you live somewhere less metropolitan good luck! When I called to cancel they were polite and helpful, but you can be nice and still be a scam. My advice if you are uninsured: 1. Go to a free/sliding scale clinic! My clinic gave me 3mo of medicine for 12 dollars that my gastro doctor was trying to charge me $900+ per month! https://howardbrown.org/ 2. Call (don't use online) the Healthcare.gov. My online account was messed up and I fixed months of confusing letters and emails with just one phone call. 1-800-318-2596
From Miami FL Dade County I have never had a problem. When I call customer service they are always willing to help me in anyway. All my claims are paid. We have plenty of Dr’s and specialist to go to. My primary Dr is a private office not a clinic. I could also go to University of Miami which they have great doctors. I recommend my Ins with no problem in anyway.
I wish I could choose NEGATIVE stars. This is the worst coverage I have EVER HAD! I had traveled to Massachusetts for Valentine's Day. Wound up getting violently ill, A BLEEDING EMERGENCY that I had to call 911 and get an ambulance for....THEN, I get A HUGE BILL from the ambulance company as WELL AS the hospital...TURNS OUT AMBETTER (SCHMUCKS) DOESNT COVER OUT OF STATE EMERGENCIES AT ALL AND NEVER PAYS FOR AMBULANCE NEEDS EVEN IN THE STATE OF OHIO! WTF! I GUESS IT WOULD HAVE BEEN CHEAPER TO JUST DIE FROM MY INJURIES!
I was enrolled in auto pay. But they told me I wasn’t and did not even inform me before cancelling my service when I was willing to pay. When I complained about it the customer service representative got rude. Now, I cannot reenroll the clinics of this health plan sucks everything sucks about this health plan. The clinics look like a typical third worls countries clinic. I only chose this plan because it was cheaper. Had I known earlier about the poor state and shape of this sorry health plan I would have invested in a better plan even if it costed more.
Can I give less than zero??? My experience tells you to run, not walk, run from Amworse from Inferiorhealth. There are few doctors that take them (for a reason), and I'm in a metro area of about 300,000. The nearest Ophthalmologist is 45 minutes away, and the nearest Neurologist is over a hundred miles away. It takes FOREVER to get approval for procedures. In fact we had to complain to the state of Texas to get them to do the right thing causing my wife to be off work for 2 months when it should have been maybe a week. We have now had 4 instances where we had a service date in 2017, but because they did not do the billing until 2018, they tried to make us pay deductibles that had already been met for 2017. The problem I'm working on now is my CPAP machine. It paid out in December of 2017, under the 2017 deductible. They have it charged in Jan of 2018 and want me to pay over $500.00 for a deductible for this year. Can you say fraud??? They more than doubled my rates from 2017 to 2018, and raised my deductible by more than 3 times. Because of this I can no longer afford to pay for my insulin, and my Xarelto. I was in the hospiltal for my AFIB and between my Cardiologist and my Primary Care doctor they are giving meds to try to keep m alive. And by the way, last time I heard Ambetter is the most profitable medical insurance company. Not hard to figure. If you can afford a reputable company, do so....
This company STOLE 616.00 out of my bank account without prior authorization. When I contacted them to get the funds back, I was promised a refund by April 30th. I have a voicemail from their billing dept promising me my refund was processed. Never received it. Have disputed it with my bank now. Stay away from this shoddy company!
This insurance is a scam. Your doctor list will be limited to homeless community services centers. Yeah. No joke. And I live in a big city houston texas. Your doctors option to choose from will be between homeless aids centers to just homeless comunity health centers. 90% of specialists on their network doctors to choose from will tell you on the phone that you will be a cash payer because they are not really in network with this insurance company. All doctors I called said they are booked for the next 4 weeks. You WONT be able to see any doctor before waiting a month for an appointment. The only place I finally got treated after 3-4 days of fighting the system was a cvc clinic LOL Yeah . Sad. I was so mad. I pay $500 a Month for this garbage insurance. $500 !!!!! Do not sign up with them. Its a scam! I canceled my membership a week ago. (May). Had enough. Just unbelievable scam in daylight. They need to be in prison. SCAM!!!!!!!!!!!!!!
Zero stars . Paying for incsurance that no one accepts . Can't get a straight answer about what my coverage actually covers . Worst insurance ever.
Impossible to actually order glasses. Cannot order anything online, and when I was told I could order at Walmart, I spent an hour and a half on the phone trying to get guidance on how they could actually implement the $130 off. My insurance expired before I could ever use benefits. 10/10 would never ever use this company. I'd imagine if you had a serious health issue, you'd die prior to receiving any sort of decision on whether they would cover.
Want to hold Ambetter accountable for the information posted on their website. The implied contract between the company and member is not being honored. When choosing a 2018 insurance provider, I spent time making sure my doctors and preferred hospitals were part of the network. In late January My primary care provider dropped Ambetter in 2018 but members were not informed this was happening prior to signing up for the year. Ambetter had amble notice (+3 months) from the doctor and time to remove her from their list. In trying to find another PCP, I've called numerous other providers listed on the website. The first five (near my residence) also no longer accept Ambetter. It's been 4 months and the list is still inaccurate. Ambetter wants me to accept a random doctor they assign and that doctor is doing a residency. The one experienced doctor I did find is about 40 minutes from my home and was not happy to accept new patients. I searched for a doctor in late January and again in March. Today (April 20) I was told the website is updated but I looked and the provider list still includes doctors who are not accepting their plans. I spoke with their customer services and the lists they’re working from are wrong - Also listing many doctors no longer practicing or no longer accepting Ambetter. After 4 months this goes beyond administrative error, Ambetter is lying to their members. They’ve been lying from the start and they should allow members who’ve been deceived to see the doctors they expected to see when they signed up and ‘eat’ the cost. Also have spent a month trying to get a prior authorization on a med I've been taking for more than 5 years. Neither Ambetter customer service nor my DR's office will accept responsibility in seeing this is completed. Each blaming the other for lack of follow through, Stuck in the middle and can't make either side do their freaking jobs!!!!
I wish I could give zero stars. They are complete liars. They list doctors on their website, which consumers use to select carriers, who are not in their network. Once you have selected Ambetter, you find out the truth and you are stuck with sub par doctors. I am stuck with them until open enrollment even though they used a bait and switch to get me as a customers. They are liars and not reputable.
They are hopelessly messed up. They continally deny my claims as out of network when I find the providers on their network website! I keep getting the same bills over and over from a Dr I went to and when I call Ambetter to ask why they are not being paid they say they never got the bill. So I call the Dr office and they say they have submitted and resubmitted bills over and over. It's like they don't want to pay the bills. I cannot believe they call this health CARE because it is NOT.
They should call themselves Amworse because if you need any specialty medication, you’re pretty much SOL. I’ve been on a medication for nearly a decade and have appealed their rejection of it without success. An ok health insurance company if you don’t actually need anything to benefit your health.
I would give zero stars if possible. Having this type of insurance feels like punishment for not being able to afford better coverage. Navigating the site is very confusing. I thought a picked a decent plan, but found out too late that vision is not included, but pediatric vision is. I do not have kids. It would have been great to have customer service help but I was just referred back to Washington Health Plan Finder, who after making me jump through many hoops told me that I should have selected a different plan and that there is no way to change anything. So I'm stuck paying for a bogus plan for another eight months until the end of the year when it expires. It's beyond disheartening that insurance in our country is so inept, broken, and expensive. Shame on Ambetter and shame on Washington Health Plan Finder.
I have no problems with this insurance. I went to the ER in 2017 and they took take of my bill .I only had to pay a few dollar out of pocket. The only draw back is that my PCP is not in there network .
We just started using ambetter this year and have been very happy with our healthcare coverage. The only negative is that not as many providers take it in our area so it has taken us awhile to find new healthcare providers that we trust.
DO NOT USE IF YOU MAKE A PAYMENT WIHT YOUR CREDIT CARD THEY WILL SAVE IT ON FILE AT CHARGE YOUR 5 TIME THE AMOUNT THE NEXT TIME AND NOT EVEN TELL YOU AND REFUSE TO GIVE YOU UR MONEY BACK!
I wish i could them a 0 star. Terrible customer service. The employees dont know anything. Just terrible.
This is second year with ambetter. This year 2018, I am paying $697.68 for me and my daughter monthly. I went allergy doctor and they denied everything. Not only this case, they pretty much denied every claim last year as well. If I pay this much for no coverage, I think I can shop better health care.
I have Ambetter insurance and pay dearly every month for my insurance, plus the deductible and co-pays. They deny all my claims and will not provide any information on why they deny them. Their customer service is crappy and know nothing more than what I can see on-line. Which after the new webpage was launched is nothing.
HORRIBLE!! Incompetent and RUDE Customer Service!! Nothing but problems since day one!! Will be filing a formal complaint. Denying, not processing and not applying monies properly to accounts!!
Just signed up for Ambetter and when I pick a primary care doctor from there list. I make an appointment and when I get to the doctors they tell me Ambetter will not pay their bills so they are not accepting the insurance. It is scam company with no Customer service support
Is the worst Health insurance. They let me die and do not approve of my oncological tests and radiation.Last year they walked through countless hospitals and did my adenocarcinoma surgery in my country.Now I have to do 3-4 brachycardy radiation sessions and I do not approve anything, the hospital is in their network and the type of insurance is agreed by the hospital.I pay them nearly $ 400 a month, the state pays another $ 1200 for me, and they do not approve of my radiation to stop cancer.The women who answer the phones send you to the hospitals without knowing where, they have no idea what to recommend and scream at me that I have to take the hospital in the network. I took hospital in the network and refused to pay for radiation and tests.I'm going to sue them and ask them for $ 10 billion in damages, because let me did.
Absolutely horrible selection of providers. I live in Indianapolis, which is the 12th largest city in the country. There are a total of two Physical Therapists in the city as options, and one of them answered the phone in a barely understandable accent with a "hello". I should have know better than to purchase my policy from Ambetter, aka "Crazy Bob's house of tacos and health insurance". As mentioned in other reviews, there are many providers listed on their site that don't accept Ambetter. I made my selection this year based on the fact that the providers I've had for years were listed. Now I either have to pay out of pocket to see them or change to new specialists, which as everyone knows is a nightmare and takes months sometimes. Had the GOP not gutted what they could of the ACA and made threats to stop subsidies that caused 2 of the 4 Indiana companies to drop out of the exchange this year, I wouldn't have to deal with this crap.
DANGER. Stay away. This company is basically a SCAM. They are taking advantage of the fact that health insurance is mandatory. So inefficient, nobody knows what they're doing. You will get different answers every time. Basically you will have to do their jobs and call the Dr office, Labs or any other provider. Finally they will deny procedures because they know more than your Doctor. Nobody wants to work with them so good luck finding a PCP. Not even the ER doctor wanted to take it so they made me wait until they found someone who will. You are basically on your own. They will wash their hands and give you an absurd excuse. They are criminals. They prey on the sick and desperate. They will take your money and the government's money and will deny coverage of procedures without a valid explanation.