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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 insurance company. Open enrollment in the HIM is closed. You may qualify for a Special Enrollment Period if you recently had a Qualifying Life Event. Ambetter provides for services like preventative and emergency care, therapy, behavioral health help, medications, maternity, and hospitalization.
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. Ambetter health insurance plans available include; Ambetter Essential Care (Bronze Plan), Ambetter Balanced Care (Silver Plan), and Ambetter Secure Care (Gold Plan). 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 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 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 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. 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. 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 (like out-of-pocket expenses, copay payments, and deductibles), 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.
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 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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THE WORST INSURANCE EVER!!! AVOID IF YOU CAN!! No one knows what day it is or what they are doing. I'm having to pay around $500 per month for insurance that doesn't cover any of my Dr's or much of anything else. I didn't have a choice & was forced to switch to them. I was assured I could keep my Drs & that my illnesses would still be taken care of. All lies! Then when you try to get a new Dr you have to pay full price as if you don't have insurance because they aren't paying the Drs for their appointments!! We already learned that they were TERRIBLE IN EVERY WAY & THEN THE HOSPITAL TELLS US MY ER VISITS AREN'T COVERED BECAUSE CRAPBETTER REFUSES TO PAY FOR ANYTHING!! I made sure to pick a plan that would cover my Drs AND the hospital visits. Waste of money & extremly frustrating!! WE SHOULD BE SUING THEM TOGETHER!!!
I have only good things to say about Ambetter. I am in Mississippi, one of the states Ambetter covers. My coverage is excellent. My doctors are please to provide it. I have had a minor surgery, my yearly PAP, Mammogram, pain management, etc. and the coverage provided, payment provided have been excellent. I am extremely happy I chose Ambetter insurance. I have recommended it to many of my friends.
I have one horrible review on Best Company against Ambetter about denying a pain med for my wife's back from her pain doctor. Well this time I went to Ambetters websight and found the generic version of the pain med that was denied last time. Ambetters web-sight states that the generic brand is covered and should have a $10 price tag to me. Sooo at the pain Dr. we request the generic brand and all should be good you would think. Wrong again Ambetter refuses to pay for this generic brand. I call them and push to speak to a supervisor and a women comes on the line and asks how she can solve this problem. I explain the problem and she then has me walk her through the steps to where I found it on Ambetters websight that it was covered. This supervisor agrees that I am right and according to their web-sight it should be covered. Now here is where I got screwed again. It seems Ambetter contracts out their prescription services to another Superior owned company and because that company says it is not covered WELL IT IS NOT covered even tho Ambetter's web-sight says it is. So once again this insurance that is costing me $1531.0 a month has screwed me. Like Isaid on my last post and will say it again DO NOT EVER BUY ANY INSURANCE FROM AMBETTER OR ANY SUPERIOR COMPANY.
Horrible! Does not cover anything! I went to the ER and nothing was covered. No doctors I know will accept. Scam!!
The coverage is worthless. They advertised a $0 co-pay with your pcp, Specialist $5, RX $0 for generic, $0 for ER after deductible. NONE of the local area hospitals accept their coverage so what good is the ER coverage? Also, much of the physician office contact information they give you is bad or outdated and they refuse to email you to information even though you have already paid for coverage. That last part is total bull if I have ever seen it. I bought coverage with Ambetter for Superior Health Plan and I was never able to use it AT ALL. Every time I attempted to use it, I would run into a problem with the provider or they would tell me they do not accept my coverage. I paid for four months of coverage for my children and I after I lost my private coverage with my employer. Either the provider could not be reached or they gave me a long run-around and I did not get the services I needed. I am extremely disappointed because I ended up wasting over $1000 in premiums on this coverage and it was completely useless. My children are now on Medicaid and I am currently uninsured. We are on social security and they robbed us of money that was much needed for other expenses. We should sue them for false advertising, really. Be extremely cautious before you purchase coverage and make sure you read the reviews. I cancelled mine today and that is the best decision I have made to date regarding my Ambetter Coverage.
Ambetter is a JoKe staff has no idea what they r doing everytime u call its a different tale i call it LIES!!!!!
Would be 0 stars if there were available. They make you wait on hold forever and never actually do anything ! - I have asked for rep names and reference numbers. All are meaning less since the last person NEVER WROTE ANYTHING I said. They denied I ever spoke with them!
We are a provider's office and we are supposed to have a contract with Home State Health Plan through Ambetter and it's supposed to be effective 1/1/18. We have never been paid for one patient seen. They still have his name incorrect on the website and still show that he is out of network. When trying to communicate with the Provider Relations Department, I get cut off after a message that says, "due to unforseen circumstances, the call center has closed." We have patients that need treatments and instead of them focusing on getting better, they are worried about their insurance not paying the claims. We have never had such a horrible experience with an insurance company in the 27 years I have been in the medical field.
In Dallas. Went via ambulance with chest pressure to an “in network” AM Better hospital. Was told that I needed bypass surgery. However, the hospital discovered an infection in my back that needed to be cleared up first. Sent me home with IV infusion therapy. While at home, I discover that my cardiologist and the only heart surgeon at the hospital are NOT covered in network. I kept getting the run around from their inept and rude CSR’s. The doctors office had to confirm they “no longer accept” AM Better because they don’t pay claims. Also was told by a CSR that my heart bypass surgery was considered ELECTIVE even though I have 100% blockage on one side and 55% on the other. She advised to - and I quote - “WAIT UNTIL YOU HAVE A HEART ATTACK AND THEN GO TO THE HOSPITAL” because then it’s and emergency and not an elective surgery. Unbelievable. RUN RUN RUN. In hindsight, I’d rather pay the penalty and go into a faith based share plan than deal with AM Better.
I have had Ambetter for 2 years. They are a discount insurance. Most of their current contracted doctors are with the local health department. It is very difficult to get an accurate list of approved doctors. I just called Ambetter for a doctor referral and they gave me 4 doctors and I got 2 more listed on their website. I have called of them 5 so far and none of them actually take Ambetter insurance. Very deceptive.
This company doesn't cover our surgery or anesthesia or wellness checkup, they make us pay for every thing and they escape when you call them they don't solve any problem and supervisor always is not available , lie after lie , I think they have to close Ambetter and Market Place because is just SCAM . and Scam from the government of USA and i'm wondering why they still force people to have insurance
Horrible insurance. Customer care is incompetent. On their website they list a provider as being in their network then they deny benefits with a code of "not in network". Deductibles and co-pays are costing me a fortune. Explanation of benefits included a lung transplant and a vasectomy. I've had neither!!! Only choice where I live in Missouri.
00000000000's. RUN, RUN, RUN, if you are considering getting insurance with Ambetter. Don't ever purchase insurance through Ambetter. It is impossible to get a question answered about anything. It is impossible to get any need taken care of no matter how small or large. You will be on the phone for 15 minutes before you even get an opportunity to address the reason you are calling in the first place. No one accepts them & now I completely understand why. The times I've check I've been told it's because they don't pay their claims. Based on how impossible it is to get anything done with them, even if it's as small as an address change, I can completely see how difficult it might be for a service provider. RUN, RUN, RUN, if you are considering getting insurance with Ambetter.
keep suspending our insurance by claiming auto pay not set up. They're shut down their call center and are not taking calls. Not even sure if they're still in business.
Terrible!! No doctor on the multiple lists that they have given me accepts the insurance. This has turned into a health-threatening situation as I'm not able to receive the needed medication. Horrible customer service, inept.
I am given different information by different people when calling Ambetter. It's very confusing. I've had nothing but trouble trying to get doctor visits approved and/or covered. This was my only choice as far as individual healthcare in Arizona.
needed a 3 month plan after moving to a new state to cover family until new job's insurance kicks in. I was told I couldn't get a 3 month plan and now I have to pay 1 year of deductible in 3 months before seeing a single $ in benefits. total garbage
Customer service are mean and very unprofessional
I wish there is an email address to contact them instead of the useless customer service people that keep answering my calls. I needed a proof insurance for all my family for the year 2017 and I had to call them more than 20 times until eventually I received the papers for all my family except my husband whom they denied he had insurance with them, I found my husband's receipts for most of the year and I want to show them that there is something wrong with their system but how can I do that?! they don't even have an office to visit in my state! Me and my family where unlucky in 2017 because someone in the marketplace referred us to ambetter !
We have been with Ambetter for 3 years and it has met all our needs. Customer service is excellent and try to help to the max. I did not give it a 5 because their provider list is very limited and not updated frequently
Ambetter misled me on 4 occasions, saying that they would cover my child when playing sports for her school. The team coach revealed, in a 3 way call with Ambetter, that they in fact DO NOT COVER my child. The school has secondary insurance ( not primary) and Ambetter will not pay anything unless the secondary (backup) insurance pays first. Even talking to a supervisor (Cathy A. ) at Ambetter did no good. Why lie, Just tell me the truth! You know you don't cover. Don't waist every ones time!
Would give no stars if possible. You get what you pay for. Unfortunately, this is what many can afford. Customer service reps are useless and rude. Good luck finding a provider who will accept this insurance. I cannot wait to change insurance companies.
WORST INSURANCE COMPANY EVER--- Been trying to get an incorrect birthdate corrected since January , 2018!!!!! Keep getting the runaround, first they say they didn't get the files from the Marketplace which they require to change info, second file sent, Ambetter saying they didn't get that file either. The latest excuse is that it is a "known Computer issue" and "everyone knows about it". So if it is a known issue why can't IT department do a patch or issue a workaround!!!! Or why can't a note be entered into the system noting what the correct birthday is so claims can be paid???? This is the WORST company I've ever had to deal with and I've been in Healthcare for 44 years. All you get are excuses . I am the successor agent for Healthcare for my sister in law who is the paying customer for this Nightmare. And by the way, my brother has paid the denied claims, so how is he to get reimbursed for monies paid due to this company's incompetence.
No one takes this insurance even when listed. Run.
It's sad that health insurance is so complicated in the United States. There are so many problems with Ambetter in terms of customer service, lack of providers that are near your place of residence, and very much a bait and switch operation in terms of QUALITY Healthcare. Paying $1500 premium for a healthy family of 4 in Arizona with providers that don't take health care seriously is EXACTLY what you deal with on an ongoing basis. It's the definition of INSANITY. This company is taking advantage of the lack of insurance for individual in ARIZONA. It's scary that I have to go to South Phoenix to my OBGYN as no OBGYN's in Scottsdale want to affiliate with Ambetter. When you have relationship with an OBGYN for years, it's uncomfortable to start over. I'm appalled there are no governing agencies that at least have minimum standards that regulate how insurance companies can operate. Ambetter is taking advantage of Arizona individual insurance as we have no LEGIT insurance companies that want to contract in Arizona. Why our Senators can't figure this out is mind boggling. It's very sad that we live in a country that has allowed companies like Ambetter to back people in a corner to accept standards in HEALTH that are WAY below where they should be. It feels like we live in a 3rd world company with the lack or organization, customer service and the PLAGUE associated with Ambetter. Pay a fine to the government for not having insurance or pay $1500 a month for a healthy family of 4 to have SUBPAR insurance and providers in the city of Scottsdale. This is BEYOND frustrating!!!!!!!! Insurance is a HUGE one sided MONOPOLY that is surely not in favor of the CONSUMER in ARIZONA. This is why you never let the government HANDLE your health insurance. We all need to call our SENATORS in AZ and get this CRISIS worked out.
DON'T EVER CHOOSE THIS COMPANY THEY STEAL YOUR MONTHLY PREMIUM THEN THEY SUSPEND YOUR INSURANCE AND THEN THEY DON'T GIVE YOUR MONEY BACK, THEY LIE AND WHY WOULD HUMAN BEINGS TREAT OTHER THIS WAY, THEY WON'T TELL YOU HOW TO CALL ANYONE BUT THE CUSTOMER SERVICE AND THEY DON'T TELL YOU WHERE THEY ARE LOCATED AT. WHAT IS WRONG WITH THIS COMPANY????????? WHY DOES THE MARKET PLACE RECOMMEND THIS COMPANY WHY DOESN'T THE STATE HELP US WITH THIS??????BEWARE OF THIS COMPANY!!!!!!
Most doctors won't take this plan. The ones that do, charge more for an office visit WITH this insurance than they would if you paid in cash. This group is simply taking advantage of our corrupt government laws. If you can find another insurer, do.
Worst insurance ever! Customer representatives are whole bunch of idiots and so irresponsible! A simple preventative blood test should be paid for but it has been more than 6 months, still not resolved. If I had a choice, I would never use them. Thanks to Obamacare! What a liar! You can keep your insurance and keep your doctor, really?
This health plan sucks so bad like nothing I have ever experienced in my life. I will private pay my own doctors rather than go to the quacks that take this health plan. Why is it that because I don't speak Spanish that I am not entitled to the same quality of care than these people do. The doctors around here speak no English. Don't EVER SIGN UP FOR THIS SHIP OF FOOLS!!
My husband has been with Ambetter for 1 1/2 years and I joined this year. We pay $1671 a month with $6500 deductible each, and we are in good health. Being self employed, there are not many choices. We send in the MyHealthPays rewards for gym visits every month to at least get $20 each off our costs. Half the time they accept my husbands, but mine have not gone through one time this year. I have called countless times and someone is always going to get back to me.........but it never happens. Many of their employees are so rude. Thank goodness we both turn 65 next year. At least then we will be on Medicare.....lower costs and better coverage.
AMBETTER .... WORST INSURANCE EVER‼️😡 While they set me up on auto pay to deduct my monthly payments without my permission or any type of warning they deducted large amounts on May 15, 2018 in the amount of $1,325.58 Another on Jun 15, 2018 in the amount of $662.79 & another in July in the amount of $1,295.00 They stated I had agreed to pay any and all charges nasasary when I agreed to do auto pay. I’m so busy I had not checked my account & when I did I was in complete Shock. Worst part is I have never once used the insurance while I was paying my reg payments. I just wanted to have insurance for peace of mind in which AMBETTER has caused me anxiety instead of peace. Please be very careful with AMBETTER insurance as all they care about is taking money from their members. I have filed a dispute against Ambetter for being THIEVES.
Most of the doctors in my area won't take this insurance. Some of my doctors that did carry it have dropped it, and I have had to find new doctors farther away. Many of the doctors that I checked on their site actually do NOT take the insurance. Every year the prices for this insurance has gone up by huge amounts. They have also decline a surgery that I needed. This is a sad excuse for medical insurance.
Customer service does not even attempt to care about questions/issues I have regarding my insurance. The plans are convoluted and inadequate, and no one even cares. What a sad broken system we have. It doesn't have to be this way.
no improvement; love the low co-pays and 0 dollars on most prescriptions
Don't get this insurance Melissa supervisor in customer service is horrible and won't help you with anything the WORST customer service Ever if you don't want to be ignored and a 0 priority stay away from getting An better coverage
I have no problems with ambetter in Indiana. My questions get answered correctly. It seems they pay the provider quickly. My husband had to have MRI and brain scans approve. We received in a timely matter. The only complaint I havevisbthr selection of providers are very limited. You have to do a lot of searching find doctors.
Horrendous! They told me that my GP was in their roster, she was not. Then they gave me a list of dr.s to call but none were GPS. The website had issues and they were not helpful. The dr I have now through them is inept.
No truthful on webpage about who primary care professional they allowed you to use
Ambetter is AWFUL! I pay $700/month and you pay very little and most of my doctors are not in your network. I have a triglyceride pill which you don't cover and I have had other insurance companies cover it for approx. 7 yrs. You have way too many prior authorizations. I will switch next year. Absolutely poor service from you.
Provide immediate answers on claims questions instead of repeating what is on the web site which we can see