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Ambetter

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5.5

Overall Score

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LAST UPDATED: September 27th, 2022
Number 3 in Blue Circle

3 Things to Look for in a Health Insurance Company

  1. Plan Options — Look for an insurer that offers the kind of health plan you need. Some insurers specialize in specific types like Medicare.
  2. Extra Benefits — Look for the extra perks offered by the insurer with your plan like a fitness program or reimbursement. While not a dealbreaker, these benefits are worth noting.
  3. Claims Experience — Look for insurers that offer a good claims experience compared to others. Reading customer reviews can give you a sense of how well an insurer takes care of its plan members.

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.

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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 87 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.

View Ambetter Reviews and Complaints

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 2021 healthcare coverage runs from November 1, 2020 to December 15, 2020. If you missed the enrollment period, you may qualify for a Special Enrollment Period after December 15, 2020 if you have a Qualifying Life Event.

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The Good

  • Health Insurance Plan Options
  • Helpful Online Account
  • Member Perks
  • My Health Pays™
  • Dental and Vision Coverage

Health Insurance Plan Options

If you're looking to get an Ambetter plan, you can view 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.

Helpful Online Account

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.

Member Perks

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™

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. 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

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 choose.

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.

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The Bad

  • Poor Customer Reviews
  • Access to Plan Information
  • Limited Service Areas
  • No Mobile App 

Poor Customer Reviews

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 likely be better served choosing another insurance provider if you can.

Access to Plan Information

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.

Limited Service Areas

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 you'll need to consider another insurance provider.

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.

No Mobile App

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 Bottom Line

Ambetter should be somewhat of a last resort when choosing an affordable health insurance company. While its plans all have decent health coverage for preventative care and some vision and dental benefits, it is difficult to access full details of its various plans. Data points such as the annual maximum out-of-pocket limit and co-pays are difficult to find on the website.

Plan cost and deductible levels vary among plans. Availability depends on location. Cost is also affected by the number of people on the plan and some demographic information, like age.

While Ambetter's plans offer comprehensive healthcare coverage, it's important to review customer reviews to get a sense of Ambetter's quality — health plans, value, cost, and customer service — and compare Ambetter to other health insurance companies before making a final decision about signing up for an Ambetter plan.

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Star Rating

1.4

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958 Reviews

Review Breakdown

5 grade

5%

4 grade

3%

3 grade

1%

2 grade

3%

1 grade

88%

Sentiment Criteria

Value

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Quality

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AmbetterIsTheWorst Tulsa, OK

You're reading reviews right now to ensure you make the right choice. Back away. Now. I mean it. Go with that other plan. I don't care how cheap Ambetter is or what plan you're choosing from them. Expect full days on the phone with constant disconnects to solve account issues that arise and they will arise. Guaranteed. Expect hour-long waits on hold before you hang up, when the poor customer service person who has no authority or information you need inevitably has to escalate your issue to a higher-up who never answers. Expect ACA violations, Ambetter shirking their legal responsibilities for preventative care as they will never properly cover procedures as such even if required to do so. Expect a very limited range of doctors where necessary appointments take 3+ months to secure. Expect billing issues, overcharges and major out-of-pockets that Ambetter should be paying but finds a way to avoid, confident that you won't bother finding a lawyer and feel you're powerless to do anything about. Expect all these things, because they will all happen. Ambetter is the worst health insurance company in the United States, which likely means the worst health insurance company in the developed world. Based on the fees you'll be paying for the year, you are literally better with no insurance at all. Just. Don't. Do it. May they finally get sued into oblivion and

1 week ago

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Gary Siegel Seattle, WA

There is nothing good about this company. I knew I was getting "high deductible" insurance, but my experience with this company was the worst of my life. Customer service is horrible. They will basically take your money and give you nothing. Try to get an authorization; they will give you a never-ending run-around to get out of paying anything. Have a question? Get ready for call-center hell. Stay away; no insurance is better!

1 day ago

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ANPR Miami, FL

Horrible…!!! I have been in ciatic pain for a month and a week, they don’t care…!!! Authorizations that never come thru, 3+ hours to be in de scalating dept, nothing gets done, I even change the plan to a better one, paying more and nothing…. How can people live with pain and this people don’t care….. now they said that my Pain management company duplicate the request… IT’S THE SAME… just with an URGENT SIGN…!!!! If I go to an emergency room they will give me a shot and won’t help, I’ve been there 3 times….!!!!! It’s a joke…. No answer s, it’s like they are dealing with animals..!!!!! They tell you a different excuse every time…!!! Please help….!!!!! I can’t take this pain anymore….!!!!!

4 weeks ago

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Wizard 4717 Spring, TX

Nothing approved. No doctors will take it. They just laugh. I don't even bother with Ambetter. Better negotiating with the doctor. I pay 50.00 a month and the government is being cheated out of 800.00 a month for this scam. I am sure that this company is just a few people in a strip mall in Florida.

1 week ago

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joe mail Naples, FL

I WISH I WOULD HAVE FOUND THESE WARNING BEFORE I PICK AMBETTER ONE OF THE WORST INSURANCE COMPANY YOU CAN GO WITH AM GOING TO ALSO FILE A COMPLAINT AGAINST THEM I CANCEL MY INSURANCE AND THEY KEPT BILLING ME UNTIL I FOUND A BILL FOR 1500 THAT I NEVER GOT TO USE THE INSURANCE NOT IN ONE DAY OF MY LIFE EVEN WHEN I WAS MAKING MY MONTHLY PAYMENT ON TIME

2 weeks ago

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Joan Castro Dallas, TX

The insurance is a the worse to pay for medication. It's almost impossible to get approve for medication. The always asking information from the primary doctor office and when they receive the reason the patients need that certain medication they still denied the medication finding another reason. And asking for more requirements. They insurance literally assume the doctors prescription is not vaillid and the patients is not sick enough even after the proper testing saying the pecient is sick. They are expensive and NOT RELIABLE when someone needs the medication. They're only good to collect payment but they put all kinds of barriers to respond financially for someone medication.

1 month ago

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Reno Dog Reno, NV

Company should be called AmWorse. Do not get insurance from this company. They will find any reason to deny coverage. My back doctor referred me for an MRI of my upper spine due to chronic pain which I had gone to physical therapy for a year before with no significant improvement. Ambetter denied the MRI and said I needed to do physical therapy (again). I started the physical therapy and after four sessions at $100 out of pocket per visit, I learned that Ambetter denied payment for physical therapy because it was not pre-authorized! My PT had checked when I started the therapy and at that time, pre-authorization was not required. They changed their policy a few weeks after I started PT and refused to grandfather me in. This was not the first major issue I had with this crappy company. I changed to a different insurer as fast as I was able. DO NOT INSURE WITH AMWORSE!

1 month ago

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Dave Fant Ozark, AR

Having had Ambetter previously myself and my wife has it. We both have found Ambetter will deny coverage for clearly medically required surgeries. Avoid this company if you can. If you don’t die from old age being on hold and then getting wrong answers and no results you will suffer from denied medical needs!

3 weeks ago

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Calvin Green Rolla, MO

There is nothing to like about Ambetter Health Insurance. I only selected one star because that was the only option available. No stars would be more reflective of my evaluation. I live in a city with a sizeable hospital and yet Ambetter has a very, very limited number of doctors to be primary care physicians, dermatologists, and enologists that are part of their network. Their customer service is atrocious. They cannot even email information such as doctors in their network for specialty procedures or treatments.

1 month ago

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JoJo St Louis, MO

Their customer service can never provide a clear answer and has just straight up told me the wrong answer on multiple occasions. This has caused serious delays in my healthcare. The only way to get a real answer is to complain on their Facebook page. I don't recommend and if I had more money I would go somewhere else.

1 month ago

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Shelley Steed Knoxville, TN

The app is useless unless you are looking for their "perks & rewards". I don't need a discount on my phone bill (because it's not better than my regular rate); I just need to be able to access (at a minimum) my bill to confirm due date!! I'm very suspect of a line of credit they are offering. $750 line of credit to be used almost anywhere. Terms are "pay back later" and "never a finance charge". Yeah, rite. I hope the marketplace, (healthcare. gov), gives this company the boot at the end of the year.

1 month ago

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Evil Jared Philadelphia, PA

Unfortunately, there’s no way to give this piece of crap company a review with negative stars. After assuring me four months ago that my upcoming surgery would be covered, they send me a letter 72 hours before the procedure telling me it isn’t approved. 12 months unabld to walk properly and they deny me 3 days before the surgery is scheduled!!! Absolutely despicable crimnal bastards. F this company! Not worth one cent, let alone the $900/month premium.

1 month ago

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Laura Schott Philadelphia, PA

I "only" pay $62/month for this insurance due to a tax credit but the plan I have is typically $250/month and it doesn't cover ANYTHING. It should be illegal. I have been trying to find a primary care doctor so I went to the Ambetter website and all these doctors came up as "in-network" but when I actually call the office to schedule an appointment it turns out I'm actually not in-network with them. I have been unable to find anyone in Philadelphia, PA that accepts this insurance through their portal. When I signed up for this insurance I chose a primary care provider (at random since I didn't have one) OFF OF THEIR WEBSITE, and when I went to schedule an appointment with her she didn't accept this insurance. I don't know how they can legally claim that all these doctors are in network with them when they're not. I would rather be uninsured than give Ambetter any more of my money. I will be getting different insurance next year.

2 months ago

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Nabrin Noor Ellenwood, GA

So my grandma was required to have surgery to remove an infected toe and after we were sent home we couldn’t figure out why we couldn’t have home heath come in. After calling the nurses, the hospital and then the insurance I figured out there was a balance due. There was no phone calls or anything to let us know that the referral wouldn’t be approved unless that balance was paid so I spend 8 hours talking to people for no reason when it could have easily been sorted if someone from insurance would have notified me. Now we are on day 3 after discharge with an old dressing on a wound. Does Ambetter wanna pay for amputation of the whole leg instead of focusing on helping us prevent further infection?

2 months ago

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Laura Langford El Mirage, AZ

If I could give Ambetter ZERO stars I would. It has been over three months, more than 3 hours of phone calls and still no-one at AMBETTER seems even slightly aware of the policy that they created for all of the state of Nevada. In Nevada, despite my reading of my benefits, I found that they do not have any idea that on April 1, 2022, they installed a new policy for specialists. These doctors are not permitted to see any Ambetter patients without a "Authorized Referral". Ambetter, however, has "Authorizations" and "Referrals". They do not have anything called an "Authorized Referral". Hmmmm. The office manager at the Gastroenterologist informed me (as well as the Ambetter representative, who I had on the phone) by reading an email sent to all Referring Doctors in the state of Nevada - Ambetter will not pay visits of any kind (including initial consultations) without an "Authorized Referral". So let's just hope that my 3.5 hours and ticking away are not wasted and I can FINALLY figure out what Ambetter means by an "Authorized Referral" and I can teach every referring doctor and specialist in the state of Nevada. But wait, there is a new development - I may not even be covered for at all to see a Gastroenterologist... Curious indeed. Seriously, what good is health insurance that doesn't cover your GI track? Okay, but I still can't see the doctor because the CATCH 22 of "Ambetter Health Insurance". They sure don't care about making making me BETTER, just themselves.

2 months ago

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Adrienne Wissa Phoenix, AZ

Was not able to reach a representative for MONTHS. Finally reached someone today. Spoke with them for 20 minutes and we're disconnected, they never called back. Spoke with another representative for 40 minutes and disconnected, never call back. Now waiting 40 minutes to speak with supervisor. Last year paid for my daughter's birth and prenatal visits out of pocket. Had an ER visit in December for her, they didn't even cover 20% despite deductible being met. No one is able/willing to answer why. Tried to get her an audiology appointment, no one would answer when I tried to find an in network provided. Finally gave up. Exhausting and worthless.

2 months ago

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Quinn Ales Chesterton, IN

I'm from Indiana so I don't know if that makes a difference, but I've never had an issue with Ambetter. I had more headaches with BCBS. Honestly the only thing that has been annoying in the last 4 years was that they didn't want me to use name brand Vyvanse for my adhd but instead preferred adderall xr...not a big deal. I'm happy with them. Just sucks insurance is so expensive these days across the board. I pay $1300

7 months ago

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Jason Walker LaFayette, GA

I have been with Ambetter as a patient / customer for nearly a year. While I totally comprehend the opinions and troubles of others and the number of one star reviews, I have been thoroughly pleased after leaving my workplace and losing excellent company insurance. Ambetter fortunately had my providers on their roster and I've had absolutely no trouble with accessing care or prescriptions. Perhaps I'm a rarity, but I'm really happy with Ambetter. I'm a Georgia resident and acccesed my Ambetter plan through Marketplace during open enrollment.

8 months ago

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Sarah Savannah, GA

Ambetter is the worst insurance on the market . I pay $200 a month and get nothing ABSOLUTELY NOTHING COVERED . They are so uninformed one representative tells you one thing and the other the opposite omg Run

2 weeks ago

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Bill O

Site doesn't work ("Try again later") so you have to deal with calling for information. You have to go through layers and layers of info just to find out if a pharmacy is covered. Idiots.

3 weeks ago

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Stephen Eldred Portsmouth, NH

Absolutely useless service. Fully paid my premiums but they block collection of meds at the pharmacy because "the computer has a glitch". Spent 4 1/2 hours over 2 days on hold. No resolution. Total crooks.

3 weeks ago

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Har Tol Lucedale, MS

I don’t understand what all this noise is about! I would say that most of these 1 stars are just not getting the understanding needed from their agent that signed then up or if they just went in and just chose the cheapest plan themselves! So with that being said my agent explained how the insurance works and helped me with the best plan for my area. All plans did not work for me and I listen and went with the one she chose for me and I never had a minutes trouble with my plans! I’ve been with Ambetter for 5 or more years and NEVER had the experiences that I’m hearing here. So far Ambetter has been far more than just insurance, it has been a life saver for me!! I say find the best plans in your area and leave Ambetter to continue to blossom in it’s good here. Molina, Cigna and the other great affordable plans are great as well in the areas they serve.

9 months ago

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Just another biller Kodak, TN

I am a medical biller and certified medical coder and have worked for providers for over 20 years. To those getting billed by the provider for lack of auth, change providers! Those bills are not your responsibility! Do your research on what you should pay. NEVER PAY THE PROVIDER BILL WITHOUT MATCHING IT TO YOUR EOB (Explanation Of Benefits) from your ins company. If it's not the same amount, send a copy of the EOB with your payment. Ambetter requires providers and the staff to do their jobs. Documenting medical necessity, submitting records supporting the diagnosis and treatment plan. I will say that once a claim or procedure is denied and multiple hands touch it, getting it approved or paid gets tougher. Providers need to do it right the first time. Providers have the ability to upload supportive documents online directly to the denied claim or auth. It is usually resolved within a few days. I actually liked working Ambetter claims because they were so easy! Even if a provider missed an auth, Ambetter would approve retro auth requests IF they were done in a timely fashion. From my experience, most of the complaints I have read are most likely from: PROVIDERS SIDE: 1. Not enough office staff to support the patient base. 2. Untrained medical scribes or physicians that are responsible for documenting medical necessity. And yes, mds, nps and all others contributing to the medical record must know what is needed to get paid. I have attended many trainings and I can count on one hand the number of physicians that attended. The ones that did, knew exactly what they were required to do in order to get a test or surgery approved and paid. 3. Untrained billers/collectors that do not know how to get the claim paid. 4. Not educated on what the step management is for authorizations (ex: the small test, the next test, then the advanced radiology) Not going straight to MRI. MEMBER SIDE: 1. Not understanding your medical policy. 2. Going to out of network providers. 3. Not looking at their EOBs and matching them to the providers bill. Overall, Ambetter requires the provider to DO THEIR JOB! As they should, in order to provide care to their patients who entrust their health and life to them.

9 months ago

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Holly Conyers, GA

If I could give 0 stars I would. Ambetter gave me an insurance quote of $46.44 a month. I was laid off from my job which made me ineligible for the tax break. Instead of informing me my insurance went up they just took $627.44 out of my account. This is theft. I agreed to pay $46.44 a month. Not $627.44. So far they haven’t refunded any of my money. If you have this insurance set up on auto pay I suggest you cancel it fast!!

2 months ago

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Zachary VanTilborg Las Vegas, NV

NEVER USE AMBETTER. Their customer service is non existent. I tried to get a PCP through them and every single doctor that pops up on their list says I need a referral from Ambetter just for a primary care. So I call Ambetter and after getting hung up on several times and repeating my information over and over the representative told me that wasn't the case and then began just reading off the FAQ page of their website. So I cant even see a PCP. Theres a 1000 links to pay them but you cant actually use their trash insurance.

2 months ago

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Robnole Canton, GA

Ambetter is the worse health insurance company I have ever used. They reject 85% of prescriptions that our Ambetter approved doctors prescribe. These are things like a decongestant when a sinus infection is diagnosed. They also approved a colonoscopy but rejected the solution you are required to drink before the procedure. I would strongly advise avoiding Ambetter.

2 months ago

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robert lee Little Rock, AR

Ambetter is basically a type of legal Scam...to scam people who cant afford health insurance. If you dont get pre-approval, nothing is covered. Whenever providers call Ambetter to get preapproval, they find themselves either unable to get through or on the phone with someone who barely speaks english and who only gives you a web address to send records and authorization requests to. Ambetter never gets back with you. Then you call again and you are sent to the "provider relations" call center (wierd that it's a call center right?) but all you get almost every time you call is a recorded message telling you that the system is down and telling you to call back. If they do answer they tell you they need more information. Trying to collect is a massive dead end. Basically, in most cases they make it virtually impossible for the provider to collect payment, which throws the bill back onto the insured member. And since Ambetter usually never even processes the claim, the member is left with a giant (unajusted) bill.

2 months ago

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Darlene Tucker Scotts Hill, TN

I would give zero stars if I could. Ambetter: lowest cost plan in my area, because Ambetter has the benchmark plan. Makes other carriers unaffordable even with tax credits. Getting prescriptions filled is a nightmare unless it's a $4 generic. For brand name RX you have to get prior authorization(PA). If the rx has a lower starter dose in the beginning, you will have to get prior authorization again to refill the normal dose! My 1st one took months. They decline it the 1st time and you have to appeal. Meanwhile, you go untreated so they can save a few hundred dollars during the delay. Expect to spend 45 minutes to an hour, minimum, if you have to call them to get assistance.

3 months ago

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Donna Reeves Charlotte, NC

This is my experience this evening. My first phone call—at 8:30 call disconnected before anyone answered Second call—someone answered, I gave my info and even gave a call back number, but the phone call was disconnected—no one ever called me back. Third call—someone answers. I give my name, date of birth, Member ID, name of the medication and the dosage. I explain that I am calling because I didn’t receive a reimbursement that another representative told me I would receive if I paid the $529 for farxiga. The rep states, “I will have to transfer you to that department.” The transfer does not go through and the call is disconnected. Fourth call—someone answers; I give my name, dob, member id, name of medication and the dosage. I get transferred to the customer relations department, but in order to speak to anyone I have to have my NCPD number. A number that I do not have so that call is disconnected. Fifth call—get representative; explain the reason for my call; then the rep takes my name, dob, member id, name of medication. I explain that I need an NCPD number and I don’t have that info. I ask if they have it and then I am put on hold. The rep comes back and says that they don’t have the NCPD, and I will have to call my pharmacy in order to get the number. I know that my pharmacy closes at 9:00 p.m. It is now 8:55. I spend two or three minutes going through the CVS phone tree and finally contact the pharmacist who gives me the NCPD. I then call the number for member services that the rep gave me. The rep gave me an incorrect number. I hang up. Sixth call—get the rep I had on call number three; give her the same info as my previous four calls. I explain the purpose for my call. She then tries to transfer the call, but the office is closed and won’t be open until Monday at 8 a.m. This could have been told to me on any one of the previous five phone calls. This company is just...the worst.

3 months ago

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Elizabeth Conard Philadelphia, PA

Ambetter is literally the worst. I signed up for my health plan because, at the time I signed up for the plan, it listed many doctors and hospitals as in-network in my local area. Upon the start of my health plan, I discovered that almost all of the doctors listed as in-network on the Ambetter website are actually out of network. I had to drive 45 minutes out of my major US city to get to the closest urgent care, and I still got a $150 bill from the urgent care clinic. I was unable to obtain the mental health counseling I needed through my insurance because the VERY FEW offices around my city that took my insurance were not taking new patients. None of the other major hospitals and clinics that I’ve gone to for blood work, ultrasounds, etc knew if ambetter was in-network, meaning that I had to obtain services without knowing if I had coverage, resulting in several large and unexpected medical bills. I also could not trust the information I got from the ambetter portal or from customer services because the offices and doctors listed on the portal had proven to be inaccurate. I’m basically paying $100 out of pocket plus hundreds in healthcare credit from the government per month to get no benefits besides my $25 prescription refill. I literally want a refund for this insurance.

3 months ago

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medrevur Elmhurst, IL

For Ambetter / Buckeye Health in Ohio My opinion.. STAY AWAY AT ALL COSTS. Literally the worst health insurance company I have ever dealt with (worst company of any type in fact)... some of the people are nice to deal with but they can't save you. The moment a dispute of a claim is sent to the back office to review, it goes into a black hole with no hope of resolution. They deny appeals through their process, appeals that have been well documented by their own reps (with their own reps saying this absolutely should be paid), and the denial reason is a couple words that make no sense whatsoever. They run out their own self-defined clock on the appeal process by taking months between responses and then refuse to examine the issue further. This company has cost me thousands of dollars I absolutely should not have owed. Why stay? I was over a barrel, this was the only company in healthcare. gov that covered the doctors I had found for some serious health concerns and did not want to use other doctors. The stress this company added to my life through their horrendous billing is criminal. Even today, as writing this, I am getting a bill from a procedure 11 months ago that for a preventative procedure that is 100% covered under my policy EOB, which they paid and THEN pulled the payment back from the provider with no explanation. I thought I'd gotten away from these monsters and they still creep in a year later. Criminal.

3 months ago

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RenoHal77 Reno, NV

After a good 6 months trying to get my online account access in order with customer service, I finally figured it out myself. I was using the wrong email address to log in with even though it was the same as what was in my account. Apparently you can have a different login email than what's in your account for communications. That is so confusing. They didn't even catch that.

4 months ago

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AK Kilani Frisco, TX

many of the PCP listed on Ambetter value 32 site say they no longer accept this plan. Many other listed PCPs do not accept new patients even though the site mentions "accepting new patients"

1 month ago

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Dali Dallas, TX

If you follow the rules of using in-network providers for both diagnostics and physicians, there will be no surprise billings. I made sure my primary care physician on paper was affiliated with a local community hospital so that I’m covered and in-network in case of an emergency. I have never had a problem getting authorization for drugs, but sometimes the pharmacies will actually lie (not Ambetter’s fault) and tell you,”It isn’t covered by your insurance,” when all you needed was a pre-auth. I always check with Ambetter directly. I never trust the doctor office staff nor the pharmacy staff to sue the due diligence. I guess I’m cynical that way, because I used to work in healthcare. I think it’s easy for people to blame this insurance company, and usually people only take time to write reviews when they are angry. If you follow the rules of the Ambetter system, and make sure you use in-network providers, you won’t have to deal with appeals over billing later. Work smarter, not harder folks! Also, being kind to customer service goes a long way. I mean, I had a lengthy convo with a rep who was absolutely outstanding and sweet. She took the time to explain how everything works, because healthcare gets complicated with deductibles and all, and even I needed some questions answered. I am so happy that I chose Ambetter and not a cheaper company, because you really do get what you pay for, right?

2 years ago

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Kristin Slink Atlanta, GA

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!

2 years ago

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Heidi Turner

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.

2 years ago

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CinderUgly Maple Valley, WA

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!

2 years ago

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Wayne Jackson Douglasville, GA

My experience have been good, got the insurance for my wife, she had to spend one night in the hospital and the total bill came to over $14,000, Ambetter paid all of it. Never had an issue finding a providing. I live outside of the Atlanta and do no have issues find a provider. If you do not live around a large city then you will most likely have issue finding a provider in your area. Also make sure you call all of your Doctors that you wish to stay prior to signing up. I worked in the Ambetter Call Center, the Provider list that they have is not up to date. Do your homework prior to joining and everything will work out.

3 years ago

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LD Darien, GA

I was scared to get the Ambetter from Peach State Health Plan after reading all of the bad reviews on here but it was all that was offered in the Marketplace for my area. I have been very happy. I have had their insurance for nearly 6 months and they have paid everything promptly with no issues. Of the nearly $6000 we have only had to pay a little over $100. I have had no problem finding doctors, although I must say they all have to be affiliated with the local hospital. Sure, I'd rather have better choices but I really did not expect more. I have been happy with every doctor or NP I have seen, especially my NP. I have no problem with their website either, including earning rewards on the visa and using it to pay my phone bill. We have not had health insurance for many years and this has given us peace of mind. I have not had to call them but I did message them on the portal a few times and got a quick response. It would be better if they sent an email saying they had replied though. I had to keep checking the message box. We thank God our health has been cleared except for a few small issues, thanks to Ambetter.

3 years ago

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Brittany Lawrenceville, GA

I have had AmBetter since July 2018. I have read the majority of the hundreds of these reviews and it seems as though folks either didn't have other options and also didn't do adequate research about whether the physicians, hospitals and urgent care centers that they prefer were covered by the AmBetter plan they were considering. I went with an AmBetter 4 (which is a Silver plan on healthcare.gov), I have a low deductible ($600) and 100% co-insurance after my deductible is met. I pay $0 for my medications and since I am self-employed, I actually pay the full amount of what this insurance premium is per month (roughly $400/month.) I have on-going health issues that they haven't penalized me for, I have received all of my 3-month prescriptions without issue as well as over 15 other Rx's that are monthly. (As I said, I have seriously, life-threatening, on-going health issues.) I just spent 8 days in the hospital being discharged on 03/30, today is 04/07/19 and ALL of the hospital bills ARE PAID IN FULL. Again, I did extensive research before selecting AmBetter as my provider. I am very pleased with them and have zero complaints. Again, I pay my premium on time, researched my physicians before selecting their insurance and understood what type of plan I was selecting. Doing your research instead of expecting someone else to do it out for you is the truth behind the majority of the complaints in all honesty.

3 years ago

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Kaye C. Marietta, GA

My experience with AMBETTER for the 2018 year has been GREAT. My husband has been to the ER three times and hospitalized one time. All the bills were paid promptly. We both have had a lot of doctor visits and several diagnostic procedures without any problems at all. All of these extremely negative reviews are terrifying and scary as it is time to pick a company for 2019. I only had two choices form 2018, either Ambetter or Kaiser and Kaiser is a true HMO so that was out. The reason I pick AMBETTER is that All the hospital systems in the Atlanta area were included: Emory, Piedmont, and Wellstar. When I have searched for doctors, there any dozens for each specialty. I don't know if my great experience is driven by my location and the fact that we are in the metropolitan Atlanta area or not. Good luck and Good health to all.

3 years ago

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Laverne Williams Irving, TX

I am a healthcare reimbursement professional with may years of experience, I file claims for various physicians, code medical records and perform physician credentialing. Currently, I do not qualify for AmBetter health plans but anytime I have needed to call to verify patient benefits, check health claim status or get an authorization for services or just so I that can help redirect a patient appropriately, every customer service person I have spoken with at AmBetter has been helpful, courteous and professional. Answering all of my questions with care and great attention to detail. As a patient, its better to allow your doctors office to handle things for you but try to be clear when attempting to get answers from your insurer. But it is the insured parties responsibility to personally understand their own insurance like what's covered and what is not, and how much will this cost me? before you leave the doctors office. For physician offices you really should let the right people handle credentialing, people with experience. AmBetter is a great payer of claims and fast; as they keep accurate records and when they recoup because someone made a mistake in claims processing its always been accurate without the chatter like some others, "because we can". Thanks AmBetter you are doing a Great job and you are easy to work with.

3 years ago

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Viktorija Kang Henderson, NV

So far everything has been great. The only reason I am writing a review is to balance a little bit the stars because majority of people gave 1 star. I am a scholar and I can tell that all the reviews are always very biased and subjective. Most of the time people leave reviews when they are extremely unsatisfied or they are extremely satisfied. What about those who are in the middle? I live in Nevada and I found primary care doctor and pediatrician for my child within 5 minutes on their website. The plan I have has a good price and very good coverage, more than I could ask. I have called customer service and I was helped promptly. The person I spoke to was very nice and professional. I would never have written the review if I hadn't seen so many terrible reviews. Imagine how many other satisfied customers have not left a review? I just don't want people to not get good prices insurance because of other people's personal experience. Just look at the coverage, the price, and compare with other insurance companies. Choose what fits your needs, not what the "stars" say.

3 years ago

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Brandon Feldman

Biggest scam insurance company ever. Tells you doctors are in network, they are NOT! Then They blame the doctor for not updating them. CVS does not accept this insurance. I can’t find doctors I want to go to. The worst company! DO NOT get this insurance!

2 months ago

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Robert Reese Indianapolis, IN

Horrible. They claim to cover Farxiga yet denied coverage after having taken medication for 3 months under a Cobra plan that has expired and they will not accept responsibility to cover use as they say it is not medical necessary though Farxiga is the only medication so far to reduce my A1C. They should be ashamed to reel people in with false claims of coverage. What will they deny next?

3 months ago

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D. Jones Arlington, TX

BUYER BEWARE!!! I spent hours filling out their member rewards program. After a few months I finally received my debit cards, and they cancelled them before I was able to use them. Tried to call their customer service about it and they basically told me I was screwed. Why bother sending the cards? Dishonest company. Thank God I never needed to make an actual claim with them. I can't imaging what would have happened. DO NOT USE THIS COMPANY.

3 months ago

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Ashley Smith Kansas City, KS

This company is awful. I have been painfully waiting for a hip replacement. They said they wouldn't pay because I smoked, so I quit. A month later they said I had to wait 2 more weeks. Today they said they can't file the same claim again until it's been 180 days longer! Worthless, greedy p.o.s. I've got an appointment to talk to my lawyer soon. There's been many previous lawsuits against them. Do yourself a favor and stay far away from these heartless a$$holes.

3 months ago

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Missy Carter Mathiston, MS

Crap, crap, crap! I used to love this insurance, but since they have started using Envolve as their benefit & claims manager, it is nothing but crap. They force you to use specialists if you want your meds & devices covered after you jump through hoops. They don't cover any pen needles or syringes. Won't approve a lot of services... & the crapiest customer service by foreign speakers with heavy accents you can't understand! I absolutely hate them now. My health is steadily going down hill since 2021 because of theit stupid ways. All they care about now is the dollar!

3 months ago

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Kimberly L. Houston, TX

Their customer service is absolutely horrible to deal with. Not only are they extremely rude but I've been flat out hung up on and/or disconnected on purpose by them numerous times. Their customer service reps continuously give you false information and the runaround. I've contacted them about a simple issue multiple times and every single person I spoke to gave me completely different information. I've caught some of them in complete lies. They seem like none of them know how to do their jobs. They could stand to get some customer service training and skills. And maybe learn about their company instead of constantly giving customers wrong advice and information. I dread every time I have to call these people, because I know how difficult it's going to be, no matter what the issue is. The worst customer service I've ever dealt with.

4 months ago

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Irritated Counselor Olathe, KS

I am a mental health counselor GETTING OFF AMBETTER AS A PROVIDER! After I see a client a few times, they begin to harass me for records. Currently, I just found out that they have been faxing me for records of a client UNDER ANOTHER COUNSELORS NAME and on. RANOM PUBLIC FAX. Not even my fax number, somehow, the owner of the fax machine was able to trace the faxes to me. Total HIPPA violation. No idea how they found this random fax number that is not my fax number. Totally irritating to deal with them! Goodbye AMBETTER! Have fun finding new mental health providers that love to work for free.

5 months ago