Ambetter Logo

Ambetter

check_circleVerified

star star_half star_border star_border star_border
850 User Reviews

6.4

Overall Score

error This company may not service all states.
See states serviced
LAST UPDATED: December 7th, 2021
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.

report_problem

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.

thumb_up

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.

Get Quote

thumb_down

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.

gavel

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.

Was this content helpful?
thumb_up Yes thumb_down No

We'll Introduce You!

Call our recommended rep over at Ambetter below.

1-(877) 326-1271

Star Rating

1.4

star star_half star_border star_border star_border

850 Reviews

Review Breakdown

5 grade

5%

4 grade

4%

3 grade

1%

2 grade

3%

1 grade

87%

Sentiment Criteria

Value

star star_half star_border star_border star_border

Quality

star star_half star_border star_border star_border

Service

star star_half star_border star_border star_border

Trustworthiness

star star_half star_border star_border star_border
cancel

Filter by:

arrow_drop_down

Sort by:

arrow_drop_down
info
star star star star star

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.

4 days ago

star star_border star_border star_border star_border

Bri Dee St Louis, MO

By far the worst insurance I've ever had. Moved states, and literally zero PCPs available. Cannot get in to see ANY doctor. The few doctors that do take this insurance are low-income clinics where you're getting the worst quality care... But like I said, haven't seen one of those in months because NONE OF THEM ARE EVEN TAKING PATIENTS. I'm paying for insurance I can't even use. I get sent an explanation of benefits I didn't ask for every two weeks in the mail, even though I'm signed up for paperless everything. No one can seem to figure out how to get them to stop sending it. The site never works, customer service is a joke and they will hang up on you if they can't figure out what you need. Lost coverage for a couple months and lost access to my therapist because Ambetter screwed up a billing issue. Never paid late once. Please, if you care about your health, don't bother with this company.

1 day ago

star star_border star_border star_border star_border

Holly Gutierrez Hamilton, TX

I wanted to try Ambetter out because they were a new company that I had never heard of and they were very reasonably priced and the deductible and out of pocket max were very low. My husband and I have a plan with them through marketplace. It was very easy to apply and sign up. I paid my 1st few months premiums and everything was going great. They even paid for the surgery on my shoulder, which had me almost meeting my yearly individual deductible. Around July, I realized that our yearly income was going to be higher than anticipated at the beginning of the year. I went into marketplace and changed it. When I did this, I still qualified for the same Ambetter care 12 plan, but I would be paying more for my premium, which I understood. I found out that my income change put me in a different tier, same plan different tier, I went from the 90% to the 80%, meaning what they would pay. I was fine with all that. But because I had changed tiers, they put me in a new policy with a new policy number. This reset all my deductibles. The 1st several times I called, either the person had no idea how to help me and would put my call into a supervisor, which I never received a call back. Two people spent over 2 hours each on the phone with me to try and get this sorted out. They were on the phone with their supervisor at the same time. At the end of the calls I was reassured by both of these people that my deductible from my previous policy would transfer over because it was the same policy but a different tier. I had also received a rewards card from them for doing different activities in the amount of $50. I had used it some to pay my monthly premium but still had a balance of $30. When my old policy was "canceled", my Visa rewards card on associated with thus policy was canceled as well and I lost that money, which I had spent the time to do the activities for. This escalated over 2 months. In all this time I never received a phone call from a supervisor. Finally, after speaking to someone on the phone and having to tell them for 30 minutes straight that they could not help me and I wanted to speak to a supervisor, they finally got me over to a lady who proceeded to tell me that I was lying about everything that I had been told because I could not provide her the conversation number. She told me she could see all the conversations that I had had but because I could not provide her with the number she could not verify that that's what that person said. She told me that they never transferred deductible that it was my fault I canceled my policy. And that if I wanted to use the rewards card I should have used it before canceling my policy. I tried to tell her that I did not cancel my policy, that it was changed by Ambetter because I had been put in a different tier. But she would not listen. She just kept saying you're right ma'am what can I do for you. And when I would tell her she would say we can't do that, we've never done anything like that before so what else can I help you with. When I ask to speak to her supervisor to her supervisor she denied this request. I did not have a problem with anything but their customer service. Their premiums were reasonably priced, they paid for my surgery with no problem, but the way they treat their customers is absolutely is absolutely uncalled for and unjustifiable. I will not have a plan with them ever again.

3 weeks ago

star star_border star_border star_border star_border

Michelle Cappellazzo Avon, OH

You get what you pay for. I'm leaving Ambetter a very unsatisfied customer. The representative kept me on the phone for over an hour just to tell me they couldn't find a plan for me after my husband passed. I would rather pay more than deal with an unprofessional company for my children's health care needs. I think it's important to share my experience as a dissatisfied former paying customer. Keep looking !!!

2 weeks ago

star star_border star_border star_border star_border

Maddybaddy01 Des Plaines, IL

Terrible customer service. Extremely disorganised and I get different answers from nearly every person I speak with. They take forever to approve claims for treatments of chronic pain. I have terrible knee pain- waited a month for prior authorisation for an injection. Got denied. Never mind I am struggling to function. I was diagnosed with sleep apnea 8 months ago. Still not being treated because nobody wants to work with Ambetter and their process of getting treatment approved is ridiculously difficult. I was told by some medical facilities that they won’t work with Ambetter because it is Medicaid. Excuse me?! I am paying $341 per month, NO government subsidy- for this so called “Medicaid “. Had they disclosed this when they coerced me and basically pressured me into buying them this plan, I would have happily declined. They’re a rip off company who wants to steal your money. Don’t let the cheap benefits fool you. I’m looking into lawsuit options.

1 month ago

star star_border star_border star_border star_border

Rachel Y Columbus, OH

I purchased AmBetter through the Marketplace. It was difficult to find providers who would take it and it was very difficult to get a medically necessary knee surgery approved because AmBetter kept denying it for no apparent reason. But the worst part about AmBetter was that I met my out-of-pocket maximum early in the year, so AmBetter tripled my out-of-pocket maximum right in the middle of my contract, even though my income did not increase. They also increased my deductible and copays. I called many times, trying to get a resolution, and AmBetter pretty much said, "Tough, we changed the contract." I have a hearing scheduled for later this month, with a Federal Hearing Officer. It is outrageous that in the middle of my year-long contract AmBetter would just be allowed to change the terms of the contract and put me in the position of paying thousands more than I had anticipated when I chose AmBetter at the beginning of the year. What good is an out-of-pocket maximum if they can just increase it after you meet it? I will never use AmBetter again.

2 months ago

star star_border star_border star_border star_border

Kelley-Dan Young St. Marys, GA

100% worst insurance I've had in my entire life. Tiny network. Claims denied for legal modifiers. Have to travel an hour in two different directions for care. Most caregivers only in the covered office 1x/week to 1x/MONTH and are booked until we colonize Mars. Few specialists in network that have rights to any hospital also in network - so can't get emergency care because hospital doctors won't touch current meds and won't communicate with primary docs. Denying claims for random code errors that other insurances don't have a problem with, and refusing to contact the medical office to discuss the problem. Having this insurance is absolutely terrifying and if there was any other option whatsoever for our location we'd bail immediately. We've literally considered moving in order to get new insurance.

2 months ago

star star_border star_border star_border star_border

SummerSpringWinter Smyrna, GA

My college age son has Ambetter Insurance in GA. I have Medicare as does my husband, his dad. He is a private pay customer as he doesn't work for a company full time that offers insurance (of course he is a college student with a part time job). My son goes to college out of state. He had an ER visit in FL, in CT, and some tests at a hospital in CT. He is an athlete so this is normal. Ambetter ignored these claims and haven't even recorded them on their claims page of my son's account. We have sent the claims personally, the hospital has sent them twice, We have called Ambetter numerous times and they don't acknowledge anything. But they bill my son $360. a month like clockwork and they never lose that. I wish we could choose a different insurance company but the only other option is Kaiser if you are private pay in GA which would not help as there is not a Kaiser Hospital where he was in school and where he is in school now. Also his pediatrician in GA is not in network with Ambetter. The insurance is worthless. I've never seen insurance this bad. I've never seen record keeping this bad. It is October and the claims have not show up for activity in April or May or anytime for that matter. Don't use Ambetter. GA needs better options.

2 months ago

star star_border star_border star_border star_border

George Cahlik Lake Worth, FL

Ambetter is horrible. Customer service has no clue on how to perform their jobs? Emails to Ambetter are never returned or answered. Fine example of how a company just wants your money, they could care less about me. Ditch Ambetter or steer clear of this incompetent company.

1 month ago

star star_border star_border star_border star_border

Mikieme Phoenix, AZ

Grievance after grievance .... nothing resolved .... then bang ... sir the podiatrist removed your female parts from your toe it has been RESOLVED your toe had female parts and a heart valve ..... Wow .... you cant make this s#$t up.... so what good is it to file a grievance... and oh yeah ... sorry but I cant find a grievance on that .... again WOW! Over a year and head of grievance to fix my account so I had my pcp and not a default pcp. .... Taiwamo not English no stateside you have no problem now ok ... yes I do you did nothing ... I fix problem for you you happy now ok and hangs up...or.... Supervisor call you ... never do... doesnt say that in notes ... well it says that in the phone recording... a Supervisor will call you NEVER HAPPENS... COMPANY IS A JOKE AND IM EMBARRASSED TO ADMIT THEY HAVE PLAYED ME SO LONG....

3 months ago

star star star_border star_border star_border

James Eason Fort Worth, TX

Ambetter must have an entire team devoted to finding ways NOT to pay a claim. I had several problems with them but the worst is this: In an attempt to feel confident in what I was told, I called Ambetter THREE times before my anti-skin cancer treatment (photodynamic therapy--PDT). All THREE representatives told me I only had to pay my $60 copay and NOTHING else. The doctor's office received a pre-authorization letter stating the same thing. A month later I get the bill and am told that I haven't met my deductible yet. For 1.5 years I fought this, going all the way to the Texas Insurance Commission. They ruled that even though Ambetter told me verbally AND wrote a letter to me (after they reviewed my claim) stating that they should indeed pay the claim, they still didn't. In case that wasn't clear: AFTER REVIEWING MY APPEAL, AMBETTER WROTE ME A LETTER SAYING THEY WOULD PAY THE CLAIM 100%, but they still didn't do and the Insurance Commission wouldn't / couldn't enforce it. Ambetter even went back and listened to the recorded conversations and admitted that I was REPEATEDLY told wrong information. Unbelievable!

5 months ago

star star star star star_border

Smileeys Hattiesburg, MS

I wish more people would write the state and general area they live in for these reviews because it seems to make a difference. I live in South Mississippi and Ambetter has overall been a good insurance for me. I work part time and would be on disability or unemployed if I didn't have a wonderful employer who allowed me to go from full to part. However, I am no longer eligible for health insurance through work so I had to go to the marketplace. I actually have better insurance paying very little than my work family does. They have united healthcare and have had so many problems. I am one of the ones the affordable care act has helped tremendously. One thing I really like about ambetter is they have a rewards system that is not hard to do. You get points for flu shot, answering simple questions, watching health videos, etc. I was able to earn $250 this year easily that I paid my electric with. There are only certain bills you can pay or they have merchandise you can get. CVS quit taking my insurance this year but I went to another pharmacy that I discovered I like better. I pay zero dollars for my medication (I take 9 a day) and copays for primary and specialists. What plan you get depends on your income, though. We are a family of four with income around $36,000 for reference. The bad is that they require pre authorization but that's any insurance. They have denied some but then approved it later all except for one. My neurologist really didn't like my insurance and kept telling me they wouldn't approve this or that and I quit seeing him. Probably should have stopped sooner really because that wasn't only problem. I haven't had much contact with live customer service so I can't offer much insight there but I'm often called by automated service to check in with me or tell me about new info. It's equal parts annoying and helpful. They also keep calling to tell me they've noticed I'm not taking my heart medication right but don't say what it is. I don't take heart meds but do take blood pressure meds. Anyway, that's just mildly annoying. On my plan they do not pay for pain management and regular doctors pretty much can't prescribe anymore so that is difficult since I'm in pain almost constantly. They have telehealth and 24 hour nurse's line but I've never used it.

11 months ago

star star_border star_border star_border star_border

David Tanner New Orleans, LA

The WORST customer service I've ever dealt with. Would rather visit dentist and that's no BS. Or talk to Verizon customer service. Minimum 51 minute wait and P,As are like pulling teeth

1 month ago

star star star star star

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?

1 year ago

star star star star star

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!

1 year ago

star star star star star

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

star star star star star

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

star star star star star

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.

2 years ago

star star star star star

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.

2 years ago

star star star star star

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.

2 years ago

star star star star star

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

star star star star star

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

star star star star star

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

star star_border star_border star_border star_border

daniel callarman Atlanta, GA

Im not sure what exactly Ambetter is? When I went to find a doctor on their site they only provided me with 3 urgent care facilities. When I went to the urgent care facility I had to wait 4 hours to be seen at which point they told me I had to go to the ER. Went to the ER and they said if I was admitted to the hospital that my AMBETTER insurance would NOT cover the stay. My monthly premium is 582.32. Who can afford that and who actually takes it? Nobody knows? Horrible insurance don't do it.

3 months ago

star star_border star_border star_border star_border

Raymond B.

Signed up for Ambetter 6 months and didn’t have to use the dental option until now. My wife had an excruciating tooth ache and I needed to find a dentist who accepts the plan. Called customer service, after 20 minutes of trying to get through, and I get a list of dentist who take their dental plan. The representative says you have to tell the dentist office it’s billed under Envolve dental. Sounds simple until I call the list of dentist to make an appointment, of course either no one accepts the plan or the numbers are disconnected. Most of the dentist I talk to tell me they haven’t accepted that plan for years! At this point I log on to the Ambetter website and just start calling down the list, regardless of distance or reviews. Same results…….nothing. Finally into day two I call back to Ambetter and speak to the 4th representative and guess what? I’ve been giving the wrong information the whole time, the dental provider they use is not Envolve but another carrier. Which explains why, after countless hours of calling every dentist, I could not find one who took the insurance. What a waste!!!

4 months ago

star star_border star_border star_border star_border

PSDTennessee Rogersville, TN

I've had Ambetter coverage for about 3 months now. Here's a typical experience for me that just happened today: Called to check the cost of a procedure (can't do it online as their website is broken and has been since I first signed up, when you search for the cost of a procedure, it comes back with the result "nothing within a 100 miles of your location" no matter what you search for). It takes just over 5 minutes each time for me to navigate the automated phone menu and talk to a live human. I finally reached someone and she had me review all of my information, including a phone number I could be reached at in case of disconnect. We, of course, get disconnected. I wait for a call back that doesn't happen. I call back, spend 5 minutes navigating the automated menu, finally get a human again, only to find that there's a really bad echo on the line. I ask the agent to call me back and she says that she's not able to place outgoing calls. Excuse me? She tells me she can understand and we continue despite me having to pause every time I say something to let the echo die down. I get the normal "please verify all of your information" questions even though I'd already answered them 4 times in the last 2 days. And then she asks "what number can you be reached at if we get disconnected?" I say "but you just told me you can't place outgoing calls?!!!" Her response? "Ma'am, it's just a field on my computer that I have to fill out before I can continue." That conversation sums up Ambetter perfectly: customer service reps responding by rote, no empathy, simply a script to follow, but no actual follow through, a computer system that's broken that no one bothers to fix and after all of my time spent, I still had the same unanswered question. No matter how cheap the price, this company will never be worth it.

4 months ago

check_circle

Review Source

star star star star star_border

Mona-Lissa Tallahassee, FL

Ambetter health insurance really came in handy when I was making doctor visits before I went to college. I didn't however understand their charging process and how I had to pay for treatments and not doctor visits.

3 months ago

star star star star star_border

R. M. Boca Raton, FL

Overall, I like Ambetter 1000x more than past plans I've had, like Humana and BCBS, which were outrageously pricey AND retroactively denied coverage for life-saving treatments, leaving me over $30K in debt. Of course there are pros and cons to every plan, but I stick with Ambetter because the positives far outweigh the negatives. So, for the good: it's affordable, I've had good customer service experiences (once they accidentally denied a claim, saying it was out of network, but quickly corrected this after a phone call), my copays aren't bad (this is important as I'm chronically ill and frequently see multiple specialists), they have a free health coaching plan, and I absolutely love the providers I found. I noticed that the providers' actual billing staff cause most of the billing errors, not Ambetter. The bad: Providers are hard to find, and while copays (like $8 for a PCP visit) are low, coinsurance is NOT. While they've allowed me to receive stellar mental health care, the same can't be said for my back. They required 5 weeks of PT before authorizing an MRI, with me paying 40% out of pocket for each session (I met my out of pocket max, so MRI was 100% covered). Meanwhile, they denied a back brace and stopped covering the pain medication I need to function. The MRI showed a mess: disc bulges, stenosis, degeneration, and bone spurs (and I'm in my 20s). Ambetter initially denied epidural steroid injections. HOWEVER - I've had a LOT of luck with providers winning appeals. My pain med is covered. My injections are authorized as far as I know (they wanted 5 weeks of PT, but I told them I'd done that, so they fixed it). I love all my providers. Yes, some stuff is a real hassle, but I'm very satisfied with Ambetter.

1 year ago

star star star star star

Meagan Mueller Chattanooga, TN

This is my second year as an Ambetter customer, and I plan to renew my plan with them for 2021. The coverage is better than any employer provided health insurance I’ve ever had, and at an incredibly reasonable price. The customer service reps are always helpful and usually go above and beyond to help, most of my prescriptions and doc visits are 100% covered or have a super low co-pay, and there are plenty of doctors and nurse practitioners in their list of providers.. I don’t know what the complainers are expecting, but this health insurance company is doing a great job.

1 year ago

star star star star star

KAREN M HARRIS Kansas City, MO

I lost my insurance 3 years ago. Never been without insurance. Bad luck happened to me and I had to have eye surgery. The only good thing that came out of that bad situation is a girl told me to call ambetter I did and I am very thankful. They have been wonderful. Had 2 more eye surgeries that same year that they paid really good. I'm low income so I qualify for a subsidy. I just can't say enough good things about ambetter.

1 year ago

star star star star star

Mata Marietta, GA

Ambetter has been a hassle free insurance company that was the most affordable out of all of them. I have never had issues with doctor visits, ED visits, or prescription drugs. They are always very pleasant customer service wise and I actually think the website is getting better. My only complaint is finding a provider is a bit difficult and obviously you are very limited on who you can see, but the cost of the insurance is so low that I am okay with that.

2 years ago

star star star star star_border

Gail H Cincinnati, OH

I have had a very positive experience with the ambetter insurance. I have been with many insurance companies in the past and they all come with some very bad problems due to people not want to do their jobs first of all. From what I see the company is trying to improve issues and I'm hoping that more people who are not having problems will post reviews because I feel that this insurance has been better than when I had United Healthcare , Humana , Blue Cross Blue Shield. All of these companies have their issues. Sometimes you just have to call back and talk to someone else because two different people would definitely give you two different outcomes.

2 years ago

star star star star star_border

Jonathan Manchester, NH

I've had Ambetter insurance for 2 years and my only complaint is how frequently they call me to make sure I take advantage of all their wellness benefits. I've read the numerous negative reviews and experienced None of what others claim. I have a pricy RX and they cover all but $30/mo. That prescription alone is double my monthly premium so how could I complain? All preventive care is covered including all tests, many in the thousands. I haven't had any 'event' requiring non-routine care so I cannot comment there. I live in NH and I cannot find a Dr or practice/facility/hospital that ISN'T in their network. Overall very satisfied.

2 years ago

star star star star star

Brenda T. Byron, GA

After much worrying and warnings from others, I chose Ambetter off the marketplace. As newly self-employed I did not have much of a choice. To my surprise, most of my doctors, except for my primary care of well over a decade, are on the plan, and the plan has been wonderful. I have even had two of my doctor's offices express that they were well pleased. They company pays promptly and at reasonable levels. Whatever Ambetter Peach Plan is doing, please keep doing it. Now, if only my beloved primary care doc would join in...

2 years ago

star star star star star

CDan Miami, FL

I absolutely love this insurance. In Miami they cover a whole lot of top doctors, you could even go to the UM hospital and most of the doctors accept AmBetter. Been saving $250 every month, since it covers for my birth control. Even the pharmacist was surprised when it showed him that I didn’t even have to pay a copay, that usually no company ever covers my specific birth control.

3 years ago

star star star star star

lynn Springfield, MO

i live in missouri and have had ambetter from home for 2018. they cover both major area hospitals and doctors that are affiliated. they have paid all the claims quickly. the only refusal was when a doctor accidentally billed them twice. the plan is changing for next year but i hope it stays similar to what i have now because this has been the best insurance i have ever had. i have had to message them a few times and the always replied pretty quickly. they do not email directly so you have to check the patient portal for replies.

3 years ago

star star star star star

PATSY LEIST Bolton, MS

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.

3 years ago

star star star star star

VILMA MONTALVAN Miami, FL

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.

3 years ago

star star star star star_border

Bronya Duhanova Tampa, FL

This is my second year with Ambetter from Sunshine health in Florida. In our state this is in my opinion the best option on the federal market place. I have Ambetter Balanced care 1 and I pay 40$ a month for me and my son, it is 0 deductible policy (after the tax credit). Copeay for PCP visit is 1$, for specialist 10$. The choice of doctors isn't the best, but if you are a reasonably healthy person, this is sufficient policy. I was able to find a multi practice primary care provider near my home, meaning I have my PCP, OBG, bloodwork and allergologist in one building. I'm also happy with my son's pediatrician. All of the hospitals in Tampa bay area, where we live, take this insurance. Added bonus is "My health pays" account, we get 50$ for each annual preventive visits, gym membership and other services, like HPV virus immunisation for my son. This are deposited to a credit card, what I can use for coinsurance and other health care expenses... Customer service is always pleasant and helpful. My life got significantly easier and less stressful thanks to Ambetter. I highly recommend this insurance plan for your basic health care needs.

4 years ago

star star star star star_border

kay molina Miami, FL

I've been with Ambetter roughly 2 or 3 years, the only complaint i have is sometimes they dont cover my medications, but normally is when itsbtier 2+ medications, as i have only tier 1 coverage and i believe they have 4 tiers. They do have prior authorizations doctor's can send in, to see if approved. But I've had very little problems with this insurance company. Im overall very happy, they have excellent coverage fpr vision and good doctors in network. The many times ive called concerning some questiond and occasional problem, they provide good service. The reps I've talked to have done all they can to help me sprt out what i need. I live in Florida and here its Ambetter with Sunshine Health.... Maybe its only decent In Florida, because these reviews are terrible and I've had little problems with them.

4 years ago

star star star star star_border

AM

My previous insurance premiums were set to increase 40% in 2017, so I took a chance by changing my health insurance company to Ambetter. So far, I have been very happy. Yes, it was a bit of a hassle to find a PCP in the beginning. Some doctors who were listed turned out not to be PCPs at all. Before choosing Ambetter, I made a list of doctors in network near me, called to confirm that they were accepting new patients (some weren't) and visited several offices on my short list before choosing the doctor I like the best. Other than the first hiccups with choosing a doctor, we are very pleased. We have already completed our annual check ups and tests, had need to visit the doctor and got an appointment for 1 hour after calling, and have had prescriptions filled. This is a good option if, like us, you are relatively healthy and use health care mainly for check ups and routine screenings and prescriptions. I also like that they offer a program to incentivize you to eat healthy and take care of your health. You can earn $ to put toward premiums, co-pays and deductibles. Keeping my fingers crossed that things continue to go smoothly.

4 years ago

star star star star star_border

Jon Warneke

Arkansas Company do believe. Trying to edge into possible Government Health Marketplace with several reasonable deductible health plans. Effort in customer service response seems fine. Have fought very hard to stay out of hospital and E.R. so have not had any medical claims review. They were responsive with requested info I requested and their benefits info & summary of benefits were as good as or better than others. The Gov't Marketplace ecchange is a viable choice for many uninsured and underinsured families and those facing uninsurable criteria for the normal Health Insurance underwriting.

4 years ago

star star star star star_border

Mark Anthony Miami, FL

It took ,me a few months to get used to how this insurer works. I and my wife have a silver plan and we use the benefits routinely such as chiro and physical therapy, dental exam etc. Our doctors have said our plan gives us more visits per year than other patients plans. We have to spend a lot of time to find the health practitioners that we like but once we do, its great! The ones who are bad we call Ambetter and report the concern and or file a complaint(and believe me there are plenty of bad actors with licenses to practice medicine.) Usually they tell you that such and such a test or treatment that I need is not covered and charge me above the copay and when the visit is done I wonder was what they did anything beyond what is routine? That's when you need to call Ambetter to discuss what took place because there is plenty of fraud perpetrated on the ignorant consumer.

5 years ago

star star_border star_border star_border star_border

Alexandra Musca Marietta, GA

I have been trying for over a month to request a refund. I was told I will receive a check in June. Here we are at the end of July, the check was not even requested, what about shipped. Each phone call gets “disconnected “ and nobody returns the calls, even if they ask “for a phone number in case it gets disconnected “. Laziness at its finest.

4 months ago

star star_border star_border star_border star_border

Sam Pennington Ada, MI

If I could give Ambetter ZERO stars I would do so. They delay, delay, delay paying providers for services that were given PRIOR AUTHORIZATION. I was billed the total cost ($9,100) of a procedure by my provider when, after 6 months, Ambetter was unable to tell the provider when they would receive payment. The customer service agents give conflicting information about providers being in network, or out of network. I have spent HOURS on the phone with Ambetter attempting to make sense of the information that I get via the website, or in the EOB'S I receive in the mail. I have filed complaints with the Insurance Board of my state, as has one of my providers. There is a reason that this company has the cheapest premium on the Marketplace.

6 months ago

star star_border star_border star_border star_border

Mike Ungar Miami, FL

I would give them negative 5 stars if I could. After using their crap service, I finally switched over to another insurance provider. When canceling, I requested a refund for the month ahead I had paid in advance. They said no problem and issued the refund. I had requested the refund to be by check as opposed to the credit card the payment had been made through. I was told it's not an issue and would be sent in 7 to 10 days. Fast forward 4 weeks later and no check received in the mail. I called in to find out where it is and they informed me that they determined that day of refund request that they can not send out the check and the refund can only be returned the the credit card payment they received it by. So my question to them was 2 fold. 1: why than have you not returned the refund to my credit card if that's the only way you can do it? 2: why has nobody called me to tell me this after 4 weeks of waiting for the check? The response from the manager on the phone was that it was my responsibility to call them and ask them if my refund request would be honored by check. They denied the request by check the day they told me it was approved yet expected me to know that information telepathically and call them and tell them to send the refund to the initial card instead. 4 weeks later no phone call from them or email or text ot anything and I have to wait another 7 to 10 business days for my money to be returned when it fact we know they can easily return in the same day. And than to blame me and put the responsibility on ME for not calling in to find out? I lost it with these guys. Do yourselves a favor and stay away from these crooks. Better go find yourself a different insurance company. Litterally anyone else. Don't say you weren't warned

6 months ago

star star_border star_border star_border star_border

Marty Novak Tucson, AZ

Ambetter is the worst. I have a very high deductible. I am not even close to meeting that. I need an MRI for a spine I already had fused, but is having problems WHEN I PERFORM MY DR. PRESCRIBED PT AT HOME!!. They will not authorize the MRI because they require 6 weeks of PT, the same PT that is causing me nerve problems, before they will authorize the MRI. They would not have to pay one cent for this MRI, as it is all out of pocket for me at this point, and are unwilling to negotiate an insured rate for me to pay out of pocket. A lot of doctors don't accept their insurance and now I know why. Don't waste your money.

6 months ago

star star_border star_border star_border star_border

matt Seattle, WA

The worst part of getting food poisoning was having to deal with Ambetter. Sure, I experienced debilitating pain and frequent vomiting, but that was nothing compared to what Ambetter put me through. They repeatedly told my health care providers that my coverage had been cancelled, while telling me that it was still active. As a result, every time I sought care from Ambetter's emergency nurse line, I was refused help. It took repeated calls and hours on hold just to get taken care of. That frustration, fear, and helplessness was far more distressing than the intense pain that I experienced. Given the choice between food poisoning and Ambetter, I'd take food poisoning.

7 months ago

star star_border star_border star_border star_border

John B Concord, NH

After losing my job and health insurance with the Covid layoffs I signed up for Ambetter NH Healthy families. It seemed to be a reasonably priced plan at $344 monthly. With the unemployment insurance when I did my taxes, and was declined the tax credit it came out to $794 monthly with a $6000 deductible and maximum out of pocket. I had met my deductible and maximum out of pocket by November 20, 2020. I had to go to the Emergency Room on December 24 by ambulance. My plan clearly states that after the deductible and out of pocket are met they will cover 100% of ambulance BOTH in network and out of network. On a $864 bill they paid 465 and said that the rest was my responsibility. I called to discuss this, they spoke with me for half an hour, gave me a reference number to refer to when calling back in a week. I called back and it was like I was calling again for the first time. The operator I spoke to kept communicating with her supervisor, who first said that I used an out of network ambulance and that was the reason for them not paying. When I explained that it didn’t matter according to my plan’s coverage, and says exactly that on my portal, they said “Well that’s the most the insurance company is going to cover for an ambulance. You have to pay the rest yourself”. They are completely dishonest, what the policy says totally doesn’t mean anything. I want to file a complaint with the Better Business Bureau. They should be put out of business. I’m not paying the bill, since I’m 100% right and have it in writing on my plan page. When the collection agency gets on it I’m saying it is not a legitimate claim.

7 months ago

star star_border star_border star_border star_border

Kristy A. Cuyahoga Falls, OH

I would give 0 stars if I could. It is the WORST insurance I have ever had. They deny everything including a preventative mammogram which in order for them to be a part of the Affordable Care Act they can't charge for preventative mammograms. Customer service is horrible. No one ever knows anything and you can never get any answers as to why they deny the claims. And you will get a new reason every time you call and talk to a new representative. AVOID this insurance at all costs!!!!!! It isn't worth the low premiums because you will pay for every service and they will cover nothing. I got their best plan at $426/mo and they still don't cover!

7 months ago