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Ambetter

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5.5

Overall Score

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LAST UPDATED: February 1st, 2023
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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1,001 Reviews

Review Breakdown

5 grade

5%

4 grade

3%

3 grade

1%

2 grade

3%

1 grade

88%

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Tanny PC Phoenix, AZ

We just took Ambetter insurance for the year 2023, as we changed from Cigna (one of the best), and in the first month itself we understood that Life’s gonna be a hell now. Every time before our visit (or for my kid), I get a call from PCP’s office saying that “Their maintenance site is down.. so you need to pay from your pocket.” Or “Your status is inactive.” And so on… Horrible customer service and poor website framework. There’s no email ID even so that we can resolve an issue with proof of documents that both parties can attach for clarity. Knock knock.. AmBetter $800-1000 per month is expensive for a middle-class person. If you take the money, make your deliverables effective or lose customers. Thanks!

1 week ago

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R H St Louis, MO

Horrible experience! Worst website! Horrible customer service!They cancelled your membership early and blamed it on the Marketplace. After Marketplace verified that it was their fault, they still kept blaming Marketplace. Called them numerous times but they not only failed to resolve your problem, but also deleted the notes made by the 3 customer service representatives about the problem and replaced it with "Problem resolved". Already filed a complaint against this company. Avoid Ambetter! There are other better and more affordable options there.

5 days ago

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Dave & Diana M Shawnee, KS

I've had a Silver plan with Ambetter from Sunflower Health Plan for several years. The insurance itself seems to be okay. The real issue for me is their customer service and website issues. I have the auto-pay set up. Every open season I apply through the ACA/Marketplace insurance. My income always changes slightly. This generates a different monthly premium tax credit from year to year and so a different monthly premium and a different member responsibility (actual member payment). Unbelievably, the way their software is set up, since the Auto-pay then is different, Ambetter will not draft a December EFT. This generates a "Notice of Termination Risk" notice on your account because they did not receive the January payment!! They don't "receive" the January payment because THEY did not process it!!!! Then the Risk Termination letter takes weeks to receive this in the mail, IF you have mailings set up. Otherwise, you only know this by noticing on your December bank statement that the payment for January (paid in December), did not process. So... this means you have to call Ambetter. You see on their website a "payment amount" that is ALWAYS incorrect/always more than the sign-up on Marketplace website. This amount is completely irrelevant! You have to go to the "Invoice" tab see the actual amount that SHOULD HAVE been drafted, tell the customer service rep this and make an over-the-phone (or online) one-time payment of the correct amount. Then you have to verify that the auto-pay is still set up and then log back in in a couple of days to make sure customer service rep did process the January payment. Then at the end of January, you have to log back in to verify that the January payment was drafted and Auto-pay still processing correctly! The customer service rep's explanation for this circus is always unintelligible! It makes absolutely NO SENSE! Really, what a messed-up system!!

3 weeks ago

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Brenda Campbell Grand Rapids, MI

Premiums are lower than most. But, you get what you pay for. Terrible customer service. I finally asked for a supervisor and she could not even get that. I called to ask why my claim was not paid in full. I had 100% coverage after deductible was met, and it was. They did not pay 100% of my ambulance claim and I wanted to know why. She asked several times what was the date of claim, what was amount, etc. Finally the last time she asked for the billed amount, I got mad. I’ve trained customer support staff for over 30 years in various positions. I skied what the problem was. She said her computer was having difficulty. I asked her why she does not write down information from the customer so she doesn’t have to keep asking. She said they re not allowed to use pencil and paper! I’ve never heard of anything so stupid. And, they need to provide ENGLISH SPEAKING SUPPORT PERSONNEL! DO NOT GET AMBETTER INSURANCE. WE LEARNED OUR LESSON AND WENT WITH BLUE CROSS. I believe Ambetter does not fully train their staff. Most likely they don’t train them because they don’t speak the same language. AMERICAN COMPANIES NEED SUPPORT LOCATED IN AMERICA. ENOUGH IS ENOUGH.

2 weeks ago

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Ivette Lago Hialeah, FL

IF I COULD GIVE THEM LESS THAN ONE STAR I WOULD! I'VE ONLY HAD AMBETTER FOR 11 DAYS AND I WISH I WOULD'VE NEVER LEFT MY PRIOR HEALTH INSURANCE CARRIER. MY SON HAS CROHNS DISEASE AND NEEDS HIS INFUSIONS VIA IV EVERY 8 WEEKS OF HIS LIFE, DOCTORS OFFICE HAS FAXED 7 TIMES THE AUTHORIZATION REQUEST, HAS EVIDENCE THE FAXES ARE GOING THROUGH AND YET AMBETTER STATES THEY HAVEN'T RECEIVED ANYTHING AND DO NOT HAVE THE AUTHORIZATION READY. I'VE SPOKE TO CUSTOMER SERVICE, SUPERVISIORS AND THEY ALL ASK FOR MY CALL BACK # IN CASE I SOME HOW GET DISCONNECTED, WELL GUESS WHAT I HAVE GOTTEN DISCONNECTED 3 TIMES A NO ONE CALLS ME BACK NOT EVEN THE SUPERVISOR! SO SAD....

3 weeks ago

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Bill Hov Lakeland, FL

I DO like the coverage. The problem is for me to find a doctor that speaks some English. Luckily I found a good American doctor that is about an hour away from my house, but worth the trip. All the doctors near me, I can't even pronounce their name let alone spell it. Anyway, today I wanted to talk to customer service because the same plan has changed how deductibles are paid. I was paying $50 month for a certain prescription but this year they want all their money up front. So I've already met my deductible. MY Problem is customer service. After going through a dozen questions to verify my identity, it took over 10 minutes just to answer my simple question, "Do I need to pay my full deductible up front"? Even after I finally got an answer she proceeded to ask about other things like self help care and other junk. Coverage is great, customer service is really bad (and hard to understand).

2 months ago

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Edina Antoine (Dina) St Louis, MO

So disappointed! I paid my premium back in december, it been almost a month and didn’t not receive my member i’d card or provider list in mail ! Called several times and still didn’t get it ! But they are so fast sending you email about your payment!! I am already so frustrated it about this insurance thinking about canceling! Website is not helpful at all !

2 weeks ago

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Yuriy Melnyk Mooresville, NC

Worst experience. At some point, they started to bill me for the full premium amount without tax credit deductible. Called them, and they said everything is fine and recommended me to call healthcare.gov. So everyone says is everything is fine. Now I can't even login into my account with them. Total scam, I can imagine how they handle the claims. Switching to another company would never recommend.

2 weeks ago

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Review Source

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Hippygirl Bradenton, FL

I could not get on the website and they never helped me to get on the website (did not send me a email to do that). They send me a bill to get the insurance for 2023 but it was over $1,000 a month so I threw it away. Tried to call to speak with a real person but on wait over 1 hour and then got kicked out. Yesterday I went on my bank website and they took over $2,000 withdraw. I dispute that on my bank website and then called today but was on wait over 2 hours and then kicked out.

2 weeks ago

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Maria Romo Yukon, OK

worst insurance company i have ever met I just waste my time with them, they offer medical insurance app for " best service" but it app does not work, then i called costumer service and they don't resolve nothing, they said my insurance was cancelled for not reason, eventhough the premiun was paid on time, so the only solution they found was to give me my money back and tell me we're sorry

3 weeks ago

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April Costello Winter Haven, FL

The worst. Every doctor they said they covered on their website or even under my plan wasn't covered. Essential services I need they said they cover they don't. Behavioral health? Non existent cause no one takes them. Physical health? Impossible noone takes them. I wish I could sue them for false advertising. I wouldn't have gotten a plan if I knew my doctor actually wouldn't take them, even though ambetter advertised they did. Waste of money and time. Useless.

3 weeks ago

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Julie K Saunders

Wow what an absolute nightmare. First experience with ambetter : found a doctor to see for ear pain through the ambetter guide on their official website. Went to an appointment only to find out that they do NOT take ambetter insurance and I then had to pay out of pocket $150 for a 2 minute appointment (no tests). Tried calling ambetter and got hung up on first try, then terrible choppy connection through the following 5 calls that ended up dropping me (my cell service was full bars.) DO NOT CHOOSE AMBETTER.

4 weeks ago

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Larry Wood Springfield, MO

1-4-2023 We did our homework before choosing Ambetter for health insurance. However, we did not find out how terrible this company was until we were fully signed up. First, calling customer service is useless, you are put on hold and never gotten back to. You are given wrong,completely false, and incorrect information at every call, if you can get any information at all. Hours and hours of phone calls with no correct answers to your questions or concerns. Before signing up we checked on line and were told verbally that our family doctor was in network. However, after signing up we were told our doctors group were ALL considered SPECIALIST and we were not allowed to keep our doctor. MAKES NO difference what their website says or what you were told before you signed up. Terrible, Terrible company. It's not like they are a cut rate insurance company. For one person in our family, Ambetter was being paid around $1300.00 a month for health insurance. Not only that but the first $1500.00 of medical expenses came out of our pocket. Only then did Ambetter start paying for any medical expenses. How can such a terrible health insurance company be allowed to operate in the USA? We cancelled our policy with Ambetter and went to another insurance company. We are paying much more, out of pocket, for the new health insurance, but we felt like we had no choice but to do so. You cannot believe anything Ambetter says on their website or information they put forth. say or tell you.

1 month ago

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Michael J

Signed up with them through a healthcare .gov agent due to finding the low pricing attractive. Only to find out after calling around my area that same day that their website listings of practices who they stated would accept their insurance was completely fabricated and/or out of date. As almost every single of the 10+ ones listed in a 25 mile radius I made an inquiry to confirmed they would *NOT* accept Ambetter insurance, and/or hadn't accepted in quite some time. Filed a cancellation and refund request direct through both healthcare.gov and Ambetter, which on both ends was acknowledged and accepted. Followed up by a switch to different insurance company who's accepted location claims on their website was legit. After a very extensive information gathering session with an Ambetter rep on the phone I was assured everything was squared away, and that after confirming my cancellation with healthcare.gov (which I did) I could expect my refund in 5-10 business days. Fast forward 10 business days latter and with no issued refund. Called in to Ambetter again and was told there was absolutely no record on their end of my refund request. Proceeded to go through the extensive information gathering process again, including a direct 3 way phone call to a healthcare.gov rep who confirmed direct to their rep my earlier cancellation/refund request. After which i was again assured my cancellation was squared away and that I could expect an issued refund in another 5-10 days. Fast forward another week latter and I get a follow up email stating I was now eligible to sign up to their website to access my account. Found that strange so called back in to Ambetter a third time to inquiry about my refund status, and was again told for a 3rd time that there was absolutely no record of my refund request, but that they would be happy to file a request for one. Borderline criminal behavior experience as far as I'm concerned, and which basically forced me into having having to file a charge dispute with my credit card company to end the blatant run-around. Would give Ambetter a zero star recommendation to anybody looking to pick them up if i could.

1 month ago

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KMP Charlotte, NC

Please heed these warnings.. This is the absolute worst insurance company I have ever dealt with. It starts with their website and trying to locate a in-network provider. The website is constantly crashing or provides falsified information. I tried locating a Family physician which was advertised on their website as such and when I called, it was actually some mental health clinic in another city. Claims will be denied but there is no real way to no for sure if you are in or out of network as it seems its all arbitrary. Customer service is useless and lie over the phone saying a Dr. is in network. I know this because I couldn't verify anything on their crappy website which forced me to call and I was given false info about an in network provided and was charged 1K for a basic mammogram that they refused to cover. I cancelled them mid-year and got temporary insurance for the remaining year because I couldn't take the hassle and mistrust anymore. They should be banned from selling insurance and sued into oblivion. Please use Blue Cross Blue Shield instead. I've never had an issue with them and learned my lesson the hard way using Ambetter.

1 month ago

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ron Silver City, NM

Absolutely useless. No doctors or few in network, same with hospitals. May 22 my gp referred me to a cardiologist, August appointment. Upon checking not in network. After many calls to Ambetter's Philippine call center referred to cardiologist 55 miles away. Failed stress test and he referred me to 3rd cardiologist 125 miles from home who took ambetter. Scheduled angiogram but cancelled 2 days before procedure by hospital due to not in network. Got ambetter recommended 4th cardiologist, scheduled angiogram which was cancelled exactly as before by the new hospital. Ambetter reps are useless, waste your time and there is no one else you can call or get passed on to.

1 month ago

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Hannah Columbus, OH

Run away from this insurance. Filed an appeal for an over $20,000 emergency room visit for my then 5 day old son. Buckeye Health Plan promised a response by September 13th, I have heard nothing, and when called to follow up was simply told it was "in review" with no further explanation. I feel very foolish for having not read reviews prior to getting this insurance. If I could give zero stars a would. It is horrific to me that this insurance is offered through healthcare.gov, which is where I signed up for it. There should be some sort of vetting process for this government run program that is supposed to be helping people.

1 month ago

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Shelly Cantrell TX

Terrible customer service…spent more than 3 hours on hold and/or speaking with someone who had no idea what was going on. In the end, they did not honor their copay amounts listed.

1 week ago

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Chris Gohl Frisco, TX

Fraudulent company that must have bribed the feds somehow to get onto Marketplace. No doctors within Value Plan network anywhere despite their website claiming ample options. Purely false advertising and fraud. Bailing on them immediately.

4 weeks ago

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Nicole Carman Lincoln, NE

Regret picking this insurance company already. Customer service is deplorable. I spent 35 minutes on the phone the first time I called to ask a simple question, was put on hold at least 5 times, didn’t get my question answered, and wasn’t able to pay the 1st months premium because the customer service representative put all my information in wrong twice. I also got the app thinking it would be helpful, but it is 100% unusable. Doesn’t even work at all. All of this is unacceptable. Buyer BEWARE!!

1 month ago

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Won’t Back Down Lemont, IL

One word describes Ambetter: horrific. Horrific network (very few hospitals or doctors), horrific customer service (they try to confuse you and/or deny everything, their people often barely speak English and it sometimes takes hours to get an answer on the phone, which usually is “no” ) and horrific coverage (if you need to use it, they twist the facts and take ridiculous positions and force you to fight them). I had to first file a grievance after they denied a claim, even though the claim was clearly covered. Had to go to the state department of insurance to file a complaint! They finally paid after the complaint was filed. It all took 2 years!!! I even know insurance law and pointed out specific policy provisions and legal theories as to why the claim was covered and only when I got an independent third party involved (department of insurance) did they react. Stay away from this place at all costs. You will have nothing but headaches and anguish if you need coverage for something other than a doctor visit. You have been warned.

2 months ago

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Justin Crafton

Worst insurance . Nobody accepts Ambetter but when you ask them if there in network with your doctor they will almost always say yes. All Ambetter has done is made it were lower income families don't get enough money to help cover a real health insurance pain since they base how much you get on the lower cost plans. Ambetter has blanketed the Marketplace with cheap low cost insurance. The reason they can offer it cheap is because they don't have to worry about paying any claims when most doctors don't accept there insurance. STAY FAR AWAY FROM AMBETTER INSURANCE. NO INSURANCE IS BETTER THEN AMBETTER INSURANCE !!!

2 months ago

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Basset Chandler, AZ

Worst company ever. Reps unhelpful and have no idea what you are even asking. Supervisor always in "meetings"Hard time with basic coverage (ex yearly preventative) bait and switch scams on pricing. Run from this company as fast as you can.

1 month ago

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Mari Gangadean Philadelphia, PA

Horrible company. If I could leave a zero rating I would. Their customer service is abominable, and uninformed. Their record keeping is sloppy, inaccurate and they take forever to process anything even after multiple phone calls. Please stay away. This company is totally incompetent.

1 month ago

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Ed Huff Austin, TX

absolutely the WORST insurance on the market. Almost no doctors will take it because it pays 20% below medicare. A week long hassle is guaranteed just to to get a routine procedure approved. This company should be sued by the state DOI for being an outright fraud ,IMO.

1 month ago

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Liana Alexandrian Anderson, IN

Ambetter is the absolute WORST insurance company, they do absolutely nothing to help!! If I can give a negative 100 star I would. 99% of the time you will get someone overseas who answers and you'll need a translator to understand anything the other 1% who actually speak English are brain dead!! Do yourself a favor and don't pay for this scam because that's literally what it is.

2 months ago

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Cheryl Norris

This is THE ABSOLUTE WORST Insurance I have EVER had. They have denied coverage twice for imperative cardiac testing wanting me to jump through hoops and they aren't even paying anything until I meet a rediculously exorbitant amount for a deductible. I pay a 588$ a month premium just for myself. Choose another company if possible. Unfortunately in Indiana its Ambetter or Caresource and both are a waste of money!!!!!

2 months ago

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jamie clark Rogersville, TN

Ambetter is the most worthless insurance company I have ever had I was diagnosed with MS and they needed to do a brain MRI and a spinal MRI to see what stage I’m at so I could get medication to help me well they think that they can play God and decide well you don’t need it so they like to play around with your life I would never recommend these people to anybody they’re dangerous and ignorant

2 months ago

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Megan Maloney West Chester, PA

The worst. Both my Pennie representative and Ambetter are responsible for this sucky review. The rep asked if there were any doctors I needed in network, I gave them their name and was assured a bronze plan from Ambetter that cost about $320 a month would be my best option. Turns out my doctor does NOT accept Ambetter. I tried to call Ambetter prior to showing up to my appointment and was put on hold repeatedly and then they sent me to a Pennie representative without giving me any knowledge that they were patching me over to them. Obviously, they couldn’t help me. Horrific customer service. Also, no one I’ve spoken to has heard of this insurance so I have no idea who accepts it.

3 months ago

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Diogenes DeFawkes Warner Robins, GA

The provider listing website is useless. Literally had to call random doctors until I found one that took Amuseless. Finally got frustrated when the website showed no optometrists in my entire state, and called the customer service number. The gentleman with a very heavy accent and a limited english vocabulary had to escalate the issue. After waiting 15 minutes he gave me 3 providers, none of which accept Amuseless. One advised me that even though they keep getting referrals they stopped taking them after a few clients got stuck with huge out of network bills after being told they were in network. After my experiences and reading others horror stories I will be changing providers this upcoming enrollment cycle. These people are useless. Go elsewhere if you want actual insurance and not a scam company.

3 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

11 months ago

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Ginger Bellevue Snohomish, WA

So absolutely bad. Left me on hold the first time for 40 minutes then hung up on me. The second time I was on hold for 20 minutes and they hung up. Said I hadn't paid my premium but bank verified it had been paid

1 month 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.

1 year 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.

1 year 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.

3 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!

3 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.

4 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.

4 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.

4 years ago

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Val Johnson Atlanta, GA

Broke my ankle and needed a scooter and later a walker. Never got them. They said I qualified but sent me all over the place while i was sick. Everytime I called they told me to do something else. I gave up. I paid my bill automatically every month never missing a payment.

2 months ago

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Claudia Ruiz Hialeah, FL

When I started with them 3 years ago, it was excellent but over time, it started to spoil. Currently I do not recommend it to anyone, poor medical care, I think they have people hired as doctors and they are not, from my bad experience I say, when I started with them 3 years ago, it was excellent but over time, it started to spoil. Currently I do not recommend it to anyone, they even charge you for wellness exams, when all compañías are to be free. I DON'T RECOMEND IT.

3 months ago

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Thomas Bath Gulfport, MS

Beware of accepting their offer of a cost free colon screening as provided in the Affordable Care Act. They will not process it as screening, so instead of no cost, we are stuck with a $1400 bill that we can't afford for a procedure that really wasn't medically necessary because there were no symptoms. You are supposed to get a colonoscopy after age 50. They will cheat you. After filing a grievance with them, they said that we weren't covered for a screening colonoscopy... EVEN though they sent us a message telling us so. Use anyone else if you can.

3 months ago

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SaneB4Kidz Leavenworth, KS

I've had Ambetter for several years and I was always happy with it.... Until recently. Lately I'm having issues with prescription coverage and my medical claims getting paid. Earlier this month I found out that as of October 30, 2022 my Primary Care Provider, my Orthopedic doctor and the hospital we use will no longer be accepting Ambetter Insurance and several other doctors, clinics, Urgent Cares and hospitals in the area are doing the same. I will definitely be changing insurance companies this year during open enrollment Based on my experience, I would not recommend signing up for Ambetter insurance. Your choices will be very limited when it comes to in network coverage for any type of service.

4 months ago

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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

4 months 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….!!!!!

5 months ago