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.
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 88 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.
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 2020 healthcare coverage runs from November 1, 2019 to December 15, 2019. If you missed the enrollment period, you may qualify for a Special Enrollment Period after December 15, 2019 if you have a Qualifying Life Event.
If you're looking to get an Ambetter plan, you can view their health plans by first selecting the state you live in and then selecting 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.
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.
The subsidy estimator in the online account also helps members see how much they would receive for reimbursement for a treatment with their benefits. If you qualify, the subsidy lowers what you pay for the monthly premium charge.
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™ is Ambetter's rewards program to provide incentives for members to live healthier with better habits. You can earn money for taking a survey provided by Ambetter, getting a flu shot, or having your wellness exam, and this money can go toward your next premium. Members can be reimbursed for gym membership payments as well. 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 are available with Ambetter, but the benefits and availability of each are entirely specific to the state you live in and the type of health plan you've signed up for. Dental 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.
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 be better served choosing another company if you can.
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.
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 Ambetter may not be an option for you.
Even if you do reside in one of the states they service, make sure to check the location of their in-network providers (e.g. a primary care physician, specialist, etc.) for your state to ensure they have an in-network provider near you.
Unlike many of its competing insurance companies, Ambetter doesn't have a mobile app. Some companies provide this for enrollees to access their accounts right from their phones, making communication and logistics much easier. Ambetter hasn't provided this yet, making account management slightly less convenient than with other companies.
Call our recommended rep over at Ambetter below.
I would rather chew glass while stabbing myself in both eyes with knitting needles than deal with AmBetter. The hold times are egregiously long. The customer service is virtually non-existent. The mistakes are rampant.
Should be called AmWORSE. Prior to signing up, I manually typed in and triple checked that all my prescriptions would be covered (they are all generic, mind you). I was told YES. Now, after paying my premium, I am told that one of my medications is not covered, and the second prescription is a price that's higher than the $7.00 copay ($0.00 deductible) stated on my card. The doctors listed as in-network are actually NOT in network with Ambetter, and for good reason. I want a refund.
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.
hem n sah
I was very worried about the negative review. But All the claims for emergency room was processed properly. It was a seamless experience and we had no issue at all. Just follow all the network networks and no issue at all.
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.
Hands down the worst healthcare company on the market. If you are able to chose another company, please do. I spent hours, days, weeks that turned into a total of two months attempting to find a psychiatrist that accepted this insurance. Until I finally changed health insurance companies, and I never did find a doctor that accepted Ambetter. More importantly, I never received any successful feedback from any representatives. Either information incorrect, or no response at all. All the doctors listed online that were suppose to be in network, either did not have a working phone number, no longer accepting new patients, but mostly didn't accept Ambetter - EVEN though their name was clear as day in the provider network as indicated online and told to me by representatives. Terrible, terrible health insurance, strongly advise to stay away if possible.
Pay my premium but they continue to deny coverage for procedures and medication. Fraud pure and simple!
Ambetter's website is a mess. I have never been able to login to my account, so every time I need to do something, I have to call their customer service.
What a nightmare... between these idiots and the idiots at the marketplace, healthcare is completely doomed. Nobody is trained on anything. Have had to call dozens of times, always at least 45 min to get a non-answer to any question I have. And everybody you speak to, each time you call, you will get a different answer. Even the "supervisor" just makes stuff up. Total scammers. They're trying to charge me double my premium for my first month, claiming $250 as my "binder payment", when asked why do I have to pay twice for my first month, she says "So we know that you are serious about wanting healthcare". Unbelievable.
This is a unorganized company. The agents are not truefull. They will take your money and not give you coverage. DO NOT BELIEVE THEM.!!!!
1) Customer service is minimum 20 minutes and usually 45- 1 hour. 2) Company could not assign a PCP because therir lists were not updated, two PCPs declined to accept me because the company wasn't paying them. The first PCP said there's a 6 week wait for appointments MINIMUM! and no service would be provided until the second appointment-the first was for their paperwork ONLY! 3) This company is so incompetent that they could not assign me to paperless billing- an advantage to them!- despite four requests. 4) Did I mention the $13,000 they were paid over the course of a year? And for that I received one PCP visit. This company is the best advertisement for Medicare For All I know of and I will be asking presidential candidates to mention them by name on the national stage.
It is the worse plan I ever had!! I can't get appointments with doctors. If you do; it's about a month wait and nobody accepts this insurance bc the doctors don't get paid.
My experience has been great in terms of coverage and customer service. I do not have anything negative to say.
Terrible "insurance" . This company exists only to scam people and receive money from the taxpayers. No concern at all for the welfare of their members. It was the only option in 2019, and if nothing different is offered in 2020, I will do without. I basically do without now (with Ambetter). Government should investigate this company but, I'm sure that many of our politicians are major stockholders.
another unsatisfied customer
If I could give Ambetter a zero I would. Using Ambetter was the most horrible experience of my life. The Arizona State Insurance Licensing Board needs to shut them down. The workers are incompetent. You could be on the phone four hours and they get nothing done. Their computers are always crashing when you call and the web site link NEVER worked. Even the grievance people are unhelpful, and one of them outright lied about the status of my appealed claims. This place gave me ulcers and stopped my surgery recovery in its tracks from all the stress. Ambetter did whatever it took NOT pay my bills hoping I would give up and go away despite the nearly 1k a month premiums I paid them. And almost a year later I am still dealing with trying to get bills paid and they are trying to rescind money for little bills they did actually pay! I could have gone without insurance and been better off! Beware if you need hospital care while using them. They refused to pay my hospital bills even though I was covered and they actually authorized the stay. The hospital executives told me it has bills pending to Ambetter for other patients dating back to 2015 that they have NEVER paid. Yet they continue to collect juicy premiums every month! Don't waste your time or money with this so-called insurance company.
Ambetter has been nothing but a problem since I purchased my plan. Repeated issues with billing even though I made sure I was IN NETWORK each time. Customer service has been terrible, the hospitals and doctors offices IN NETWORK that I “owe money to” have been more helpful to me and actually feel bad that I have Ambetter insurance. Please please do yourself a favor and stay away from this coverage, it’s been nothing but headache after headache.
Worst coverage I have ever had. I broke my back and they would not approve an mri because the doctor didn't provide my physical therapy regime. Well my regime was being lucky to get out of bed. Stay away............
Giving 1 star because it's the least allowed. They will delay and deny claims until you can no longer collect. Seriously right out of hollywood movie script. Do not enroll with this company. You will be sorry.
Worst insurance ever. DO NOT USE THEM. They will give you wrong information and fight you over ridiculous things when it's obvious the patient is right. Their customer service is **** too. Bad coverage, bad information, bad morals. They do us a disservice and should be shut down!
They cancelled my account after they lost my payment and still want me to pay even if they don't cover me, and it was only 10 days since they lost they lost the payment and I try to pay the bill and they told me the cancelled my account .
SCAM! Wish I had read reviews before joining. I just called to cancel and I will still have to pay the "required" 3 months additional. RUN!!
Across the board, every interaction with them has been a FAIL. Their website provider directory lists medical providers that retired YEARS AGO. Their robodialers call 3 or 4 times per week saying we need to call them about IMPORTANT things. When we call it's just a computer voice asking questions and it does not understand a simple "No" answer, then the call last 5 to 8 minutes of blah, blah, blah. There appears to be no limit to the company's lameness. : O
Had Ambetter in FL and now in AZ it is pretty bad. Latest is spent 20 minutes on a 3 way call with neurologist, myself and Ambetter AZ Complete Health. To make certain ALL I would owe was the $50copay for an in office diagnostic procedure. Drs office has this phone call in their records that Ambetter Rep stated EXACTLY that over and over that coded as such it would be ONLY the $50 copay. I received a bill for $310. The total for the procedure $360. Ambetter has listened to the recorded 3 way conversation and confirmed THEIR Rep stated this and then told me pretty much well our Rep gave you the wrong info, but tough you gotta pay anyways per the terms of your policy". So DONT believe them when they tell you to make certain you get information from them and it's even confirmed at the Drs PRIOR to procedure. They will stuff you anyways oh and "talk with the Rep that gave you the wrong info".
I can't wait to switch to another insurance. I pay about $400 per month for insurance that NO ONE accepts (because they're known for fighting claims instead of PAYING for them), insurance that barely covers anything, that has conflicting information about coverage, and that is impossible to use the way you'd think you'll be able to use it when you sign up. I've been referred by doctors for specialists -- dermatology and rheumatology -- and yet, the handful of doctors who accept this insurance are booked out for MONTHS, as they only accept at certain times of certain days (presumably to minimize their own cost risks). STAY AWAY FROM AMBETTER!!!! IT'S A TOTAL SCAM!!! Whoever works at Ambetter and makes money off of scamming people who are just looking for simple, reliable healthcare, SHAME ON YOU.
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.
Unbelievable runaround trying to see a neurologist after my son had a seizure and referred to a neurologist by ER. Different instructions every time we call. One wanted the ER report faxed. Went to the hospital, got it (79 pages!). Too much to fax but they can't say what they want. Another one wants a primary doctor referral faxed. Went to doctor and got a referral. They can't see it for up to 48 hours. They don't know if it will be enough. They won't know until a doctor reviews it. They can't tell me what of the ER report they want. Meanwhile, 3 full days have passed and he is no further to getting an appt than he was when he was in the ER. Can he work? Can he drive? Who knows and the added stress of dealing with Ambetter has been unbelievable. I took over to try to help and I've made no progress.
If you get cancer you might as well slit your wrists and wait to bleed out. Its been months and they will not approve a PET or a CT scan, only biopsy after biopsy. I hope that I get through and can get accepted by another insurance company (not likely) but yea. its very scary to know you can DIE and they will not allow the centers to treat you in the most proactive way to get rid of this wretched disease. terrible.
Breast cancer, 2016. 5 surgeries in 8 months, including latissimus dorsi flap bilateral mastectomy with reconstruction, full hysterectomy. In the past 3 years have been diagnosed with Reflex Sympathetic Dystrophy, CRPS, PMPS. Unable to drive, work, or even do small household chores without a pain flare. See a pain specialist, who let me know that Ambetter will not cover certain procedures that offer relief, including a neural stimulator. My pain specialist has to submit a prior authorization for every pain med he prescribes. Recently Lyrica became generic, a circumstance I have been waiting for for over a year and a half, as Ambetter will not cover the non-generic form. Discovered that they will not cover the generic form either-the only med that truly offers relief from maddening and very severe nerve pain. Regardless of the diagnosis from four different doctors of suffering from nerve pain, this company does not cover the medication I desperately need in order to live day by day.
They fight to not pay any claims.I truly believe this is there business model.I am opening a complaint to the Ohio insurance commission.
This is the worst insurance!! Stay away from them. My husband had to go to ER and they denied all claims saying he didn't have coverage, which is a lie. I have gotten my insurance agent involved to communicate with them so that I don't curse them out. They are trying to play stupid but really, they are just trying to get out of paying the claims. I will make a complaint to the board of insurance and get an attorney involved if I have to. I'm not going to pay these claims when I paid good money for the insurance premiums.
Worst insurance I have ever experienced!! Had to have rods and screws installed in back due to a fall. After a year and a half have a popping and grinding in back ,,called primary physician office they referred me to an imidiat care orthopedic dr,,they did grays , ,couldn't see anything wanted to do an MRI Insurance denied wanted to do 6 weeks of therapy!!! It's metal on bone grinding when I walk I paid for MRI out of pocket and Dr wanted me to see original neurological surgeon to look at scan,, He wanted to do a CT scan ,,,insurance again denied,,, He set me up for surgery to remove hardware,,, Get a letter today insurance deny surgery to remove... Have an appointment with therapy Tuesday ,,have already talked to therapy and they agreed that therapy will not fix problem.
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...
This company is the worst. I have been fighting with them for since January. The gov reinstated my insurance because of their mistake on May 3rd. But Ambetter says I owe them 6000 bucks in back pretax premiums. August 1st the gov paid for a new policy which they show is active until the end of Aug. I had emergency heart surgery the 17th and AB is saying that I am suspended on the new policy even though it was paid by ACA. I have been fighting with these clowns for over six months and now they will not pay the hundreds of thousands for my emergency surgery. I also got a new and better policy from ACA that will go into effect Sept 1st. I have not been able to get my meds or my insulin since June when they decided to throw me under the bus. I wish they had a star for below 1, then I could really rate this company.
I am needing an mri an ambetter Insurance has denied it. I have 2 disc missing on L4 qn L5 in my lower spine I have DDD an bulging disc arthritis nerve damage thru out my back an severe muscle spasms that goes from the middle of my spine to my chest. Ambetter claimed it is not medically needed an I need to have new nerve complaints..so here goes another appeal an probable another denial. Said my injuries are old an so are my test but before they will pay for a nerve conducting test I have to have proof I have nerve damage..all they do is deny your request from drs. I think they should call this Insurance the death panel Insurance they want your money but wont pay for nothing..I'm needing surgery an cant get it till I get that MRI that's being denied to me. I thought they pd for pre existing conditions nope they dont..if i don't get this approved by Nov I'm dropping them. Worst Insurance company ever..I'm literally in tears over this..stay away from ambetter
HORRIBLE. A scam. I have been on the same ADD meds since 2017. We switched to Ambetter on the exchange for 2019 due to their co-pay for this med being $50. They immediately started denying my medications, and basically said that whatever my doctor had prescribed did not matter; I would not be able to get my medication unless I tried a different, generic medication first. I tried to discuss this with them directly but to no avail. So I took the different, generic medication, which has neurologically destroyed my tongue (even though I went off of that med after 2 months). They still will not approve my doctor's prior authorizations. First, they told me the doctor had given the wrong diagnosis. Honestly, I don't know how adult ADD is the wrong diagnosis for Vyvanse, since that is what it is made for. So the doctor submitted another prior authorization with a different code for ADD. Denied again. So instead of the medication costing me $50, which they scammed me into believing I would pay for this med, I am paying $300, and have to stop cold-turkey because of the price. I called Ambetter again today, and after wasting over an hour on the phone, the first person the representative called (with me on the line) said they hadn't received any prior authorizations (a lie) or my doctor's appeal (a lie). He tried a different person at apparently a different place, Amanda, who said that it was denied because, again, the diagnosis was not suitable for this med. The representative (Jasper, who was actually quite helpful) asked what the exact issue was ... then Amanda said that it was denied because I hadn't taken the generic, alternative med yet. WHICH I HAD, for two months, and have permanent damage from it. So SHE LIED. It wasn't about the diagnosis, it was about this med, which they could easily see I have taken since THEY HAVE PAID FOR IT. Now my doctor, who has not been given accurate information from Ambetter about what she needs to do to get this approved, has to submit ANOTHER prior authorization with the info on my prior usage of their recommended alternative, which is information they had already and is just one more bogus excuse to deny coverage. And she said the doctor needed to request a peer-to-peer, which was information they didn't share with my doctor. I have been trying to get my medication back since JANUARY. Almost 9 months. We pay $12000 per year for two people and a ridiculously high deductible ($12K) and I can't even get my meds. Ambetter is a complete scam and they only exist to take advantage of people on the exchange. The internet is full of very, very, very angry Ambetter clients who have also been scammed. They have also disabled any comments on their FB page because they were all negative (unethical) and took away the ability to message them on FB (also unethical). This company should not be allowed to be in business. They are keeping people from becoming or staying healthy, and every road block is there on purpose and completely arcane.
The worst insurance available. The WORST. Any Medicaid plan is 100 X better than this one. Avoid at all costs.
Horrific customer service. Automated phone service disconnect every time I call. When I'm finally able to get through to a customer service representative, they tell me their system doesn't work and I'll need to call back in 24-48 hours. They didn't offer to answer any generic questions or provide assistance. Obviously, this is a direct reflection of their corporate management and lack of training.
We have had Ambetter in Kansas for the last two years and it has been an absolute nightmare. Terrible customer service and administration. No one knows what is happening when you call them and you never get the same answer twice. If I could have given no stars I would.
I have good experiences with Ambetter,the only thing is some doctors don't accept their insurance but it's getting better.Sometimes u have to call a few times to receive ur card but a million times better than blue cross and blue shield Anthem,had problems with them since day 1,never used it until it was canceled,they wanted $1,300 a month,ridiculous.
Ugh I didn't even want to give them one star... this insurance company is horrible!!! I am in Houston Texas yet can't seem to find any providers in my area. Had a procedure scheduled for today, an epidural of my neck. I took today off of work and had a friend drive me AN HOUR out of my way. I am in alot of pain and when I got here... surprise! They can't do the procedure because Ambetter has not authorized it yet. I have been fighting with them for TWO HOURS trying to get this approved when they've know about this for weeks. They can't tell me why it's not been approved, and they won't tell me when it might be. Everytime I call I get a different story as to why it hasn't been approved yet. And... they don't have ANY supervisors that will speak to me about this. I am so pissed.
terrible, terrible company. after paying $1240 to get re-instated, they still haven’t done it after a week. they straight up lied to us! My wife is a Type 1 diabetic and she can’t get her insulin!! these people will tell you anting to get you off the phone. worst insurance company ever..!
do not pick up this insurance if you have preexisting conditions because they will drop you without even giving a reason. Don’t sign up for an insurance company this widely disliked period. They are scum and scam artists.
I guess i get what i pay for. $25 a month. After i left my company to enter a new career field needed some insurance for the mean time. Took over a month to sign up cause i got locked out of the system and customer service would ignore my calls. Then finally after getting on it took another month to receive an insurance card with my named misspelled "matthaw". Im still waiting for a refund bc i couldnt show my insurance to the front desk lady at my doctors which is $150. Maybe for Christmas ill get the refund. On top of that will only cover generic medications which isnt a problem if the medication im on had a generic but doesn't. Have to wait 8 weeks bc insurance wants me to try a generic bc its cost effective. Not going 2. I take 2 meds which one is generic and one is not so might have to pay out of pocket until i get it approved. Ambetter is last resort cheap insurance that only covers a few doctors and some vitamin C. I dont think anyone who has a serious medical condition would survive long with this insurance company.
Perfect for everything we need. Site works well. Fast response times. Always introducing new ways to make things easier. Been here for 3 years and have no intention of changing
The Accumulator Functionality doesn't work, therefore, the customer reps, members and medical providers are given inaccurate information. Ambetter told my doctor I had only paid $2000 of my deductible, when the truth was I had paid all but $36. I almost was unable to great radiation treatment for breast cancer because of it. I over paid my out of pocket amount by $120, and was told to ask the hospital to return it. Do not get insurance from them!!!! They don't care and have told me to be patient, the problems started in February why should I be patient. Ambetter should be able to provide accurate deductible and out of pocket totals. i'd given them a zero if I could. i even filed a grievance with the company , their answer, you over paid, sorry for the inconvenience, we are working to get documentation so you can get the $120 back.
One of the All Time worst, website don't work, misleading and/or no doctors in the network, they exist only to collect the premium, and do not understand how they stay in business.
I bought Ambetter coverage thru the marketplace for 2018 and 2019 and on several occasions they have denied claims as being "out of network" even though all my doctors show up as "in network" on their website. I truly believe that when they are having cash flow problems they just deny the claim and leave it up to the provider to sort it out. Calling their customer service is a complete waste of time, nothing is ever done to resolve issues. So glad I will soon qualify for Medicare.
I called Ambetter before I had a procedure done to make sure it was covered and they assured me that it was covered and my only cost would be a $5.00 co-pay. Of course after the procedure was done received a bill. I called Ambetter customer service and 2 different people said that I would not have to pay it because it was a covered expense. Someone in customer service offered to dispute the claim. After over 2 months of the claim in review, I found out by Ambetter customer service that it was not a covered procedure. What a crappy way to conduct a health insurance business. Geez. Thanks a lot for nothing. Very disappointed, Susan M.
I signed up for this insurance company because they said my medicine was covered by them and I could continue to see my doctors of which I have had for years. I have been trying to get my medicine for weeks now. They are still giving me and my doctors the run around. My doctors have done all they have been asked to do yet I still am not approved to get my medicine that I have been on for years. I cannot recommend this company. I have spoke with them and they say to do this and I will get my meds. I do what they ask and yet nothing. I can't function properly without my meds. They keep coming up with reasons to postpone helping me.
I have a Gold level plan costing over $13,000 per year with their Ambetter Health Insurance. This company is effectively operating a scam. It may not meet the legal definition of fraud, but it certainly meets the moral definition. I have a $1000 deductible policy. They have very limited options for providers and hospitals with the hospitals being among the worst around per Yelp reviews. Even after getting approved for procedures supposedly covered by Ambetter, I have been saddled with the bulk of the bills. For example, I needed medical imaging work done. Only two hospitals with bad reputations are in-network in a city/burbs with a few dozen hospitals. I got the pre-approvals for the imaging procedures, but then Ambetter refused to pay for the radiologists ($2200.00) who read the tests. I had no choice of radiologists that the approved hospital used. I didn't even know who they were until I was billed. Ambetter says the radiologists are covered in the plan, but must be billed through the hospital. The hospital and the radiologists say they cannot bill through the hospital. Ambetter won't budge. If they won't cover the radiologists at one of their only two approved hospitals, then they aren't really providing me coverage. As I've seen how Ambetter/Celtic operates, I am realizing that even with my pricey $1000 deductible plan, even if I use their very limited in-network provider list, I could one day end up with $100s of thousands in medical bills that they won't cover because of the way the game the in-network rules. Most recently, I needed urgent care. I checked their site for the nearest urgent care clinic in their network. Nearest one is over an hour drive away--that's for urgent care. There are dozens of urgent care clinics within 10 miles of my location. None are in-network. I would advise anyone to stay away from Celtic/Ambetter for insurance. Even if you pay an arm and a leg for coverage, they exploit every legal avenue available to avoid actually providing the coverage you think you're getting.