Ambetter
4.9
Overall Score
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Maria Tajman Fayetteville, NC
Please be aware this is the worse insurance I’ve ever had. If they had a minus star that’s what they would get from me. Now why I understand most of the doctors in my area do not accept it. Had to drive 2 hours for mammogram, 1 1/2 fir colonoscopy ( which by the way they are trying for me to pay 500+ out of pocket because supposedly it’s not preventive, did I understand correctly? Colonoscopy after 50 is to prevent colon cancer, right ?? They refused to pay for an MRI that I needed for approval on a epidural shot I needed which I had to pay myself out of pocket and they still did not approve it!! Nevertheless I changed to United Healthcare at beginning of this year and after seeing my MRI and X-rays approved it right away. Never ever again I would use their services
2 years ago
Steve D Overland Park, KS
Jan 2022: I'm a brand new customer with Ambetter - Kansas and...
Dropping them already!
In Dec 2021, before signing up, I confirmed by calling Ambetter Customer Service, that my physician was in plan and my daughter's pediatrician was in plan. I was told they both were. Yeah!
Now 10 days into January, I cant assign either of our physicians as the PCP using my online account, can't even find them in plan. Called Ambetter C/S and was "escalated" to the Resolutions Dept. I was informed both physicians are "Specialists", not PCP's and unable to be assigned... WTH?
Nice to have known that about 1 month and a over $1,000 ago.
2 years ago
Michelle Coatesville, PA
They charged my credit card twice and never gave me a member number or account. When I called multiple times to try to resolve it they said they could not find me in the system. The foreign customer care couldn’t understand my name despite me spelling it many times. He gave me a number to help me, which I found out after dialing it was to healthcare.gov. I didn’t purchase through them so that was pointless. The next person transferred me to a number that hung up on me immediately.
At this point I had to dispute the charges with my credit card company because I could find zero person to actually help me. Needless to say I won’t be moving forward with Ambetter, this felt much like a scam.
2 years ago
MAXINE POWELL Riverdale, GA
Ambetter is a rip off. I have been paying over 2 years for my sons. I just happen to call Market Place and they informed me that I was that I was not supposed to be paying a premium for the past 2 years. I reach out to Market Place to update information and this was when I found out. I have tried calling Ambetter 5 times and they hung up on me, when I explained reason for call.
I did ask for legal department to discuss reimbursement and they did not have number. Still cant get help so I will be reaching out back to Market Place see if they can help me get over $1000 back that Ambetter took from my account each month. At least $40 month.
2 years ago
Bri Dee St Louis, MO
By far the worst insurance I've ever had. Moved states, and literally zero PCPs available. Cannot get in to see ANY doctor. The few doctors that do take this insurance are low-income clinics where you're getting the worst quality care... But like I said, haven't seen one of those in months because NONE OF THEM ARE EVEN TAKING PATIENTS. I'm paying for insurance I can't even use. I get sent an explanation of benefits I didn't ask for every two weeks in the mail, even though I'm signed up for paperless everything. No one can seem to figure out how to get them to stop sending it. The site never works, customer service is a joke and they will hang up on you if they can't figure out what you need. Lost coverage for a couple months and lost access to my therapist because Ambetter screwed up a billing issue. Never paid late once. Please, if you care about your health, don't bother with this company.
2 years ago
Holly Gutierrez Hamilton, TX
I wanted to try Ambetter out because they were a new company that I had never heard of and they were very reasonably priced and the deductible and out of pocket max were very low. My husband and I have a plan with them through marketplace. It was very easy to apply and sign up. I paid my 1st few months premiums and everything was going great. They even paid for the surgery on my shoulder, which had me almost meeting my yearly individual deductible. Around July, I realized that our yearly income was going to be higher than anticipated at the beginning of the year. I went into marketplace and changed it. When I did this, I still qualified for the same Ambetter care 12 plan, but I would be paying more for my premium, which I understood. I found out that my income change put me in a different tier, same plan different tier, I went from the 90% to the 80%, meaning what they would pay. I was fine with all that. But because I had changed tiers, they put me in a new policy with a new policy number. This reset all my deductibles. The 1st several times I called, either the person had no idea how to help me and would put my call into a supervisor, which I never received a call back. Two people spent over 2 hours each on the phone with me to try and get this sorted out. They were on the phone with their supervisor at the same time. At the end of the calls I was reassured by both of these people that my deductible from my previous policy would transfer over because it was the same policy but a different tier. I had also received a rewards card from them for doing different activities in the amount of $50. I had used it some to pay my monthly premium but still had a balance of $30. When my old policy was "canceled", my Visa rewards card on associated with thus policy was canceled as well and I lost that money, which I had spent the time to do the activities for. This escalated over 2 months. In all this time I never received a phone call from a supervisor. Finally, after speaking to someone on the phone and having to tell them for 30 minutes straight that they could not help me and I wanted to speak to a supervisor, they finally got me over to a lady who proceeded to tell me that I was lying about everything that I had been told because I could not provide her the conversation number. She told me she could see all the conversations that I had had but because I could not provide her with the number she could not verify that that's what that person said. She told me that they never transferred deductible that it was my fault I canceled my policy. And that if I wanted to use the rewards card I should have used it before canceling my policy. I tried to tell her that I did not cancel my policy, that it was changed by Ambetter because I had been put in a different tier. But she would not listen. She just kept saying you're right ma'am what can I do for you. And when I would tell her she would say we can't do that, we've never done anything like that before so what else can I help you with. When I ask to speak to her supervisor to her supervisor she denied this request. I did not have a problem with anything but their customer service. Their premiums were reasonably priced, they paid for my surgery with no problem, but the way they treat their customers is absolutely is absolutely uncalled for and unjustifiable. I will not have a plan with them ever again.
2 years ago
Maddybaddy01 Des Plaines, IL
Terrible customer service. Extremely disorganised and I get different answers from nearly every person I speak with. They take forever to approve claims for treatments of chronic pain. I have terrible knee pain- waited a month for prior authorisation for an injection. Got denied. Never mind I am struggling to function. I was diagnosed with sleep apnea 8 months ago. Still not being treated because nobody wants to work with Ambetter and their process of getting treatment approved is ridiculously difficult. I was told by some medical facilities that they won’t work with Ambetter because it is Medicaid. Excuse me?! I am paying $341 per month, NO government subsidy- for this so called “Medicaid “. Had they disclosed this when they coerced me and basically pressured me into buying them this plan, I would have happily declined. They’re a rip off company who wants to steal your money. Don’t let the cheap benefits fool you. I’m looking into lawsuit options.
2 years ago
Rachel Y Columbus, OH
I purchased AmBetter through the Marketplace. It was difficult to find providers who would take it and it was very difficult to get a medically necessary knee surgery approved because AmBetter kept denying it for no apparent reason. But the worst part about AmBetter was that I met my out-of-pocket maximum early in the year, so AmBetter tripled my out-of-pocket maximum right in the middle of my contract, even though my income did not increase. They also increased my deductible and copays. I called many times, trying to get a resolution, and AmBetter pretty much said, "Tough, we changed the contract." I have a hearing scheduled for later this month, with a Federal Hearing Officer. It is outrageous that in the middle of my year-long contract AmBetter would just be allowed to change the terms of the contract and put me in the position of paying thousands more than I had anticipated when I chose AmBetter at the beginning of the year. What good is an out-of-pocket maximum if they can just increase it after you meet it? I will never use AmBetter again.
3 years ago
Kelley-Dan Young St. Marys, GA
100% worst insurance I've had in my entire life. Tiny network. Claims denied for legal modifiers. Have to travel an hour in two different directions for care. Most caregivers only in the covered office 1x/week to 1x/MONTH and are booked until we colonize Mars. Few specialists in network that have rights to any hospital also in network - so can't get emergency care because hospital doctors won't touch current meds and won't communicate with primary docs. Denying claims for random code errors that other insurances don't have a problem with, and refusing to contact the medical office to discuss the problem.
Having this insurance is absolutely terrifying and if there was any other option whatsoever for our location we'd bail immediately. We've literally considered moving in order to get new insurance.
3 years ago
SummerSpringWinter Smyrna, GA
My college age son has Ambetter Insurance in GA. I have Medicare as does my husband, his dad. He is a private pay customer as he doesn't work for a company full time that offers insurance (of course he is a college student with a part time job). My son goes to college out of state. He had an ER visit in FL, in CT, and some tests at a hospital in CT. He is an athlete so this is normal. Ambetter ignored these claims and haven't even recorded them on their claims page of my son's account. We have sent the claims personally, the hospital has sent them twice, We have called Ambetter numerous times and they don't acknowledge anything. But they bill my son $360. a month like clockwork and they never lose that. I wish we could choose a different insurance company but the only other option is Kaiser if you are private pay in GA which would not help as there is not a Kaiser Hospital where he was in school and where he is in school now. Also his pediatrician in GA is not in network with Ambetter. The insurance is worthless. I've never seen insurance this bad. I've never seen record keeping this bad. It is October and the claims have not show up for activity in April or May or anytime for that matter. Don't use Ambetter. GA needs better options.
3 years ago
Neville Mistri Berwyn, IL
My wife and I pay about $1500/mo for incredibly subpar coverage. I don't think most people could even fathom how bad this company is, so let me give a few examples:
- Often when I try to login to my account it's locked on the first attempt. If I send for a link to unlock my account, the email rarely comes. A representative once told me they almost never do. If I call the number on my card I get a long wait time of course, but wait there's more. When you finally get to a representative, seriously probably 30 - 40% of the time they'll tell you their system is down, so they can't unlock your account either. I think they’re on Windows 3.1. So they cannot unlock your account, and you cannot look for a doctor in your plan. That's not subpar service that's literally the definition of no service. I've gone through this several times.
- Twice now my wife has had to spend hours calling Ambetter and her doctor to try and get them to pay for a mammogram. Even initiating a conference call with them both. I believe both times it took 6 months plus to resolve that simple matter.
- I’ve lost count of the number of times the phone disconnects on you after substantial time on hold, or it just throws you into voice prompt loop to nowhere where you’ll be repeatedly asked to enter your personal information.
- Oh and even though we've been with Ambetter for a few years now and had the same primary care physician the entire time whenever we're talking to a representative they can't find her in their system. So don't forget to get your doctor's NPI number so you can give it to Ambetter. Anyone can look it up on the web, except for Ambetter apparently.
I honestly can't even believe such a company exists. They make Comcast and AT&T look like superstars. I would really only use them for major medical coverage if it’s your only option. After the $15,000 deductible they may pay if you can get through to someone, and they can find your doctor.
3 years ago
Mikieme Phoenix, AZ
Grievance after grievance .... nothing resolved .... then bang ... sir the podiatrist removed your female parts from your toe it has been RESOLVED your toe had female parts and a heart valve ..... Wow .... you cant make this s#$t up.... so what good is it to file a grievance... and oh yeah ... sorry but I cant find a grievance on that .... again WOW!
Over a year and head of grievance to fix my account so I had my pcp and not a default pcp. .... Taiwamo not English no stateside you have no problem now ok ... yes I do you did nothing ... I fix problem for you you happy now ok and hangs up...or.... Supervisor call you ... never do... doesnt say that in notes ... well it says that in the phone recording... a Supervisor will call you NEVER HAPPENS... COMPANY IS A JOKE AND IM EMBARRASSED TO ADMIT THEY HAVE PLAYED ME SO LONG....
3 years ago
Raymond B.
Signed up for Ambetter 6 months and didn’t have to use the dental option until now. My wife had an excruciating tooth ache and I needed to find a dentist who accepts the plan. Called customer service, after 20 minutes of trying to get through, and I get a list of dentist who take their dental plan. The representative says you have to tell the dentist office it’s billed under Envolve dental. Sounds simple until I call the list of dentist to make an appointment, of course either no one accepts the plan or the numbers are disconnected. Most of the dentist I talk to tell me they haven’t accepted that plan for years! At this point I log on to the Ambetter website and just start calling down the list, regardless of distance or reviews. Same results…….nothing. Finally into day two I call back to Ambetter and speak to the 4th representative and guess what? I’ve been giving the wrong information the whole time, the dental provider they use is not Envolve but another carrier. Which explains why, after countless hours of calling every dentist, I could not find one who took the insurance. What a waste!!!
3 years ago
PSDTennessee Rogersville, TN
I've had Ambetter coverage for about 3 months now. Here's a typical experience for me that just happened today: Called to check the cost of a procedure (can't do it online as their website is broken and has been since I first signed up, when you search for the cost of a procedure, it comes back with the result "nothing within a 100 miles of your location" no matter what you search for). It takes just over 5 minutes each time for me to navigate the automated phone menu and talk to a live human. I finally reached someone and she had me review all of my information, including a phone number I could be reached at in case of disconnect. We, of course, get disconnected. I wait for a call back that doesn't happen. I call back, spend 5 minutes navigating the automated menu, finally get a human again, only to find that there's a really bad echo on the line. I ask the agent to call me back and she says that she's not able to place outgoing calls. Excuse me? She tells me she can understand and we continue despite me having to pause every time I say something to let the echo die down. I get the normal "please verify all of your information" questions even though I'd already answered them 4 times in the last 2 days. And then she asks "what number can you be reached at if we get disconnected?" I say "but you just told me you can't place outgoing calls?!!!" Her response? "Ma'am, it's just a field on my computer that I have to fill out before I can continue." That conversation sums up Ambetter perfectly: customer service reps responding by rote, no empathy, simply a script to follow, but no actual follow through, a computer system that's broken that no one bothers to fix and after all of my time spent, I still had the same unanswered question. No matter how cheap the price, this company will never be worth it.
3 years ago
Sam Pennington Ada, MI
If I could give Ambetter ZERO stars I would do so. They delay, delay, delay paying providers for services that were given PRIOR AUTHORIZATION. I was billed the total cost ($9,100) of a procedure by my provider when, after 6 months, Ambetter was unable to tell the provider when they would receive payment.
The customer service agents give conflicting information about providers being in network, or out of network.
I have spent HOURS on the phone with Ambetter attempting to make sense of the information that I get via the website, or in the EOB'S I receive in the mail.
I have filed complaints with the Insurance Board of my state, as has one of my providers.
There is a reason that this company has the cheapest premium on the Marketplace.
3 years ago
Mike Ungar Miami, FL
I would give them negative 5 stars if I could. After using their crap service, I finally switched over to another insurance provider. When canceling, I requested a refund for the month ahead I had paid in advance. They said no problem and issued the refund. I had requested the refund to be by check as opposed to the credit card the payment had been made through. I was told it's not an issue and would be sent in 7 to 10 days. Fast forward 4 weeks later and no check received in the mail. I called in to find out where it is and they informed me that they determined that day of refund request that they can not send out the check and the refund can only be returned the the credit card payment they received it by. So my question to them was 2 fold. 1: why than have you not returned the refund to my credit card if that's the only way you can do it? 2: why has nobody called me to tell me this after 4 weeks of waiting for the check?
The response from the manager on the phone was that it was my responsibility to call them and ask them if my refund request would be honored by check. They denied the request by check the day they told me it was approved yet expected me to know that information telepathically and call them and tell them to send the refund to the initial card instead. 4 weeks later no phone call from them or email or text ot anything and I have to wait another 7 to 10 business days for my money to be returned when it fact we know they can easily return in the same day. And than to blame me and put the responsibility on ME for not calling in to find out? I lost it with these guys. Do yourselves a favor and stay away from these crooks. Better go find yourself a different insurance company. Litterally anyone else. Don't say you weren't warned
3 years ago
Marty Novak Tucson, AZ
Ambetter is the worst. I have a very high deductible. I am not even close to meeting that. I need an MRI for a spine I already had fused, but is having problems WHEN I PERFORM MY DR. PRESCRIBED PT AT HOME!!. They will not authorize the MRI because they require 6 weeks of PT, the same PT that is causing me nerve problems, before they will authorize the MRI. They would not have to pay one cent for this MRI, as it is all out of pocket for me at this point, and are unwilling to negotiate an insured rate for me to pay out of pocket. A lot of doctors don't accept their insurance and now I know why. Don't waste your money.
3 years ago
matt Seattle, WA
The worst part of getting food poisoning was having to deal with Ambetter. Sure, I experienced debilitating pain and frequent vomiting, but that was nothing compared to what Ambetter put me through. They repeatedly told my health care providers that my coverage had been cancelled, while telling me that it was still active. As a result, every time I sought care from Ambetter's emergency nurse line, I was refused help. It took repeated calls and hours on hold just to get taken care of. That frustration, fear, and helplessness was far more distressing than the intense pain that I experienced. Given the choice between food poisoning and Ambetter, I'd take food poisoning.
3 years ago
John B Concord, NH
After losing my job and health insurance with the Covid layoffs I signed up for Ambetter NH Healthy families. It seemed to be a reasonably priced plan at $344 monthly. With the unemployment insurance when I did my taxes, and was declined the tax credit it came out to $794 monthly with a $6000 deductible and maximum out of pocket. I had met my deductible and maximum out of pocket by November 20, 2020. I had to go to the Emergency Room on December 24 by ambulance. My plan clearly states that after the deductible and out of pocket are met they will cover 100% of ambulance BOTH in network and out of network. On a $864 bill they paid 465 and said that the rest was my responsibility. I called to discuss this, they spoke with me for half an hour, gave me a reference number to refer to when calling back in a week. I called back and it was like I was calling again for the first time. The operator I spoke to kept communicating with her supervisor, who first said that I used an out of network ambulance and that was the reason for them not paying. When I explained that it didn’t matter according to my plan’s coverage, and says exactly that on my portal, they said “Well that’s the most the insurance company is going to cover for an ambulance. You have to pay the rest yourself”. They are completely dishonest, what the policy says totally doesn’t mean anything. I want to file a complaint with the Better Business Bureau. They should be put out of business. I’m not paying the bill, since I’m 100% right and have it in writing on my plan page. When the collection agency gets on it I’m saying it is not a legitimate claim.
3 years ago
Kristy A. Cuyahoga Falls, OH
I would give 0 stars if I could. It is the WORST insurance I have ever had. They deny everything including a preventative mammogram which in order for them to be a part of the Affordable Care Act they can't charge for preventative mammograms. Customer service is horrible. No one ever knows anything and you can never get any answers as to why they deny the claims. And you will get a new reason every time you call and talk to a new representative. AVOID this insurance at all costs!!!!!! It isn't worth the low premiums because you will pay for every service and they will cover nothing. I got their best plan at $426/mo and they still don't cover!
3 years ago
Jessie B Chicago, IL
Working with ambetter customer service for almost 3 months was the worst customer service I have ever experienced in my life. The employees take your number in case you get disconnected, however they do not call back if a disconnect occurs. On more than 5 occasions, I explained my situations and got hung up on by customer service because they seemingly didn’t want to deal with the complexity of my situation. This was not a disconnect, they had my number to call back, they sounded unpleased and you could hear a phone click every time. At times it was me asking to speak to a supervisor, as soon as I asked to speak to a supervisor, they would hang up the phone. Never was my situation ever handled by the same person, which made this a hundred times more difficult. I spend so much time retelling and retelling this story to new employees who had to be caught up on the situation, only to try the same thing that the last employee tried and then to say good luck and part ways with nothing changed. I was a huge inconvenience trying to get my money back for the time period in which I could not use my card, not to mention the time I took every day to try to resolve these matters. No reimbursement was ever given. To top it off, most the doctors listed on the ambetter website are fake or old listings. I paid additionally money for a ambetter dental plan, I was unable to ever go to a dentist because the dentists listed on their site either don’t work where ambetter says they work, they don’t actually take ambetter insurance, they work in an entirely different state, or they are no longer in business. Please see the examples below. These fake listing are not just in the dental. They have occurred in PCP, physical therapists, and chiropractors. Filed a BBB complaint, and when they did get back to me they investigated everything 3 months after. I could not use my insurance all of January until the 28th when they finally gave me the card numbers to get my meds at the pharmacy. Since I finally could use the card on the 28th they said I had to pay for the full month of January and they would not reimburse me. Not to mention still never being able to see a dentist when I paid extra for a dental plan with them because of the fake doctors listed on their website. Over 20 dentists in my area are all fake listed and DO NOT TAKE AMBETTER. Save yourself money and stress and do not ever get this insurance. They do not even pay for basic labs that other insurances do. If you get normal physical blood work done it is gonna cost you 300 dollars. Even my pap smear cost money (a service that is something to be covered but ambetter always finds a way to make you pay something). They will never care about their members even if you are on tears on the phone crying because of the damages done to your health when your insurance was "active" but they wouldnt let you use it for 28 days. I could have died and their response was well you used it on the 28th so we will not reimburse you anything.
3 years ago
Katie Spring, TX
My husband went for annual wellness exam. He received a bill charged to his deductible. Contacted the provider and she said that she correctly submitted the preventative codes. Filed a complaint with Ambetter since Oct 2020 until now ( March 2021). Every time we submitted the complaints and we received back a letter saying that " we will mail the answer to your complaints within 30days" ! Nothing happens but just some random person gave me different (verbal) answers. I spent so much time to work with this issue and no solutions yet. This complaint/Grievance department service is really horrible. Stay away from this company if you don't want to receive a surprise bills and no-one seems responsible for complaints filed.
3 years ago
Cayamarie Springfield, MO
Had no issue with ambetter the first like 3/4 yrs I had it. It was somewhat of an issue finding a provider.
Come this year, I went to pick a prescription up to which I had to pay in full. I called ambetter, just for them to say that I was missing a payment. A $350 payment! I had absolutely no clue where it came from. Then I got February's bill and it is $400. I called once for them to tell me that my account was terminated then again that same afternoon (their system went down and had to call back later) for them to tell me that the $400 is what I pay a month. I should have reviews before getting it. I'm just gonna be canceling it. Hopefully I can, but seems to me I will have issues with it (from reading other reviews)
3 years ago
Disgusted Lincolnton, GA
This company is breaking the law and getting away with it.
Under the Affordable Care Act they cannot cancel insurance except for non-payment or fraud/misrepresentation. Cancellations require a 30 day notice in writing so that the usered person can obtain another plan through the Marketplace as a special enrollment.
In my case, as of January 2021, they have deon neither, and I am now out of the blue, in the middle of a pandemic without health insurance.
I had coverage with them in 2020, and used it for vision, dental and general doctor checkups. Finding anyone would that take this insurance proved a challenge initially.
I paid for a new similar plan (with increased premiums and increased co-pays/deductables of course - pay more for less as always) via the Marketplace in November to start January, 2021, and paid by credit card my firs month's new premium in December.
All seemed ok, Ambetetr sent me a new Welcome 2021 pack with plan and new insurance cards with Coverage Effective from 01/01/2021.
On january 17th I presented my new card to my pharmacy for my refoill for high blood pressure medication, and was told my coverage had been 'cancelled' - so I had to pay in full for them.
I have never missed a monthly payment or co-pay or anything, and have copies as proof from their statement/billing on their website.
The following day it took 3 calls to Ambetter and 3 calls to the Marketplace to get NOWHERE. The Marketplace says I have a plan that Ambetter has cancelled but no reason has been given, so I can't simply enroll in a new one, they also say I have to deal with Ambetter about this. Ambetter, of course, tell me I have to deal with the Marketplace.
The worse thing is that each of the three different customer service agents I spoke to at Ambetter eithe lie, do not know whatt ehya re doing and ALL refused to pass me to a Supervisor when they admitetd there was nothign they could do. One stated I didn;t have any insurance for 2021, and denied I had a new card for 2021 from them wheich I had in my hand! One said he'd speak to a superior and put me on hold and after 20 miutes of loud call waiting music the call was, surprise, surprse, terminated his end. He said he would call me back, but did not. The final customers service agent was downright rude and evasive, and said they would transfer me and actually only sent me back to the Marketplace.
Ambetter has 'cancelled' my new policy for 2021 for no known reason whatsoever, which was purchased through the Marketplace but did not notify me, they returned my first month's paid premium online halfway through the month as if by doing so this made the customer just disappear.
I have now had to make appeal through their system which I doubt will result in anything, and one through the Marketplace. I recmooned anyone having trouble with this company do the same, perhaps even lawyerup as their breaking the law as regards their requirements under the Affordable Care Act, 2010, might be worthy of a class action suit - I am sure they are doing this to others all over the country.
I have written to the CEO of the company as below, again, I recommend anyone do the same. Point out their own words, which is the very opposite of how it seems Ambetter treats its customers.
I suspect they are an Obamacare mohey-grab set-up to pocket as much of anyone's tax credit they can get + premiums paid whilst providing almost no true health care to their insured. This must be the end result of the Affordable Care Act, a clever ruse to transfer tax dollars and pooer people's hard-earned money to the already wealthy.
Nothing changes, does it...
3 years ago
Penny ,
Giving 1 star but the company doesn’t even warrant that. This is the worst company I have ever had. In the 40 + years of dealing with health insurance companies they are the worst. Since our health care system has been ruined I have been stuck with this company, no other companies participated in the county I live in. High cost over $1500.00 monthly w/ 16k deductible. Customer service is terrible, cost is high, I have been trying to resolve an issue of overpayment for more than 60 days and get the run around, am told first person dropped the ball, I am taking care of it only to have the ball dropped again, 4 people no resolution no return calls from anyone. It’s no little matter either. Do yourself a favor and avoid this company, if you have a choice any other company would have to be better. Next step fling a complaint with the dept of insurance at state level.
3 years ago
Paige White Kennesaw, GA
Getting pre approval has been a nightmare. 15 bus days to approve all procedures or care has left me in immense pain for over 2 months because each new procedure has to go through a 15 day process. Office staff confirmed only ambetter has such terrible requirements. I wish I had stuck with Kaiser because I would not be living on meds daily while I wait for the procedures I need. Also don’t believe them when ambetter says the delay is because the doctor office doesn’t file correctly. Ambetter told me this about multiple different providers and after being on hold for over 2 hours a rep finally told me the only way to bypass the 15 day approval wait period is in the case of life or death.
3 years ago
Michelle Hefner Cedar Creek, TX
Do not choose this company!!!! They are completely inept. They charged me for insurance for 6 months and when I went for a checkup, I was told my insurance was inactive. There was never any communication and they continued charging my credit card each month! After many hours of conversation, they refunded my money in November. Today, I received an email saying, "Thank you for your payment." They had charged me again! When I called, the woman said the confirmation number that accompanied the email was wrong and there was nothing she could do to help me. I told her that was the confirmation number on the email from ambetter! This is insane and totally unprofessional. What kind of scam is this company running?!
3 years ago
Tracy Bridgeview, IL
It’s the worst insurance ever. The lists of doctors and hospitals in their website as “in net-work” are all lies. I’m pregnant but there’s no OBGYN accepts this insurance. After calling 3 pages of “in net-work” doctors according to the website, I finally found a OBGYN doctor who’s 45 mins away from where I live (Chicago). I was bleeding a lot when I was 14 weeks pregnant and went to the nearest emergency. This insurance only covers if I used an ambulance or emergency room but all the tests I had to take including ultrasound, they did not cover. The doctor prescribed me medications but this insurance didn’t cover either. My OBGYN doctor transfered me to a different hospital for another ultrasound which also says “in net-network” in their website. This insurance also denied this coverage so I called them and they don’t know why i got denied when it says “ in network” like wtf? She told me to call the hospital so I did, she said called my insurance. I called my insurance and they told me they would call me back, it’s been a week already and haven’t heard anything. I’m so sick of this insurance but it doesn’t expires until the end of this year. I don’t understand why I am paying this insurance every month for monthly payment when this insurance doesn’t covers anything. Stay away from ambetter.
3 years ago
Dewana Gray Morman Little Rock, AR
This company horrible they stopped my surgery that i had to opinions from 2 specialist stating that there is a need for this so u can walk this is a surgery that is needed they canceled my surgery less than three hours before I was supposed to have it I pay for all the things that I need to have surgery renting equipment and everything out of my pocket just to be told that they felt like I need to be in pain a little bit longer before I could get my hip fixed I tried to explain to them if I got my hip fixed then I could work and I wouldn't have to be on Social Security but they don't care I can't pay my bills or do anything I went from working as a nurse for over 22 years to not being able to work at all or stand and now I'm on a walking cane if I get my hip fixed then I will be able to walk work and take care of my household and I won't have to be on assistant I would think this is what you would want you would not want your customers or clients to be sick or sitting at home hurting when they don't have to be for you to sit in the office and tell me that I am not in pain and that I should be in a little bit more pain than this so I said maybe I should go outside and fall hard on the concrete and then they said they would fix my head really so I have to go outside and hurt myself for you to fix something that should be fixed anyways this is horrible this is supposed to be a company through Obamacare it sucks what's the point in having insurance if something's really wrong and you have went through all the precautions it took 3 years for me to get approved for surgery spine specialist because I did every other alternative that I could do besides surgery to help me now I'm in chronic pain constantly they say they don't want people to take opiates or get addicted but I have no choice but to take these medications because my insurance will not fix the problem so that I can get off of medication ridiculous
3 years ago
SBM Albuquerque, NM
I am new to Ambetter, and I have never in my life experience the frustration of having to deal with them. I have been trying to sign up and absolutely no one in their sales department knows anything about the plans or any benefits that the plans provide. I don't understand, how you can work selling something and not know anything about it. All I wanted to know is what benefits does Ambetter offer HSA accounts? no one new what an HSA account was or what it was used for. I was transferred 4 times to different people in sales that might know more than the other. The conclusion was that I didn't know what I was talking about. I have worked in insurance for years, I know exactly what an HSA is, but each individual insurance company has different benefits. This company desperately needs to invest in actually educating their sales department including the member services. Think of the hassle you will go through I they can't even answer a simple question of " what benefits does this plan provide?" pretty pathetic. I would NOT RECOMMEND
3 years ago
Victoria C West Palm Beach, FL
I purchased a plan with vision and dental.
It was not worth having the vision and dental.
The dental only had one provider that would accept the plan in my area and they are so bad I walked out, and will pay out of pocket.
Division benefit barely covered the eye exam and gave me nothing towards a new pair of glasses.
Even trying to change my primary doctor It has been impossible to find providers who will accept ambetter.
Not just primary but that happens often with specialists also.
Ambetter's websites are never updated, and even their employees will give you names of providers who don't even practice anymore and or don't take ambetter. I had to have foot surgery this year so I had to meet my out-of-pocket. I don't even have a job and I'm disgusted at how much I had to pay including the premium. I only chose this plan so I could keep one particular doctor, but it is by far the worst health insurance I've ever had. Really sad that you can pick based on your ZIP code and there weren't many good plans available. I hope I don't get stuck with them next year because they are pathetic.
3 years ago
Arielle D Duluth, GA
Terrible in Atlanta. If you need an x-day half of the places listed in their network online DO NOT do x-days or do not accept Ambetter. They only accept it for the ER. Which needs to be listed.
I've been in pain over a month barely able to use my left hand & the only place who accepts the insurance and actually do the x-rays says it can take 2 additional weeks to get an appointment because it takes so long to get the green light from Ambetter 🤨🤨🤨 so you'll continue to be in pain after calling tons of places to be turned down. They need to take them off their networks or specify what they do and don't cover.
3 years ago
emad serry Houston, TX
Actually , i lost right ear hearing , then after visiting the primary care doc. transfereing me to ENT doc. then the problem started with Ambetter . The Ent asked for MRI on th brain , Ambetter did not approve the MRI . I had to pay the whole amount out of my pocket just to find out why the sudden hearing loss.
The ENT transferred me to a neuroglial doc , which ordered 2 more MRIs and a some kind of special test And here it comes the tragedy.
As usual Ambetter did not approve, the reason is i don't have a medical history that requires MRI - the sudden hearing loss is not enough reason and also they said that the doctor did not submit enough docs to get the approval , so its not approved.
i called them and they advised me to apply for an appeal , Then i did that appeal.
the result is the usual denial and the new advice was asking the doctor to do a call ( Peer to Peer call ) it means that the doctor must call the authorization department and ask for the doctor that gave the denial trying to explain to him the reasons for the MRI . after this scenario we got the first approval for the first MRI.
It took 4 months to get the first approval. Then another month to get the 2nd approval.
Now with the another neuroglial clinic , i am suffering from the same scenario because , the doctor asked to redo one of MRIs we did.
By the way , i paid the hearing aid without Ambetter help and the first MRI completely out of my pocket.
don't waste you health with AMBETTR
4 years ago
Michael Main San Antonio, TX
I found it hard to find doctors. The company web site listed doctors (in my case I was looking for an ENT) but when I tried to make an appointment I was told the docs didn't accept Ambetter. I called Ambetter and asked them to find an ENT locally who accepted their insurance, they never called me back. I changed insurance
4 years ago
RVM Lubbock, TX
THEY WERE REALLY WONDERFUL. THEY HAVE TOP DOCTORS. THE COVERAGE HAS BEEN A LIFESAVER. I WOULD STILL BE WITH THEM, BUT THEIR RATES WENT UP ON THE OBAMACARE MARKET PLACE.
4 years ago
Kristin Chester Fort Wayne, IN
After being out of work for months and my balance becoming past due I have finally figured out a way to bring my balance current again....the only problem is Ambetter, the most utterly WORTHLESS insurance company I've ever had, cannot tell me one way or another whether my coverage will be terminated even if I pay the overdue amount. HOW CAN A COMPANY AND ITS REPRESENTATIVES AND SUPERVISORS NOT KNOW THIS ANSWER? It's sad, but I guess I'm losing all coverage rather than taking a chance paying the bill only to lose coverage anyways! So much for the healthcaremarketplace.gov helping anyone out....all it did was cost me a bunch of money. I'm in good health but would rather not lose my coverage, however I would rather put the money available to me towards rent or groceries since I am still currently unemployed due to coronavirus restrictions. Ambetter is the WORST insurance company you could ever use....do yourself a favor and pick anyone else!
4 years ago
David Helms Euless, TX
The customer experience with Ambetter was clearly the worst in my role as a consumer. The EFT payment schedule was incorrectly programmed resulting in a premature cancellation of coverage that had to be reinstated. Then, their customer service reps gave nothing but inaccurate information. They advised my dentist that we had an $8000 deductible and then advised my dentist they did not cover routine fillings. My dentist refused service on this basis. The staff at Ambetter is both incompetent and uninspired. They have no business advising policyholders on their insurance products. This company should be prohibited from writing insurance in any state.
4 years ago
Aaron & Ashley Trincado Dayton, OH
If I could leave ZERO stars I would. I was with Ambetter part of 2019. I got a bill from a provider from something I got done back in July. I was covered in July. I paid what I owed based on my plan. Ambetter was supposed to pay the rest or so they told me. But they DID NOT. Then I kept getting billed for the same thing. Ambetter kept telling me that they would take care of it. This happened multiple times. I kept calling Ambetter again and again so try to solve this issue. Now they are denying me apparently and are saying that I have to pay the full amount! It's just RIDICULOUS! No straight answers from Ambetter. No explanations. Nothing. Awful company. Awful service.
4 years ago
Rusty Cottar Weatherford, TX
Health insurance ran by circus clowns. Ambetter loves taking money from their customers and they make it almost impossible to get approval for any procedure that is above a basic checkup. They continually deny any procedure, regardless of what type of physician (general practitioner, specialist, surgeon, etc.) requests it. On their website, they list a ton of doctors in any area of practice you can think of. However, this is a fraud as well. A majority of doctors, who Ambetter list as in network, refuse to accept the trash known as Ambetter. After fighting alongside my doctors against Ambetter trying to get required & necessary procedures approved, I understand why most doctors will not accept this lousy insurance. Ambetter requires everyone who they deal with jump through so many hoops that it is impossible for the doctors to make any money. Moreover, Ambetter is only concerned with the money which they can swindle from their customers with no regard to the health, betterment or required & necessary needs of the customers who are making this company filthy rich. In my opinion, the name of this company should not be Ambetter. A more fitting name would be Amworse.
4 years ago
Flora Grebe St Louis, MO
I called the market place looking for a good health insurance. The next day I received calls after calls from different phone numbers, non-stop. Then in few days I received a bill from Ambetter for my first payment of my plan. I ignored it since I didn’t apply to any health insurance.. then the next month Ambetter sent me again another bill and so with the next month. I got tired and called Ambetter. I told the lady I didn’t apply and she said she cancelled it. And transferred me to another phone which she said the market place so I can tell I didn’t apply for Ambetter which I also told that I didn’t apply and they must cancel it.. which they both said they did cancel it. Then why still I am receiving a bill every month? This health insurance is fishing people by their tricks. You don’t drag people to buy your insurance, you have to wait if they choose you!
4 years ago
Chuck jolley Auburn, WA
Hot happy...when you need to get specialty help from outside of the network because in their network does not have the medical ability to take care of special needs for medical needs of their clients...they need to look into getting the Seattle cancer care alliance under their umbrella. And the University of Washington hospital in Seattle under their umbrella. That's where all the specialties doctors are for multiple diagnosis and blood diseases and cancers.....because when insurance company only lets you go to certain facilities and you need facilities outside they say they will cover but you have to beg borrow and still and get doctors and doctors and doctors on phone calls to prove your case to get referred to see a doctor like at the University of Washington hospital..and you have no choice but to be under that network which is in Wenatchee Washington You're very limited to facilities in Seattle one hospital... This bill is almost criminal to the patient..very unhappy and can't change insurance because of our location where we live. And you're not allowed to have more than one insurance company.... Sorry for all the patience and spouses that are suffering like us just to get the best medical care.....
4 years ago
Melissa Osweiler New Port Richey, FL
Billing is terrible. We are set up on automatic payments from our credit card. Ambetter uncharged us for a month, then suspended our policy, stating we did not pay. It was not our fault they charged the incorrect amount. As a result, a procedure had to be canceled and has to be resubmitted for approval, and two doctor appointments were canceled as well. When we tried to straighten it out, they overcharged us $1600 and refused to issue a refund. We got this plan through healthcare.gov, so I'm wondering if we can cancel and get another company. We've had BCBS for many years with no problems. We should have stayed with them but were trying to save money.
4 years ago
Cheryl Tucson, AZ
I was hoping to choose a different Obamacare provider this year but Ambetter is the only option that includes both major hospitals in my city in their network. That's the only positive thing I can say about them. Their website makes it easy to pay but hard to do anything else. Lists of specialists are out of date and calling customer service is an exercise in futility. Referrals from your doctor can take weeks or months because so few specialists accept this lousy insurance. And once you finally find one, you will pay high rates out of pocket. It took two months worth of rejected referrals to finally find an in-network physical therapist and I found out the day before my first appointment that my cost would be $100 per session. I chose to go elsewhere for less, even though it won't count against my $7,000 deductible. I did the same thing with a medical device -- Ambetter wanted $1200 and I bought one privately for $650. So I am spending thousands for premiums and thousands out of pocket that doesn't even pay down my deductible. It's blackmail. It's craptastic, catastrophic insurance that meets the ACA guidelines on paper but, as a practical matter, is almost impossible to actually use.
4 years ago
gpacc Hillsborough, NC
Ambetter of North Carolina has been a nightmare. I used to own a large business which provided over 400 employees with healthcare coverage. Typically when changing carriers there can be a few bumps but Ambetter has been almost impossible to deal with. People at the call center are nice enough but have no ability to really help. We have three family members on meds for multiple years. Ambetter denied coverage even though they said the meds were covered when we were choosing carriers. Our doctor has sent pre-authorization forms in but they Ambetter had no record. How can you be HIPPA comment if you lose authorization forms?
4 years ago
C DeMeritt Indianapolis, IN
I would give this so called Ambetter a zero if I could. My husband is diabetic. When I unrolled in this plan I wasn told they covered his $1100.00 med. I said great. So I enrolled and went to get his prescription filled.
Well I get a letter in the mail and saying. Now mind you the pharmacist made this final decision. Well wont cover this med because his A1c was not above a 8,5. Well the reason why it wasn't is because he was on this med that lowered his A1c for 3 months. Got free samples. But I dont get how a pharmacist can make a final call on what my husband needs. That is why he has a doctor. Also he is on metformin. The pharmacist says he cant be on both tyoes of meds. Are you serious.
So I pay a monthly premium for nothing. Cause there are no doctors that wont take this insurance.
So I might as well pay out of our pocket. Totally rediculous. So very frustrating.
4 years ago
Kathy Schillo Chicago, IL
I signed up for this insurance company effective January 1st. Got messages to pick a primary care provider. I did but it was not updated in their system. When I called, the customer service person said it wouldn’t be effective until February 1st! So it takes their system weeks to update a doctor’s name? They cashed my premium right away.
Sounds like a scam to me.
They did give me a reference number to use, but when I called my doctor’s office I was told Ambetter would not pay until the doctor was updated in their system so I should wait until Feb. 1st. So they got $700 for January for nothing.
4 years ago
Lori Walker Addison, TX
Doctors listed on the website are not on the plan! Most of the numbers for the doctors are not correct or working numbers. I was on the phone with Ambetter for 52 minutes. I could not find a primary care doctor on their list after calling over 42 of them listed in the Dallas- Fort Worth Area that would take my plan. Even after 52 minutes on the phone and Ambetter calling doctors they were not able to find me a primary care doctor. I pay close to 2,000.00, a month for insurance. The plan says you do not need referral yet all the doctors I have contacted said they need a referral from the doctor yet you can not find a primary care doctor. I feel like this is false advertising and I feel the State of Texas should get involved and a class action suit should follow this scam. Texas Attorney General's Consumer Protection Hot Line at 1-800-621-0508. Because you deserve better than Ambetter!
4 years ago
Carmela Corvato Fort Mill, SC
What a horror, our insurance increased 400% so our only choice was AmBetter. They promise dental benefits up to 1000 in SC but NO ONE takes their insurance EVEN THE NAMES THEY GENERATE FOR YOU AS NETWORK DENTISTS. I called for assistance after the dentist AM BETTER sent me to refused to serve me, I spent 90 minutes ( mostly on hold) with sub par representative who "found me another dentist within the plan" but that dentist declined to take me too. Then I spent ANOTHER 90 MINUTES trying to get that resolved. They put me on hold and never came back on the line. I gave a denral emergency and no one can help. They only pay a small % of tge ER so an ER room visit will cost me 1000.00
The next day I tried again, was asked if I wanted more names. I asked for a supervisor and was put on hold for over 35 minutes. No supervisor ever responded.
I checked our benefits for urgent care and the closest urgent care is 100 miles away. Sorry, they cant help.
DO NOT SIGN UP FOR THIS COMPANY.....THIS ISNT INSURANCE IT IS A SCAM.
They denied my husbands RX even though the " website" includes his medication as pre approved. They wont assist or repond to help getting the RX approved.
Can we file a complaint with a governnent agency? PLEASE DONT TAKE THIS INSURANCE
4 years ago
Shar
This insurance marketplace should be investigating this company for not meeting their standards. This company is so TERRIBLE I decided to forego having insurance for 2020 as they are the ONLY insurance available on the marketplace for the area I reside in. The doctors and hospitals will NOT work with this company (will not contract with them) because the insurance company will not pay the same amount to the doctors and hospitals that all the other insurance companies pay--this company wants too good a deal for themselves, (a better deal/contract to pay the hospitals/doctors LESS THAN their competing insurance companies pay) so rather than form proper coverage areas, they simply provide their insured patients with very, very spotty coverage (INVESTIGATE THEM Health Insurance Marketplace) forcing people to drive hundreds of miles for specialists, and giving them one single choice of primary care physician per town.
I was told by one of the major hospitals in my area, at the beginning of 2019, that I would have been better off having NO insurance company, rather than this company, because they had programs for low income uninsured individuals that would have given me more options at a cheaper price. But because I had this terrible insurance, even though it was inadequate, I could not qualify for the hospital's low-income program. Better no insurance, than lousy insurance, if you have limited income.
After one year of fighting with this company constantly, finding their directories to be downright FALSE, and their coverage so spotty its all but useless--I decided I'd rather pay out of pocket than ever deal with them again.
I'm calling around right now finding various doctors with the lowest prices for uninsured patients, along with online prescription programs versus local pharmacies and will have a game plan ready in case of emergencies. I'll be putting the money aside that I would have been paying this lousy company (for next to nothing coverage) and use that for any doctor visits I may need.
In addition to the lousy coverage area this company has, (because none of the doctors or hospitals want to deal with them) and a directory you absolutely cannot trust, you have to pay 25% co-insurance IN NETWORK using their marketplace plans.
They should be investigated by the Health Insurance Marketplace-- there is no way they are meeting marketplace requirements, I had two companies before them, HUMANA & BLUE CROSS, both through the marketplace and both were a million times better with proper coverage and correct directories.
4 years ago
Kara Maricich Gardnerville, NV
I would give Ambetter a zero star if the option was available. My rates were around 1800 for my two children and I with 7,500 individual deductible and 15, 000 for the family. This company refused to pay for anything. My daughter who has asthma and was hospitalized multiple times as a child was denied having her inhaler covered because they deemed it unnecessary. They are also denying acne medication even though my son has acne and a prescription from a dermatologist. I am switching to hometown health with around the same premium, way better coverage and a 500.00 deductible. This insurance companies only goal is to make money off of people who can actually pay for health insurance and to deny covering everything. Some of our local doctors now refuse to even bill Ambetter because the companay makes it so hard to get reimbursed.
4 years ago
