Ambetter

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.

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!

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.....

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.

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.

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?

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.

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.

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!

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

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.

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.

If you are considering Ambetter, please read this. I've been on the phone for hours each day with Ambetter for almost a month since my coverage began Aug 1, 2023 just trying to get a PCP. That's all...I just need a PCP. That should be the easiest thing ever with health insurance, right? First Ambetter told me that even though my policy says "virtual" for certain visits, that I could switch to an inperson doctor, and they assured me in that phone call (on or near Aug 1) that they had done that for me. Then the next day I called Ambetter to confirm the doctor that the Ambetter rep from the previous day had assured me that I had been switched to was now my listed PCP, but this rep told me that it was impossible for that to happen and the previous rep made a mistake because only the Marketplace could switch from virtual to in person--not an Ambetter employee. So Then I called Ambetter a day or so later for more hours on the phone with them, and this time the rep told me that Babylon (virtual care) would be my PCP. However, on Ambetter's own website, it says that Babylon is no longer in existence, and that all appointments through Babylon had been cancelled. Ambetter continued to give me the incorrect info to contact Babylon for PCP coverage, even though Ambetter's own website said to no longer contact Babylon. So I did call Babylon as the incompetent Ambetter rep instructed me, and Babylon told me that they are no longer in existence, and that all appointments scheduled with them had been cancelled. So then I called Ambetter again (each of these calls lasts for hours because they put me on hold for at least 45 min each time, and then I'm mysteriously disconnected, then I call back, etc). Then after a couple hours, the Ambetter rep confirmed what their own website says, that Babylon is no longer in existence so therefore I can see an in person PCP. They gave me the name of a doctor that accepts Ambetter, and when I asked them to confirm, the next rep said that I had been given wrong info by the previous Ambetter reps, and that I do have to see a virtual dr through Teledoc since Babylon is not in existence So then I spent hours setting up a Teledoc call by following the instructions of Ambetter. When I had my Teledoc appointment, I told the Teledoc doctor that I needed to establish as a new patient with Teledoc. However, the Teledoc doctor told me that NO doctors through Teledoc can be PCPs, and they have NEVER been able to be PCPs. So then I called Ambetter then next day and of course the rep denied that Teledoc cannot be PCPs, even though Teledoc specifically told me that. Then after a few hours of being on hold, the rep told me that it's true that Teledoc cannot be PCPs. HOW IS IT POSSIBLE THAT AMBETTER REPS TOLD ME TO CONTACT THEIR PROVIDER FOR VIRTUAL (Babylon), AND AMBETTER REP WOULD NOT KNOW THAT COMPANY IS NO LONGER IN EXISTENCE. This was their ONLY COMPANY for virtual...but the reps did not know the company was closed. I've wasted literally hundreds of hours on the phone because of Ambetter's incorrect incompetent uninformed uncaring protocol. THEN HOW IS IT POSSIBLE THAT I WOULD SPEND MANY MORE HOURS ON THE PHONE WITH AMBETTER REPS (after the first disaster of their incorrect, or possibly lying info about Babyon)WHEN THEY THEN TOLD ME THAT I MUST CONTACT TELEDOC FOR A PCP, WITHOUT THE AMBETTER REPS BEING AWARE THAT TELEDOC ABSOLUTELY CANNOT BE PCPS?? Are the reps lying to make their job easier and get the customer off the phone? Are the reps that uninformed and complete lack of training to not even know the Teledoc CANNOT serve as PCP (as they insisted to me for hours that I must contact Teledoc for my PCP). Fact: the representatives have no idea what is going on in the company or how to help their paying customers get the services that they are paying for . They don't care. Complete untrained, uninformed incompetence and apathy. Next day: After hours more on the phone with Ambetter, they finally admitted that Teledoc cannot be PCPs and Ambetter gave me the number of a local dr that can serve as my PCP. I went to that Dr yesterday. Today I called Ambetter to update that Dr THAT AMBETTER SENT ME TO as my PCP, and Ambetter told me that THE VERY DR THAT AMBETTER REFERRED ME TO GO TO THE PREVIOUS DAY TO BE MY PCP IS ACTUALLY NOT A PCP, and that his entire practice are specialists. Note: this is the exact dr that Ambetter told me the previous day to go to for a PCP, but the next day, Ambetter is denying the claim and saying that he is not a PCP...mistakenly saying that his entire huge practice are all specialists. None of them are or have ever been specialists. I"ve been on the phone with Ambetter for hours each day for almost a month JUST FOR THE PURPOSE OF GETTING A PCP, and this still is not solved because of all of the ridiculouly incorrect info, incompetence, and apathy of Ambetter. MY ADVICE: NEVER USE AMBETTER AS YOUR HEALTH INSURANCE. Ambetter has mistakenly listed the entire group of PCPs at Athens Internal Medicine Associates (St Mary's Medical Group) as "Specialists," NOT PCPs as they are. Therefore, Ambetter will not allow my PCP there (Dr Brandon T) to make a referral to a specialist for me because Ambetter says that Dr T and all of the doctors at Athens Internal Medicine Associates are specialists, which they are not. I've been sent to the "escalation team" at Ambetter, and they've told me the same thing...that all of the doctors at Athens Internal Medicine Associates are specialists, NOT PCPs, which is entirely incorrect. Ambetter does not care to correct this. Each day for almost a month, I'm placed on hold with Ambetter for over an hour, and each day my phone call is mysteriously disconnected. I call back, and the same thing happens. On Tues Aug 15, I actually got to talk to a live person from the escalation team at Ambetter, and he was supposed to call me back the following dau at 5pm to see if the situation above had been resolved but of course, he did not call me as he said that he would. Ambetter is the most incompetent, uncaring, unorganized scam of a business I've ever encountered. I"ve been on the phone with Ambetter for hours each day for almost a month JUST FOR THE PURPOSE OF GETTING A PCP, and this still is not solved because of all of the ridiculouly incorrect info, incompetence, and apathy of Ambetter. My advice is NEVER USE AMBETTER AS YOUR HEALTH INSURANCE. I've asked THREE TIMES TO FILE A GRIEVANCE BECAUSE OF THE INCORRECT INFO (or lies) THAT AMBETTER HAS GIVEN ME AND THE 40-100 hours THAT I"VE HAD TO WASTE BECAUSE OF THEIR INCORRECT INFO (or lies), BUT NO ONE HAS FOLLOWED UP WITH ME ON FILING A GRIEVANCE ON THIS INCOMPETENT (Imo CORRUPT) COMPANY.

They are terrible. I have the dental plan. Needed an Endodontics. They have one in a 200 mile radius of Atlanta. Made appointment, paid deposit for appointment, doctor didn't show up. Couldn't make another appointment, so I called Ambetter. Spent 1.5 hours with four different people on the phone. First they told me I could go out and find an Endodontic and get them to accept Ambetter terms, I said fine, I will charge Ambetter my consulting fee to do their job. They said no, so they tried calling doctors to see if one would accept Ambetter terms. None would - that tells you something. I asked them for an email, giving me the names of available Doctors and she said she couldn't do that (the person the day before did). She would let me ask why not, and quickly sent me to hold and never came back. I think I will go and get the work done and then take Ambetter to small claims court suing for the medical, time lost from work, and travel costs. Like my son says "they suck"

This is the worse Health Insurance company. I have a lower back pain issue for many months and got this insurance in hopes of finally getting better without going to the hospital. However, their list of providers are very poor and of low quality. Most of them have bad review online, and when you finally have a decent doctor they have a long waiting list for an appointment. So far, many of the treatments or medication the doctors try to prescribe me have to be first approved Ambetter. Really!! Even when they get all the information from the doctor, they still don't approve and you are left untreated. Please, unless you are just worry about minor illnesses, like a cold or the flu, do not get this insurance! They are really bad and omit information regarding the details of your plan

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

On Thursday June 20th at 9:45AM I called in and spoke with a "Debbie", she was so rude and spoke so fast I could barely understand her. And at some point in the call she needed to speak with my husband who was working in the other room. I walked across the house and gave him the phone and with no prior knowledge of how rude she was with me, he was instantly shocked and asked her to please slow down and asked if it was possible to speak using "please" and "thank you" as he always does. She ignored that request, verified some information, my husband could barely understand her, and when he gently asked for her to speak up she muttered some swears and redirected the call to the general 800 number. NONE of the changes were made, she undid 35 minutes of phone work out of spite. We had to start all over with another rep. No one is "monitoring or recording" any calls out of Debbie's line, it's all a big headache (this happened before) and I'm tired of AM Better's lousy service. If changing my PCP is such an ordeal, I can only imagine what they are like when I have something important like an emergency. The bad reviews I have read on here so far are all credible in my opinion. Good luck in your searches :)

Like this article says, Ambetter should be a last resort. It certainly was for me; I signed up for my insurance very late, as my mother cut me off of her insurance without telling me. I was attracted to Ambetter for the low premiums and seemingly comprehensive coverage. However, there are very few places in my town in Tennessee that accept Ambetter, and many of those places are poorly rated, and far in between. I cannot get therapy for my PTSD because no psychologist will accept my insurance. Pretty much anything that’s not emergency-level necessary is not covered by this insurance. The price is nice, sure, but I almost always have to pay out-of-pocket, whether it’s a simple prescription level Ibuprofen or an actual appointment. Being a holder of this insurance leaves me a bit worried about any emergencies that may occur since I do not feel protected or secure with this plan. The lack of a mobile app leaves some accessibility concerns as well, since the website frequently crashes for me and the interface is a little confusing. Ultimately, I came to this website to see if anyone else’s experience with Ambetter was similar to mine, and unfortunately I am correct. If you can, please seek out a better service for insurance.

I am so pissed! I have been fighting with Ambetter for years. I tried to go into my account today to make sure nothing was wrong. Because they are constantly putting in the wrong information. One hospital claim wasn't even mine. It was another patient!! Well I couldn't go into my portal because It states it didn't exist. So I had to call them again. And now they said my account is suspended!!! They said I didn't make a payment. I even paid 8 days before it was due! So then they said the marketplace said I had two accounts. I called the Marketplace and they said NO WAY. That my account is up to date and no issues. So Ambetter had to go into my portal because I couldn't. After 5 phone calls they said that my 2016 policy information is in my 2019 portal. And they don't know what happened. I have a Dr appointment this Wednesday and prescriptions that need covered. But they said it will take up to 10 business days to fix my account!!! Which I do not believe!!! And I cannot see a DR or get my scripts until it is fixed. I was given no reason this happened. Just that they messed it up AGAIN!! This insurance company is messing with people's lives and no one makes them accountable! GOD HELP US!!!!!

This is the ABSOLUTE WORST INSURANCE EVER! WE LIVE IN TEXAS AND MY HUSBAND WENT INTO SEVERE ATRIAL FIBULATION IN SOUTH CAROLINA AND HAD TO HAVE A CARDIO VERSION. AMBETTER HAS REFUSED TO PAY BECAUSE WE WERE OUT OF STATE. FIRST THEY SAID IT WAS BECAUSE IT WASN'T AN EMERGENCY; WHEN THE CARDIOLOGIST PROVIDED A LETTER SAYING IT WAS THEY STILL REFUSED TO PAY. WE NOW OWE A HOSPITAL $10,000.00 DESPITE HAVING PAID AMBETTER FOR A LONG TIME ALMOST $1,000 A MONTH. ALSO, MY HUSBAND WAS TOLD THE HOSPITAL HE GOES TO IN TEXAS WAS COVERED AND THE CARDIOLOGIST HE WENT TO IN TEXAS WERE COVERED-THEY WERE NOT AND CLAIMS WERE DENIED. SO FAR WE HAVE RACKED UP OVER $18,000 DUE TO UNPAID MEDICAL CLAIMS BEING DENIED BY AMBETTER. ONE STAR IS ONE TOO MANY!

Had them for years then I got a little behind on my payments so I worked a second job to catch up every thing. Missed a dead line when I made the last payment by 4 days and they sure used it to cancel me. Wouldn't work with me at all. It was my fault for not reading all my paperwork and seeing the deadline(I was working two jobs ) ,but 4 days late on a payment and won't work with me at all. I made the payment on 8th of the month evidently my deadline was the 4th,but it took my payment and then didn't tell me I was cancelled till the 18th of the month. Way to have a heart Ambetter You were lucky to have us we're healthy and hardly ever used it.

Apparently any income (taxable or not) will reflect on your assistance. Had several people I work with in tears this year as they were handing over $1000’s at tax time. Also, terrible network (all the worst doctors in your area) and the website never works. Plus you can expect to jump through hoop after hoop after hoop trying to prove who you are and your income, ect. You will either stay on hold forever or find yourself using a website that never loads. Only to find yourself facing another bureaucratic hoop. We had to cancel in May because we couldn’t get on the website to upload our information, and when we tried calling we were told that was the only way. $1000’s thrown down the drain in bills and taxes, and the policy was more expensive than if we had both paid for several visits and medications out of pocket!!! Awful, terrible company!

I have had Ambetter for 16 months and have not been successful finding any ob/gyn in Dallas. Even when I call them, they supposedly call the providers and verify that they take my insurance and then when I call to make an appointment, they don't. The same is true for the website. None of the people on there actually take my insurance. I'm starting to think the Texas market is completely fake. I need to see someone and am long overdue. 8 hours this week alone, with Ambetter customer "assistance" trying to make an appointment and no success. One person they gave me was only high risk pregnancy and I'm not pregnant. I tried all of this last year and eventually gave up because I was so frustrated. I pay $717 per month and have no illnesses or medications yet they can't seem to assist me in getting my annual exams. I will probably go to Planned Parenthood and pay out of pocket at this point, even though the annual exam is a benefit. I guess it's a hide and seek benefit. If you can find a doctor you can have it. This is how they save money, by taking all of mine and being a fake insurer.

If I could give them a negative rating I would. I have been trying to get in to see a doctor since January 22, 2019. Today is April 12th. I finally found a Dr. that takes Ambetter whose new patient wait list isn't 6 months out. Yes that is correct because I am a new patient to these physicians, the earliest I could be seen was August 4th. (Seriously!!!) I got an appointment for April 15th, received a call confirming the appointment on April 11th, Call from Dr's office on April 12th canceling the appointment. Reason - "the Doctor will only be doing physicals and since you are not here for a physical she can't see you!" Unbelievable!!! I am not giving them another cent! The worst insurance ever!!!

If you are looking for Health Insurance do not pay your hard earned money to Ambetter. As many of you know, in October 13, 2017 I was working in Dallas, Texas. I had placenta previa (where the placenta is near the cervix) and had painless bleeding. I had to go to an Emergency C section and as soon as I found this out I called my husband to inform him and he also called our insurance Ambetter to be added on to our insurance. It was approved for her to be on our insurance. Months past and the hospital filed the claim but Ambetter denied it Baylor S and W filed multiple claims and Ambetter had multiple excuses (hospital didn't file on time which they did in that 90 day period, baby's name didn't not the claim, the baby's birthdate didn't match the claim, etc.) THEY REFUSE TO PAY AND MAKE ANY EXCUSE IN THE BOOK TO DENY CLAIM. AMBETTER IS SUCH A SCAM.

I have been in a fight for over a year for them to cover a bill I am not responsible for. I found a primary doctor and called in to have the customer services rep make sure she was listed as my primary as the website function never changed anything. After this approval I went to the doctor only to receive a $108 bill a few months later for a new patient service. I had a $1 copay. I called to have them fix this error. Apparently my Doc was not listed as "in-network" until months after I saw her. Why did they approve her as my primary? Why was she listed as in network on their website? Why am I still trying to get this dealt with 12 months later after 4 appeals and 3 grievances? Oh, and that bill has since gone into collections and is now affecting my credit score. Thanks Ambetter! You are the worst insurance I have ever used!

Today is April 8th, 2019 and I called Ambetter twice and their system was down. I have written six complaint letters to Ambetter concerning their terrible services and none have been answered. I have been denied services and prescriptions after having paid my premiums. I have had to call a total of nine times to establish a primary care physician. Each time I call the representative it is always an incompetent human being who is unable to remember the reason I called or that I had already established a primary care provider on a previous call weeks ago. A supervisor whom I escalated the issues to was rude and nasty to me. After having paid for my insurance, my provider ran my insurance through Availity and is was showing me as inactive. Ambetter charged me twice for one month of service and still showed me as inactive in their system. I have requested my ID card three times and it has been over a month, I still do not have an insurance card. These are just some of the few issues that make this the worst insurance ever.

Terrible customer support service. I have had this insurance for 4 months, and I have never once been able to login successfully to my member account on their website. I called multiple times for help, and each time I got the run around and horrible communication. They would say they are creating a "ticket" and that they would follow up with me via a phone call when my problem was resolved, but they never called back, and the issue after 4 months has still never been resolved. I still cannot login. So, I haven't been able to pick a Primary Care Doctor or see anything related my coverage online. The customer service representatives have been rude, inconsiderate, unsympathetic, robot-like, and unwilling or able to resolve my issue. As of writing this review, the problem is still ongoing. I cannot stand this company and their customer service. DO YOURSELF A HUGE FAVOR AND STAY FAAAAR AWAY FROM THIS COMPANY. The worst. Ever.

Ambetter is a fraud of a company. I have been trying to get an infusion for the past month and nothing can be done because: 1) the infusion centers that can administer the medication are not in network or 2) the infusion centers that are in network cannot administer the medication. I have spent countless hours on the phone with them trying to find a place that works. When I call they give me a list of infusion centers that are supposedly in network and then when I call these centers to use their facility they tell me that they are not in network. They have even given me centers that no longer exist! I am very very frustrated. I have been waiting for over 30 days now for a medication that has a rush on it all because my insurance company can not find a place for me to do my infusion. When I ask to speak to a manager they send me to the resolution center. They are insensitive beings that do NOT care about your health or wellbeing and only want your money. This isn't even about money its about finding a place to receive my medication. And because of Ambetter I am left in the wind..What to do now? I don't know

This company is an administrative nightmare. They can rarely find you in their systems and online access is very far behind piers. I got locked out of my account for some unknown reason and had to wait 24 hours to access it after customer service reset it. A month ago they canceled my policy and couldn’t even tell me why. Later I found out the exchange forced them to cancel it because I didn’t provide my ss# when I signed up. Ironically the week before I got my form 1095-a from the exchange that guess what had my ss# on it. Unfortunately, this is what happens when choices get limited because of obummercare. I guess they are used to working with people who get their insurance for free so they have very low expectations anyway. Not this guy!

They are waiting for my wife to die. They will not even approve diagnostic tests for my wife who is having heart problems. We have a great hospital 8 min away,but Ambetter does not approve. There are approved doctors in our area, but they don’t have access to the nearest approved hospital which is over an hour away. I despise this company and will launch a 100 million dollar lawsuit if my wife dies while waiting on them. Wake up America! This is Socialism! Ambetter was the only ACA company in Georgia this year. They are getting almost $1600.00 a month subsidy for us. For what? Our doctor, which is not in their network, told us that Ambetter is turning down treatments all over our area. I’m contacting my Congressman next.

They r a terrible company. They have denied almost every claim my doctor has sent in. I have a herniated disc and they denied the MRI. I had to go pay for it out of pocket. Then they denied when he sent in for a procedure to help me. This company does not care about their clients when you call in they don't care all they care about is getting your money doctors are even fed up with this company it is the worst company we have ever seen I know a lot of nurses they say this is the worst company they have ever had to deal with if you are smart and you want a good company you will go somewhere else everything you will regret getting insurance from this company

I have has ambetter for 3 years and it is wonderful! I have lots of doctors to choose from and they pay alot on my Bill's. I love they rewards programs as well!