Ambetter
4.9
Overall Score
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Kay Anderson LaFayette, GA
Was told by Ambetter Dr. Wayne R in Trion was in our network. Made the appointment after driving 20 minutes and when my husband and I show up, we were told Ambetter had Dr. R's address wrong. Therefore, they could not get paid until Ambetter corrected. The doctors office had called already and gave Ambetter the correct information; however, Ambetter had not made corrections. We left after making the appointment in December for our January appointment, so we could get med refills. We planned ahead, but it didn't pay off. Thank you Ambetter. You receive $1500 per month and we get nothing in return really. No doctor I've ever seen is in our network....not one! We are from a very small town and now have to travel far just to see a doctor. So miss Alliant!
5 years ago
Katie Mesa, AZ
Trying for 3 weeks to get a pre-authorization for a biologic medication that I have been on for 4 years and for 2019 they told my doctor I don't need a pre-auth; however, I know I do, as it is an expensive medication that is done by infusion. I called Ambetter myself and have been given four different answers! I have two weeks until I must get my medication and they are either totally inept or totally trying to pull a fast one (as in, telling me I don't need a PA, I get the infusion and then they tell me they won't pay it because I didn't get the PA). My next step is to file a formal complaint with the AZ Dept of Insurance, as I cannot deal with this runaround and my doctor's office has spent over 10 hours on this!
5 years ago
Peter Ko Peachtree City, GA
A very bad company, trick their customers with their reward program. I spent half hour in front of the computer to finish a health survey for $50 debit card reward. They sent me the card because I earned it by spending my time and effort to put in my health data. However, when I did not enroll with their plan in 2019, just a few weeks ago. They suspended my debit card, claiming it is their policy. How could they take away something you earned? This is a total greed for such large company. It is ashamed for company with such deceitful practice to their customers. I wish government can take some action and punish their bad business policy.
Everyone be aware and used up your reward debit card immediately. They deserve no star but I cannot move to next page without picking a star.
5 years ago
Laura Wellsville, OH
Our family recently picked up this insurance through open enrollment. I wish I hadn't. We pay nearly 400 a month and have to drive 4 towns away (passing a non covered hospital on the way) for hospital care in the network. To get to a dermatologist, I have to drive over an hour away to towns I've never heard of. As for a PCP, they aren't far away but they are only affiliated with the hospitals that are not on the providers list. What's the sense? One or the other won't be covered either way and that's after the 6000 dollar deductible. I don't know what to do. I been crying all year with this possibility of breast cancer coming back.
5 years ago
Casey Raleigh, NC
If I could give a zero I would. My daughter has had a heart condition since I was 24 weeks pregnant. She requires medicine and visits to a pediatric cardiologist monthly. When her cardiologist said they would not be accepting BCBS anymore they recommended Ambetter to us. To our surprise when we went to ask for her medication that she needs to LIVE be covered they told us that they would not cover it until we met our $6000 deductible and even then they may not cover her cardiology appointments. What?!?!?!? How is that ok?!!! I am filing a lawsuit. They should not be allowed to offer coverage when they literally cover NOTHING! You pay totally out of pocket until your deductible is met. And I mean YOU PAY FOR EVERY SINGLE DOCTOR VISIT. There is a special place in hell for the people behind this scam.
5 years ago
Dacia Kirkland, WA
Zero stars for this fradulant company. I purchased a plan from them that would cost me $140 a month for my premium, they changed the rate to $318 a month and said I pay the updated rate or I lose my insurance. I explained it is fraud to add to the cost of my plan. I signed up for the specific plan based on the monthly premium, that is where I signed the T's and dotted the I's. I will not pay more then the $140. Lucilky the health exchange is resubmitting my paperwork to them, if ambetter does not abide by our agreement then I can get new insurance through a special Enrollment period. I will never choose Ambetter again. Horrible company with customer service worse than any company I have ever felt with.
5 years ago
Erik D. Hamilton Lynnwood, WA
This company is absolutely a trash. I called both the WAHealthPlanFinder and Ambetter to cancel my policy on last October. Today, they just sent me a bill saying they just renew my policy for the 2019. Because I forgot to turn off the auto-payment, they just come and take my hard-earning money. I don't even give a hint that I need their health insurance. After looking at the reviews, I find hundreds of people have the same situation as me. I really cannot trust to give their my bank account as well as personal information for them right now. I will call them back tomorrow to ask for the refund as well as delete any tie I have with them as soon as possible.
Now I understand when people say I should read the bad review first before I buy something for me and for my family.
5 years ago
Stephanie Jacksonville, FL
They never update their website. If you think that your doctor takes ambetter just based on the website think again. You need to call you physician because ambetter will never take that physician down and they trick you into thinking you’ll be covered. I went to a certain place for an eye exam but before we started they asked for my insurance and I gave them my ambetter card. The looked at me and said we do not take that. I showed them the website and they asked to call ambetter to see what was going on. Turns out they don’t have a contract with this eye place. SO WHY IS IT ON THEIR WEBSITE!!!! Luckily the people I speak with are nice but they can’t help you. It’s like ambetter knows not give there employees to much abilities on their webpage because then those people could actually help.
5 years ago
Max Lohr Dallas, TX
I have used Ambetter by Superior before and it is cheapish and stingy when the doctor asks for anything special, but generally it is OK once 'proof' has been given that XYZ is needed.
However, the place is run by malicious idiots who use helpess telephone minions to make false apologies about even the worst and most harmful malfeasance.
In 2017, they double charged me for January 2018, and it took 2 months to get that straight. I let it go. It was a small amount.
This time, they have surpassed themselves in malfeasance, tinpot-baron-robbery, and chicanerous corruption.
Today December 17, 2018, Ambetter fraudeulently debited my family bank account for over $860 in advance for the January 2019 payment. This is fraud because the correct and contracted-by-the-US-government amount for the first month was less than $50. They have stolen the $860 only 8 days before Christmas. The funds were not all going to be spent on the Holidays, but some of them were, and they are now gone.
Their telephone minion and his flightless bird of a higher-up just hold out their hands (figuratively) and say they can do nothing about it for some unspecified time of 5 to 10 days, which, based on past experience, likely will be at least as long as 10 business days.
That's funny, as in a devilish joke. Their computer snatched the bucks out of my account in a blink of an eye, and so surely it could replace them as promptly. But no, that would require personal attention and the intervention of important decision-making and responsible persons inside Ambetter. I suppose Ambetter's MOUTH works when it's time to consume funds, but Ambetter's OTHER END does not, due to corporate constipation. Like a rodent, Ambetter is also unable to regurgitate that which it should not have eaten!
The minion also told me what happened -which he should not have.. There were two figures for the monthly cost that showed up in their broken-yet-again computer system, one correct, and one incorrect at 71 times the rate, and instead of them investigating that obviously confusing situation, some other minion simply decided with no further checking, to have the computer simply withdraw the insane 71x amount. He said that this is a growing trend, this sort of "error". So they know about it!
My family's custom regarding holiday and celebrations expense is that we do not to use credit cards for them. We put aside $ and use a budget, and we really do have very fine celebrations to which we all look forward. No debt.
So you can see where this is going. Ambetter is "the grinch who stole Christmas", and indeed, most of January! However, we will not be put out of good cheer this Season, because we know what the Season is for. It's little comfor that Ambetter will be getting a switch and lump of coal and a whipping from Krampus.
I had to call the bank and report this fraud. The bank has temporarily replaced the funds, so at least our plans won't be disrupted for now. All of the emergency worry placed upon us by Ambetter is not appropriate.
5 years ago
Linda D Cantrall, IL
Ambetter is a huge headache when trying to help a parent to at the very least enroll. Ambetter sent an invoice that was not received due to being out of state and mail was not collected properly. Ok...our fault. Then sent another invoice that included the first invoice and a new total that included a price difference for a new health bracket that he qualified for. Ok... no problem. The invoice was mailed with a ck to cover the total right away. A couple weeks later a letter is received stating that the application for the ins. was not processed due to the lack of payment of the first invoice. Umm...the first invoice was paid with the revised invoice. A week later another letter comes stating that the coverage that was applied for is not longer available, so if you don't contact us then we will just enroll you automatically into something of their picking that will actually be better for him. Okay no problem.
2 days later a ck and a letter stating that the actual ck that was received was an over payment of the invoice and because you didn't pay that first invoice that was not received, you get no insurance and have to start all over again!
I spent several calls and hours on the phone between Ambetter and Marketplace in reference to just getting him enrolled and why the ck was sent back and denied all together. One pointing the finger at the other and it's beyond words that I can actually post on here. So if you are helping a parent or trying to get this insurance yourself look elsewhere or if you have to go with them keep a close eye on them and write down everything you can about your call if you have to talk to them. Oh and for those trying to help out a parent or member, they say you have 24 hours of authorization from the member. Nope. You have until 10pm central time that day. As for question #4 below, It shouldn't matter if you are a paying customer or not.
5 years ago
Mitch Federal Way, WA
Every interaction with Ambetter has been a nightmare. You have to contact customer support anytime you need to do anything online because their website is so bad. It seems that anything that might cost them money is burrowed deep into the darkest corners of their site where you would never find it without guidance. In addition, customer service does not respond in a timely manner and is never very helpful. Right from the start I knew they were shady when I signed up for one price and SURPRISE, next month my bill is 20% higher! Not to mention the health providers covered are poverty status. This company preys on people that don't really have any other options. That way they can charge whatever and treat you like garbage. DO NOT USE AMBETTER!
5 years ago
HealthIsABlessing Acworth, GA
Complete waste if money every month. Living outside the perimeter of Atlanta there are only 2 insurance plans available. Kaiser HMO and Ambetter. Refered to as AmGhetto. Our premiums are what a typical mortgage payment would amout to. Nothing is covered and no top rated providers are accepting it...not even the Walmart Care Clinic will take it. We consider ourselves "self pay" in order to get a reduced rate to see quality docs. Thankfully nothing catastrophic has occurred because I have a feeling our local hospitals would not accept the plan. Soooo.... forced to buy an expensive and useless plan through the marketplace that no one accepts, where we would have to spend nearly $12k in premiums and deductible per year before they pay the 1st $1 in reimbursement. Yeah that makes sense. I want my individual plan prior to Obama care back that was reasonably priced, that everyone accepted, and covered everything.
5 years ago
Ryan Ansonia, OH
My daughter has Crohn's and has had 8 remicade infusions this year at Dayton Children's, all were pre approved and it still shows no payments made, all payments are pending. First treatment was in February, When asked, they say they are still in negotiations, in negotiations since Feb?!?!?!
They also refused to pay a bill to Cincinnati Children's (out of network) By the way, Cincinnati Children's is the number 1 children's hospital in the country, but they are out of network?!?!?! I urge everyone to bombard their advertisements on Facebook with their complaints and concerns, I did that and was messaged right away. Their member services contacted me, it was obviously no help, but social media is one way to let the world know about them and also maybe get them to act.
Another fun fact, they have to give the Ohio Department of Insurance's phone number on their website, when you call that number you get a survey company that wants to give you a "free" cruise. I dialed a couple times and so did my wife to make sure we didn't misdial.
6 years ago
Theresa
I have been trying for 3 weeks to find a neurosurgeon with Ambetter, all the ones listed are no longer with Ambetter. I was told that I was referred to a member advocate to find a neurosurgeon that would take my case, my neurologist suggested a Dr. in his area but he would not work with Ambetter. I have been on the phone for 4 hrs. today with supervisors trying to find out why no one has followed up on this. When trying to follow up on this for the 3rd time today. I reached an advisor who told me that open enrollment started today and I should switch insurance. This company should not be allowed by the Florida Insurance Agency to sell insurance in the state of Florida.
6 years ago
Chung Lim Norcross, GA
Ambetter couldn't consistently provide access to healthcare for my 2 year old. Earlier in 2018, I was prompted to alter my current plan to include my 2 year old . The process to include him was fraught with error and employees who meant well but really couldn't help.
I spent hours on the phone with membership services and enrollment, bouncing back and forth because no one knew the number of the appropriate department that handles modifications to existing accounts. And I really mean not a single person. Not the membership/customer service reps, enrollment department, managers, supervisors, and not even the director. Well at least I'm sure that is what they are trained to say.
To give you an idea of how bad it actually is, I spent over 3 hours on the phone today because my 2 year old son's coverage was mistakenly voided, without any notification, even though all bills were paid on time.
When I called and asked why was he dropped from coverage, the membership service rep claimed that the change may have from the Marketplace. Really?
Ok, I contacted the Marketplace to see if any new direction came from them. NOPE. That was an outright lie.
According to the Marketplace, their last communication was dated, May of 2018 and it informed Ambetter to include my son in my current balanced care plan via a completed escalation.
It clearly laid out retroactive starting dates, insurance rates, who should be covered, etc. That information was transmitted to them on more than one occasion, dating back as far as March of this year.
Nothing indicated that my son should be dropped on Oct. 30th, as the customer service rep suggested.
I contacted Ambetter membership services again but this time I did so via a three way call with a Marketplace supervisor. This supervisor actually said, " We've been getting nothing but the run around for nearly 2 hours." Eventually, and perhaps by error or overwhelmed by the complete drudgery of it all, she quietly disconnected.
This is all true. I don't have a history of any particular bad luck and I am by anyone's standard a good person. Personally, I don't bear any malice to the folks that work there. They really tried to help but they weren't given the appropriate venue to succeed or to be honest. That's what Ambetter is.
The part that really breaks my heart is that the only person who was penalized by all this was a 2 year old boy.
Prior to this fiasco, I never had any problems like this.
If you have kids ... don't walk away, run.
6 years ago Edited September 14, 2021
Luis Chicago, IL
My rating would be zero stars of i had the option. TERRIBLE. My recommendation is to avoid it at all cost. I recently had to look for a specialist. I called 3 separate imes. Each time they would give me contact information on two to three doctors. When I called each one of the doctors in the list, the doctor would do not accept the plan or the doctor no longer worked there. When I lost my patience and called a fourth time they transferred me to another office where they said they would find a doctor and would make a contract with him/her to take me. I waited for a day and a half and finally went to see a doctor and paid out of pocket. This insurance is the same as not having any.
6 years ago
Kenna Denton, TX
I would give a 0 if possible. My insurance was dropped because my husband started Medicare. When he called to remove himself, there was no mention that my and my two dependent children’s coverage would be cancelled. When we found out it was canceled, we got myself set up on a new policy. They never mentioned that they were not going to still use the same credit card for the payments, so then my insurance was invalid for a little while because no payment has been made. When I found out about this, I contacted the insurance again and added the credit card back onto the insurance for payment. I then received when we found out it was canceled, we got myself set up on a new policy. They never mentioned that they were not going to still use the same credit card for the payment, so then my insurance was in valid for a little while because no payment had been made. When I found out about this, I contacted the insurance again and add a credit card back onto the insurance for payment. I then received two bills - dated one day apart. I don’t even know where they pulled the numbers from her for the bill and there was no explanation. The amount was over twice what my policy is. The bi I don’t even know where they pulled the numbers from for the bill and there was no explanations. The amount was over twice words my policy is. When Bill was dated a day earlier than the first and said that the first bill had not been paid so there was a penalty. Medicine that cost me zero dollars just a month ago now cost me $24. Now when I called two days in a row to find out why I had to pay for this prescription and why I receive these bills, their whole system is down and they can’t figure out anything.
6 years ago
Doug T. Tucson, AZ
Ambetter called me twice to inform me that since I am over 60, I should get a colonoscopy which would be an insurance covered procedure. They did not tell me that if a polyp was found they would refuse to pay for the procedure. I had the colonoscopy, a polyp was found and now I have a very large bill to pay which was a totally unplanned expense for me. The doctor was demanding his money so I had to pay him with a credit card and will have to quit taking blood pressure and cholesterol medications and quit checking blood sugar until this is paid off. There is probably no reason to see a doctor if I can't afford the meds, so I can save the physician co-pays as well. Fortunately, I don't have to worry about dying from colorectal cancer and with any luck I won't have a stroke before I can get back on my meds. The polyp was very small and was unlikely to have ever caused me any trouble. I wish that I had never let the Ambetter employee talk me into getting a colonoscopy, as I am now in a worse position than I was at in the beginning. I have appealed this decision but it will take months for them to decide.
6 years ago
FAISAL Des Plaines, IL
Worst company ever !!!! They employ people who doesnt know anything. they put you on hold and transfer to anyone who is not part of Ambetter. like in my case they transfered me after waiting long to any Housing company. Guys dont waste your time. they screwed you. for 8-9 months they keep on telling that we send claimed amount to hospital and after 8 months they said you have to pay them because deductable doesnt meet. I was very upset. Even you will not get response for your grievance. I had acknowledgement letter stating you should get reply in 60 days, almost 90 days -NO REPLY. you have to call them again and again. because they are just interested in making money. BEWARE OF THIS CHEATER COMPANY !!!
6 years ago
Patti Lilburn, GA
I gave it a 1, but I really want to rate it a "0". It's like paying a premium to have not coverage at all. None of the doctors take it (or only the bottom of the barrel offices do take). My pediatricians office applied to be able to take their coverage and they were denied. Why deny an office who wants to take your insurance and provide that to their patients? I emailed the company about this and NEVER received any email or call back. Something is not right about this insurance. We paid for almost all of our medical coverage this year out of pocket because practically nothing was covered.
6 years ago
Gail Johnson Hudson, FL
They list so many doctors as taking the plan! Most of the doctors/providers DO NOT TAKE this plan. I have been calling them for over 4 months trying to get assistance in finding a specialist in my area. They have swept me under the rug each and every time. They claim to "escalate" your problem and assign you to an advocate. You will also be give a "refence number". This does you no good as there will be no records kept of your phone calls and what actions taken on your behalf.
As a result of not having required medication, I have had two seizures!!! This is beyond ridiculous, as well as dangerous for my well being. I plan on taking this to the Fl Insurance Commissioner, social media, and the news if need be.
6 years ago
Daliah
I can't add much more than has been added. This insurance is terrible. My husband's pain Dr. is on the plan because he chose to be for my husband. I am trying to find him a primary care physician and cannot. There are plenty listed close to home, but when I call, either the number is not working and the provider actually is in Houston or El Paso and I'm near Dallas. Or they answer the phone and are not and have never been, on the plan. Found a dr. just by looking online and called because their website said Ambeter pending. I crossed my fingers and hoped it was no longer pending. Nope, sure wasn't. They decided after repeated tries to get onto the plan, to no longer try since Ambeter was unresponsive. I have been looking for a doctor for over a year, this is ridiculous. I get excited when I see a new dr. listed on the website, only to see it's another bogus listing. How is this legal to lie to everyone about this. If I could afford it, i would put him on my work health insurance. At least then he'd get drs. But I have a $5000 dedcutible. I have BCBS PPO, everyone take that. So we pay $500/month for his useless insurance. I feel like we are throwing money away that we can't afford to spend to begin with.
6 years ago
anonymous Arlington, TX
Worst company ever. Send endless messages to member benefits through the online portal and they are ignored even after getting an auto-response that says they respond within 1 biz day LOL. Supervisor handling my case promised to call me back and never did. Impossible to get hearing aids even though my policy clearly says they are covered and I went to an in-network provider. NO ONE knows anything at this company. Total incompetence. Still waiting on an answer online and I've given up on ever being called back by the supervisors. Broken promises and despicable sorry excuse for member service. IN addition, ambetter provider services REFUSED to give an IN-NETWORK PROVIDER the proper pre-auth code for an adult hearing aid as opposed to one for a child!!!!!!! Aren't they supposed to work together with their providers!! Why are they keeping it a secret from their own provider!! UNACCEPTABLE. This company promises everything, then does everything to avoid paying. This is borderline Fraud. This is not insurance!! It's a racket!!
6 years ago
Daveretired Phoenix, AZ
WORST COMPANY EVER. Called in July to have me dropped off the insurance due to going on Medicare. My wife would still be using them until next year when she goes on Medicare. She called in Sep to check on some services she needed done and finds out she had been canceled all together. When she asked why, they told her the bank took the payment back. I checked our bank and found the payment was taken as scheduled and Ambetter returned it. Now they tell her she has to reapply and be approved all over again. They screwed up and won’t reenstate her, claims she has to wait for open enrollment. What gets me is, they claim we were canceled after we called to drop me. However the policy was canceled a week before we even called in and they had my current months payment. I don’t understand how this company is not being investigated by any government agency for the bad business practices this company does.
6 years ago
Aaron Nashville, TN
I moved to a new state where Ambetter does not provide coverage. In this new state, I signed up for a new policy through the Healthcare Market Place and cancelled my Ambetter policy, effective the date of the new policy. Ambetter continues to bill me, the amount due accruing each month. I have called their customer service line for four months in a row and conferenced in three way with Ambetter and the Healthcare Market Place. When we are on the phone, the Healthcare Market Place says the policy is cancelled and Ambetter says they will follow through with their part. Then they mail a letter saying request for cancellation is denied. I have spent over 3 hours on five phone calls with Ambetter and they are condescending as well as incompetent.
6 years ago
Pam Houston, TX
So you guys actually found doctors??!! I am in Houston, TX and have been searching for WEEKS. Every time I choose a doctor, the number is disconnected, the company name has changed, the doctor is no longer there, etc etc etc SERIOUSLY? There is NO WAY to reach these supposed doctors?? I am a recovering breast cancer patient, who had the best insurance during treatment, but no longer have a Corporate job, so am stuck with this crap? Ambetter is asking me to see a nurse practitioner instead of a doctor? BECAUSE THERE ARE NO DOCTORS. This is nuts. I am at high risk for other cancers, and have NO HELP.
6 years ago
Frustrated In GA Kennesaw, GA
THE WORST INSURANCE EVER!!! AVOID IF YOU CAN!! No one knows what day it is or what they are doing. I'm having to pay around $500 per month for insurance that doesn't cover any of my Dr's or much of anything else. I didn't have a choice & was forced to switch to them. I was assured I could keep my Drs & that my illnesses would still be taken care of. All lies! Then when you try to get a new Dr you have to pay full price as if you don't have insurance because they aren't paying the Drs for their appointments!! We already learned that they were TERRIBLE IN EVERY WAY & THEN THE HOSPITAL TELLS US MY ER VISITS AREN'T COVERED BECAUSE CRAPBETTER REFUSES TO PAY FOR ANYTHING!! I made sure to pick a plan that would cover my Drs AND the hospital visits. Waste of money & extremly frustrating!! WE SHOULD BE SUING THEM TOGETHER!!!
6 years ago
dan Marble Falls, TX
I have one horrible review on Best Company against Ambetter about denying a pain med for my wife's back from her pain doctor. Well this time I went to Ambetters websight and found the generic version of the pain med that was denied last time. Ambetters web-sight states that the generic brand is covered and should have a $10 price tag to me. Sooo at the pain Dr. we request the generic brand and all should be good you would think. Wrong again Ambetter refuses to pay for this generic brand. I call them and push to speak to a supervisor and a women comes on the line and asks how she can solve this problem. I explain the problem and she then has me walk her through the steps to where I found it on Ambetters websight that it was covered. This supervisor agrees that I am right and according to their web-sight it should be covered. Now here is where I got screwed again. It seems Ambetter contracts out their prescription services to another Superior owned company and because that company says it is not covered WELL IT IS NOT covered even tho Ambetter's web-sight says it is. So once again this insurance that is costing me $1531.0 a month has screwed me. Like Isaid on my last post and will say it again DO NOT EVER BUY ANY INSURANCE FROM AMBETTER OR ANY SUPERIOR COMPANY.
6 years ago
Christopher Rosharon, TX
The coverage is worthless. They advertised a $0 co-pay with your pcp, Specialist $5, RX $0 for generic, $0 for ER after deductible. NONE of the local area hospitals accept their coverage so what good is the ER coverage? Also, much of the physician office contact information they give you is bad or outdated and they refuse to email you to information even though you have already paid for coverage. That last part is total bull if I have ever seen it. I bought coverage with Ambetter for Superior Health Plan and I was never able to use it AT ALL. Every time I attempted to use it, I would run into a problem with the provider or they would tell me they do not accept my coverage. I paid for four months of coverage for my children and I after I lost my private coverage with my employer. Either the provider could not be reached or they gave me a long run-around and I did not get the services I needed. I am extremely disappointed because I ended up wasting over $1000 in premiums on this coverage and it was completely useless. My children are now on Medicaid and I am currently uninsured. We are on social security and they robbed us of money that was much needed for other expenses. We should sue them for false advertising, really. Be extremely cautious before you purchase coverage and make sure you read the reviews. I cancelled mine today and that is the best decision I have made to date regarding my Ambetter Coverage.
6 years ago
Becky Williams Springfield, MO
We are a provider's office and we are supposed to have a contract with Home State Health Plan through Ambetter and it's supposed to be effective 1/1/18. We have never been paid for one patient seen. They still have his name incorrect on the website and still show that he is out of network. When trying to communicate with the Provider Relations Department, I get cut off after a message that says, "due to unforseen circumstances, the call center has closed." We have patients that need treatments and instead of them focusing on getting better, they are worried about their insurance not paying the claims. We have never had such a horrible experience with an insurance company in the 27 years I have been in the medical field.
6 years ago
Brett Ballard Dallas, TX
In Dallas. Went via ambulance with chest pressure to an “in network” AM Better hospital. Was told that I needed bypass surgery. However, the hospital discovered an infection in my back that needed to be cleared up first. Sent me home with IV infusion therapy. While at home, I discover that my cardiologist and the only heart surgeon at the hospital are NOT covered in network. I kept getting the run around from their inept and rude CSR’s. The doctors office had to confirm they “no longer accept” AM Better because they don’t pay claims. Also was told by a CSR that my heart bypass surgery was considered ELECTIVE even though I have 100% blockage on one side and 55% on the other. She advised to - and I quote - “WAIT UNTIL YOU HAVE A HEART ATTACK AND THEN GO TO THE HOSPITAL” because then it’s and emergency and not an elective surgery. Unbelievable. RUN RUN RUN. In hindsight, I’d rather pay the penalty and go into a faith based share plan than deal with AM Better.
6 years ago
c grossman Bradenton, FL
I have had Ambetter for 2 years. They are a discount insurance. Most of their current contracted doctors are with the local health department. It is very difficult to get an accurate list of approved doctors. I just called Ambetter for a doctor referral and they gave me 4 doctors and I got 2 more listed on their website. I have called of them 5 so far and none of them actually take Ambetter insurance. Very deceptive.
6 years ago
sarah Dallas, GA
00000000000's. RUN, RUN, RUN, if you are considering getting insurance with Ambetter. Don't ever purchase insurance through Ambetter. It is impossible to get a question answered about anything. It is impossible to get any need taken care of no matter how small or large. You will be on the phone for 15 minutes before you even get an opportunity to address the reason you are calling in the first place. No one accepts them & now I completely understand why. The times I've check I've been told it's because they don't pay their claims. Based on how impossible it is to get anything done with them, even if it's as small as an address change, I can completely see how difficult it might be for a service provider. RUN, RUN, RUN, if you are considering getting insurance with Ambetter.
6 years ago
Vivian Guerra Miami, FL
We have been with Ambetter for 3 years and it has met all our needs. Customer service is excellent and try to help to the max. I did not give it a 5 because their provider list is very limited and not updated frequently
6 years ago
Helen Bryson Lilburn, GA
WORST INSURANCE COMPANY EVER--- Been trying to get an incorrect birthdate corrected since January , 2018!!!!! Keep getting the runaround, first they say they didn't get the files from the Marketplace which they require to change info, second file sent, Ambetter saying they didn't get that file either. The latest excuse is that it is a "known Computer issue" and "everyone knows about it". So if it is a known issue why can't IT department do a patch or issue a workaround!!!! Or why can't a note be entered into the system noting what the correct birthday is so claims can be paid???? This is the WORST company I've ever had to deal with and I've been in Healthcare for 44 years. All you get are excuses . I am the successor agent for Healthcare for my sister in law who is the paying customer for this Nightmare. And by the way, my brother has paid the denied claims, so how is he to get reimbursed for monies paid due to this company's incompetence.
6 years ago
TAustin Scottsdale, AZ
It's sad that health insurance is so complicated in the United States. There are so many problems with Ambetter in terms of customer service, lack of providers that are near your place of residence, and very much a bait and switch operation in terms of QUALITY Healthcare. Paying $1500 premium for a healthy family of 4 in Arizona with providers that don't take health care seriously is EXACTLY what you deal with on an ongoing basis. It's the definition of INSANITY. This company is taking advantage of the lack of insurance for individual in ARIZONA. It's scary that I have to go to South Phoenix to my OBGYN as no OBGYN's in Scottsdale want to affiliate with Ambetter. When you have relationship with an OBGYN for years, it's uncomfortable to start over. I'm appalled there are no governing agencies that at least have minimum standards that regulate how insurance companies can operate. Ambetter is taking advantage of Arizona individual insurance as we have no LEGIT insurance companies that want to contract in Arizona. Why our Senators can't figure this out is mind boggling. It's very sad that we live in a country that has allowed companies like Ambetter to back people in a corner to accept standards in HEALTH that are WAY below where they should be. It feels like we live in a 3rd world company with the lack or organization, customer service and the PLAGUE associated with Ambetter. Pay a fine to the government for not having insurance or pay $1500 a month for a healthy family of 4 to have SUBPAR insurance and providers in the city of Scottsdale. This is BEYOND frustrating!!!!!!!! Insurance is a HUGE one sided MONOPOLY that is surely not in favor of the CONSUMER in ARIZONA. This is why you never let the government HANDLE your health insurance. We all need to call our SENATORS in AZ and get this CRISIS worked out.
6 years ago
Denise Vance Carmel, IN
My husband has been with Ambetter for 1 1/2 years and I joined this year. We pay $1671 a month with $6500 deductible each, and we are in good health. Being self employed, there are not many choices. We send in the MyHealthPays rewards for gym visits every month to at least get $20 each off our costs. Half the time they accept my husbands, but mine have not gone through one time this year. I have called countless times and someone is always going to get back to me.........but it never happens. Many of their employees are so rude. Thank goodness we both turn 65 next year. At least then we will be on Medicare.....lower costs and better coverage.
6 years ago
Mary Rivera Irving, TX
AMBETTER .... WORST INSURANCE EVER‼️😡
While they set me up on auto pay to deduct my monthly payments without my permission or any type of warning they deducted large amounts on May 15, 2018 in the amount of $1,325.58 Another on Jun 15, 2018 in the amount of $662.79 & another in July in the amount of $1,295.00 They stated I had agreed to pay any and all charges nasasary when I agreed to do auto pay. I’m so busy I had not checked my account & when I did I was in complete Shock. Worst part is I have never once used the insurance while I was paying my reg payments. I just wanted to have insurance for peace of mind in which AMBETTER has caused me anxiety instead of peace. Please be very careful with AMBETTER insurance as all they care about is taking money from their members. I have filed a dispute against Ambetter for being THIEVES.
6 years ago
Brian Meyer Chicago, IL
Like many, I would give zero stars to this insurance policy, which fits the criteria in name only. The network is partially fictitious, as many providers listed in network will angrily hang up on you for trying to book an appointment with this insurance. Other providers listed as being in Chicago were actually located in St. Louis, due to a data entry error that seems like it may have been intentional considering the other problems with the network. What providers they do offer will generally treat patients even without insurance, making it much more expensive to seek care while using Ambetter insurance than if you simply remained uninsured. None of my providers have concealed their contempt and frustration with Ambetter, which has a reputation for not paying on claims. For this reason, do not be surprised if providers suddenly drop their support for certain benefits. Yes, it is nice that some of their plans include vision policies; it's much less nice to learn that your vision provider will only provide an eye exam and no longer honor the contact lens/eyeglass benefit from Ambetter, due to a history of unpaid claims. A class action lawsuit against is underway against an Ambetter plan in Washington for its lack of coverage; this lawsuit should go nationwide as the provider employs the same cynical practices in nearly every state, as the reviews suggest.
6 years ago
Rodney Kreinbrink Port Charlotte, FL
I signed up for Ambetter Sunshine health, and came to find out that none of the local hospitals would accept the insurance. The closest participating providers for my needs are around 30 miles away and into a adjacent county. Called to cancel the insurance, and they replied that they are required to give a 14 day notice and that I as an insured am responsible for the full months bill of that window period. Further the I.R.S may access a penalty fee of $642.00 or 3.5% of my Gross income. I feel that they should be sued for bait and switch- for not having enough participating providers within a specific coverage area. At the beginning of next month, I will send them a delivery confirmation letter that states that this will be the last month of coverage.
6 years ago
Andrea Mugnier Reno, NV
BUYER BEWARE!!!! I pay my premiums on time. Every month. But when one of my healthcare providers submitted her claim nothing happened. She is one of their providers. So I called several times. She called several times. We both verified that she was using the correct form, the correct numbers, the correct address to send the claim in. So she resubmitted the claim. After 6 months, still no payment. When I've called I keep getting excuses, usually they try to tell me that the problem must be with the postal service. I"m REALLY tired of their runaround. Today this provider told me she can't continue to see me because she's not getting paid. She said she won't even take people with Ambetter insurance anymore because they don't pay their claims. I filed a complaint with my state insurance commission. These people are horrible- I manage to pay my premium on time every month so I'm holding up my part of the bargain but they're not hold up theirs. They need to stop making excuses and FIX THIS!!!! I'm done being nice about it. I'm going to write negative reviews on every healthcare bulletin board I can find because people need to be warned about Ambetter Insurance- BUYER BEWARE!!!!!
6 years ago
Melanie Green Tampa, FL
Ambetter commits fraud regularly. First, they decided that $8,900 is less money than our $3,000 deductible so we owe everything. They don't comply with federal regulations to provide breast pumps to mothers. They then reprocess your claims to put some money toward co-insurance instead of the deductible so you owe more money and they owe nothing. This isn't how insurance works. They work the Better Business Bureau automated system, saying they're looking into it and then because you don't respond BBB closes the complain. They claimed because my deductible changed after my son was born that his deductible wasn't met. This doesn't even make sense. Ambetter scams health care providers, too, so it's difficult to find one that even accepts Ambetter.
6 years ago
Mariela Picon Dallas, TX
The worsest health plan that I ever had. Do not be accepted in any providers, pharmacies nor clinic or hospital. Irresponsible at 100% you call for help to find a provider and they always say the same thing "we'll call you back during the next 5 days" and never call back. They are #1 to bill you but not to pay for the health needs. Im was recently pregnant and I had been waiting for them to indicate what they are going to do to provide me an OBG cause theres not providers in the entire area of Dallas and nears city that accepted this insurance and nobody took responsible for that. Every time I called they said the same "we are going to evaluate your case and see to assign you a provider out of the network for your prenatal care" never they did it. So not choose this insurance for you or your family. Im not recommended to anyone.
6 years ago
Mandy E Las Vegas, NV
Ambetter by SilverSummit is by far the worst insurance We could have ever possibly chosen for my husband and myself. First of all, even after paying a deductable in full, I am still getting sent bills in the mail that I have to spend hours on the phone disputing, only to get dismissed and pawned off to unqualified people. They don’t have accurate book keeping at all. All their numbers were off. When I filed a claim with them to fix this, they only put one charge on thit claim and not all the charges that they promised would be dealt with. So I’ve had to call again, only to get on the phone with a slow representative that sounded unconfident in what they were doing.
Also, even after you are done paying the deductable, you will die before they approve life saving procedures and tests like mri. My husband now has permanent nerve damage down his leg and foot, because our insurance refused to pay for MRI and pain/steroid injection at the time he could have prevented it. They insist that he has to do 2 months physical therapy first. So we took him to see a Physical therapist and they won’t even touch him because they were never able to examine an mri to know how to properly handle him and they could see that he was in a lot of pain. Huge waste of time and money. They will not pay for the healthcare on time. We think it’s because once you get mri, they know they might be having to pay for surgery so they will take forever just to even review your case - over two months of my husband in the worst pain of his life, just to get a denial. Also, top to bottom, they only pay for what they want to pay for. I was prescribed a medication that they would not let me fill unless I tried a cheaper one for 2 months first which was ineffective. They will try to avoiding paying for the healthcare your doctor thinks you need, and make that decision for you what u can take. We have been going through this so Long that we went broke and now qualify for Medicaid which will actually pay for an MRI. So we now live with regret for ever trusting Ambetter. But are thankful that Uncle Sam can help us out. Ambetter should be shut down they are the worst. You’ve been warned!!!
6 years ago
Tre laf Atlanta, GA
The market place first off mistold me the benefits of this plan. And will not change it. Ambetter can’t override them. So always check and confirm with Ambetter before choosing a plan. I am not at all on a plan that is beneficial to my needs. My other half is a pharmacist and we both know a lot of insurance plans. Ambetter is not clear on their plans, their representatives are long winded talking you in circles only to find out that they can’t do anything to help you. Read the fine print. For me doctors visits and specialists aren’t covered to meet my medical eductible. Only lab work and certain general doctors are. When you get a bill for lab work it’s then you find out that that’s the only thing they cover outside of a general physician after you meet a high deductible. READ THE FINE PRINT AND GO OVER IT WITH MARKETPLACE AND AMBETTER BEFORE YOU CHOOSE A PLAN!!!
6 years ago
Melissa Chicago, IL
Ambetter is health insurance like tying a string around yourself in a car is a seatbelt--it might resemble the real thing, but it's probably more dangerous than nothing.
I got Ambetter because I was sick, uninsured, about to travel and terrified. Suffice to say I am lucky that my health held up and I didn't need to use them at all.
1. They have no gastroenterologists covered in CHICAGO--so if you live somewhere less metropolitan good luck!
When I called to cancel they were polite and helpful, but you can be nice and still be a scam.
My advice if you are uninsured:
1. Go to a free/sliding scale clinic! My clinic gave me 3mo of medicine for 12 dollars that my gastro doctor was trying to charge me $900+ per month! https://howardbrown.org/
2. Call (don't use online) the Healthcare.gov. My online account was messed up and I fixed months of confusing letters and emails with just one phone call. 1-800-318-2596
6 years ago
Jon Low
Can I give less than zero???
My experience tells you to run, not walk, run from Amworse from Inferiorhealth. There are few doctors that take them (for a reason), and I'm in a metro area of about 300,000. The nearest Ophthalmologist is 45 minutes away, and the nearest Neurologist is over a hundred miles away. It takes FOREVER to get approval for procedures. In fact we had to complain to the state of Texas to get them to do the right thing causing my wife to be off work for 2 months when it should have been maybe a week.
We have now had 4 instances where we had a service date in 2017, but because they did not do the billing until 2018, they tried to make us pay deductibles that had already been met for 2017. The problem I'm working on now is my CPAP machine. It paid out in December of 2017, under the 2017 deductible. They have it charged in Jan of 2018 and want me to pay over $500.00 for a deductible for this year. Can you say fraud???
They more than doubled my rates from 2017 to 2018, and raised my deductible by more than 3 times. Because of this I can no longer afford to pay for my insulin, and my Xarelto. I was in the hospiltal for my AFIB and between my Cardiologist and my Primary Care doctor they are giving meds to try to keep m alive.
And by the way, last time I heard Ambetter is the most profitable medical insurance company. Not hard to figure. If you can afford a reputable company, do so....
6 years ago
Amit Sorojon Houston, TX
This insurance is a scam.
Your doctor list will be limited to homeless community services centers. Yeah. No joke. And I live in a big city houston texas.
Your doctors option to choose from will be between homeless aids centers to just homeless comunity health centers.
90% of specialists on their network doctors to choose from will tell you on the phone that you will be a cash payer because they are not really in network with this insurance company.
All doctors I called said they are booked for the next 4 weeks.
You WONT be able to see any doctor before waiting a month for an appointment.
The only place I finally got treated after 3-4 days of fighting the system was a cvc clinic LOL Yeah . Sad. I was so mad.
I pay $500 a Month for this garbage insurance. $500 !!!!!
Do not sign up with them. Its a scam!
I canceled my membership a week ago. (May).
Had enough. Just unbelievable scam in daylight.
They need to be in prison. SCAM!!!!!!!!!!!!!!
6 years ago
constance vernier St. Petersburg, FL
Want to hold Ambetter accountable for the information posted on their website. The implied contract between the company and member is not being honored.
When choosing a 2018 insurance provider, I spent time making sure my doctors and preferred hospitals were part of the network.
In late January My primary care provider dropped Ambetter in 2018 but members were not informed this was happening prior to signing up for the year. Ambetter had amble notice (+3 months) from the doctor and time to remove her from their list. In trying to find another PCP, I've called numerous other providers listed on the website. The first five (near my residence) also no longer accept Ambetter. It's been 4 months and the list is still inaccurate.
Ambetter wants me to accept a random doctor they assign and that doctor is doing a residency. The one experienced doctor I did find is about 40 minutes from my home and was not happy to accept new patients. I searched for a doctor in late January and again in March. Today (April 20) I was told the website is updated but I looked and the provider list still includes doctors who are not accepting their plans. I spoke with their customer services and the lists they’re working from are wrong - Also listing many doctors no longer practicing or no longer accepting Ambetter.
After 4 months this goes beyond administrative error, Ambetter is lying to their members. They’ve been lying from the start and they should allow members who’ve been deceived to see the doctors they expected to see when they signed up and ‘eat’ the cost.
Also have spent a month trying to get a prior authorization on a med I've been taking for more than 5 years. Neither Ambetter customer service nor my DR's office will accept responsibility in seeing this is completed. Each blaming the other for lack of follow through, Stuck in the middle and can't make either side do their freaking jobs!!!!
6 years ago
Nicoleta Skokie, IL
Is the worst Health insurance. They let me die and do not approve of my oncological tests and radiation.Last year they walked through countless hospitals and did my adenocarcinoma surgery in my country.Now I have to do 3-4 brachycardy radiation sessions and I do not approve anything, the hospital is in their network and the type of insurance is agreed by the hospital.I pay them nearly $ 400 a month, the state pays another $ 1200 for me, and they do not approve of my radiation to stop cancer.The women who answer the phones send you to the hospitals without knowing where, they have no idea what to recommend and scream at me that I have to take the hospital in the network. I took hospital in the network and refused to pay for radiation and tests.I'm going to sue them and ask them for $ 10 billion in damages, because let me did.
6 years ago
