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Ambetter

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5.5

Overall Score

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LAST UPDATED: March 14th, 2024
Number 3 in Blue Circle

3 Things to Look for in a Health Insurance Company

  1. Plan Options — Look for an insurer that offers the kind of health plan you need. Some insurers specialize in specific types like Medicare.
  2. Extra Benefits — Look for the extra perks offered by the insurer with your plan like a fitness program or reimbursement. While not a dealbreaker, these benefits are worth noting.
  3. Claims Experience — Look for insurers that offer a good claims experience compared to others. Reading customer reviews can give you a sense of how well an insurer takes care of its plan members.

Ambetter insurance specializes in health insurance plans on the Health Insurance Marketplace in twelve states. These plans are also sometimes called Obamacare plans. Ambetter health plans are operated by the Centene Corporation. If you're looking for another kind of plan or don't live in an Ambetter service area, you'll need to consider other health insurers.

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Attention: Ambetter is a very unpopular health insurance company.

It has received a 1.4/5 star rating from reviews left on Best Company. Roughly 87 percent of the Ambetter reviews on Best Company gave a 1-star rating. Complaints against Ambetter include poor customer service, difficulty with pre-authorization, and high costs for limited coverage. Most customers do not recommend buying healthcare coverage from this insurance company.

View Ambetter Reviews and Complaints

Ambetter health insurance's covered services include preventative and emergency care, therapy, behavioral health help, medications, maternity, and hospitalization. It is an on-exchange health insurance option in the Health Insurance Marketplace.

Health Insurance Marketplace plans offer comprehensive health insurance coverage. For health plans to be on the Marketplace, they must be a qualified health plan that covers the essential health benefits listed in the Affordable Care Act.

To enroll in Ambetter insurance, you need to apply during Open Enrollment. The Open Enrollment period for 2021 healthcare coverage runs from November 1, 2020 to December 15, 2020. If you missed the enrollment period, you may qualify for a Special Enrollment Period after December 15, 2020 if you have a Qualifying Life Event.

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The Good

  • Health Insurance Plan Options
  • Helpful Online Account
  • Member Perks
  • My Health Pays™
  • Dental and Vision Coverage

Health Insurance Plan Options

If you're looking to get an Ambetter plan, you can view health plans by first selecting the state you live in and then selecting the type of health plan tier you're most interested in. From there, your options open up to several different plans with varying prices and benefits.

Ambetter Health Insurance Marketplace plan options include: Ambetter Essential Care (Bronze Plan), Ambetter Balanced Care (Silver Plan), and Ambetter Secure Care (Gold Plan).

Each plan offers insurance coverage for the essential health benefits listed in the Affordable Care Act, but the cost-sharing rules for medical expenses are different for each tiered plan option.

Members with Ambetter Essential Care pay lower premiums but have higher out-of-pocket expenses.

Ambetter Balanced Care, the Silver Plan, offers higher premiums and a lower out-of-pocket limit.

Ambetter Secure Care has higher monthly premiums, but the lowest out-of-pocket expenses of the three plan types.

For specific coverage and cost information, including the deductible, out-of-pocket expenses, and premium costs, you'll need to work with Ambetter directly. Depending on your income, you may qualify for a tax credit subsidy on your monthly premium.

Helpful Online Account

Each Ambetter member has access to an online portal through which they can make all of their payments, view healthcare plan benefits, and take care of logistics like obtaining a member ID card. The member portal offers extra features, too, such as providing reminders for members when they are due for another doctor's visit or allowing them to take a health risk assessment to determine which steps they can take to live healthier.

Members can track their claims 24/7 through the online portal, as well as connect with member services at any hour of the day.

Member Perks

Ambetter provides more than just logistical tools for members. Many of the extra features it offers also send the message that Ambetter wants members to get healthier and stay healthier. These tools include a 24/7 nurse hotline that members can access for questions and medical needs.

There are also health-promoting programs to support members with dealing with behavioral health and maternity and newborn care. Ambetter offers 24/7 Nurse Advice Line and integrated health management to enhance members ability to get the most out of their medical care.

Ambetter also offers telehealth access with some of its plans. With telehealth, members can have phone or video access to in-network providers for non-emergencies.

My Health Pays™

My Health Pays™ is Ambetter's rewards program to provide incentives for members to live healthier with better habits. You can earn money for taking a survey provided by Ambetter, getting a flu shot or having your wellness exam. This money can go toward your next premium. Members can be reimbursed for gym membership payments as well. This rewards program promotes health and well-being among Ambetter members. While this program is great, it's only available in some of the states Ambetter services.

Dental and Vision Coverage

Dental and vision coverage are available with Ambetter, but the benefits and availability of each are entirely specific to the state you live in and the type of health plan you choose.

Dental benefits, for example, is not available in Texas, but vision insurance is. Dental coverage includes exams, cleanings, and screenings, overall, and vision benefits include yearly eye exams and glasses or contacts. Those seeking vision coverage and dental benefits in addition to health insurance can find options through Ambetter.

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The Bad

  • Poor Customer Reviews
  • Access to Plan Information
  • Limited Service Areas
  • No Mobile App 

Poor Customer Reviews

Ambetter has received an overwhelming number of 1-star reviews on Best Company. These Ambetter reviews mention difficulty getting medication and treatments approved for coverage, issues with claims that were difficult to resolve, frustration with customer service, and difficulty finding an in-network provider.

With such a high number of 1-star reviews, you'll likely be better served choosing another insurance provider if you can.

Access to Plan Information

It's somewhat difficult to access specific information about the types of health plans Ambetter has. Its website primarily just explains the metal tiers (gold plan, silver plan, and bronze plan) as well as how essential health benefits are covered by every plan.

To find out what kinds of plans these are, such as Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO), not to mention what prices and benefits you qualify for (like out-of-pocket expenses, copayments, deductibles, covered services specifics,and if you need prior authorization for certain medical services), you'll have to contact a representative.

Upfront, it's important to know that Ambetter is part of the Health Insurance Marketplace (HIM). It's Centene's option for HIM plans, which are intended for people who don't have health insurance and maybe don't qualify for typical plans.

Ambetter only offers Marketplace plans. If you are looking for another kind of insurance plan, like a short-term health insurance, Medicare, or Medicaid, you'll need to find another insurance carrier.

Limited Service Areas

Ambetter plans are available in a some states. These include Arkansas, Florida, Georgia, Illinois, Indiana, Massachusetts, Mississippi, New Hampshire, Ohio, Texas, Washington, and Wisconsin. If you don't live in any of these states, then you'll need to consider another insurance provider.

Even if you do reside in one of the states they service, make sure to check the location of their in-network providers (e.g. a primary care physician, specialist, etc.) for your state to ensure they have an in-network provider near you.

No Mobile App

Unlike many of its competing insurance companies, Ambetter doesn't have a mobile app. Some companies provide this for enrollees to access their accounts right from their phones, making communication and logistics much easier. Ambetter hasn't provided this yet, making account management slightly less convenient than with other companies.

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The Bottom Line

Ambetter should be somewhat of a last resort when choosing an affordable health insurance company. While its plans all have decent health coverage for preventative care and some vision and dental benefits, it is difficult to access full details of its various plans. Data points such as the annual maximum out-of-pocket limit and co-pays are difficult to find on the website.

Plan cost and deductible levels vary among plans. Availability depends on location. Cost is also affected by the number of people on the plan and some demographic information, like age.

While Ambetter's plans offer comprehensive healthcare coverage, it's important to review customer reviews to get a sense of Ambetter's quality — health plans, value, cost, and customer service — and compare Ambetter to other health insurance companies before making a final decision about signing up for an Ambetter plan.

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Star Rating

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1.1

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1,117 Reviews

Review Breakdown

5 grade

4%

4 grade

3%

3 grade

1%

2 grade

3%

1 grade

89%

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Julissa Nicole Tampa, FL

My name is Julissa and I just want to say that there is majority of customer service reps who are horrible, but there is hope and I truly appreciate Tiffany a customer service rep, she was super understanding I called on 3/6/24 approximately around 5:30-6:00pm eastern time and I really wish i had the chance to do the survey bc she truly deserves it she took a look into my account and in no way shape or form had an attitude or hesitations, she truly cared about my issue i was having and she took her sweet time to help me figure out my problem. It was confusing for the both of us but because of her patience it made me feel like we had a connection bc of her kind heart of helping me I felt like i can trust her with everything I was going through she even reached out to her team which they 3 of them responded 1 of them mentioned about what a co-pay assistance was, another one mentioned about getting into Sales Marketing which so i can get a better plan and another one advised to her that yes what she told me about my problem about i can pay no matter how i pay my maximum, so the fact that she had to triple check with what she already knows means that she really cares for us. She was very honest with me in regarding to coming into an understanding, I am not great in my grammee and she still tried her very best she can to help me get to my answer bc i realized i myself did not make sense so re word it and she knew exactly where I was coming from and she truly opened doors for me. She really saved my sanity bc i was so stressed about my my medication issues and she was such a blessing I am very grateful that she came through and i really want Ambetter to see this post bc she was truly amazing she should work for a better company at that! And I want to make it known that in our conversation iver the phone she mentioned she was 27 so If you guys ever reach Tiffany from Ambetter give her her props! Im trying to be specific as i Can from our conversation.

2 weeks ago

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AmbetterIsTerrible Nashville, TN

This is the worst healthcare insurance I've ever had. Do not get it. Every PCP listed on their site that is supposed to me in my area is no longer accepting their insurance or no longer in service or actually dead. I'm not making this up. After calling repeatedly and getting my case escalated, I tried to get them to switch my insurance over. They supposedly did "an investigation" and sent a letter to me with the names of 2 radiologists! Does Ambetter even know which physicians do which kind of work? The customer service is obnoxiously terrible. Their knowledge base is extremely poor. As I mentioned their information on their site is outdated. Their network basically doesn't exist in Nashville, TN. They're basically stealing money by charging for insurance that they are not providing. DO NOT get Ambetter. It'll be a terrible mistake. In fairness, I will admit that my prescription drugs are cheaper on their plan than my previous one.

1 week ago

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Waylon R Lambert

Ambetter is a joke...For example, I just called with issues, and I spoke with a "customer service rep" who didn't have a working phone...Yes, you read that correctly...A phone CS who didn't HAVE A WORKING PHONE...I was transferred and the next rep justified the fact that the first didn't have a working phone by saying "Things don't last forever..."...This exchange is so symbolic of just how pathetic Ambetter is...It took 4 months to get my auto draft set up, and in the meantime, the company sent a letter saying that it dinged my credit report for not paying my premiums...When I thought the premium was on auto draft...This entire company is just an excuse for rich folks to prey on poor people...I had surgery and wound up paying more than they did for service...Yet, they got over 700 bucks a month from the govt for my coverage...I wonder whose pocket that cash wound up in...Do yourself a favor and run as fast as you can away from Ambetter...The company of non working phone phone reps...It's almost surreal...

1 month ago

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Andrea Podolski

I have been trying to get a refund for initial payment as I was in a fragile mental state from a recent health crisis. I got this call for Insurance, he said I didn't have much time and I need to get a supplemental provider. This occured on December 8, 2023 as I was getting assistance with my affairs the case worker told me that I didn't even need what the representative repeatedly told me I needed it. So on January 2, 2024 I cancelled this policy and asked for a for a refund. I called 4 more times on the fifth call the representative Rebecca told me, I wasn't getting a refund because I was covered in January 2024, not so I cancelled it as soon as their Holiday break was over 01/02/2024 and I could speak to someone to cancel. I feel I was conned because the representative knew my current health state was compromised. I'm so disgusted with this company with their manipulative ways. I was treated awful while trying to get a refund. I'm still recovering and this kind of stress was the last thing I needed. I cancelled it, I never used it, all I did was get conned. I would never recommend this company for your health care after the way I was treated. Also, on the sixth call after sitting on hold for ever when I asked for a representative to speak with so I could ask for the supervisor since Rebecca refused to let me speak to the supervisor on my fifth call, I was hung up on!!!

1 month ago

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Sherrick Thuesmunn Seattle, WA

AVOID THIS INSURANCE. It seems like a scam company, but I think they're actually just completely incompetent. I'm currently going through my second denied claim appeals process. The first time, I used their website to find an in-network doctor, and went to that doctor. When the claim was denied, they told me the doctor was out of network. Their website is completely inaccurate. But this inaccuracy isn't just a one-time thing, it seems like around 50% or more of the info on there is outdated or inaccurate. I initially tried to set up an appointment with the doctor Ambetter had automatically designated for me as my primary care physician, but when I called the office number listed for that doctor, they told me that doctor hadn't worked there in years! So I tried again to get a PCP, and this time I went through the process on the phone with an Ambetter representative. They walked me through everything and we made sure the provider was in-network and near my home. After going to my first routine office visit with that provider, however, I got a $700 bill from their office! I checked online and my EOB said that the whole claim was denied, and they put a reason that was very cryptic. I called Ambetter to explain the claim, and they honestly had no clue what was happening. They couldn't explain it at all. I called the doctor's office, and they explained to me that Ambetter told them the claim had been denied because I went to see a PCP different from the one they had on file for me as my approved PCP. But it was the same person! Ambetter will give you cancer. Only sign up with Ambetter if you hate your life. I now find myself in the unlucky situation where I am actually just not going to the doctor anymore. Of the three claims I've made since starting with them, they've all been denied for different BS reasons. I've appealed two of them, one is being processed while the other did result in reimbursement for me. The third was small enough that I didn't deem it worthwhile to spend the requisite 10 hours on the phone with support and all the stress the process entails. So now I can't switch my health coverage since open enrollment has ended, but my insurance is so untrustworthy I can't really go see a doctor unless it's an emergency. The only reason I haven't canceled is I need my monthly medications and in case of an emergency. Heed the warnings of others: STAY AWAY!

1 month ago

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Kenneth Newman Spring, TX

This is the worst insurance company anyone can have from poor communication skills from customer service to not covering anything, to finding doctors to accept this insurance is joke. What a scam. For govt to subsidize this fraud is even a bigger scam.

2 weeks ago

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John Seattle, WA

Ambetter denies claims saying preauthorization was needed even after saying it was not needed over the phone. There customer service is awful. Of shore call center where the people are difficult to understand constantly put you on hold and just want to get you off the phone so they can move on and not help the next person.

2 weeks ago

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jeffrey hill Matawan, NJ

I wish I could leave zero stars. BEWARE OF THIS COMPANY. DO NOT DO ANY SORT OF BUSINESS WITH THIS COMPANY. I have been in a battle for over a month for a refund. Hours I’ve spent on the phone trying to get my money back. I signed up and payed twice for the first month - accidentally bc of simultaneously signing up and paying with autopay. I keep getting sent to different people who are the opposite of helpful. This company has robbed me of $551.24 and will not return my money. Stay as far away from this company as possible. BUYER BEWARE

1 month ago

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Eric Perry

Been insured for just over a year so I call for my 1095 form for my taxes and got the run around,so I got transfered three times and the final transfer was a no help recording.I will cancel first thing in the morning and very unhappy by the lame service I received ,the last person I talked to was speaking over me and was of NO Help....Will not be back

1 month ago

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Leah Haynes Keller, TX

This company somehow obtained my info and had started sending me Bills/ invoices after I was n an accident and already covered with my states insurance Medicaid, Granted after I became 21 in November and they are somehow claiming they paid some of my medical bills from an accident i was in!! I only found out about my SUPPOSED membership through my contacting them and them telling ME I did sign up to become a member and I am VERY AWARE I have NOT signed up for ANY IAMBETTER anything!! They've sent a bill to my lawyers with my name as well as a person named Antonio M!! and this is in FACT the hold up for my financial payout!! I MAY sue them next for this unwarranted confusion, it fells like someone who works for the ER also moonlights for obtaining injured soon to be uninsured victims, because how else did they obtain my personal information and to mix it up with Antonio M' is CRAZY!!

2 months ago

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Brian Wall

This is literally one of the worse insurance companies I've ever dealt with and you should avoid them at ALL cost!! They are horrible in all areas including coverage for services received. My wife was covered by them and we chose to cancel the plan due to financial hardship and horrible coverage. Once I cancelled the policy and turned off auto-pay the illegally debited by account for two months of premiums, which is theft! We cancelled the policy prior to them doing so and completed the process they suggested to receive reimbursement for their illegal act. It's now been over 60 days (reimbursement should be received within 7-10 days as per their representative and it hasn't been. We have contacted them multiple times with no resolution. In fact, whenever we DO contact them they continue to give bogus reasons for why we haven't received a reimbursement for $436.58, which included "you have an outstanding balance" of one month's premiums. When asked which month that would cover they were unable to clarify. These folks are a bunch of crooks and only out to take advantage of people even if it requires illegal actions. I've filed complaints with the insurance department AND the better business bureau as I believe these two entities are there to represent the people in such situations. If Ambetter is in the mix to consider, shop elsewhere until you find a company that is now owned or operated by them!!

2 months ago

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Tiffany Cochran

I feel like I'm talking to a 1 year old when I call customer service. It's hard to understand what they're saying and the words I DO understand make no sense! I'm pretty sure SHE didn't understand what she was saying. I saved up my points and had them put on pre-paid visa. It arrived about 4 weeks later. I go to Walmart to buy some FOOD and my card was declined. SO EMBARRASSING! I call customer service and the customer service rep tells me, "Mam, you can spend your card on a bill, rent and phone but can only spend on food at a Walmart in Georgia"...I LIVE IN OHIO! So all the commercials about them talking about the rewards IS A LIE. You CANNOT withdrawal cash. You CANNOT spend on groceries (in your state). You CANNOT use the prepaid Visa card on things you need. So if you're thinking about getting the card I hope you live in Georgia.

2 months ago

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Holly Myers St Louis, MO

I enrolled in Ambetter for 2024 in early November. On 11/13 I long into the enrollment portal to check on something and I see that the status says "cancelled" so I call customer service to see what that's about. The lady insisted multiple times that I was currently enrolled and it was not cancelled, and everything looked fine when I created an account for the member portal so I took her word for it. Then a couple months later in early January I tried to log into the member portal a few days in a row but I kept receiving an error message. So I called about that and they said the reason was because my coverage was CANCELLED VOLUNTARILY which it sure as hell was not. Never received any sort of email about this supposed cancellation and never got reimbursed the $680 premium I paid to enroll. So they transfer me to someone else to look into this more and get my health coverage reinstated for January. But then that person says that the notations for the call I had with the customer service said I had cancelled my plan at that time. They said they would open a case about it and someone would call me in the next couple of days but they said that it might not work out since that dimwit notated that I had cancelled my coverage. Since open enrollment is still available for a little while I may just cancel for real and go with someone else as long as they give me my $680 back. DO NOT RECOMMEND based on customer service alone

2 months ago

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Catherine Scanlan Seattle, WA

I've read many of the reviews and agree with many and disagree with a few. I've never had a problem with Ambetter paying my claims, as long as I am enrolled according to them. Earlier this year, January-February timeframe, I went to pick up my insulin and it was over $1,000, when it was supposed to be $25. They said they cancelled me because I hadn't paid my premiums for several months, which I had. After hours on the phone, I paid what they said I owed and they reinstated me. After sending them front and back of cancelled checks, they gave me a credit on my account. Today, I was checking on a prescription for insulin that my doctor said they submitted 11/29/23. The pharmacy initially said they hadn't received, it. I called the doctor who called the pharmacy and they said it was a problem with my insurance. I called Ambetter and they said it was a problem with the exchange. I called the exchange and they said that I was eligible and enrolled through 12/31/2023. Apparently, when I renewed for 2024, Ambetter put in a start date of 1/1/24, which somehow cancelled my insurance for December 2023. After several hours on the phone in a 3-way call with Ambetter and the exchange, they said they would fix it. The problem is I am out of insulin in a few days. It is the weekend so nothing is going to happen. However, insulin doesn't stop for the weekend. I am beyond upset. I have Type 1 diabetes and will literally die without insulin by the end of the month until the new insurance takes effect on 1/1/24. As it is, it looks like I will have to go a few days without it even if they reinstate it as promised and can't go to the hospital without insurance. I shouldn't have to spend hours and hours doing some else's job and fixing someone else's errors.

3 months ago

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Michelle Little Rock, AR

DO NOT GET THIS INSURANCE!!! they will hang up on you, Deny every pre-authorization your Dr sends over and offer zero assistance to diabetic patients. Absolutely pathetic. They could not care less if you died. Stay away from Ambetter!!!

1 month ago

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tom tomorrow

Nightmare hell!!! They don't respond to online questions no matter how many messages you send, and NONE of their in-network PCPs even exist! All fake numbers that go to other hospitals where they say the Dr. doesn't work there. Impossible to get healthcare with Ambetter.

1 month ago

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Monica Miami, FL

Awful Customer service from 3 different cs reps today. Last call was a foreigner named 'John' he was no help at all. Asked for a list of providers and he refused stating for me to go online to view covered doctors. Explained I had already done that and called Several doctors and they verified THEY DO NOT TAKE AMBETTER VALUE. This is Insane!!!

1 month ago

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Enya Bradner Redmond, WA

The worst health insurance. I was called by a facility to set up primary care, but the earliest appt for “new patients” was 3-4 months down the road. Had an health situation and needed to go to a clinic for immediate attention. Got turned away from THREE clinics because they wouldn’t see me with Ambetter insurance. All the clinics Ambetter contracted with were 20-200miles away and NONE were open on weekends. Apparently with Ambetter, you need to only get sick on the weekdays and be able to drive hours for “immediate” care. The worst money I’ve ever spent.

2 months ago

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Laura “Vanilla” Jamison

Yes, I am leaving a 2nd review because this is beyond ridiculous. NO ONE can tell me WHY I have to contact THEM to verify MY information and now they are claiming on their site that my insurance has lapsed even though they aren't letting me know why and they did send me my membership cards and I know they will tell me to contact them AGAIN when I should NOT have to go through all of that JUST FOR A SIMPLE ANSWER. Screw this company, you have lost a customer, I don't even want to pay y'all a cent if this is how you treat your customers!!!

2 months ago Edited January 24, 2024

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Ekta Kamboj Lakewood, WA

I would rate them 0 star if that was an option. The WORST customer service ever. The agents are clueless. They would lie to you about premiums in order to get you to feel satisfied with the call, causing more problems and then refuse to take you call. One specific person for sure would be Samantha Aquinolara (agent), lied about the call was handled properly and when called back about it, she refused to take the call. There was also no notes written by her regarding the call that she had with me the last time. So unprofessional.

2 months ago

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Amy Jo Schoeberl

Absolutely horrible customer service! I was with Ambetter for 5 years and finally gave up! I am extremely healthy and only used the insurance for the 100% covered services like yearly physical, mammograms etc. nearly 100% of the time AMBETTER would deny the claim and I would have to fight it for months. These were in network totally normal services, nothing out of the norm. The last "100% covered yearly physical" billing issue went on for over 8 months before I gave up and switched to another Insurer. If you value your sanity and your money, stay away from AMBETTER!

2 months ago

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Christine Lussier Evansville, IN

So far i am finding it impossible to find a provider. Even when I called customer service because I was so frustrated with trying to do it myself online, I came to another dead end. The customer service agent was clueless and actually gave me a primary care nurse practitioner (which I asked for) but she only treated children!! Their website also leads you to one after another after another dead end with practitioners who do not do what the website says they do. I need to find another company

2 months ago

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Luke Brock

I bought the policy through the Marketplace. I was with Oscar (Which was actually pretty good insurance) but they didnt cover all of our doctors, so I looked at the tool from the Marketplace said that the Ambetter insurance covered all of our Doctors. I signed up for what was supposed to be their "Gold Plan".. It was a lie.. None of our doctors took the plan, prescriptions were less buying them trough Good RX, and they refused to approve the tests our doctors ordered.. Dont waste your money..

2 months ago

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John Smithers New York, NY

Ambetter from WellCare of New Jersey. I WOULD NOT UNDER ANY CIRCUMSTANCES ENROLL IN THIS HEALTH INSURANCE COMPANY. Their customer service is absolutely terrible. Their customer service is in India and I could not understand what their customer services reps were saying to me because their English was incredibly poor. They sent me a letter saying my insurance was going to be cancelled and no one at Ambetter from WellCare of New Jersey could explain why my insurance was going to be cancelled. Every time I contacted them no one could answer me. I was terrified that they were going to cancel my insurance. In New Jersey, insurance companies are required by law to send out a letter about re-enrollment and any possible increase in the premium. This company never did that. I believe this company is operating in violation of the law in New Jersey. The New Jersey Insurance Commissioner's Office should investigate this company and shut them down for not being in compliance with New Jersey law.

3 months ago

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Melinda McCarthy Hawkins, TX

Outsourced customer service with poor communication. Hours on the phone to try and get to a complaint department to no avail and resorted to filing a complaint with Texas Insurance Department and finally got an unsatisfactory response from Ambetter. They quoted my monthly premium for 2024 at $113. I checked Healthcare.gov and the premium was listed at $299/ month. When I contacted Ambetter they confirmed that the premium would be $299/ month. Had I not done the checking of premiums I would not have know until after open enrollment had ended and been stuck with the $299/ month. Their response to the complaint was to blame Healthcare.gov with doesn’t make sense they are the ones that listed the correct premium. How can Ambetter not know the correct premium they are charging? They have very limited in network providers . They have denied claims for my yearly dental cleanings saying I have to get all the paperwork work with codings from the office, fill out the forms and send them in since the dentist isn’t in network. There are no dentist in the area in the network. Their policy states they pay the same for in network or out of network for dental. They just don’t tell you you’ll have to do a hula dance to get reimbursed. I’m not a coding expert have no idea what they want and I would have to drive an hour to the office to get the paperwork. I gave up and just pay out of pocket even though I’m supposed to have dental coverage. The also denied a CT requested by a surgeon for a hernia repair. It’s been appealed and the surgeon send additional noted to justify and they find another reason to deny. Amazing that these denials come right as I have met my out of pocket maximum. Mean while the hernia gets bigger daily and my guts and literally falling out. Yes the insurance is cheap but you get what you pay for and I definitely would not recommend Ambetter.

3 months ago

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Chloe wood-henrickson Olympia, WA

Worthless insurance plan. They do not have a single in-network urgent care in my city. I live in an urban area walking distance from 10+ urgent care clinics but instead I had to ask a friend to drive me 30 minutes to a clinic that was in network. If no one could have driven me then I would have paid an extra $80 for the cab fare both ways. Its a lot to try and figure out when you're already in the midst of a medical crisis. Another time I waited 6 months for a dermatologist appointment. I had a rash the entire time and it left permanent scars on my skin because of the delay in treatment. I also had a stye in my eye this year and Ambetter does not cover a single ophthalmologist in my state, so I could not have the surgery to remove it, and once again was left with permanent visible damage. An insurance plan this neglectful should be illegal, it is basically no more than a cheap scam.

3 months ago

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Martin Milner Hernando, MS

Ambetter Health Insurance review Good at claims payment. Very poor customer service, you are directed to a third world call center, not an Ambetter employee , very loud and busy background noise. Reps don’t speak fluent English, nor do they understand your fluent English. If they can’t understand or address your needs/inquiries, they eventually just hang up on you and you have to call them back and start the process all over again…… they put the CUSS! in customer service.

3 months ago

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Blink Drive Roanoke, TX

Ambetter insurance is not a scam. However, every phone call made to them results in an endless loop, typically lasting at least one hour, before you can speak with someone, and even then, there is no progress. Seriously, we called them for 10 consecutive days, averaging one and a half hours each day, yet nothing was resolved. I just want them to approve my Primary Care Physician (PCP) and assign me to any in-network specialist. Their call center is unprofessional. Even if you ask them something as simple as the current date, they still put your call on hold to get the answer from their manager. It feels as if they might as well hire stupid robots instead of real humans to work there. My wife got pregnant for three months. They are helpless since day one till now.

3 months ago

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Tara Snyder Marshall, MI

I have alopecia, an auto immune disease where my hair falls out. This company won’t let me have a simple steroid, let alone a legitimate medication. Scam. Do. Not. Get. This. Insurance.

1 month ago

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Har Tol Lucedale, MS

I don’t understand what all this noise is about! I would say that most of these 1 stars are just not getting the understanding needed from their agent that signed then up or if they just went in and just chose the cheapest plan themselves! So with that being said my agent explained how the insurance works and helped me with the best plan for my area. All plans did not work for me and I listen and went with the one she chose for me and I never had a minutes trouble with my plans! I’ve been with Ambetter for 5 or more years and NEVER had the experiences that I’m hearing here. So far Ambetter has been far more than just insurance, it has been a life saver for me!! I say find the best plans in your area and leave Ambetter to continue to blossom in it’s good here. Molina, Cigna and the other great affordable plans are great as well in the areas they serve.

2 years ago

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Just another biller Kodak, TN

I am a medical biller and certified medical coder and have worked for providers for over 20 years. To those getting billed by the provider for lack of auth, change providers! Those bills are not your responsibility! Do your research on what you should pay. NEVER PAY THE PROVIDER BILL WITHOUT MATCHING IT TO YOUR EOB (Explanation Of Benefits) from your ins company. If it's not the same amount, send a copy of the EOB with your payment. Ambetter requires providers and the staff to do their jobs. Documenting medical necessity, submitting records supporting the diagnosis and treatment plan. I will say that once a claim or procedure is denied and multiple hands touch it, getting it approved or paid gets tougher. Providers need to do it right the first time. Providers have the ability to upload supportive documents online directly to the denied claim or auth. It is usually resolved within a few days. I actually liked working Ambetter claims because they were so easy! Even if a provider missed an auth, Ambetter would approve retro auth requests IF they were done in a timely fashion. From my experience, most of the complaints I have read are most likely from: PROVIDERS SIDE: 1. Not enough office staff to support the patient base. 2. Untrained medical scribes or physicians that are responsible for documenting medical necessity. And yes, mds, nps and all others contributing to the medical record must know what is needed to get paid. I have attended many trainings and I can count on one hand the number of physicians that attended. The ones that did, knew exactly what they were required to do in order to get a test or surgery approved and paid. 3. Untrained billers/collectors that do not know how to get the claim paid. 4. Not educated on what the step management is for authorizations (ex: the small test, the next test, then the advanced radiology) Not going straight to MRI. MEMBER SIDE: 1. Not understanding your medical policy. 2. Going to out of network providers. 3. Not looking at their EOBs and matching them to the providers bill. Overall, Ambetter requires the provider to DO THEIR JOB! As they should, in order to provide care to their patients who entrust their health and life to them.

2 years ago Edited December 6, 2021

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Dali Dallas, TX

If you follow the rules of using in-network providers for both diagnostics and physicians, there will be no surprise billings. I made sure my primary care physician on paper was affiliated with a local community hospital so that I’m covered and in-network in case of an emergency. I have never had a problem getting authorization for drugs, but sometimes the pharmacies will actually lie (not Ambetter’s fault) and tell you,”It isn’t covered by your insurance,” when all you needed was a pre-auth. I always check with Ambetter directly. I never trust the doctor office staff nor the pharmacy staff to sue the due diligence. I guess I’m cynical that way, because I used to work in healthcare. I think it’s easy for people to blame this insurance company, and usually people only take time to write reviews when they are angry. If you follow the rules of the Ambetter system, and make sure you use in-network providers, you won’t have to deal with appeals over billing later. Work smarter, not harder folks! Also, being kind to customer service goes a long way. I mean, I had a lengthy convo with a rep who was absolutely outstanding and sweet. She took the time to explain how everything works, because healthcare gets complicated with deductibles and all, and even I needed some questions answered. I am so happy that I chose Ambetter and not a cheaper company, because you really do get what you pay for, right?

3 years ago

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Kristin Slink Atlanta, GA

I honestly couldn't say anything bad about Ambetter and feel compelled to write a review based on its one star rating. Disclaimer: I live in Atlanta proper, so I have Emory locations all around me. Access was easy and although scheduling my annual appointment wasn't instant (several months out) I have very limited needs, so this worked for me. I am not going to boast about the price, but compared to the other offers, it was pretty reasonable. I will not comment on the overall status of government healthcare. I don't understand how we are supposed to afford it, but this is not the fault of Ambetter. When I was offered benefits through my employer and had to cancel my plan, the person who helped me was extremely polite and helpful. I was able to submit a request to refund my recent payment and she went through my account to remove my cards so I wouldn't get an auto payment. No issues at all. Very happy. Give them a chance!

4 years ago

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Heidi Turner

I love Ambetter! My place of employment is now offering Insurance so I'm going to loose coverage since I'm in with Markplace. Ambetter has been great! I don't want to switch. They approved without even hearing the arguement I was ready to take on, a very expensive liver medication that I had been trying to get for years. It was even delivered to my door step. They have also approved all my husbands medications which are also very expensive. Our co-payments are low and they cover our family of four at a reasonable price considering the market. I'll be so sad if they say I have to get the company insurance at renewal.

4 years ago

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CinderUgly Maple Valley, WA

I don’t understand all the bad ratings going towards AmBetter’s medical insurance, I can only attribute that to people who aren’t looking at the plans being offered more closely and choosing the wrong plan that don’t fit more true to your health. Also, most of the time, it’s either the doctors office or the hospitals that are the problem. Billing procedures not pre authorized, care under doctors that are not covered on your plan, billing incorrect codes, causing problems with out of network charges to appear. I took months looking at plans for me and my husband, and came across AmBetter, under ACA Plans. If it’s about your health take the time to READ your plan, the whole plan! I took my age 50+ & husband 60+, and the type of Health plan I was hunting for. ****1.) Most Important!!! It had to cover a total catastrophic event, (stuff happens) what type of plan would cover that and not put me in the poor house, with affordable deductible & affordable out of pocket, or preferably one that combines both, so deductible & out of pocket are one total, with copays that goes toward that? 2.) Very Very Important- Once my affordable deductible is met, what do they cover 100%??? It has to be 100% after deductible is met... not this 20/80 garbage. So make sure it’s 100% after you’ve met your deductible, and once that’s met you best take advantage and get things done that you’ve been holding back, because they weren’t an emergency, but should be done, such as; colonoscopy, prostate exams, breast exams, health check & bloodwork (most plans cover this for free, because it’s considered preventative maintenance). We are fairly healthy, or I should say we don’t see doctors very often, so paying maybe once or twice at the doctors office yearly is... normally affordable. Mine was all about catastrophic events that could happen and a lower deductible with co-pay that goes toward my deductible and my out of pocket costs were my main goal, not to go broke. 3.) who are the Hospital’s they sponsor... are they close and who are their doctors? Then look up those doctors (people review them online), theres always one with high stars you can review. 4.) If you can... find on the same plan, “ No Referrals“ for seeing any doctor you want to visit, (not always available, very few available) my didn’t offer that. 5.) “NEVER, NEVER Let a doctor or procedures done to you WITHOUT prior approval from your Health Insurance!” I can’t repeat that enough! That is a must, never waver! That’s why I always know where my hospitals are under my coverage, there is always doctors in emergency covered under your plan, if you use hospitals under your plan.. If you are coherent, ask for procedures to be preapproved by AmBetter or any insurance company for that matter, and that the people that are doing the procedures are covered and registered with a Ambetter or what ever Insurance your using. Normally, there is a person on staff that her/his responsibility is to make sure things flow with getting all of this pre-approved while your in emergency. Take huge advantage of that, you’ll need it. “(Always have someone, loved one or who ever is your emergency contact knows your plan, in case of being unconscious when arriving at the hospital). “ 5.) keep in contact with your insurance and write down who you talked to and a reference number, if you need it for fixing a billing problem. Ambetter agents are very helpful, and if you get one that isn’t understanding or not getting you where you need to go, don’t feel intimidated to ask for someone else, with new ears. That’s their job. My plan had dual as one total; deductible/out of pocket $5100 total deductible, with copays that went towards that deductible. I had a TIA stroke this year, went into Emergency on my own cognizance (catastrophic event) hit my deductible of course, but I was willing to pay the $5100, and had set aside most of that amount just for this reason. My plan covered 100% of ALL charges after deductible was met. Xrays, MRI, CAT Scans, neurosurgeon visits and months of testing to determine what happened and it turns out it was a TIA stroke. This was part of my policy. The costs that I would have been billed were unimaginable... at the cost around $70k, then all was said and done, cost me $5100. So what I’m trying to say is that looking for catastrophic insurance over conventional insurance is ten fold in the long run for people over 50. Now I’m up for renewal for same policy plan, but now the deductible is $5200+ Soooo... now I have to wave if I can afford that new increase or find another plan. I’ll probably stick to the same plan, since there is always financial help if needed... still that’s a far cry from paying $70k to only paying $5100. So AmBetter does have great plans out there, but like anything... do your research, know what your looking for and READ your policy, always get referrals if needed, a MUST get pre-approved procedures prior to having them performed, and always make sure that all the people providing your care are sponsored by your insurance, and if you have questions, speak to an agent. keep in mind that ALL medical insurance company’s now required you to be responsible for your own care under their policies, and all require you to make sure you know these procedures and most of all using ONLY in-network pre-approved procedures and pre-approved doctors are used under your plan. Hope all that made sense, even if I did repeat myself. Good Luck!

4 years ago

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Wayne Jackson Douglasville, GA

My experience have been good, got the insurance for my wife, she had to spend one night in the hospital and the total bill came to over $14,000, Ambetter paid all of it. Never had an issue finding a providing. I live outside of the Atlanta and do no have issues find a provider. If you do not live around a large city then you will most likely have issue finding a provider in your area. Also make sure you call all of your Doctors that you wish to stay prior to signing up. I worked in the Ambetter Call Center, the Provider list that they have is not up to date. Do your homework prior to joining and everything will work out.

4 years ago

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LD Darien, GA

I was scared to get the Ambetter from Peach State Health Plan after reading all of the bad reviews on here but it was all that was offered in the Marketplace for my area. I have been very happy. I have had their insurance for nearly 6 months and they have paid everything promptly with no issues. Of the nearly $6000 we have only had to pay a little over $100. I have had no problem finding doctors, although I must say they all have to be affiliated with the local hospital. Sure, I'd rather have better choices but I really did not expect more. I have been happy with every doctor or NP I have seen, especially my NP. I have no problem with their website either, including earning rewards on the visa and using it to pay my phone bill. We have not had health insurance for many years and this has given us peace of mind. I have not had to call them but I did message them on the portal a few times and got a quick response. It would be better if they sent an email saying they had replied though. I had to keep checking the message box. We thank God our health has been cleared except for a few small issues, thanks to Ambetter.

4 years ago

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Brittany Lawrenceville, GA

I have had AmBetter since July 2018. I have read the majority of the hundreds of these reviews and it seems as though folks either didn't have other options and also didn't do adequate research about whether the physicians, hospitals and urgent care centers that they prefer were covered by the AmBetter plan they were considering. I went with an AmBetter 4 (which is a Silver plan on healthcare.gov), I have a low deductible ($600) and 100% co-insurance after my deductible is met. I pay $0 for my medications and since I am self-employed, I actually pay the full amount of what this insurance premium is per month (roughly $400/month.) I have on-going health issues that they haven't penalized me for, I have received all of my 3-month prescriptions without issue as well as over 15 other Rx's that are monthly. (As I said, I have seriously, life-threatening, on-going health issues.) I just spent 8 days in the hospital being discharged on 03/30, today is 04/07/19 and ALL of the hospital bills ARE PAID IN FULL. Again, I did extensive research before selecting AmBetter as my provider. I am very pleased with them and have zero complaints. Again, I pay my premium on time, researched my physicians before selecting their insurance and understood what type of plan I was selecting. Doing your research instead of expecting someone else to do it out for you is the truth behind the majority of the complaints in all honesty.

4 years ago

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Kaye C. Marietta, GA

My experience with AMBETTER for the 2018 year has been GREAT. My husband has been to the ER three times and hospitalized one time. All the bills were paid promptly. We both have had a lot of doctor visits and several diagnostic procedures without any problems at all. All of these extremely negative reviews are terrifying and scary as it is time to pick a company for 2019. I only had two choices form 2018, either Ambetter or Kaiser and Kaiser is a true HMO so that was out. The reason I pick AMBETTER is that All the hospital systems in the Atlanta area were included: Emory, Piedmont, and Wellstar. When I have searched for doctors, there any dozens for each specialty. I don't know if my great experience is driven by my location and the fact that we are in the metropolitan Atlanta area or not. Good luck and Good health to all.

5 years ago

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Laverne Williams Irving, TX

I am a healthcare reimbursement professional with may years of experience, I file claims for various physicians, code medical records and perform physician credentialing. Currently, I do not qualify for AmBetter health plans but anytime I have needed to call to verify patient benefits, check health claim status or get an authorization for services or just so I that can help redirect a patient appropriately, every customer service person I have spoken with at AmBetter has been helpful, courteous and professional. Answering all of my questions with care and great attention to detail. As a patient, its better to allow your doctors office to handle things for you but try to be clear when attempting to get answers from your insurer. But it is the insured parties responsibility to personally understand their own insurance like what's covered and what is not, and how much will this cost me? before you leave the doctors office. For physician offices you really should let the right people handle credentialing, people with experience. AmBetter is a great payer of claims and fast; as they keep accurate records and when they recoup because someone made a mistake in claims processing its always been accurate without the chatter like some others, "because we can". Thanks AmBetter you are doing a Great job and you are easy to work with.

5 years ago

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Viktorija Kang Henderson, NV

So far everything has been great. The only reason I am writing a review is to balance a little bit the stars because majority of people gave 1 star. I am a scholar and I can tell that all the reviews are always very biased and subjective. Most of the time people leave reviews when they are extremely unsatisfied or they are extremely satisfied. What about those who are in the middle? I live in Nevada and I found primary care doctor and pediatrician for my child within 5 minutes on their website. The plan I have has a good price and very good coverage, more than I could ask. I have called customer service and I was helped promptly. The person I spoke to was very nice and professional. I would never have written the review if I hadn't seen so many terrible reviews. Imagine how many other satisfied customers have not left a review? I just don't want people to not get good prices insurance because of other people's personal experience. Just look at the coverage, the price, and compare with other insurance companies. Choose what fits your needs, not what the "stars" say.

5 years ago

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AuntyK _83 Kearney, NE

This company stole 525$ our of my personal account! They charged my work account also! It took them 1 day to mess my account up and up to 45 days to fix it! What a joke! I'm canceling as soon as I get my money back! I would never recommend them!

2 months ago

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dustin opper Chattanooga, TN

OUTSOURCED CALL CENTER IN THE PHILIPPINES CANNOT HELP I have had the worst experience with Ambetter, they canceled my policy for non payment even though I paid. Then it took two months to have my policy reinstated and all they did was apologize for canceling my policy in error.. It took two mangers who didn't even work directly for Ambetter and then another 2 months to get results. They still owe me $390.00 for doctors visits during my policy cancellation done in error... THE WORST INSURANCE YOU CAN HAVE.

3 months ago

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Damon Rome, GA

This is the worst insurance company I've ever had in my 57 years! Do NOT ever sign up with Ambetter. It's one step away from being a straight up scam! They refused to pay "approved doctors " saying "oh we accidentally put them on the approved list" yet never remove them from the list. They don't apply money spent to the deductible. God forbid you have to call customer service. If you get someone who can speak English, they use a litany of canned excuses for everything. Shady company! NEVER, NEVER USE THIS INSURANCE COMPANY!!

3 months ago

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Grace Bagno

I've never written a negative review but I feel so strongly that I don't want anyone else to go through the stress I went through with them, so here we are. I enrolled through the marketplace with Ambetter, paid several months worth of my premium, yet never received a welcome packet, a member ID, a way to create an online account, nothing. I probably spent over 10 hours with their TERRIBLE customer service who clearly has no idea what's going on trying to get this issue resolved so I could simply make an appt with a PCP. The few times customer service was willing to transfer me to their escalation team, the call dropped every time. I was never able to receive medical care, and the only resolution I got came after I filed a complaint with my state's insurance commissioner (which I highly recommend you do as well if you have issues with them). I couldn't IMAGINE having actually received medical care and having to contact them with an issue or concern. AVOID AT ALL COSTS.

4 months ago

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Lydia Yaeger Pottstown, PA

I am pregnant and have been trying to get prenatal Routine labwork done for 2 weeks. It took me 3 phone calls to figure out that all labwork needs a preauthorization, whether routine or not. The people on the phone have heavy accents and don't seem to understand what I am trying to say, they keep reading screen prompts that have nothing to do with why I'm calling. Then it took my provider more than a week to hear back, and I had to call member services again, upset, and stressed out while pregnant to advocate for myself to be able to get the bloodwork covered. Today, I am still waiting for the preauthorization, and my appointment is now 2 business days away. So I will get my ultrasound and first OB appointment without even having my bloodwork confirming my pregnancy or any of the routine things they check for. This is absurd, all this money I pay through the marketplace and I can't even get the prenatal care that my baby deserves. Yes, I selected this insurance because it has no deductible and a lower OOP max, and chose to pay more monthly to have those things. But when I chose this I also thought that my care would be covered and I would not be spending hours on the phone trying to advocate for myself.

4 months ago

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Donna Lembke Hemingford, NE

Horrible. Do not use them. Took payment but was not applied to account. Called customer service ( could not understand any representative as they speak broken English) they took another payment and then had a credit on balance. Went to use it and was denied. Spent 3.5 hours trying to get to the bottom of this only to be told to call back in a week. Is all they can do is put a ticket in. Asked to talk to supervisor, was told they were one. Asked to talk to their superior then told there was non!! So can not fill my prescription because I now have no insurance and with out insurance it costs $1600. And this prescription is vital for my health.

4 months ago

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Sarah Broom

I have been battling with this insurance company for over two months for a pre authorization diabetic medication. First, I was told my diabetic medication wasn't a medical necessity, despite hitting the required A1C numbers. Then I was told I haven't tried a different medication first for 3 consecutive months, even though currently I have been on that medication for 9 months. Now they are blaming my doctor. I have been without my DAILY injection for over a week at the time of this review, despite consistently attempting to get the prior authorization approved for future doses since SEPTEMBER 1, 2023. It is the end of day, writing this review NOVEMBER 14, 2023. This is BEYOND ridiculous. I wish I could give 0 stars. A customer support agent called yesterday to see if my prior phone calls with the company had been resolved, I told her no, then we continued to go right back through the entire process again with the conversation ending with no new information, no medication, and irritation.

4 months ago

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DJ Tucson, AZ

Sadly, I HAD to give 1 star because they don't allow ZERO stars. They have managed to screw me out of $400 and I can't seem to do A THING about it. I have contacted BBB, filed a complaint, they stepped in as mediator but SCAMBETTER says they can't share info because of customer privacy ... they are a multi-million dollar business ... I have jumped through all of the ridiculous hoops for their bogus "My Rewards" card ... and it has been over TWO MONTHS since redeeming my points and SEVERAL CALLS, GRIEVANCES, AND EMAILS, and here I sit ... still waiting! I will be carrying in insurance elsewhere, at the beginning of the year and they say ... if they don't get their "glitch" 🙄 ( I SAY SCREW UP) fixed in time, I will not get my $400. I am beginning interactions with my state Attorney General's office and State Insurance Commission. The number of HOURS I have put in, trying to get them to STAND BEHIND THEIR "GLITCH" HAS BEEN CRIMINAL!!!! Only to be told, REPEATEDLY, that I will not be able to use the card, after I leave, at the first of the year. I have called "The Marketplace" for help .... NOTHING! I have called the "My Rewards" people ... NOTHING! We'll see if BBB can help but SCAMBETTER hides behind this whole "client privacy" BS ... and won't disclose information. I said, give 'em (BBB) 100% access! Don't hide behind some sort of bogus HIPAA proclamation!!! SCAMBETTRR SUCKS! CUSTOMER SERVICE CAN'T DO A THING!!! THEY ARE CLUELESS!!! And this (above) isn't even all of their screw-ups!!! ... oh, excuse me, "glitches". 🙄 I have been in tears, on MULTIPLE occasions, while dealing with them!!! A-holes!!!!!

4 months ago

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Marmalade000000

They cancelled my auto pay without warning. They overestimated the amount for treatment I was receiving, but when that amount turned out to be less, I STILL had to pay the balance out of my own pocket - for an ESTIMATED AMOUNT!! Furthermore, I received NO communication whatsoever about this - no letter in the mail, no email, no phone call - no nothing! Their website is outdated. Most if not all of the doctors listed are either no longer practicing or don’t take Ambetter insurance. Every year my premium has gone up considerably, but I don’t get what I pay for in the least. Lastly, customer service is a complete and utter joke! Imagine hearing barking dogs and screaming children in the background while you try to get answers from people who clearly have no clue what they’re doing. This company should be investigated for deception and fraud.

5 months ago