Ambetter
1.4
5.1
Overall Score
matt Seattle, WA
The worst part of getting food poisoning was having to deal with Ambetter. Sure, I experienced debilitating pain and frequent vomiting, but that was nothing compared to what Ambetter put me through. They repeatedly told my health care providers that my coverage had been cancelled, while telling me that it was still active. As a result, every time I sought care from Ambetter's emergency nurse line, I was refused help. It took repeated calls and hours on hold just to get taken care of. That frustration, fear, and helplessness was far more distressing than the intense pain that I experienced. Given the choice between food poisoning and Ambetter, I'd take food poisoning.
5 years ago
John B Concord, NH
After losing my job and health insurance with the Covid layoffs I signed up for Ambetter NH Healthy families. It seemed to be a reasonably priced plan at $344 monthly. With the unemployment insurance when I did my taxes, and was declined the tax credit it came out to $794 monthly with a $6000 deductible and maximum out of pocket. I had met my deductible and maximum out of pocket by November 20, 2020. I had to go to the Emergency Room on December 24 by ambulance. My plan clearly states that after the deductible and out of pocket are met they will cover 100% of ambulance BOTH in network and out of network. On a $864 bill they paid 465 and said that the rest was my responsibility. I called to discuss this, they spoke with me for half an hour, gave me a reference number to refer to when calling back in a week. I called back and it was like I was calling again for the first time. The operator I spoke to kept communicating with her supervisor, who first said that I used an out of network ambulance and that was the reason for them not paying. When I explained that it didn’t matter according to my plan’s coverage, and says exactly that on my portal, they said “Well that’s the most the insurance company is going to cover for an ambulance. You have to pay the rest yourself”. They are completely dishonest, what the policy says totally doesn’t mean anything. I want to file a complaint with the Better Business Bureau. They should be put out of business. I’m not paying the bill, since I’m 100% right and have it in writing on my plan page. When the collection agency gets on it I’m saying it is not a legitimate claim.
5 years ago
Kristy A. Cuyahoga Falls, OH
I would give 0 stars if I could. It is the WORST insurance I have ever had. They deny everything including a preventative mammogram which in order for them to be a part of the Affordable Care Act they can't charge for preventative mammograms. Customer service is horrible. No one ever knows anything and you can never get any answers as to why they deny the claims. And you will get a new reason every time you call and talk to a new representative. AVOID this insurance at all costs!!!!!! It isn't worth the low premiums because you will pay for every service and they will cover nothing. I got their best plan at $426/mo and they still don't cover!
5 years ago
Jessie B Chicago, IL
Working with ambetter customer service for almost 3 months was the worst customer service I have ever experienced in my life. The employees take your number in case you get disconnected, however they do not call back if a disconnect occurs. On more than 5 occasions, I explained my situations and got hung up on by customer service because they seemingly didn’t want to deal with the complexity of my situation. This was not a disconnect, they had my number to call back, they sounded unpleased and you could hear a phone click every time. At times it was me asking to speak to a supervisor, as soon as I asked to speak to a supervisor, they would hang up the phone. Never was my situation ever handled by the same person, which made this a hundred times more difficult. I spend so much time retelling and retelling this story to new employees who had to be caught up on the situation, only to try the same thing that the last employee tried and then to say good luck and part ways with nothing changed. I was a huge inconvenience trying to get my money back for the time period in which I could not use my card, not to mention the time I took every day to try to resolve these matters. No reimbursement was ever given. To top it off, most the doctors listed on the ambetter website are fake or old listings. I paid additionally money for a ambetter dental plan, I was unable to ever go to a dentist because the dentists listed on their site either don’t work where ambetter says they work, they don’t actually take ambetter insurance, they work in an entirely different state, or they are no longer in business. Please see the examples below. These fake listing are not just in the dental. They have occurred in PCP, physical therapists, and chiropractors. Filed a BBB complaint, and when they did get back to me they investigated everything 3 months after. I could not use my insurance all of January until the 28th when they finally gave me the card numbers to get my meds at the pharmacy. Since I finally could use the card on the 28th they said I had to pay for the full month of January and they would not reimburse me. Not to mention still never being able to see a dentist when I paid extra for a dental plan with them because of the fake doctors listed on their website. Over 20 dentists in my area are all fake listed and DO NOT TAKE AMBETTER. Save yourself money and stress and do not ever get this insurance. They do not even pay for basic labs that other insurances do. If you get normal physical blood work done it is gonna cost you 300 dollars. Even my pap smear cost money (a service that is something to be covered but ambetter always finds a way to make you pay something). They will never care about their members even if you are on tears on the phone crying because of the damages done to your health when your insurance was "active" but they wouldnt let you use it for 28 days. I could have died and their response was well you used it on the 28th so we will not reimburse you anything.
5 years ago
Katie Spring, TX
My husband went for annual wellness exam. He received a bill charged to his deductible. Contacted the provider and she said that she correctly submitted the preventative codes. Filed a complaint with Ambetter since Oct 2020 until now ( March 2021). Every time we submitted the complaints and we received back a letter saying that " we will mail the answer to your complaints within 30days" ! Nothing happens but just some random person gave me different (verbal) answers. I spent so much time to work with this issue and no solutions yet. This complaint/Grievance department service is really horrible. Stay away from this company if you don't want to receive a surprise bills and no-one seems responsible for complaints filed.
5 years ago
Cayamarie Springfield, MO
Had no issue with ambetter the first like 3/4 yrs I had it. It was somewhat of an issue finding a provider.
Come this year, I went to pick a prescription up to which I had to pay in full. I called ambetter, just for them to say that I was missing a payment. A $350 payment! I had absolutely no clue where it came from. Then I got February's bill and it is $400. I called once for them to tell me that my account was terminated then again that same afternoon (their system went down and had to call back later) for them to tell me that the $400 is what I pay a month. I should have reviews before getting it. I'm just gonna be canceling it. Hopefully I can, but seems to me I will have issues with it (from reading other reviews)
5 years ago
Disgusted Lincolnton, GA
This company is breaking the law and getting away with it.
Under the Affordable Care Act they cannot cancel insurance except for non-payment or fraud/misrepresentation. Cancellations require a 30 day notice in writing so that the usered person can obtain another plan through the Marketplace as a special enrollment.
In my case, as of January 2021, they have deon neither, and I am now out of the blue, in the middle of a pandemic without health insurance.
I had coverage with them in 2020, and used it for vision, dental and general doctor checkups. Finding anyone would that take this insurance proved a challenge initially.
I paid for a new similar plan (with increased premiums and increased co-pays/deductables of course - pay more for less as always) via the Marketplace in November to start January, 2021, and paid by credit card my firs month's new premium in December.
All seemed ok, Ambetetr sent me a new Welcome 2021 pack with plan and new insurance cards with Coverage Effective from 01/01/2021.
On january 17th I presented my new card to my pharmacy for my refoill for high blood pressure medication, and was told my coverage had been 'cancelled' - so I had to pay in full for them.
I have never missed a monthly payment or co-pay or anything, and have copies as proof from their statement/billing on their website.
The following day it took 3 calls to Ambetter and 3 calls to the Marketplace to get NOWHERE. The Marketplace says I have a plan that Ambetter has cancelled but no reason has been given, so I can't simply enroll in a new one, they also say I have to deal with Ambetter about this. Ambetter, of course, tell me I have to deal with the Marketplace.
The worse thing is that each of the three different customer service agents I spoke to at Ambetter eithe lie, do not know whatt ehya re doing and ALL refused to pass me to a Supervisor when they admitetd there was nothign they could do. One stated I didn;t have any insurance for 2021, and denied I had a new card for 2021 from them wheich I had in my hand! One said he'd speak to a superior and put me on hold and after 20 miutes of loud call waiting music the call was, surprise, surprse, terminated his end. He said he would call me back, but did not. The final customers service agent was downright rude and evasive, and said they would transfer me and actually only sent me back to the Marketplace.
Ambetter has 'cancelled' my new policy for 2021 for no known reason whatsoever, which was purchased through the Marketplace but did not notify me, they returned my first month's paid premium online halfway through the month as if by doing so this made the customer just disappear.
I have now had to make appeal through their system which I doubt will result in anything, and one through the Marketplace. I recmooned anyone having trouble with this company do the same, perhaps even lawyerup as their breaking the law as regards their requirements under the Affordable Care Act, 2010, might be worthy of a class action suit - I am sure they are doing this to others all over the country.
I have written to the CEO of the company as below, again, I recommend anyone do the same. Point out their own words, which is the very opposite of how it seems Ambetter treats its customers.
I suspect they are an Obamacare mohey-grab set-up to pocket as much of anyone's tax credit they can get + premiums paid whilst providing almost no true health care to their insured. This must be the end result of the Affordable Care Act, a clever ruse to transfer tax dollars and pooer people's hard-earned money to the already wealthy.
Nothing changes, does it...
5 years ago
Penny ,
Giving 1 star but the company doesn’t even warrant that. This is the worst company I have ever had. In the 40 + years of dealing with health insurance companies they are the worst. Since our health care system has been ruined I have been stuck with this company, no other companies participated in the county I live in. High cost over $1500.00 monthly w/ 16k deductible. Customer service is terrible, cost is high, I have been trying to resolve an issue of overpayment for more than 60 days and get the run around, am told first person dropped the ball, I am taking care of it only to have the ball dropped again, 4 people no resolution no return calls from anyone. It’s no little matter either. Do yourself a favor and avoid this company, if you have a choice any other company would have to be better. Next step fling a complaint with the dept of insurance at state level.
5 years ago
Paige White Kennesaw, GA
Getting pre approval has been a nightmare. 15 bus days to approve all procedures or care has left me in immense pain for over 2 months because each new procedure has to go through a 15 day process. Office staff confirmed only ambetter has such terrible requirements. I wish I had stuck with Kaiser because I would not be living on meds daily while I wait for the procedures I need. Also don’t believe them when ambetter says the delay is because the doctor office doesn’t file correctly. Ambetter told me this about multiple different providers and after being on hold for over 2 hours a rep finally told me the only way to bypass the 15 day approval wait period is in the case of life or death.
5 years ago
Michelle Hefner Cedar Creek, TX
Do not choose this company!!!! They are completely inept. They charged me for insurance for 6 months and when I went for a checkup, I was told my insurance was inactive. There was never any communication and they continued charging my credit card each month! After many hours of conversation, they refunded my money in November. Today, I received an email saying, "Thank you for your payment." They had charged me again! When I called, the woman said the confirmation number that accompanied the email was wrong and there was nothing she could do to help me. I told her that was the confirmation number on the email from ambetter! This is insane and totally unprofessional. What kind of scam is this company running?!
5 years ago
Tracy Bridgeview, IL
It’s the worst insurance ever. The lists of doctors and hospitals in their website as “in net-work” are all lies. I’m pregnant but there’s no OBGYN accepts this insurance. After calling 3 pages of “in net-work” doctors according to the website, I finally found a OBGYN doctor who’s 45 mins away from where I live (Chicago). I was bleeding a lot when I was 14 weeks pregnant and went to the nearest emergency. This insurance only covers if I used an ambulance or emergency room but all the tests I had to take including ultrasound, they did not cover. The doctor prescribed me medications but this insurance didn’t cover either. My OBGYN doctor transfered me to a different hospital for another ultrasound which also says “in net-network” in their website. This insurance also denied this coverage so I called them and they don’t know why i got denied when it says “ in network” like wtf? She told me to call the hospital so I did, she said called my insurance. I called my insurance and they told me they would call me back, it’s been a week already and haven’t heard anything. I’m so sick of this insurance but it doesn’t expires until the end of this year. I don’t understand why I am paying this insurance every month for monthly payment when this insurance doesn’t covers anything. Stay away from ambetter.
5 years ago
Dewana Gray Morman Little Rock, AR
This company horrible they stopped my surgery that i had to opinions from 2 specialist stating that there is a need for this so u can walk this is a surgery that is needed they canceled my surgery less than three hours before I was supposed to have it I pay for all the things that I need to have surgery renting equipment and everything out of my pocket just to be told that they felt like I need to be in pain a little bit longer before I could get my hip fixed I tried to explain to them if I got my hip fixed then I could work and I wouldn't have to be on Social Security but they don't care I can't pay my bills or do anything I went from working as a nurse for over 22 years to not being able to work at all or stand and now I'm on a walking cane if I get my hip fixed then I will be able to walk work and take care of my household and I won't have to be on assistant I would think this is what you would want you would not want your customers or clients to be sick or sitting at home hurting when they don't have to be for you to sit in the office and tell me that I am not in pain and that I should be in a little bit more pain than this so I said maybe I should go outside and fall hard on the concrete and then they said they would fix my head really so I have to go outside and hurt myself for you to fix something that should be fixed anyways this is horrible this is supposed to be a company through Obamacare it sucks what's the point in having insurance if something's really wrong and you have went through all the precautions it took 3 years for me to get approved for surgery spine specialist because I did every other alternative that I could do besides surgery to help me now I'm in chronic pain constantly they say they don't want people to take opiates or get addicted but I have no choice but to take these medications because my insurance will not fix the problem so that I can get off of medication ridiculous
5 years ago
SBM Albuquerque, NM
I am new to Ambetter, and I have never in my life experience the frustration of having to deal with them. I have been trying to sign up and absolutely no one in their sales department knows anything about the plans or any benefits that the plans provide. I don't understand, how you can work selling something and not know anything about it. All I wanted to know is what benefits does Ambetter offer HSA accounts? no one new what an HSA account was or what it was used for. I was transferred 4 times to different people in sales that might know more than the other. The conclusion was that I didn't know what I was talking about. I have worked in insurance for years, I know exactly what an HSA is, but each individual insurance company has different benefits. This company desperately needs to invest in actually educating their sales department including the member services. Think of the hassle you will go through I they can't even answer a simple question of " what benefits does this plan provide?" pretty pathetic. I would NOT RECOMMEND
5 years ago
Victoria C West Palm Beach, FL
I purchased a plan with vision and dental.
It was not worth having the vision and dental.
The dental only had one provider that would accept the plan in my area and they are so bad I walked out, and will pay out of pocket.
Division benefit barely covered the eye exam and gave me nothing towards a new pair of glasses.
Even trying to change my primary doctor It has been impossible to find providers who will accept ambetter.
Not just primary but that happens often with specialists also.
Ambetter's websites are never updated, and even their employees will give you names of providers who don't even practice anymore and or don't take ambetter. I had to have foot surgery this year so I had to meet my out-of-pocket. I don't even have a job and I'm disgusted at how much I had to pay including the premium. I only chose this plan so I could keep one particular doctor, but it is by far the worst health insurance I've ever had. Really sad that you can pick based on your ZIP code and there weren't many good plans available. I hope I don't get stuck with them next year because they are pathetic.
6 years ago
Arielle D Duluth, GA
Terrible in Atlanta. If you need an x-day half of the places listed in their network online DO NOT do x-days or do not accept Ambetter. They only accept it for the ER. Which needs to be listed.
I've been in pain over a month barely able to use my left hand & the only place who accepts the insurance and actually do the x-rays says it can take 2 additional weeks to get an appointment because it takes so long to get the green light from Ambetter 🤨🤨🤨 so you'll continue to be in pain after calling tons of places to be turned down. They need to take them off their networks or specify what they do and don't cover.
6 years ago
emad serry Houston, TX
Actually , i lost right ear hearing , then after visiting the primary care doc. transfereing me to ENT doc. then the problem started with Ambetter . The Ent asked for MRI on th brain , Ambetter did not approve the MRI . I had to pay the whole amount out of my pocket just to find out why the sudden hearing loss.
The ENT transferred me to a neuroglial doc , which ordered 2 more MRIs and a some kind of special test And here it comes the tragedy.
As usual Ambetter did not approve, the reason is i don't have a medical history that requires MRI - the sudden hearing loss is not enough reason and also they said that the doctor did not submit enough docs to get the approval , so its not approved.
i called them and they advised me to apply for an appeal , Then i did that appeal.
the result is the usual denial and the new advice was asking the doctor to do a call ( Peer to Peer call ) it means that the doctor must call the authorization department and ask for the doctor that gave the denial trying to explain to him the reasons for the MRI . after this scenario we got the first approval for the first MRI.
It took 4 months to get the first approval. Then another month to get the 2nd approval.
Now with the another neuroglial clinic , i am suffering from the same scenario because , the doctor asked to redo one of MRIs we did.
By the way , i paid the hearing aid without Ambetter help and the first MRI completely out of my pocket.
don't waste you health with AMBETTR
6 years ago
Michael Main San Antonio, TX
I found it hard to find doctors. The company web site listed doctors (in my case I was looking for an ENT) but when I tried to make an appointment I was told the docs didn't accept Ambetter. I called Ambetter and asked them to find an ENT locally who accepted their insurance, they never called me back. I changed insurance
6 years ago
RVM Lubbock, TX
THEY WERE REALLY WONDERFUL. THEY HAVE TOP DOCTORS. THE COVERAGE HAS BEEN A LIFESAVER. I WOULD STILL BE WITH THEM, BUT THEIR RATES WENT UP ON THE OBAMACARE MARKET PLACE.
6 years ago
Kristin Chester Fort Wayne, IN
After being out of work for months and my balance becoming past due I have finally figured out a way to bring my balance current again....the only problem is Ambetter, the most utterly WORTHLESS insurance company I've ever had, cannot tell me one way or another whether my coverage will be terminated even if I pay the overdue amount. HOW CAN A COMPANY AND ITS REPRESENTATIVES AND SUPERVISORS NOT KNOW THIS ANSWER? It's sad, but I guess I'm losing all coverage rather than taking a chance paying the bill only to lose coverage anyways! So much for the healthcaremarketplace.gov helping anyone out....all it did was cost me a bunch of money. I'm in good health but would rather not lose my coverage, however I would rather put the money available to me towards rent or groceries since I am still currently unemployed due to coronavirus restrictions. Ambetter is the WORST insurance company you could ever use....do yourself a favor and pick anyone else!
6 years ago
David Helms Euless, TX
The customer experience with Ambetter was clearly the worst in my role as a consumer. The EFT payment schedule was incorrectly programmed resulting in a premature cancellation of coverage that had to be reinstated. Then, their customer service reps gave nothing but inaccurate information. They advised my dentist that we had an $8000 deductible and then advised my dentist they did not cover routine fillings. My dentist refused service on this basis. The staff at Ambetter is both incompetent and uninspired. They have no business advising policyholders on their insurance products. This company should be prohibited from writing insurance in any state.
6 years ago
Aaron & Ashley Trincado Dayton, OH
If I could leave ZERO stars I would. I was with Ambetter part of 2019. I got a bill from a provider from something I got done back in July. I was covered in July. I paid what I owed based on my plan. Ambetter was supposed to pay the rest or so they told me. But they DID NOT. Then I kept getting billed for the same thing. Ambetter kept telling me that they would take care of it. This happened multiple times. I kept calling Ambetter again and again so try to solve this issue. Now they are denying me apparently and are saying that I have to pay the full amount! It's just RIDICULOUS! No straight answers from Ambetter. No explanations. Nothing. Awful company. Awful service.
6 years ago
Rusty Cottar Weatherford, TX
Health insurance ran by circus clowns. Ambetter loves taking money from their customers and they make it almost impossible to get approval for any procedure that is above a basic checkup. They continually deny any procedure, regardless of what type of physician (general practitioner, specialist, surgeon, etc.) requests it. On their website, they list a ton of doctors in any area of practice you can think of. However, this is a fraud as well. A majority of doctors, who Ambetter list as in network, refuse to accept the trash known as Ambetter. After fighting alongside my doctors against Ambetter trying to get required & necessary procedures approved, I understand why most doctors will not accept this lousy insurance. Ambetter requires everyone who they deal with jump through so many hoops that it is impossible for the doctors to make any money. Moreover, Ambetter is only concerned with the money which they can swindle from their customers with no regard to the health, betterment or required & necessary needs of the customers who are making this company filthy rich. In my opinion, the name of this company should not be Ambetter. A more fitting name would be Amworse.
6 years ago
Flora Grebe St Louis, MO
I called the market place looking for a good health insurance. The next day I received calls after calls from different phone numbers, non-stop. Then in few days I received a bill from Ambetter for my first payment of my plan. I ignored it since I didn’t apply to any health insurance.. then the next month Ambetter sent me again another bill and so with the next month. I got tired and called Ambetter. I told the lady I didn’t apply and she said she cancelled it. And transferred me to another phone which she said the market place so I can tell I didn’t apply for Ambetter which I also told that I didn’t apply and they must cancel it.. which they both said they did cancel it. Then why still I am receiving a bill every month? This health insurance is fishing people by their tricks. You don’t drag people to buy your insurance, you have to wait if they choose you!
6 years ago
Chuck jolley Auburn, WA
Hot happy...when you need to get specialty help from outside of the network because in their network does not have the medical ability to take care of special needs for medical needs of their clients...they need to look into getting the Seattle cancer care alliance under their umbrella. And the University of Washington hospital in Seattle under their umbrella. That's where all the specialties doctors are for multiple diagnosis and blood diseases and cancers.....because when insurance company only lets you go to certain facilities and you need facilities outside they say they will cover but you have to beg borrow and still and get doctors and doctors and doctors on phone calls to prove your case to get referred to see a doctor like at the University of Washington hospital..and you have no choice but to be under that network which is in Wenatchee Washington You're very limited to facilities in Seattle one hospital... This bill is almost criminal to the patient..very unhappy and can't change insurance because of our location where we live. And you're not allowed to have more than one insurance company.... Sorry for all the patience and spouses that are suffering like us just to get the best medical care.....
6 years ago
Melissa Osweiler New Port Richey, FL
Billing is terrible. We are set up on automatic payments from our credit card. Ambetter uncharged us for a month, then suspended our policy, stating we did not pay. It was not our fault they charged the incorrect amount. As a result, a procedure had to be canceled and has to be resubmitted for approval, and two doctor appointments were canceled as well. When we tried to straighten it out, they overcharged us $1600 and refused to issue a refund. We got this plan through healthcare.gov, so I'm wondering if we can cancel and get another company. We've had BCBS for many years with no problems. We should have stayed with them but were trying to save money.
6 years ago
Cheryl Tucson, AZ
I was hoping to choose a different Obamacare provider this year but Ambetter is the only option that includes both major hospitals in my city in their network. That's the only positive thing I can say about them. Their website makes it easy to pay but hard to do anything else. Lists of specialists are out of date and calling customer service is an exercise in futility. Referrals from your doctor can take weeks or months because so few specialists accept this lousy insurance. And once you finally find one, you will pay high rates out of pocket. It took two months worth of rejected referrals to finally find an in-network physical therapist and I found out the day before my first appointment that my cost would be $100 per session. I chose to go elsewhere for less, even though it won't count against my $7,000 deductible. I did the same thing with a medical device -- Ambetter wanted $1200 and I bought one privately for $650. So I am spending thousands for premiums and thousands out of pocket that doesn't even pay down my deductible. It's blackmail. It's craptastic, catastrophic insurance that meets the ACA guidelines on paper but, as a practical matter, is almost impossible to actually use.
6 years ago
gpacc Hillsborough, NC
Ambetter of North Carolina has been a nightmare. I used to own a large business which provided over 400 employees with healthcare coverage. Typically when changing carriers there can be a few bumps but Ambetter has been almost impossible to deal with. People at the call center are nice enough but have no ability to really help. We have three family members on meds for multiple years. Ambetter denied coverage even though they said the meds were covered when we were choosing carriers. Our doctor has sent pre-authorization forms in but they Ambetter had no record. How can you be HIPPA comment if you lose authorization forms?
6 years ago
C DeMeritt Indianapolis, IN
I would give this so called Ambetter a zero if I could. My husband is diabetic. When I unrolled in this plan I wasn told they covered his $1100.00 med. I said great. So I enrolled and went to get his prescription filled.
Well I get a letter in the mail and saying. Now mind you the pharmacist made this final decision. Well wont cover this med because his A1c was not above a 8,5. Well the reason why it wasn't is because he was on this med that lowered his A1c for 3 months. Got free samples. But I dont get how a pharmacist can make a final call on what my husband needs. That is why he has a doctor. Also he is on metformin. The pharmacist says he cant be on both tyoes of meds. Are you serious.
So I pay a monthly premium for nothing. Cause there are no doctors that wont take this insurance.
So I might as well pay out of our pocket. Totally rediculous. So very frustrating.
6 years ago
Kathy Schillo Chicago, IL
I signed up for this insurance company effective January 1st. Got messages to pick a primary care provider. I did but it was not updated in their system. When I called, the customer service person said it wouldn’t be effective until February 1st! So it takes their system weeks to update a doctor’s name? They cashed my premium right away.
Sounds like a scam to me.
They did give me a reference number to use, but when I called my doctor’s office I was told Ambetter would not pay until the doctor was updated in their system so I should wait until Feb. 1st. So they got $700 for January for nothing.
6 years ago
Lori Walker Addison, TX
Doctors listed on the website are not on the plan! Most of the numbers for the doctors are not correct or working numbers. I was on the phone with Ambetter for 52 minutes. I could not find a primary care doctor on their list after calling over 42 of them listed in the Dallas- Fort Worth Area that would take my plan. Even after 52 minutes on the phone and Ambetter calling doctors they were not able to find me a primary care doctor. I pay close to 2,000.00, a month for insurance. The plan says you do not need referral yet all the doctors I have contacted said they need a referral from the doctor yet you can not find a primary care doctor. I feel like this is false advertising and I feel the State of Texas should get involved and a class action suit should follow this scam. Texas Attorney General's Consumer Protection Hot Line at 1-800-621-0508. Because you deserve better than Ambetter!
6 years ago
Carmela Corvato Fort Mill, SC
What a horror, our insurance increased 400% so our only choice was AmBetter. They promise dental benefits up to 1000 in SC but NO ONE takes their insurance EVEN THE NAMES THEY GENERATE FOR YOU AS NETWORK DENTISTS. I called for assistance after the dentist AM BETTER sent me to refused to serve me, I spent 90 minutes ( mostly on hold) with sub par representative who "found me another dentist within the plan" but that dentist declined to take me too. Then I spent ANOTHER 90 MINUTES trying to get that resolved. They put me on hold and never came back on the line. I gave a denral emergency and no one can help. They only pay a small % of tge ER so an ER room visit will cost me 1000.00
The next day I tried again, was asked if I wanted more names. I asked for a supervisor and was put on hold for over 35 minutes. No supervisor ever responded.
I checked our benefits for urgent care and the closest urgent care is 100 miles away. Sorry, they cant help.
DO NOT SIGN UP FOR THIS COMPANY.....THIS ISNT INSURANCE IT IS A SCAM.
They denied my husbands RX even though the " website" includes his medication as pre approved. They wont assist or repond to help getting the RX approved.
Can we file a complaint with a governnent agency? PLEASE DONT TAKE THIS INSURANCE
6 years ago
Shar
This insurance marketplace should be investigating this company for not meeting their standards. This company is so TERRIBLE I decided to forego having insurance for 2020 as they are the ONLY insurance available on the marketplace for the area I reside in. The doctors and hospitals will NOT work with this company (will not contract with them) because the insurance company will not pay the same amount to the doctors and hospitals that all the other insurance companies pay--this company wants too good a deal for themselves, (a better deal/contract to pay the hospitals/doctors LESS THAN their competing insurance companies pay) so rather than form proper coverage areas, they simply provide their insured patients with very, very spotty coverage (INVESTIGATE THEM Health Insurance Marketplace) forcing people to drive hundreds of miles for specialists, and giving them one single choice of primary care physician per town.
I was told by one of the major hospitals in my area, at the beginning of 2019, that I would have been better off having NO insurance company, rather than this company, because they had programs for low income uninsured individuals that would have given me more options at a cheaper price. But because I had this terrible insurance, even though it was inadequate, I could not qualify for the hospital's low-income program. Better no insurance, than lousy insurance, if you have limited income.
After one year of fighting with this company constantly, finding their directories to be downright FALSE, and their coverage so spotty its all but useless--I decided I'd rather pay out of pocket than ever deal with them again.
I'm calling around right now finding various doctors with the lowest prices for uninsured patients, along with online prescription programs versus local pharmacies and will have a game plan ready in case of emergencies. I'll be putting the money aside that I would have been paying this lousy company (for next to nothing coverage) and use that for any doctor visits I may need.
In addition to the lousy coverage area this company has, (because none of the doctors or hospitals want to deal with them) and a directory you absolutely cannot trust, you have to pay 25% co-insurance IN NETWORK using their marketplace plans.
They should be investigated by the Health Insurance Marketplace-- there is no way they are meeting marketplace requirements, I had two companies before them, HUMANA & BLUE CROSS, both through the marketplace and both were a million times better with proper coverage and correct directories.
6 years ago
Kara Maricich Gardnerville, NV
I would give Ambetter a zero star if the option was available. My rates were around 1800 for my two children and I with 7,500 individual deductible and 15, 000 for the family. This company refused to pay for anything. My daughter who has asthma and was hospitalized multiple times as a child was denied having her inhaler covered because they deemed it unnecessary. They are also denying acne medication even though my son has acne and a prescription from a dermatologist. I am switching to hometown health with around the same premium, way better coverage and a 500.00 deductible. This insurance companies only goal is to make money off of people who can actually pay for health insurance and to deny covering everything. Some of our local doctors now refuse to even bill Ambetter because the companay makes it so hard to get reimbursed.
6 years ago
carol shepherd Athens, GA
PLEASE DO NOT CHOOSE THIS HORRIBLE INSURANCE COMPANY. This insurance company's goal is to steal your money and give you NO benefits, especially not any diagnostic tests/scans/imaging.. Last year, they denied a CT scan for 9 months, even after 3 doctors requested it, and even after 2 "peer to peer" interviews with my doctor, they still denied the CT scan. Ambetter's doctors that do the "peer to peer" interviews with the patients doctors completely disregard the patients doctors and THEIR POLICY IS TO AUTOMATICALLY DENY REQUESTS FOR SCANS. The only scan they will approve without a fight is an ultrasound, and that is because an ultrasound is low cost for them. Unfortunately, ultrasounds don't show MANY problems that require diagnosis by a CT scan or some other scan. This time, I waited their 15 days required before the CT scan, only to be told that they denied it. Then they denied it again after an interview with my surgeon. This same thing happened last year. Ambetter denied the CT scan after numerous requests from doctors for 9 months, and by the time they approved it, I had to have emergency surgery because they had denied the diagnostic imaging for so long, until it became an emergency situation.
6 years ago
J.F. Alpharetta, GA
They are terrible. I have the dental plan. Needed an Endodontics. They have one in a 200 mile radius of Atlanta. Made appointment, paid deposit for appointment, doctor didn't show up. Couldn't make another appointment, so I called Ambetter. Spent 1.5 hours with four different people on the phone. First they told me I could go out and find an Endodontic and get them to accept Ambetter terms, I said fine, I will charge Ambetter my consulting fee to do their job. They said no, so they tried calling doctors to see if one would accept Ambetter terms. None would - that tells you something. I asked them for an email, giving me the names of available Doctors and she said she couldn't do that (the person the day before did). She would let me ask why not, and quickly sent me to hold and never came back.
I think I will go and get the work done and then take Ambetter to small claims court suing for the medical, time lost from work, and travel costs.
Like my son says "they suck"
6 years ago
Ana Maria Hudtwalcker Tampa, FL
This is the worse Health Insurance company. I have a lower back pain issue for many months and got this insurance in hopes of finally getting better without going to the hospital. However, their list of providers are very poor and of low quality. Most of them have bad review online, and when you finally have a decent doctor they have a long waiting list for an appointment. So far, many of the treatments or medication the doctors try to prescribe me have to be first approved Ambetter. Really!! Even when they get all the information from the doctor, they still don't approve and you are left untreated. Please, unless you are just worry about minor illnesses, like a cold or the flu, do not get this insurance! They are really bad and omit information regarding the details of your plan
6 years ago
Michelle H Clearwater, FL
Hands down the worst healthcare company on the market. If you are able to chose another company, please do. I spent hours, days, weeks that turned into a total of two months attempting to find a psychiatrist that accepted this insurance. Until I finally changed health insurance companies, and I never did find a doctor that accepted Ambetter. More importantly, I never received any successful feedback from any representatives. Either information incorrect, or no response at all. All the doctors listed online that were suppose to be in network, either did not have a working phone number, no longer accepting new patients, but mostly didn't accept Ambetter - EVEN though their name was clear as day in the provider network as indicated online and told to me by representatives.
Terrible, terrible health insurance, strongly advise to stay away if possible.
6 years ago
Mitchell Hyett Reno, NV
What a nightmare... between these idiots and the idiots at the marketplace, healthcare is completely doomed. Nobody is trained on anything. Have had to call dozens of times, always at least 45 min to get a non-answer to any question I have. And everybody you speak to, each time you call, you will get a different answer. Even the "supervisor" just makes stuff up. Total scammers. They're trying to charge me double my premium for my first month, claiming $250 as my "binder payment", when asked why do I have to pay twice for my first month, she says "So we know that you are serious about wanting healthcare". Unbelievable.
7 years ago
Richard Eckler Jacksonville, FL
1) Customer service is minimum 20 minutes and usually 45- 1 hour.
2) Company could not assign a PCP because therir lists were not updated, two PCPs declined to accept me because the company wasn't paying them. The first PCP said there's a 6 week wait for appointments MINIMUM! and no service would be provided until the second appointment-the first was for their paperwork ONLY!
3) This company is so incompetent that they could not assign me to paperless billing- an advantage to them!- despite four requests.
4) Did I mention the $13,000 they were paid over the course of a year? And for that I received one PCP visit.
This company is the best advertisement for Medicare For All I know of and I will be asking presidential candidates to mention them by name on the national stage.
7 years ago
another unsatisfied customer Scottsdale, AZ
If I could give Ambetter a zero I would. Using Ambetter was the most horrible experience of my life. The Arizona State Insurance Licensing Board needs to shut them down. The workers are incompetent. You could be on the phone four hours and they get nothing done. Their computers are always crashing when you call and the web site link NEVER worked. Even the grievance people are unhelpful, and one of them outright lied about the status of my appealed claims. This place gave me ulcers and stopped my surgery recovery in its tracks from all the stress. Ambetter did whatever it took NOT pay my bills hoping I would give up and go away despite the nearly 1k a month premiums I paid them. And almost a year later I am still dealing with trying to get bills paid and they are trying to rescind money for little bills they did actually pay! I could have gone without insurance and been better off! Beware if you need hospital care while using them. They refused to pay my hospital bills even though I was covered and they actually authorized the stay. The hospital executives told me it has bills pending to Ambetter for other patients dating back to 2015 that they have NEVER paid. Yet they continue to collect juicy premiums every month! Don't waste your time or money with this so-called insurance company.
7 years ago
Dana Surprise, AZ
Had Ambetter in FL and now in AZ it is pretty bad. Latest is spent 20 minutes on a 3 way call with neurologist, myself and Ambetter AZ Complete Health. To make certain ALL I would owe was the $50copay for an in office diagnostic procedure. Drs office has this phone call in their records that Ambetter Rep stated EXACTLY that over and over that coded as such it would be ONLY the $50 copay. I received a bill for $310. The total for the procedure $360. Ambetter has listened to the recorded 3 way conversation and confirmed THEIR Rep stated this and then told me pretty much well our Rep gave you the wrong info, but tough you gotta pay anyways per the terms of your policy". So DONT believe them when they tell you to make certain you get information from them and it's even confirmed at the Drs PRIOR to procedure. They will stuff you anyways oh and "talk with the Rep that gave you the wrong info".
7 years ago
Hillary Chicago, IL
I can't wait to switch to another insurance. I pay about $400 per month for insurance that NO ONE accepts (because they're known for fighting claims instead of PAYING for them), insurance that barely covers anything, that has conflicting information about coverage, and that is impossible to use the way you'd think you'll be able to use it when you sign up. I've been referred by doctors for specialists -- dermatology and rheumatology -- and yet, the handful of doctors who accept this insurance are booked out for MONTHS, as they only accept at certain times of certain days (presumably to minimize their own cost risks). STAY AWAY FROM AMBETTER!!!! IT'S A TOTAL SCAM!!! Whoever works at Ambetter and makes money off of scamming people who are just looking for simple, reliable healthcare, SHAME ON YOU.
7 years ago
Carson Baird
Unbelievable runaround trying to see a neurologist after my son had a seizure and referred to a neurologist by ER. Different instructions every time we call. One wanted the ER report faxed. Went to the hospital, got it (79 pages!). Too much to fax but they can't say what they want. Another one wants a primary doctor referral faxed. Went to doctor and got a referral. They can't see it for up to 48 hours. They don't know if it will be enough. They won't know until a doctor reviews it. They can't tell me what of the ER report they want. Meanwhile, 3 full days have passed and he is no further to getting an appt than he was when he was in the ER. Can he work? Can he drive? Who knows and the added stress of dealing with Ambetter has been unbelievable. I took over to try to help and I've made no progress.
7 years ago
Lilah Stiger Eureka Springs, AR
Breast cancer, 2016. 5 surgeries in 8 months, including latissimus dorsi flap bilateral mastectomy with reconstruction, full hysterectomy. In the past 3 years have been diagnosed with Reflex Sympathetic Dystrophy, CRPS, PMPS. Unable to drive, work, or even do small household chores without a pain flare. See a pain specialist, who let me know that Ambetter will not cover certain procedures that offer relief, including a neural stimulator. My pain specialist has to submit a prior authorization for every pain med he prescribes. Recently Lyrica became generic, a circumstance I have been waiting for for over a year and a half, as Ambetter will not cover the non-generic form. Discovered that they will not cover the generic form either-the only med that truly offers relief from maddening and very severe nerve pain. Regardless of the diagnosis from four different doctors of suffering from nerve pain, this company does not cover the medication I desperately need in order to live day by day.
7 years ago
Jack Arterberry Wadesville, IN
Worst insurance I have ever experienced!!
Had to have rods and screws installed in back due to a fall.
After a year and a half have a popping and grinding in back ,,called primary physician office they referred me to an imidiat care orthopedic dr,,they did grays , ,couldn't see anything wanted to do an MRI
Insurance denied wanted to do 6 weeks of therapy!!!
It's metal on bone grinding when I walk
I paid for MRI out of pocket and Dr wanted me to see original neurological surgeon to look at scan,,
He wanted to do a CT scan ,,,insurance again denied,,,
He set me up for surgery to remove hardware,,,
Get a letter today insurance deny surgery to remove...
Have an appointment with therapy Tuesday ,,have already talked to therapy and they agreed that therapy will not fix problem.
7 years ago
Linda Church Saint Joseph, MO
This company is the worst. I have been fighting with them for since January. The gov reinstated my insurance because of their mistake on May 3rd. But Ambetter says I owe them 6000 bucks in back pretax premiums. August 1st the gov paid for a new policy which they show is active until the end of Aug. I had emergency heart surgery the 17th and AB is saying that I am suspended on the new policy even though it was paid by ACA. I have been fighting with these clowns for over six months and now they will not pay the hundreds of thousands for my emergency surgery. I also got a new and better policy from ACA that will go into effect Sept 1st. I have not been able to get my meds or my insulin since June when they decided to throw me under the bus. I wish they had a star for below 1, then I could really rate this company.
7 years ago
Gail Hermitage, MO
I am needing an mri an ambetter Insurance has denied it. I have 2 disc missing on L4 qn L5 in my lower spine I have DDD an bulging disc arthritis nerve damage thru out my back an severe muscle spasms that goes from the middle of my spine to my chest. Ambetter claimed it is not medically needed an I need to have new nerve complaints..so here goes another appeal an probable another denial. Said my injuries are old an so are my test but before they will pay for a nerve conducting test I have to have proof I have nerve damage..all they do is deny your request from drs. I think they should call this Insurance the death panel Insurance they want your money but wont pay for nothing..I'm needing surgery an cant get it till I get that MRI that's being denied to me. I thought they pd for pre existing conditions nope they dont..if i don't get this approved by Nov I'm dropping them. Worst Insurance company ever..I'm literally in tears over this..stay away from ambetter
7 years ago
Melissa Silverman College Corner, OH
HORRIBLE. A scam.
I have been on the same ADD meds since 2017. We switched to Ambetter on the exchange for 2019 due to their co-pay for this med being $50. They immediately started denying my medications, and basically said that whatever my doctor had prescribed did not matter; I would not be able to get my medication unless I tried a different, generic medication first. I tried to discuss this with them directly but to no avail. So I took the different, generic medication, which has neurologically destroyed my tongue (even though I went off of that med after 2 months).
They still will not approve my doctor's prior authorizations. First, they told me the doctor had given the wrong diagnosis. Honestly, I don't know how adult ADD is the wrong diagnosis for Vyvanse, since that is what it is made for. So the doctor submitted another prior authorization with a different code for ADD. Denied again. So instead of the medication costing me $50, which they scammed me into believing I would pay for this med, I am paying $300, and have to stop cold-turkey because of the price.
I called Ambetter again today, and after wasting over an hour on the phone, the first person the representative called (with me on the line) said they hadn't received any prior authorizations (a lie) or my doctor's appeal (a lie). He tried a different person at apparently a different place, Amanda, who said that it was denied because, again, the diagnosis was not suitable for this med. The representative (Jasper, who was actually quite helpful) asked what the exact issue was ... then Amanda said that it was denied because I hadn't taken the generic, alternative med yet. WHICH I HAD, for two months, and have permanent damage from it. So SHE LIED. It wasn't about the diagnosis, it was about this med, which they could easily see I have taken since THEY HAVE PAID FOR IT.
Now my doctor, who has not been given accurate information from Ambetter about what she needs to do to get this approved, has to submit ANOTHER prior authorization with the info on my prior usage of their recommended alternative, which is information they had already and is just one more bogus excuse to deny coverage. And she said the doctor needed to request a peer-to-peer, which was information they didn't share with my doctor.
I have been trying to get my medication back since JANUARY. Almost 9 months. We pay $12000 per year for two people and a ridiculously high deductible ($12K) and I can't even get my meds. Ambetter is a complete scam and they only exist to take advantage of people on the exchange. The internet is full of very, very, very angry Ambetter clients who have also been scammed.
They have also disabled any comments on their FB page because they were all negative (unethical) and took away the ability to message them on FB (also unethical).
This company should not be allowed to be in business. They are keeping people from becoming or staying healthy, and every road block is there on purpose and completely arcane.
7 years ago
Tiff Houston, TX
Ugh I didn't even want to give them one star... this insurance company is horrible!!! I am in Houston Texas yet can't seem to find any providers in my area. Had a procedure scheduled for today, an epidural of my neck. I took today off of work and had a friend drive me AN HOUR out of my way. I am in alot of pain and when I got here... surprise! They can't do the procedure because Ambetter has not authorized it yet. I have been fighting with them for TWO HOURS trying to get this approved when they've know about this for weeks. They can't tell me why it's not been approved, and they won't tell me when it might be. Everytime I call I get a different story as to why it hasn't been approved yet. And... they don't have ANY supervisors that will speak to me about this. I am so pissed.
7 years ago
Mike Emrick New York, NY
I guess i get what i pay for. $25 a month. After i left my company to enter a new career field needed some insurance for the mean time. Took over a month to sign up cause i got locked out of the system and customer service would ignore my calls. Then finally after getting on it took another month to receive an insurance card with my named misspelled "matthaw". Im still waiting for a refund bc i couldnt show my insurance to the front desk lady at my doctors which is $150. Maybe for Christmas ill get the refund. On top of that will only cover generic medications which isnt a problem if the medication im on had a generic but doesn't. Have to wait 8 weeks bc insurance wants me to try a generic bc its cost effective. Not going 2. I take 2 meds which one is generic and one is not so might have to pay out of pocket until i get it approved. Ambetter is last resort cheap insurance that only covers a few doctors and some vitamin C. I dont think anyone who has a serious medical condition would survive long with this insurance company.
7 years ago
