Complaints

The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

• Initial Complaint

  Date:09/14/2023

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I contacted Am Better ***** about being fraudulently enrolled under their service. I was told at that time that I would be contacted in ***** hours because it was an urgent health are matter that had be interrupted by the fraud. That was Sept.07,2023. No one has yet to contact me so that I can get the medical treatment I need through my correct medical provider.. I have never used their service or their doctors it was verified that I did not enroll in their insurance this has been ongoing since August. I desperately need to resolve this matter.

  Business Response

  Date: 09/15/2023

  September 15, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re:  *****************
  Complaint ID: ******** 
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 9/14/2023 concerning (*****************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you, 

• Initial Complaint

  Date:09/08/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I am unable to find any healthcare providers that accept my health insurance plan and I believe this to be due to my health insurance company engaging in fraudulent and deceptive practices. I have been searching for months for a new doctor after my last one dropped my insurance. My insurance plan from Ambetter (**********************************************************) is not accepted for new patients at both AdventHealth and ******* Health, the two largest healthcare provider networks in ***************. I have searched for private providers and none of them will accept it either. At this point, I am unable to even refill my insulin prescriptions. My insurance plan only offers two telehealth visits for medication refills per year, which I have already exhausted. Urgent care centers will not refill medication either so my only option is an ER visit which is prohibitively expensive on my plan. Furthermore, Ambetters list of providers that are in-network on their website is filled with inaccurate information. Many of the providers that are listed as in-network do not actually accept the insurance or in some cases are no longer even practicing medicine.I have attempted to contact Ambetter numerous times by both phone and through their website. I have also explained all of this in a grievance that I sent to Ambetter and they confirmed that they received on 7/28/2023. However, as of today 9/8/2023, Ambetter has not taken any action or replied further to my grievance and request for assistance.

  Business Response

  Date: 09/08/2023

  September 8, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re:  *************************
  Complaint ID: ******** 
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 9/8/2023 concerning (*************************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you, 

  Customer Answer

  Date: 09/11/2023

   
  Complaint: 20573019
  
  I am rejecting this response because:
  

  Ambetter Sunshine Health is using privacy laws as an excuse to not make a good faith effort to address and resolve my issue. It has been nearly two months since I filed an official grievance with Ambetter. A decision was supposed to be made within 30 days. Ambetter should be advised that I have also filed a formal complaint with the ******* Office of Insurance Regulation regarding their actions. 

  
  Sincerely,
  
  *************************

  Business Response

  Date: 09/20/2023

  September 20, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re:  *************************
  Complaint ID: ******** 
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 9/8/2023 concerning (*************************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you, 

  Customer Answer

  Date: 09/21/2023

   
  Complaint: 20573019
  
  I am rejecting this response because:

  Again, Ambetter has made ZERO effort to resolve this issue and has not even contacted me about it yet.

  
  Sincerely,
  
  *************************

  Business Response

  Date: 11/09/2023

  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  
  Re:  *************************
  Complaint ID: ******** 
  
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 9/8/2023 concerning (*************************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. Please see included plans' efforts to address member's concerns  
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you, 

• Initial Complaint

  Date:09/06/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  As of January of 2023 I have Ambetter as my Insurance. On 1/19/23 I called Ambetter to Double check that my insurance covered Durable Medical Equipment. Spoke with ****, Case # (I)94045324, and after he verified with someone else I was told yes it was covered. I needed to purchase, an at home And a portable O2 concentrator. My next question was did a need a referral to purchase, his response, no. I just needed to purchase the fill in the forms with my receipts and mail them in. So, I mailed them in right away.( twice, because the said the first set was missing a code) so, I have been denied and filed a complaint. I have called many time and I get nowhere. Last time I called I was transferred 5 timed, and hung up on twice. I tried to find a number of someone higher up the food chain with no success. I believe I do have the right to reimbursement here and cant get anywhere. Portable Oxygen concentrator was $2,890.00 and the Home Oxygen Concentrator was $710.00.

  Business Response

  Date: 09/06/2023

  September 6, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re:  *******************
  Complaint ID: ******** 
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 9/6/2023 concerning (*******************,BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you,
  

  Customer Answer

  Date: 09/07/2023

   
  Complaint: 20562010
  
  I am rejecting this response because:
  
  Sincerely,
  
  *******************

• Initial Complaint

  Date:08/28/2023

  Type:Product Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I received a zero-balance due invoice for health insurance from this company. I already have other insurance, never applied for this policy, never gave my information to this company, never contacted them, and never heard of them until receiving this invoice.Although the invoice indicates I don't need to send money in, they seem to be fraudulently billing the federal government $638.32 per month.

  Business Response

  Date: 08/30/2023

  August 30, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re:  ***********************
  Complaint ID: ******** 
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 8/28/2023 concerning (***********************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you, 

• Initial Complaint

  Date:08/16/2023

  Type:Order Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  This company has been sending mail to my address for *******************, ******************, ***************************, and other people who do not live at my address for three years despite being asked numerous times in writing to stop. I am the only person at this address and my insurance is through my employer; no one at my address is a client of Sunshine Health. They need to stop sending PHI to my address.

  Business Response

  Date: 08/16/2023

  August 16, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re: ***********************
  Complaint ID: ******** 
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 8/16/2023 concerning (***********************, BBB Complaint Case 20469506).Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you,
  

  Customer Answer

  Date: 08/21/2023

   
  Complaint: 20469506
  
  I am rejecting this response because:

  I don't need them to disclose any information with me, I need them to stop sending their clients' PHI to my address and I don't care if that's where the client says they want it sent, they do not live at my address and have no right to use my mail box, which is a locked box and anything addressed to them received in it is shredded. If the company does not comply I'm going to treat further communication addressed to ******* or ****** as a willful HIPPA violation because they have been informed that they are sending PHI to an incorrect address.
  
  Sincerely,
  
  ***********************

  Business Response

  Date: 08/23/2023

  August 23, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re: ***********************
  Complaint ID: ******** 
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 8/16/2023 concerning (***********************, BBB Complaint Case 20469506).Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information.
  
  We will respond directly to the consumer / affected members.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you, 

  Customer Answer

  Date: 08/28/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  

  Acceptance is per telephonic discussion of this matter and assumes that the business will keep its promise.
  
  Sincerely,
  
  ***********************

• Initial Complaint

  Date:08/15/2023

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Cannot access or contact PCP and cannot get treatment via Teladoc.

  Business Response

  Date: 08/15/2023

  August 15, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re: ***********************
  Complaint ID: ******** 
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 8/15/2023 concerning (***********************, BBB Complaint Case 20469316).Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you,
  

• Initial Complaint

  Date:08/06/2023

  Type:Service or Repair Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  For the last 2 years I have been enrolled in a Marketplace Policy Choice Bronze HSA plan # *********. My member ID # ********* and the plan was administered by Ambetter Health. My monthly payments of $197.97 were paid by autopay. I am going on ******** in the month of August (which is the month I turn 65) and I planned on making my last months payment in June (pay in advance so June payment covers the month of July). The Rewards programs gives you points during the year for completing programs and learning how to best care for given situations. In June I had enough points for a $225.00 Reward and requested it be sent to me. I planned to use the points for my final payment. The Rewards took longer than I expected to arrive and the July payment was paid on 6/15/23 from autopay and my credit card. I called Ambetter on 6/16/23 and asked that they reverse the charge back to the credit card and explained my situation. After assuring Ambetter that I would use my Rewards points for the final payment they said they would reverse the charge. I was told that it would take 10 to 14 days for the transaction to happen. The following is what transpired after that:7/01/23- Called Ambetter they said I need to wait longer 7/7/23- Called Ambetter and asked them to transfer my Rewards points to my insurance payment. At that time it showed double July Payment (autopay and Rewards) 7/10/23- Called Ambetter again. Rep agrees there is a double payment for July and told me it's all set up to reverse ,I need to wait ***** days. I requested to speak with a supervisor. They forwarded me to someone who said he is in charge he gave me a confirmation # ******** and reference # ********* and stated that it should happen.7/31/23 Called Ambetter spoke with Ayis Reference # I-*******. Told her I can see from the Ambetter website that they reversed my Rewards points payment and sent it back. Just the opposite of what I wanted. She assured me she fixed it.8/2/23 no longer member can't c

  Business Response

  Date: 08/11/2023

  August 11, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  
  Re: *****************************
  Complaint ID: ******** 
  
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 8/5/2023 concerning (*****************************, BBB Complaint Case 20429944).Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you, 

  Customer Answer

  Date: 09/11/2023

  ***BBB Have Received Additional From The Consumer***
  

   

  A representative from Ambetter did call us to ask questions about the complaint on or about 8/14/23 and ended the conversation saying they will call back. We are not aware of any further calls from Ambetter.

       Thank You, ******** and ***************************

  Business Response

  Date: 09/11/2023

  September 11, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re:  *****************************
  Complaint ***********
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 8/5/2023 concerning (*****************************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you, 

  Customer Answer

  Date: 09/13/2023

   
  Complaint: 20429944
  
  I am rejecting this response because: Ambetter did contact me but only to understand the situation. Ambetter said they would respond with their position but never contacted us. We are still missing a refund from Ambetter. 
  
  Sincerely,
  
  *****************************

  Business Response

  Date: 09/20/2023

  September 20, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re:  *****************************
  Complaint ***********
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 9/13/2023 concerning (*****************************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you,
  

  Customer Answer

  Date: 09/25/2023

   
  Complaint: 20429944
  
  I am rejecting this response because: No Ambetter representatives have contacted us. This is the second time that they (Ambetter) have responded to you saying they will contact us but fail to make any efforts to make contact.
  
  Sincerely,
  
  *****************************

  Business Response

  Date: 10/05/2023

  October 5, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re:  *****************************
  Complaint ***********
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 9/13/2023 concerning (*****************************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you,
  

  Customer Answer

  Date: 10/06/2023

   
  Complaint: 20429944
  
  I am rejecting this response because: the response from Ambetter on 10/5/23 does not provide any determination as to whether or not they have decided to reimburse me for $197.97. I spoke with ***************************** on 10/2/23 and provided all background info. Assume they contacted BBB only to state that they cannot disclose any info. Believe they are disregarding our requests.
  
  Sincerely,
  
  *****************************

  Business Response

  Date: 10/17/2023

  October 17, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re:  *****************************
  Complaint ***********
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 9/13/2023 concerning (*****************************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you,
  

  Customer Answer

  Date: 10/17/2023

   
  Complaint: 20429944
  
  I am rejecting this response because: Ambetter did not provide BBB with a status they just stated that they don't have to respond. I believe we have reached an acceptable position with Ambetter whereby I called my bank (10/9/23) and processed a dispute on my $197.97 as per direction from Ambetter  (*****************************). If Ambetter does not take exception to the hold within 90 days we will have an acceptable settlement. Believe I need to wait 90 to ensure the closure works.
  
  Sincerely,
  
  *****************************

  Business Response

  Date: 10/19/2023

  October 19, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re:  *****************************
  Complaint ***********
  
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 9/13/2023 concerning (*****************************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you, 

  Customer Answer

  Date: 10/23/2023

   
  Complaint: 20429944
  
  I am rejecting this response because: I need Ambetter to state that the $197.97 double payment has been resolved by having the credit card company put a hold on the transaction. Ambetter will consider the case resolved and will not try to undo the hold. Or words to that effect.

  After putting a hold  on the charge(as directed by ***************************** of Ambetter)  I have received a letter from Ambetter on 10/20/23 stating that they want it repaid.
  Sincerely,
  
  *****************************

  Business Response

  Date: 11/20/2023

  November 20, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  
  Re:  *****************************
  Complaint ***********
  
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 9/13/2023 concerning (*****************************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you, 

  Customer Answer

  Date: 11/20/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. I have been told by the Ambetter ****************** (******* N that of 11/6/23 there is no balance due on the account Ref# **********. Given that there is no balance due I am satisfied and would like to thank Ambetter Customer Support (*****************************) and ******************** (********) for their help in resolving the issue.   
  Sincerely,
  
  *****************************

• Initial Complaint

  Date:07/07/2023

  Type:Product Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  My deductible for my plan was $550. I have paid $708.80. Filed a grievance as they said this has never happened before. Received letter stating ************ does not see the overpayment. No phone number to talk to anyone about it. Right on my portal on their website, it shows that I have over paid my deductible. They sent me my Accumulator Spreadsheet and it shows the overpayment! Opened another grievance and cannot get a response after calling for days and days, they disconnect you. NEVER A CALL BACK. There is a "Consumer Advocate" line that hangs up on you, absolutely no way to get in touch with anyone. Sometimes they answer only to connect you to the right department and get disconnected. I am pulling my hair out. NO accountability. My last claim they denied took 6 MONTHS and 5 grievances to be paid! PLEASE HELP! Only ONE member service number and NO HELP WHAT SO EVER. The government should shut them down. If I was in my 90's they would have killed me. They are absolutely stealing from people that are too old to call for months on end. If someone calls me from Ambetter, I have and they have already received all supporting documents!

  Business Response

  Date: 07/20/2023

  July 19, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  
  Re: *********************
  Complaint ID: ******** 
  
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 7/7/2023 concerning (*********************, BBB Complaint Case 20287494).Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you, 

  Customer Answer

  Date: 07/26/2023

   
  Complaint: 20287494
  
  I am rejecting this response because: ****** service agent ******, called me went over my issue last week. she did not want to hear ANY of my complaints against the company. Today she calls me back & hasn't done ANYTHING to get supporting documents from her company AMBETTER. She is asking me what does the ACCUMULATOR SPREADSHEET say? She cannot access the ACCUMULATOR SPREADSHEET sent to me via email, from HER company (Ambetter). Ambetter sent me a 30 COLUMN SPREADSHEET to figure out what facility I overpaid my deductible to (that was AMBETTER's mistake) She said she has no idea who the last facility was that they had me overpay, I need to figure that out, I need to figure out what to say to their billing ***** call them & tell them I OVERPAID and please send me my money back. No updated *** to support my statement. If I was 90, how would I be able to get on a computer, open a 30 column spreadsheet and figure out who to call, ask for money back, and they say Oh yes, we will do that right away. I already called one Dr and they have nothing but the *** saying I owed them the deductible. All I have is a 30 column spreadsheet showing I overpaid $109.01! I am 65 years old and I have NEVER dealt with such an INCOMPETENT INSURANCE COMPANY in my LIFE! How do I report this to the ******* Health Insurance Commissioner. They have a non working number. Or PLEASE let me know how I can report this Health Insurance Company in *******.
  Sincerely,
  *********************

  Business Response

  Date: 07/27/2023

  July 27, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re: *********************
  Complaint ID: ******** 
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 7/7/2023 concerning (*********************, BBB Complaint Case 20287494).Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you, 

• Initial Complaint

  Date:07/06/2023

  Type:Product Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I provided my banking information to Ambetter when I started my insurance policy in April. My statements clearly showed a credit balance up until June, when I owed $110.21. However, on July 3rd, Ambetter attempted to draft $688.70 from an old and compromised checking account, without any prior notice. This caused an overdraft, and since the bank returned the draft due to insufficient funds, I immediately contacted Ambetter. After being on hold for half an hour, a customer service representative apologized and issued a credit, but could not satisfactorily explain why I was being charged such a high amount. Despite my persistent attempts to get to the bottom of this issue, Ambetter has been extremely unhelpful. Consequently, I am now seriously considering contacting the ************************* for further investigation. Today, to my dismay, Ambetter informed me that they do not issue credits once a bill has been completed, which is in direct contrast to what their representative had earlier told me. Furthermore, I have noticed that Ambetter has attempted to bill my accurate account number for $827.84, instead of the previous amount of $110.21. I fervently hope that the BBB can promptly and effectively assist in resolving this issue and that Ambetter does not respond with an unhelpful phone call from a representative who does not fully comprehend the gravity of the situation. I firmly believe that Ambetter has two different policies for me, which is causing the current discrepancy in payment. I have also notified AMBETTER of an address change several times to no avail. I have also tried to get my PCP changed for over a year now and nobody seems to know how to complete this task either. It is only digging deeper into my account records that there are posted notices (REMIND YOU ALL NONE OF WHICH I RECEIVED VIA: EMAIL, PHONE CALL, OR ***** of chargebacks and insufficient account notices. This is messed up on the AMBETTERS end.

  Business Response

  Date: 07/19/2023

  July 19, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  
  Re: ***********************************
  Complaint ID: ******** 
  
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 7/6/2023 concerning (***********************************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you,
  

  Customer Answer

  Date: 07/20/2023

   
  Complaint: 20280889
  
  I am rejecting this response because:  I will get the ***** form notarized and sent off the BBB so as AMBETTER will communicate directly to the BBB.  As far as a response to my complaint, AMBETTER has yet to respond and resolve an issue from a year ago.  I received a call the other day from a woman who could not explain the billing whatsoever and all she did was to repeatedly read from invoices, but again failing to explain any of it in her own words or to the satisfaction of the consumer.  I then received back-to-back in **** mail 2 different bills and 2 different amounts.  The first date 07/06/2023 in the amount of ****** and then the second date of 07/07/2023 AMBETTER turned around and contradicted themselves sending an invoice in the amount of 688.70.  I then received a call on 07/19/2020 from the dispute department stating that I owed nothing to AMBETTER and that the absorbent amount being charged was removed.  She informed me that my insurance was of no cost and dating back to the beginning of the policy year.  That same day she once again called informing me that the billing was a mess and she was informed to leave it alone and let the billing/accounting department sort through it all and as it stood the amount of $688.70 was indeed owed.  Come on AMBETTER Really?  Seems the left hand does not now what the right hand is doing.  BBB please see the attached invoices in question.  

  
  Sincerely,
  
  ***********

  Business Response

  Date: 07/27/2023

  July 27, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re: ***********************************
  Complaint ID: ******** 
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 7/6/2023 concerning (***********************************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you, 

  Customer Answer

  Date: 07/28/2023

   
  Complaint: 20280889
  
  I am rejecting this response because:  I have received no communication from AMBETTER concerning this matter.  AMBETTER was also informed to discuss this matter directly with the BBB.  
  
  Sincerely,
  
  ***********************************

  Customer Answer

  Date: 08/08/2023

  08/08/2023 AMBETTER left this writer a voice mail to call their resolution department which I attempted to.  The first time around the CSR had no idea, no record of why I was calling and then transferred me to their "dispute" department.  After hanging on the line with the new CSR and her gathering information all over again she decided there was nothing she could do for me and that there are no notes on my account pertaining to any compliant.  This writer than redialed the phone number to only have it ************* and ring and then disconnected.  This writer will try once again tomorrow 08/09/2023 to make contact. 

  Customer Answer

  Date: 08/11/2023

  ***BBB Has Received The Hippa Release Form As Requested From The Business***

  ***Please See Attachment***
  

  Business Response

  Date: 08/15/2023

  August 15, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re: ***********************************
  Complaint ID: ******** 
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 7/6/2023 concerning (***********************************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information.
  
  To be able to share the resolution to this complaint with the BBB, please have member *********************************** fill out and sign the attached PHI release form.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you, 

  Customer Answer

  Date: 08/16/2023

   
  Complaint: 20280889
  
  I am rejecting this response because: 1.  No attachment was found to consumer response 2.  Form " Authorization to Use and Disclose Health Information" was received and emailed back to AMBETTER on 08/16/2023 designating the BBB as a group to receive information.  This said notice has been attached to this grievance.  Furthermore a 3-way discussion was holed healthcare.gov, Ambetter, and writer on 08/14/2023 whereas AMBETTER stated that consumer should have been insured from 05/01/2023 and for healthcare.gov to back date consumers application to said date. ID# ***********.  The *** from healthcare.gov appeared to be at a lost at this point in time and stated she would escalate the case further.  Case had already been assigned to a case manager but with no outcome as of yet.  AMBETTER stressed several times that healthcare.gov needs to escalate the matter so as coverage would be provided with no lapse in time to pay for outstanding doctor care and scripts.  Consumer at a loss at this point and stands with no coverage to date.  Writer stated the fact that no notice was given of cancellation and that consumer stumbled upon cancelation notice mixed with other notices on his inbox on AMBETTER website.  No notice was given of any notices within this "box" and again writer stressed that with such importance as a cancellation of coverage that AMBETTER should has mailed out notices to writer's address on file.  
  
  Sincerely,
  
  ***********************************

  Customer Answer

  Date: 08/16/2023

  ***BBB Has Received Requested Release Form Consumer***

  ***Please See Attachment***
  

  Business Response

  Date: 08/17/2023

  August 16, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re: ***********************************
  Complaint ID: ******** 
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 7/6/2023 concerning (***********************************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information.
  
  Ambetter from Sunshine Health has performed a review of the request for information, and provides the following response:
  
  Thank you for allowing us the opportunity to address members concerns.

  1) Issue:
  
  Ambetter drafted $688.70 on 07/03/2023 and Ambetter advised the member when his policy started in April that his statement showed a credit balance until June when he owed $110.21. This caused the member to overdraft. 1st CSR issued a credit and could not explain why he was charged. 2nd CSR informed that we do not issue credits.
  
  Root cause:
  The plan has an original effective date of 02/01/2023 under plan type ** Balance C32 87% Core with a premium of $192.83. Then the plan shows a new and current effective date of 08/01/2023 under the same plan type however the premium went up to $688.70. The tax credit from 02/01/2023 until 07/31/2023 was $1121.00 and then it decreased to $937.37 increasing the amount of the members premium. The paid thru date shows 12/31/2023 but the last payment for $688.70 was returned.
  
  Solution:
  Attached is the members payment audit provided by the Enrollment Team which show the payment of $688.70 that was billed to the members account on 6/30/2023 and voided on 07/06/2023 due to insufficient funds on the account.
  
  
  
  2) Issue:
  
  Member believes he might have two Ambetter policies open causing the issue.
  
  Root cause:
  Every time the Policy rate (subsidy) is updated by the Marketplace the health plan receives a new enrollment file for a new enrollment span to be created with a new policy due to the member responsibility update.
  GA Policies: *********, *********, *********, 111236961
  ** Policies: *********, *********, *********, *********, *********, 130854515,136298212
  
  Solution:
  Research of the members account did not yield any additional policies for the member.
  
  3) Issue:
  
  Not being able to change his PCP over a year.
  
  Solution:
  The member is currently not active with the health plan, however, member is scheduled to become active again as of 09/01/2023.  Once the member becomes active again, a PCP change can be completed to a doctor who is par under TIN: ********** for the same location office as the requested APRN ************************************ NPI:**********.
  
  4) Issue:
  
  Void payment notices were mailed to member advising that payment was not processed due no account/unable to locate account and member ********************* that these notices were sent to an old address: *************************************************************
  
  Root cause:
  Notices were mailed to the members old address: ***************************************************** as the member did not update his new address with the health plan until 06/30/2023 at 10:38am Call ID#***********.
  
  Solution:
  Health plan records show that the member called the health plan, Call ID# *********** on 6/30/2023 at 10:38 AM to update his address to ************************************************************. During the call the member was advised to please allow **** business days for processing and was also transferred to the Marketplace to complete updating his address.
  
  Attached are the Void Payment notices mailed to the member prior to the effective change of address dated 3/15/2022, 6/17/2022, 7/19/2022, 8/17/2022, 9/17/2022, and 7/6/2023. 
  The Void Payment notice dated 7/6/2023 references the $688.70 payment voided due to insufficient funds in the members account. This notice was sent to the members old address due to the address change request still being within the processing timeframe of the **** business days mentioned to the member at the time of the call. Subsequent notices regarding termination of the policy were sent to the members updated address of **************************************************************** on 08/07/2023, 08/08/2023 and 08/10/2023. Copies of all the notices are attached.
  

  Also noted during the call on 06/30/2023, the member requested that the payment of $688.70 billed to the members account on 06/30/2023 be refunded. However, the plan was unable to refund the amount as the members account had insufficient funds and the payment was consequently voided on 7/6/2023.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you,

  
  

  Customer Answer

  Date: 08/17/2023

   
  Complaint: 20280889
  
  I am rejecting this response because:  See attached 

  
  
  Sincerely,
  
  ***********************************

  Business Response

  Date: 08/28/2023

  August 28, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  
  
  Re: ***********************************
  Complaint ID: ******** 
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 7/6/2023 concerning (***********************************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information.
  
  Ambetter from Sunshine Health has performed a review of the request for information, and provides the following response:
  
  Thank you for allowing us the opportunity to address members concerns.
  
  In reference to the overdraft fee for the payment of $688.70 submitted to the members account:
  On 6/30/2023, the health plan submitted a $688.70 payment to the members checking account, however, on 7/6/2023, the $688.70 payment was voided due to insufficient funds in the members checking account.
  These transactions are outlined on the payment audit provided on the response uploaded to the BBB portal on 08/17/2023. No credit is due, since the payment was returned to the member's financial institution.
  
  In reference to the Wrong Pricing issue:
  The members Premiums changed during his coverage period because his Tax Credit (Subsidy) was updated with a lesser amount for that coverage period by the Marketplace. Tax Credits (Subsidies) are not determined by the health plan.
  The tax credit from 02/01/2023 until 07/31/2023 was $1121.00 and then it decreased to $937.37 therefore increasing the members share of cost amount of the members premium.
  
  In reference to the issue with assignment of a ******* Care Provider (PCP):
  The member is not currently enrolled in an HMO plan in which they need to be assigned to a PCP for claims to be paid, or for authorizations to be submitted if a provider is not assigned.
  The member has been seeing provider ********************************* from **************** since 2022 and claims have been adjudicated. His most recent visit to the provider was on 7/11/2023 and the corresponding claim was also processed.
  Most of the authorizations on file for the member are being requested by provider ********************************* from ************************* PLLC and there are no authorizations submitted by the **** from ****************
  The physicians office is welcome to submit any new Prior Authorization requests through the following methods:
  Secure Web Portal:provider.sunshinehealth.com (This is the preferred and fastest method.)
  Fax: Medical ***************) or Behavioral Health ***************)
  
  In reference to the call recordings requested:
  Please be advised that calls are recorded for training purposes and are proprietary to the plan. An audit of the call was conducted and determined that the information regarding processing time of an address change request made to the Marketplace was relayed to the member.
  On the call on 6/30/2023 at 10:38am, the agent updated the address in the plan systems and at the end of the call he advised he would need to transfer the member to the Marketplace to complete the address update. The member was transferred to the Marketplace.
  Please be advised that addresses are loaded from enrollment files directly received from the member's Marketplace application. The health plan can only update a wrong address provided by the Marketplace once the policy holder calls to update it.
  On the call on 8/14/2023 at 4:26 PM, the member contacted the plan, with a Marketplace representative named *** already on the line, due to not having coverage until 09/01/2023. The health plans agent advised that to avoid a gap in coverage from 4/30/2023, the plan would need to be effective 5/1/2023 and not 9/1/2023. The agent also explained the health plan would need to get the new application from the Marketplace showing that the policy will take effect in May. The agent explained that this is the only way we can cover the claims.  **** the Marketplace representative, advised she would assign the matter to a case worker to see if they can retro-active the members coverage.
  Please be advised that Enrollment files, application backdates and corrections to such files are done by the Marketplace and the health plan would need to receive an updated file to be able to update the health plans records.
  As of today, the Marketplace has not sent an updated file to backdate the member's coverage t be effective as 5/1/2023. Please have the member contact the ** at ************** to check on the status of the request.
  
  In reference to any credits owed to the member:
  As outlined on the Payment Audit provided:
  2023 Premium:
  2/1/2023 - 4/30/2023: Full Premium: $1260.14/APTC: $1121 /Member Responsibility per month: $139.14
  Total Member Responsibility per Period: $417.42
  9/1/2023 - 12/30/2023: Full Premium: $970.52/APTC: $951 / Member Responsibility per month: $19.52
  Total Member Responsibility per Period: $78.08
  2023 Payments Received by Member: $146.14 (12/31/2022) / $132.14 (7/14/2023)/ $19.52 (8/11/2023)/ $139.14 (8/13/2023)
  The payments referenced above cover the period from 02/01/2023-04/30/2023 and the payment received on 08/11/2023 is for the policy starting on 09/01/2023.
  There are no credits owed to the member.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you,
  
  

  Business Response

  Date: 08/28/2023

   

   

  
  August 28, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  
  
  Re:  ***********************************
  Complaint ID: ******** 
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 7/6/2023 concerning (***********************************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information.
  
  Ambetter from Sunshine Health has performed a review of the request for information, and provides the following response:
  
  Thank you for allowing us the opportunity to address members concerns.
  
  In reference to the overdraft fee for the payment of $688.70 submitted to the members account:
  On 6/30/2023, the health plan submitted a $688.70 payment to the members checking account, however, on 7/6/2023, the $688.70 payment was voided due to insufficient funds in the members checking account.
  These transactions are outlined on the payment audit provided on the response uploaded to the BBB portal on 08/17/2023. No credit is due, since the payment was returned to the member's financial institution.
  
  In reference to the Wrong Pricing issue:
  The members Premiums changed during his coverage period because his Tax Credit (Subsidy) was updated with a lesser amount for that coverage period by the Marketplace. Tax Credits (Subsidies) are not determined by the health plan.
  The tax credit from 02/01/2023 until 07/31/2023 was $1121.00 and then it decreased to $937.37 therefore increasing the members share of cost amount of the members premium.
  
  In reference to the issue with assignment of a ******* Care Provider (PCP):
  The member is not currently enrolled in an HMO plan in which they need to be assigned to a PCP for claims to be paid, or for authorizations to be submitted if a provider is not assigned.
  The member has been seeing provider ********************************* from **************** since 2022 and claims have been adjudicated. His most recent visit to the provider was on 7/11/2023 and the corresponding claim was also processed.
  Most of the authorizations on file for the member are being requested by provider ********************************* from ************************* PLLC and there are no authorizations submitted by the **** from ****************
  The physicians office is welcome to submit any new Prior Authorization requests through the following methods:
  Secure Web Portal: provider.sunshinehealth.com (This is the preferred and fastest method.)
  

  Fax: Medical ***************)

  or Behavioral Health ***************)

  
  
  In reference to the call recordings requested:
  Please be advised that calls are recorded for training purposes and are proprietary to the plan. An audit of the call was conducted and determined that the information regarding processing time of an address change request made to the Marketplace was relayed to the member.
  On the call on 6/30/2023 at 10:38am, the agent updated the address in the plan systems and at the end of the call he advised he would need to transfer the member to the Marketplace to complete the address update. The member was transferred to the Marketplace.
  Please be advised that addresses are loaded from enrollment files directly received from the member's Marketplace application. The health plan can only update a wrong address provided by the Marketplace once the policy holder calls to update it.
  On the call on 8/14/2023 at 4:26 PM, the member contacted the plan, with a Marketplace representative named *** already on the line, due to not having coverage until 09/01/2023. The health plans agent advised that to avoid a gap in coverage from 4/30/2023, the plan would need to be effective 5/1/2023 and not 9/1/2023. The agent also explained the health plan would need to get the new application from the Marketplace showing that the policy will take effect in May. The agent explained that this is the only way we can cover the claims.  **** the Marketplace representative, advised she would assign the matter to a case worker to see if they can retro-active the members coverage.
  Please be advised that Enrollment files, application backdates and corrections to such files are done by the Marketplace and the health plan would need to receive an updated file to be able to update the health plans records.
  

  As of today, the Marketplace has not sent an updated file to backdate the member's coverage t be effective as 5/1/2023. Please have the member contact the ** at **************

  to check on the status of the request.

  
  
  In reference to any credits owed to the member:
  As outlined on the Payment Audit provided:
  2023 Premium:
  2/1/2023 - 4/30/2023: Full Premium: $1260.14/APTC: $1121 /Member Responsibility per month: $139.14
  Total Member Responsibility per Period: $417.42
  9/1/2023 - 12/30/2023: Full Premium: $970.52/APTC: $951 / Member Responsibility per month: $19.52
  Total Member Responsibility per Period: $78.08
  2023 Payments Received by Member: $146.14 (12/31/2022) / $132.14 (7/14/2023)/ $19.52 (8/11/2023)/ $139.14 (8/13/2023)
  The payments referenced above cover the period from 02/01/2023-04/30/2023 and the payment received on 08/11/2023 is for the policy starting on 09/01/2023.
  There are no credits owed to the member.
  
  

  If you have questions, please call us at **************

  (TDD/TTY **************)

  .

  
  Thank you,
  

  Customer Answer

  Date: 08/29/2023

   
  Complaint: 20280889
  
  I am rejecting this response because:  SEE ATTACHED
  
  Sincerely,
  
  ***********************************

  Business Response

  Date: 09/07/2023

  September 7, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  
  Re:  ***********************************
  Complaint ID: ******** 
  
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 7/6/2023 concerning (***********************************, BBB Complaint Case ********). Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information.
  
  Ambetter from Sunshine Health has performed a review of the request for information, and provides the following response:
  
  Thank you for allowing us the opportunity to address members concerns.
  
  In reference to the overdraft fee for the payment of $688.78:
  On 6/30/2023, the health plan submitted a $688.70 payment to the members checking account, however, on 7/6/2023, the $688.70 payment was voided due to insufficient funds in the members checking account.
  If the payment submission caused for the member that have an overdraft fee, please have the member provide the health plan with the bank statement and the credit will be issued. At this time, the health plan has no submissions of proof of loss for a credit to be issued. This is why a credit was not issued at the time of billing since the health plans ****************** needs proof of loss submitted to the health plan to process the credit.
  
  In reference to the wrong pricing issue:
  What was updated throughout the members policy was the "premium tax credit," which is provided by the Marketplace. Once the health plan is provided the enrollment file with these updates from the Marketplace, the health plan then needs to adjust the members premium share of cost.
  Please refer to the below health care.gov source for more information on "premium tax credit". Website: *******************************************************************.
  
  For information regarding why the "premium tax credit" changed, please have the member reach out to the Marketplace directly at **************, since these changes can only be done with them directly and the policy holder. The health plan only receives the files with the updated tax credit amount to be applied to the monthly premium to calculate a subscribers share of cost responsibility to the health plan.
  
  In reference to the *** assignment:
  The member is currently assigned to a Heart of ******* Health Center provider as of 9/1/2023. This is the same practice of APRN ***************************, whom the member has been seeing.  Please be advised that since the member is not in an HMO plan, the member can continue seeing ************************************ NPI: 1578074969.
  
  In reference to the notification of a denial sent to the Marketplace on 08/14/2023:
  Please see the attached letters sent to the member on 08/15/2023 and 08/21/2023 with the responses regarding inquiries the member sent to the Marketplace.  The member's retroactive start date request of 05/01/2023 was denied.
  
  Health plan records show the member was enrolled in the Focused Silver plan, policy number *********, with an effective date of 01/01/2023. The base rate of the policy was $1260.14, with a tax credit in the amount of $1121.00, leaving the monthly premium in the amount of $139.14. This policy was terminated effective 04/30/2023 due to nonpayment.
  
  The member was enrolled in the Focused Silver plan, policy number *********, with an effective date of 08/01/0223. The base rate of the policy was $937.37, with a tax credit in the amount of $937.37, leaving the monthly premium in the amount of $0.00. This policy was cancelled effective 08/01/2023 due to nonpayment.
  
  The member was enrolled in the Focused Silver plan, policy number *********, with an effective date of 09/01/2023. The base rate of the policy is $970.52, with a tax credit in the amount of $951.00, leaving the monthly premium in the amount of $19.52. The member may contact the Marketplace to see if they qualify for an appeal.

  
  Please refer to the Payment Audit provided for the 2023 Premium:
  
  2/1/2023 - 4/30/2023: Full Premium: $1260.14/APTC: $1121 /Member Responsibility per month: $139.14
  Total Member Responsibility per Period: $417.42
  9/1/2023 - 12/30/2023: Full Premium: $970.52/APTC: $951 / Member Responsibility per month: $19.52
  Total Member Responsibility per Period: $78.08
  2023 Payments Received by Member: $146.14 (12/31/2022) / $132.14 (7/14/2023)/ $19.52 (8/11/2023)/ $139.14 (8/13/2023)
  The payments referenced above cover the period from 02/01/2023-04/30/2023 and the payment received on 08/11/2023 is for the policy starting on 09/01/2023.
  There are no credits owed to the member.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you, 

  Customer Answer

  Date: 09/08/2023

   
  Complaint: 20280889
  
  I am rejecting this response because:  Ambetter is now playing around with wording to my response, and they continue to "skirt" around the issue.  As it now stands this is not going to be resolved between consumer and Ambetter.  Marketplace did inform consumer that they were in a agreement with back dating this unfortunate mishap but it was once again Ambetter who blocked this update and refuses to come to an admirable conclusion.  Consumer feels a third party is necessary at this time for the BBB is ineffective in resolving this issue. 
  
  Sincerely,
  
  ***********************************

• Initial Complaint

  Date:06/27/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  This Healthcare Insurance business is like running a "FRAUD" business. Their operator/customer service is sending me to pediatricians, Dentists, or *************** clinics. I asked for what I needed a Primary Physician. "I was asking for a referral to a primary physician." These calls back and forth took at least a week of my wasted time. Before leaving my work from a thirteen and a half hours flight. I arranged with the Metro Patient Portal (primary physician) to book me an appointment. The appointment was done and booked up as soon as I get back here in *******. I got messages at the portal and in person that my appointment was confirmed. Today June 27 at 11 am, I showed up with my appointment. I was told that my appointment was canceled due to Ambetter. Sunshine Health removing the *** that I'm supposed to see. This is another wasted week and time for me. Why? why wasn't notified by this Health Insurance of this matter? Per the ************ (Primary Physcian) the Ambetter.Sunshine Health immediately took off my *** from their In-Network Provider. I am in pain, both of my feet are giving me a lot of pain.So I called the Health Insurance Ambetter.Sunshine again for a referral. It took me more than ten calls because their telephone service kept dropping me on every call. Until now I am not getting any help with this insurance. And I do not have the cash to take care of my health and just go to any doctor.

  Business Response

  Date: 06/30/2023

  June 30, 2023
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  *****************************************************************************
  
  Re: *************************
  Complaint ID: ******** 
  
  To Whom It May Concern:
  
  Ambetter from Sunshine Health received your correspondence on 6/28/2023 concerning (****************, BBB Complaint Case 20243146).Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.
  
  If you have questions, please call us at ************** (TDD/TTY **************).
  Thank you,