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Complaint Details
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Initial Complaint
03/25/2024
- Complaint Type:
- Product Issues
- Status:
- Resolved
I HAVE RECIVED A 1095-A FROM, AMBETTER FROM PEACH STATE HEALTH PLAN INSURANCE, I NEVER HAD OR REQUESTED ANY INSURANCE FROM THIS ENTITY. I AM MILITARY AFFILIATED AND NEVER NEEDED OR REQUESTED THIS INSURANCE. I AM PUZZLED AS TO HOW MY IFORMATION WAS GATHERED. I CALLED THESE PEOPLE LAST YEAR TO INQUIRE WHY WAS IB GETTING MAIL SAYING I HAD INSURANCE WITH THEM THAT I NEVER REQUESTED, AND WAS TOLD THEY WOULD TAKE CARE OF THE MISTAKE. I WOULD LIKE A RECORDING OF ME ACCEPTING THIS INSURANCE BECAUSE I NEVER DID. IWOULD LIKE TO KNOW WHY I HAVE RECEIVED THIS.
Business response
03/29/2024
Please see attached letter.Customer response
03/31/2024
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.
Sincerely,
*************************Initial Complaint
03/11/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I started services with Ambetter on January 1, 2024. They have been giving me the run around since February 12,2024. They paid for medication in January. February they didnt cover it. I had to get a prior authorization sent over from my doctor for them to cover it. 2 weeks later I got a letter in the mail stating that medication will be covered for 6 months. I called back there pharmacy line asking how to get a reimbursement. The representative told me where I would be able to find the form and where to submit it to. I emailed back the form and the receipt for the reimbursement. I go to the doctor today March 11, 2024 once again my medication is not covered. I called the pharmacy line again. I called about 10 times. I got hung up on by every representative I talked to. After my first initial call. I called back asking for a supervisor. each one just as lost and confused as the last one, fail to resolve the issue, fail to allow me to speak with a super Some would tell me no one is available. Then some would hang up on me because I refuse to give them my information. I worked at a call center and if a customer wants to escalate the matter they are supposed to get you one. Not Ambetter. I wasted 2 hours of my time getting a run around. I called customer finally talk to someone to assist me but he still wouldnt get me a supervisor. He said he would have to submit a ticket to see why my medication wasnt being paid for. He said that my pharmacy was running the wrong NDC number which he didnt have the number Then I called the reimbursement line to ask for my reimbursement claim/ refund for paying out of pocket for medication. I got transferred all around. I also submitted a claim today because I had to pay out of pocket again. I would like to be reimbursed $540 and honor my prior authorization and pay for medication. I cannot get anyone to talk to me to resolve this issue. I am at a loss and need someone else to help me resolve this since the company will not.Business response
03/14/2024
Please see attached letter.Customer response
03/26/2024
Complaint: 21419251
I am rejecting this response because: As of today it has not been resolved. ************************* reached out to me on March 18, 2024. She said she will look into what's going on. I haven't received a call back from her. I left her a message on Friday March 22 and today March 25, asking the status of my complaint. As of today I haven't received a call back nor the letter she stated in the response. So No, I'm not satisfied with the response and I would like the case to open back up until the issue is resolved. Also can my email address be added to my file for faster communication?
Sincerely,
*************************Business response
04/01/2024
An Ambetter Member Representative contacted the Complainant directly to provide assistance. The Ambetter Rep will continue to work with the Complainant to address her issues. Due to HIPAA guidelines we are unable to provide further detail about this case through this Website. A formal response will be mailed to the Complainant. Thank you.Customer response
04/02/2024
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.
Sincerely,
*************************Customer response
04/08/2024
I would like to re-open this case. Same thing happened again when I went to the pharmacy. ****** the representative from ambetter told me they fixed the issue. But it hasnt been resolved.
Business response
04/16/2024
The issue was resolved as of 04/09/2024. Please contact Ambetter should you need further assistance. Thank you.Initial Complaint
03/11/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I recently received mail from Peach State Health Plan saying I owe them $725.60. I have never signed a contract with this company or even heard of them before this letter. I tried to contact them by phone but their services give you the runaround. When you call it asks for a card number or the last four of your social, I have never received a card so I don't have a card number so I tried to do my social with my date of birth and the system replied with something along the lines of "there is no member in our system with this information". I think this company is trying to scam people by sending them invoices and hoping people pay them. Once again I have never heard of this company or signed anything from this company or received any mail from this company previously. I will not pay a single ***** to this company as I never agreed to anything with them. I tried to contact them by phone but it seems impossible to speak to a person. Please help.Business response
03/25/2024
Please see attached letter.Initial Complaint
03/08/2024
- Complaint Type:
- Product Issues
- Status:
- Answered
I have fulfilled my deductible of $550 along with my out-of-pocket requirement; however, I am still being charged a deductible for the medications which is fully covered by my insurance plan. I have contacted Ambetter, which is outsourced, 15 times but have not received any help in understanding why I am still being charged. Despite confirming that I have met my deductible and out-of-pocket requirements, the representatives are unable to provide me with any information on why I am still being charged. Several representatives kept repeating the same response (that I've met my requirements) and escalated my dispute to different offices. Many disconnected me after they hit a roadblock with how to respond to me. One time, I was on the phone for 2.5 hours with no results. HELP!!!Business response
03/25/2024
Please see attached letter.Initial Complaint
03/05/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
My account with this ********************************************* was terminated in August of 2023. But every month since then, I have been charged. I literally have the termination letter in writing and have been told that the account is closed but this month, I've been charged again. I was also told that a refund would be issued but it has not. I want my money back and for the payments to stop.Business response
03/08/2024
Please see attached letter.Initial Complaint
02/28/2024
- Complaint Type:
- Customer Service Issues
- Status:
- Answered
On their website and when I called customer support they told me I could use "myhealthpays" Rewards card to pay my utilities or get get grocery at Wal-Mart. I have tried both and my card gets declined every time. I have even tried to pay for my medicine at Wal-Mart and my card got declined. To night was my 2nd time calling customer support and the guy had no knowledge about helping me. He didn't see the tickets that supposedly the 1st lady I talked to about 2 weeks ago, put in. FALSE ADVERTISING where this cards can be used in the state of Georgia. I asked a **************** personal in wal-mart have anyone else tried to use this pink card and had trouble? They tell me yes and the people have to use their own debit card because it don't work. Also too, I have tried to change my PCP 3 times and they still have my PCP as some random person I don't know and never seen before. Supposedly a ticket was put in about that and it has yet to be change since the 1st of 2024. When you call Customer support they're reading off a prompter and don't know how to help you! I was put on hold tonight by Customer support ***************) for 10 mins for the person to come back on and say he was going to give me another number to call to help me with my rewards. I told him your customer support what number are you giving me? He got quite and never said anything else. i kept saying hello and he wouldn't say anything until i just hung up. REDICULOUS!! Very disappointed in this programBusiness response
03/07/2024
Please see attached letter. Thank you.Initial Complaint
02/09/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I was insured through Ambetter for the entirety of 2023 via Healthcare.gov. I paid each monthly premium in a timely manner. I have proof that I paid every single month but I am receiving delinquent premium notices threatening to send me to collections. I have called multiple times. Each person claims my account is closed and I owe no monies but then I receive another false statement in the mail a month later. This has been an endless merry-go-round. I canceled with Ambetter in November for coverage to end on 12/31/23. I owe no monies and I want someone to verify in writing that my account has been closed and updated to reflect that.Business response
02/16/2024
Please see attached letter.Initial Complaint
02/01/2024
- Complaint Type:
- Billing Issues
- Status:
- Answered
Had a doctor's visit on Jan. 12, ****. Doctor's ****** admits they accidentally transmitted my old insurance information to Ambetter, which resulted in three claims being (one for doctor, two for lab work). Ambetter representative claimed it will take ***** days to remove the INCORRECT insurance information from my account before claims can be resubmitte for processing - this is not acceptable - Health Insurance Marketplace representative agreed that this is not acceptable. Thank you.Business response
02/07/2024
See attached letter.Initial Complaint
01/28/2024
- Complaint Type:
- Billing Issues
- Status:
- Answered
A fraud report was placed in my name *************************** by *********************** with Ambetter from H393537373******437H. Two policy were issued #********* and policy start date 01/01/2023-02/28/2023 sec policy #**/01/2023-**31/2023 I never spoke or ask for any H33333233353**6333830H policy to be taken out. *********************** ***#******** got the information off his computer.I have spoken to the department of H323935323532333**834H and human service :*************** and reported a fraud account being in my name. I *************************** have NEVER taken out any H323935323532333**834H H33333233353**6333830H with any H323**235393****53932H associated with Ambetter from H393537373******437H. Or H323935323532333**834H H33333233353**6333830H marketplaceBusiness response
02/02/2024
Please see attached letter.Initial Complaint
01/21/2024
- Complaint Type:
- Product Issues
- Status:
- Answered
I am writing to formally submit a complaint/grievance in accordance with your established procedures for handling such matters. This letter is to address significant and ongoing issues with AmBetter concerning the cancellation of my health insurance coverage and the handling of my payments and refunds.Detailed Sequence of Events: November 10: Upon attempting to make a payment of $369.10 for November's premium, I encountered an unsettling revelation. My doctor informed me that my insurance was marked as canceled during a routine appointment confirmation call. This prompted me to check my AmBetter account, where, to my dismay, I discovered the policy was indeed marked as canceled. In seeking clarity, I contacted AmBetter **************** and learned that my coverage had been retroactively canceled back to August 31. This abrupt cancellation was attributed to a supposedly failed $600 payment on October 20, a claim that starkly contrasted with my bank records. The customer service representative advised me to prepare a letter from my bank to substantiate my case and mentioned they would be in touch. Amidst my frustration and confusion, I paid the $369.10 for November's premium and, driven by the shock of the situation, immediately requested a refund for the same. November 15: A reimbursement of $369.10 for the November premium was processed and received, offering a small solace amidst the ongoing confusion. December 1: In a 44-minute call with AmBetter, I was perplexedly informed that the full $600 refund was not issued due to deductions for fees from a doctor's visit, which I was apparently liable for. This explanation seemed nonsensical and further compounded the confusion surrounding my policy's status and the payments involved. December 11: I dedicated an hour to co-filing a thoroughly documented official complaint with AmBetters ****************. The expectation set was a response within a week. I was reassured that the letter from my bank, verifying the successful transaction, would be requested upon their follow-up. Regrettably, this follow-up never materialized. December 18: Resolving that the prolongation of this issue was intolerable and directly impacting my health, I initiated another call with AmBetter. This time, I spoke with a senior representative, **************** The conversation, unfortunately, did not yield any clear resolution or coherent explanation regarding the cancellation and partial refund. Remarkably, **************** indicated that there was no record of the $600 payment bouncing within their system.This further muddled the situation, leaving me with more questions than answers. This call was carefully recorded and documented under confirmation number: I119544683.Business response
01/26/2024
Please see attached letter.
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Customer Complaints Summary
162 total complaints in the last 3 years.
59 complaints closed in the last 12 months.