Complaints
Customer Complaints Summary
- 142 total complaints in the last 3 years.
- 22 complaints closed in the last 12 months.
If you've experienced an issue
Submit a ComplaintThe 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:06/09/2025
Type: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 applied for this insurance back in 2024 and continue to rectify with the supervisor who no longer answer his phone. Each and every time there was a issue with this insurance. It wouldn't pull up in the computer or ill be charged for service that I was informed was covered. I've reached out repeatedly concerning this matter but I get no answer. I'm trying to find a solution to this problem about back charges please responded by e-mail thank you
Business Response
Date: 07/02/2025
Please see attached letter. Thank you.Initial Complaint
Date:05/22/2025
Type: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.
December 2024 I applied for health insurance through Ga access. I was approved I applied for the Ambetter and the Delta Dental plan. I thought I paid my first month with Ambetter because I didnt receive any notices for payments. It slipped my mind again for February. I went to the doctor and they told me I didnt have coverage. I immediately applied again on March 5, 2025 this time I didnt have a cost share. When April 1, 2025 came I had not received any insurance cards and I called Ambetter they stayed they havent received anything from Ga Access to begin my coverage. This went on for about a month. When May 2025 came I still didnt have coverage when I went to the doctor. At this point Ive paid for my visits and medication out of pocket. On May 5, 2025 I called Ambetter again they tell me they havent received anything for Ga Access. I contacted ********* again they said they will submit a ticket to fix the issue. I called back on May 13 to get an answer back for the ticket. I was told the plan was canceled for non payment in January. I told the *** I wasnt inquiring about that policy because I reapplied in March. She still couldnt give me an answer to my question. I applied once again for my coverage and made a payment. Once again Im scared GA Access and Ambetter are going to fail me again and have my coverage fall through the cracks once again. I would like someone to reach out to me to give me the answer to why my coverage didnt start for April. Just April coverage. I know the answer to what happened in January. I want to know what happened to the coverage I applied for in March. I would like to be reimbursed if possible for the office visit I had to pay out of pocket for the inconsiderate inconvenience on both companies parts.Business Response
Date: 06/21/2025
A detailed response letter will be mailed to the consumer's home. Thank you.Initial Complaint
Date:04/07/2025
Type: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.
Refuse to cancel policies that I didn't fill out for. I have a life threatening injury and can not work and can not get the help or surgical procedure.Business Response
Date: 05/05/2025
Please see attached acknowledgement letter. A detailed response letter will be mailed to your home. Thank you.Initial Complaint
Date:04/03/2025
Type: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 due a refund of two overpayments totaling $1924.13. Have been given various excuses and numerous 30 business days and numerous 7-10 business days for check to arrive since September 11, 2024. Most recently they sent me a check in my husband's name dated February 12, 2025. He is both deceased and was never an Ambetter policy holder. They got his name from a check that had been a joint checking account in both our names. My name was also on both of the checks that created the overpayment. On February 19, 2025 I called to inform them that the check been issued to my late husband. Was told 7-10 business days. No check arrives. On March 17, 2025 called about no check arriving and had almost identical conversation as February 19th. 7-10 business days - again. Today is April 3, 2025. No check has arrived.Business Response
Date: 04/30/2025
Dear Consumer,
Please see attached acknowledgement letter. A detailed letter with case resolution was mailed to your home address. Thank you.
Initial Complaint
Date:04/02/2025
Type: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.
I went to a *** specialist in October of last year and received a TMJ appliance to help me with my TMJ. I payed ******* for treatment. I submitted to get reimbursed and it was dec lined because it was supposedly out of network. So I disputed it. Every time I call the *** has no clue what they are talking about and are not much help. I have recorded every phone call with the persons permission each time and would love to show them to someone at ambetter but there is no number to call for reimbursement. I have mailed dispute letters over and over. Also it shows that ambetter covers TMJ appliances in the coverage form. Also the service ***s have said that there are also no TMJ specialists in ******* so where would they like me to go? After doing some research it says if there is not a ** within a certain distance I should be able to go wherever I need to go to receive treatment.Business Response
Date: 04/30/2025
Due to federal and state privacy and confidentiality regulations, we are unable to disclose any protected health information, including eligibility, claims, and billing information on this Website. A letter with details of your case and resolution was mailed to your home. If you have questions, please call us at **************. Thank you.
Customer Answer
Date: 05/02/2025
Complaint: 23153249
I am rejecting this response because: I have been speaking with someone named ***** from Centene. He said he got my claim approved and told me to submit him all of the papers. I am still waiting back to see what happens with him. The papers were sent to him April 28th.
Sincerely,
****** *****Business Response
Date: 05/15/2025
The consumer's request has been processed. Please allow 7-10 business days for receipt of reimbursement. Thank you.Customer Answer
Date: 05/20/2025
Complaint: 23153249
I am rejecting this response because:I am waiting for the refund still. I am replying so the case does not close because I did not answer within seven days.
Sincerely,
****** *****Initial Complaint
Date:03/19/2025
Type: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.
Ambetter has continually denied me medications that I absolutely need and my autoimmune disease is getting worse because of it. I have been trying to get a biologic approved for 8 weeks and theyve denied 3 different ones. Im in an incredible amount of pain and I feel like they could care less. I was doing really well last year and wholeheartedly regret switching insurance companies.Business Response
Date: 04/02/2025
Please see attached letter. A detailed response was mailed to your home.Customer Answer
Date: 04/02/2025
Complaint: 23087325
I am rejecting this response because:
I received a letter in the mail a couple days ago stating the approved medication(*********) was denied because I apparently went and got the medication administered before it was approved, which is a flat out lie. My doctor submitted an appeal on my behalf for ******, which I need due to fertility goals, and it finally got approved, at the cost of my health declining. The way Ambetter handled my case has been completely unacceptable. I have been without medication for over 9 weeks now and they try to claim I went behind their backs and got medication without approval. I will be switching insurance companies in May thankfully, so I no longer have to deal with this nightmare. I have never struggled this much trying to get anything done and Ive had a chronic illness since 2019.Sincerely,
***** ***********Business Response
Date: 04/08/2025
An Ambetter Member Relationship Liaison (MRL) tried contacting you on 04/02/2025. Please call the *** back during normal business hours for more information. Thank you.Initial Complaint
Date:02/26/2025
Type: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 have fulfilled my $800 deductible and out-of-pocket requirements, yet I'm still being charged for medications fully covered by my insurance. I've contacted Ambetter 15 times without getting any answers. Despite confirming my coverage status, representatives could only repeat that *** met my requirements and escalated my issue without resolution. One call lasted 2.5 hours, and I faced a similar problem last year. Why is the Ambetter database not up to date with deductibles? I am being changed $637.00 for my Rx. Who has the funds to pay the deductible and hope for a refund?Business Response
Date: 03/26/2025
Please see attached letter. Thank you.Initial Complaint
Date:02/12/2025
Type: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.
******* a payment from my bank account and is not applying the payment to my insurance premium.Business Response
Date: 03/20/2025
See attached acknowledgement letter. A detailed response letter has been mailed to the Ambetter member. Thank you.Customer Answer
Date: 03/27/2025
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
Date:01/17/2025
Type: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.
I have contacted Ambetter from Peach State Health Plan at least 3 times to cancel my coverage since I am now on ********. I keep getting welcome letters from them with cards. I currently have tried calling them again and waiting on hold for *********************************************************** there is over a five thousand minute wait!!!Business Response
Date: 02/11/2025
Please see attached acknowledgement letter. A detailed response will be mailed to you.Customer Answer
Date: 02/11/2025
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
Date:01/14/2025
Type: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 have been a member of Ambetter for years there customer does not have proper training i have to keep calling about my account due to a discrepancy in my payments also I get a reward card to help pay for insurance or medication it's alwaysva problem with the card. I can't pay my insurance Ambetter is telling me I'm past over due when **** not..Business Response
Date: 02/11/2025
Please see attached acknowledgement letter. A detailed response will be mailed to you.
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