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:01/30/2023

  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.

  The company continues to charge me for the wrong healthcare plan totaling $465 a month. Ive called multiple times to correct this and theyve suspended my account and coverage because i wont pay for something I dont want. This company is scam. I shouldve stuck with ********** blue shield.

  

  Business Response

  Date: 02/08/2023

  See attached letter

• Initial Complaint

  Date:01/26/2023

  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 enrolled for a off Marketplace 2023 health plan from Ambetter, received a bill, paid my new year premium in December 21st of *********************************************************************** the beginning of January I checked my online account and found out that my coverage was cancelled for no reason and without any warning. After multiple hour long phone calls, speaking with at least 4 different representatives and promises to resolve the issue there was not any resolution. The open enrollment period was over and I had no coverage. Another bill from Ambetter for February arrived on time. I paid the bill on January 9th then checked my online account and saw that the coverage was reinstated. It was reinstated for a few days and then terminated again. Another very long phone call with a very professional Representative who finally looked into the issue, contacted the appropriate department (escalation) and informed me that it would take about 5 business days to resolve. After that period I checked my account, and yes, the coverage was indeed active. For a few short days. Yesterday it was in the terminated status again. By choosing the company I trusted them, paid my premiums on time only to end up with this nasty endless circle. Contacting the customer service seems to have no point at this time since they have not, despite multiple tries, restored my coverage to date.

  

  Business Response

  Date: 02/17/2023

  Please see attached letter. 

• Initial Complaint

  Date:01/25/2023

  Type:Sales and Advertising 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 enrolled with Ambetter with the hope of seeing my doctor (who was listed as accepting the insurance) however when I was enrolled and received the paperwork, I found out that my doctor was replaced by one who is out of my area. When I requested replacing the doctor provided with my own, I was told that she wasn't on the list although she definitely accepts the insurance. Then I replaced that doctor with one in my area only to find out that he doesn't take new patients so I had to call someone else. That doctors office was unable to get the correct date of birth because the insurance had it wrong. When I called the insurance they said that it was right on their end. I called the doctors office back and let them know what I was told so I had to cancel that appointment. As a result, I called Ambetter back to cancel my enrollment and was told that it was cancelled only to find out that it had not been cancelled. I sent an inquiry through the member portal who told me that I had to contact Healthcare marketplace and have them contact Ambetter. I contacted the agent who I spoke with and let her know about the situation. I also requested a full refund of the premiums I paid. This is by far the most frustrating experience I've had to deal with. I am extremely shocked that this company has an A+ rating. I did get an email from the BBB with a response from Ambetter. It was the same generic response that they give all other complaints. I do not accept this response, I will only accept the fact that my enrollment has been cancelled and my premiums have been refunded.

  

  Business Response

  Date: 01/26/2023

  See attached letter. Thank you.

• Initial Complaint

  Date:01/25/2023

  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 upgraded my Ambetter health plan for 2023 from a silver to a gold plan. I paid my $663.79 premium. I have my new 2023 insurance card showing my new coverage. I have invoices that show I paid and my next premium isn't due until January 31, 2023, yet I continue to have problems with Ambetter's website showing I am enrolled, with claims going through, with getting prior authorizations to go through and to get my prescriptions paid. Friday, January 20, 2023, it finally showed an enrolled status. Today, January 25, 2023, it is back to "canceled" status. I have logged over 15 hours of hold time in the past 10 days. I cannot continue to call over and over and being on hold forever. This is the most ridiculous and almost criminal way to do business. You can't speak to anyone who speaks plain English, they leave you on hold and never come back despite asking you for a "good call back number" in case we get disconnected. I was on hold over an hour once and the phone just "hung up" and no one called me back. That happened several times. I have no other choice of where to get health insurance.

  

  Business Response

  Date: 01/27/2023

  Please see attached letter.

• Initial Complaint

  Date:01/24/2023

  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 contracted for a health care plan with Ambetter from Peach State, which had a $625 deductible, I paid/met the deductible, with the purchase of a required prescription.When I was required to renew the prescription the ******, ** ****** said they showed I still owed $625. And their system goes off of Ambetter's system for their information.I spent more than 10 days and over 10 hours trying to get Ambetter and the pharmacy to get their systems to communicate and just kept getting caught in a loop of Ambetter "creating resolution tickets/escalating my problem, waiting for their system to update, etc..." but as of 12/30/22, was not able to pick up my prescription for what it should have been: $0.00.This is a required medication for my health and I don't know where else to go to get help me with this problem.Please help me. - I need a 90 day supply of a Xarelto, 20 mg @ $0.00, from the ****** Pharmacy in ******, ** **************. And evidently, I need Ambetter to communicate that to them.

  

  Business Response

  Date: 01/26/2023

  Please see attached letter.

  Customer Answer

  Date: 01/29/2023

   
  Complaint: 18670352
  
  I am rejecting this response because:
  

  As of 1/29/23 I have not received a response from Ambetter.
  

  It's been more than a month and as I stated when I filed this claim:  I called their with their customer service for ten days and was on the phone far more than ten hours in December.  I sent emails and yet they still have not resolved the issue...

  It's a simple resolution:  Get me a ninety day supply of my medication for $0.00; as I have paid my premiums and met my deductible.

  Now what BBB?...How do I get them to give me what I have paid for?
  

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

  

  Business Response

  Date: 01/31/2023

  Please see attached letter.

  Customer Answer

  Date: 02/02/2023

   
  Complaint: 18670352
  
  I am rejecting this response because:

  As of today, 2/2/23 @ 12:31 pm, despite my providing proof of payment to CVS Pharmacy and a screenshot of my account with Ambetter, showing that my deductible was met; **************************************;A Regulatory Member **************************** of *********** sent this message: 

  "Good morning ************,
  
  I wanted to take this time to reach out to you to provide an update on where we are in the investigation.  Giving the screenshots (Proof of Purchase) that you provided me with, I have solicited the assistance of another internal Ambetter department in addition to working very closely with CVS Mail order management. I have identified exactly when your account traveled off course and am working diligently with other departments to get your account back in good working order (I have asked for expedited assistance, but to be on the safe side please allow 7 to 10 business days for resolution)."
  

  ...I'm at a loss for decent, acceptable words, to describe just how unbelievably terrible this is. - Without a doubt, by the farthest margin, this is the absolute worst experience I have ever had with any business...
  

  At best; this is malicious.  At worst; it's criminal.

  Is there nothing you can do to help me?!
  
  Sincerely,
  
  ***********************

• Initial Complaint

  Date:01/20/2023

  Type:Order 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.

  Member ID ***********. Member with Ambetter alongside my spouse throughout 2022. In Dec my husband and I were auto enrolled for coverage into Jan 2023 onwards on the Complete Silver plan. My husband begun a job and gained his own health insurance as of Dec 3rd 2022. We informed Ambetter and marketplace of this change on multiple occasions in Dec and due to this update I was enrolled on my own in the same Complete Silver plan for $77.25. He was never removed and in Jan my payment of $164.33 was still including my spouse. I paid the $164.33 because I did not want my own coverage jeopardized by incompetence to get this simple change made. I contacted marketplace who informed me that Ambetter had not made the change in time and so my coverage record showed my *********** on the plan from 1/1/23 1/31/23 and then by myself from 2/1 onwards. Up until 1/15/23 my insurance had shown enrolled/active on my Ambetter portal. On 1/16/23 I logged on to find that my own insurance had been changed to cancelled. Something I did not ask for, nor was I provided any notice of which is illegal. I spoke with marketplace who told me I was still active and enrolled on their side and to contact Ambetter. Ambetter told me this shouldnt have happened as I had paid my premium and appealed the decision for me to have my insurance reinstated. As of 1/18 it appears this appeal was successful as Ambetter now says enrolled/active again. However due to the incompetence of Ambetter cancelling my insurance without consent in the first place, this has now updated on the marketplace side and now my marketplace coverage shows cancelled, not just for ******* but the entirety of 2/23 onwards as well. Marketplace has completely passed over blame to Ambetter and now I, as a cardiac patient, am stuck without knowing if I even have coverage, or whether that coverage will continue through no fault of my own.

  

  Business Response

  Date: 01/27/2023

  Please see attached letter.

  Customer Answer

  Date: 01/27/2023

   
  Complaint: 18861543
  
  I am rejecting this response because: zero attempt to contact me at my phone number ************ has been made. I have zero missed calls from anybody at Ambetter from the date I filed this complaint & I also have no voicemails that have been left since, from Ambetter. Please ensure you are calling the number above, which should be the same one that is on my insurance file.
  
  Sincerely,
  
  *******************************

  

  Business Response

  Date: 02/08/2023

  An Ambetter Member Relationship Liaison (MRL) contacted **************** on 2/1/2023. Due to federal and state privacy and confidentially regulations, we are unable to disclose any protected health information, including eligibility, claims, and billing information, with anyone other than our members or their authorized representatives. The Ambetter MRL will work with the member directly to resolve the case.

• Initial Complaint

  Date:01/17/2023

  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.

  In mid-December of 2022, Ambetter raised my health insurance premium by $225.00. I contacted my insurance agent to purchase different coverage, which she did. She advised the .Gov *********** cancels the prior coverage prior to writing the new coverage. In an abundance of caution, insomuch as the Ambetter plan was set-up as a direct debit from my account, I called on or about 12/27/2022 to insure it was cancelled and would not be debited, as those funds would be necessary for the new coverage. The day I called Ambetter I received a prompt that the telemarketing center was "closed."I then went to the Ambetter website and inputted my name, address, birth, last four of social, and even the Member ID number -- each attempt of which was met with "Not a Member." I have the screen shots. I reasonably assumed the Membership was cancelled and no debit would be taken.On December 31, 2022, I received an e-mail from Ambetter advising they had taken $915.25 from my bank account. I immediately called Ambetter and was told they have two different systems and the telemarketing staff couldn't yet see the debit -- though their system sent the e-mail.I called on January 3, 2023, and after more than 4 disconnected calls with four different people confirmed the Coverage was cancelled, as was the debit authorization, and I would receive a refund direct to my account within "7 to 10 days."It is now January 17, 2023. There is no refund. When I called this morning I was told they could initiate a "refund request." I asked for the Ambetter corporate office phone number and was put on hold for 30 minutes.By profession I am a trial lawyer. The attorney side of me believes this could be nefarious. I will give the benefit of the doubt. I just want my money back for next month's premium to a legitimate provider.Absent a prompt response, my inclination is to draft a class action lawsuit for all similarly situated, as my insurance agent assures me I am not alone.

  

  Business Response

  Date: 02/07/2023

  Please see attached letter.

• Initial Complaint

  Date:01/09/2023

  Type:Billing 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'm a customer of ********************************************************************. My account with Ambetter is funded through an auto-payment process on their systems. Since June 2022, I have had numerous problems with Ambetter billing due to the company not drafting my auto payment and suspending my healthcare and in other cases drafting the payment but not updating my account in their system. I have called Ambetter's billing department (ref# I92953178) in August 2022, October 2022, and January ***************************************** each of these meetings Ambetter states they have resolved the issue, yet the disruptions to my healthcare continue. I am only able to reach customer service reps in ***** and I'm unsure that they are actually fixing the issue. I am concerned that this practice of billing and denying coverage could happen while I'm hospitalized and unable to dispute their records. My desire is to have someone who can correct this auto-payment problem with my account do so. That way my coverage will stop being suspended.

  

  Business Response

  Date: 01/13/2023

  Please see attached letter.

• Initial Complaint

  Date:01/04/2023

  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.

  I renewed my health insurance plan on Nov 15th with Ambetter and paid the premium for my January 2023 plan. Ambetter mailed me my new insurance cards. I went to pick up my medicine and found out that Ambetter cancelled/ terminated my coverage out of no where. When I call they can see my premium is paid and that I am covered, but there system says terminated and no one can help me get it resolved. I have one day left of my medication and my daughter had to cancel her Doctor **** because of this. It's very serious and I have hours of time spent trying to get someone to help me. They need to fix it in their system STAT and return me to ACTIVE so I can have my coverage. I have probably logged 15 hours now on hold and speaking with agents who have not helped in the least bit. The health place marketplace has me as active and when I call they say only Ambetter can fix this.

  

  Business Response

  Date: 01/06/2023

  Please see attached letter. 

  Customer Answer

  Date: 01/06/2023

   
  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.
  
  Sincerely,
  
  ***************************

• Initial Complaint

  Date:01/03/2023

  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.

  Ambetter processed a policy/coverage without my consistent and took payment. A Gold plan I did in fact process an application and coverage (Silver plan) through the marketplace which was verified TWICE via 3 way call with Ambetter reps as a Marketplace. Ambetter continues to fail to correct the issue and no I have no access fo my online account now.Every call to Ambetter is answered by someone in *************** that can not resolve anything. I have tried over 12 different people and everyone speaks poor English and has no ability to correct anything.

  

  Business Response

  Date: 01/04/2023

  See attached letter.