Complaints

This profile includes complaints for Ambetter from Buckeye Health Plan's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  Ambetter from Buckeye Health Plan

  4349 Easton Way Ste 120 Columbus, OH 43219-6114

  
• 

  Ambetter from Buckeye Health Plan

  3700 Embassy Pkwy Ste 200 Akron, OH 44333-8385

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:08/30/2024

  Type:Billing 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.

  04/22/2024 amount of rewards owe to me is 75.00 I’ll be do for another reward for having my annual dental cleaning as well

  

  Business Response

  Date: 09/17/2024

  Good morning, On 9/10/2024 ***** ******* Grievance and Appeals Coordinator with Buckeye Health plan contacted member ***** ****** (MMIS # ************) to advise her we received her BBB # ******** and that we will be contacting her again on or before 9/16/2024 with our findings. On 9/12/2024 ******* ****** advised the following Prophylaxis Cleanings that have been rendered within the last year. Claim # ************** DOS: 8/19/2024 1110 Prophylaxis – Adult Claim #************** DOS: 4/20/2023 D1110 Prophylaxis – Adult. On 9/16/2024 the Supervisor of Member Services with Buckeye Health plan has reported. The $75 reward for the Wellness visit has been applied to the members My Health Pays rewards card. On 9/16/2024 Ms. Herold contacted member to advise of our findings. Member thanked Ms. ****** for her call. 

  Thank you,

  ***** ******

  Grievance and Appeals Coordinator II

  Buckeye Health plan

   

   

  
  

  

  Business Response

  Date: 09/27/2024

  Good afternoon, Buckeye Health plan has completed their review of the BBB # ******** filed by member ***** ******.  On 9/27/2024 ***** ******* Grievance and Appeals Coordinator with Buckeye contacted member to advise if she has received her 75.00 rewards. Member advised she received them today and thanked Ms. ****** for her call. 

  Thank you,

  ***** ******

  Grievance and Appeals Coordinator 

  Buckeye Health plan

  Customer Answer

  Date: 09/27/2024

  I accept the business's response to resolve this complaint. Yes I received them thank you all for the great service 
  
  Regards,
  
  ***** ******

• Initial Complaint

  Date:05/30/2024

  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 from Buckey Health Plan claims we purchased insurance from them from 1.1.23 to 2.28.23. They have no proof of payment. We have insurance through my workplace. They claim we agreed over the phone. We had a claim from 12.22.2022 denied and we just were made aware of this in the early part of 2024. Now we are being turned into collections for 2 claims that the money was taken back claiming we had Ambetter as our primary insurance. We have no knowledge of ever agreeing to do business with Ambetter or paying them. We want them to send a letter stating we never had insurance coverage.

  

  Business Response

  Date: 06/19/2024

  **********************

  Thank you for taking the time to submit your concerns in the above-referenced complaint to the Ohio Better  Business Bureau regarding being enrolled in an Ambetter health insurance plan without your consent.  Ambetter from Buckeye Health Plan (“Ambetter”) insured you with an Ambetter Choice Bronze HSA, bonze  level, on-exchange plan with an effective date of 01/01/2023. The base rate of this policy was $934.76 with an  advance premium tax credit ("APTC") of $934.76, leaving a monthly member responsibility of $0. Your member  ID was ***********.  

  Thank you for taking the time to speak with me on 06/11/2024 and 06/18/2024. Per our conversation, you  stated that you never agreed to enroll in an Ambetter plan because you were enrolled with Blue Cross Blue  Shield through your wife’s employer.  

    

  Ambetter initiated an investigation into the broker on your account. Per the statement received from the  brokerage, an individual identifying themselves as yourself spoke with an agent affiliated with ****** ***** on  10/25/2022. During this call, the caller agreed to enroll in a ****** plan. During Open Enrollment for the 2023  policy year, another agent with the brokerage identified an Ambetter policy that better suited the information  provided during the October 2022 call and enrolled you into an Ambetter plan for 2023. The brokerage has  deactivated your record in their system.  

  Ambetter is currently reviewing your account to determine whether we are permitted to retroactively cancel the  policy per your request. I will remain in contact with you until a final determination is made in this matter.  

  I can be reached at ###-###-#### or via email at **************************, should you have any questions.  Respectfully,  

  ****** ******  

  Member Relationship Liaison  

  Ambetter Health 

  **** ****** **** ***** **** ********* ** ***** | ###-###-#### (TTY/TDD ###-###-####) **********************

  
  

• Initial Complaint

  Date:05/06/2024

  Type:Billing 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 paid my healthcare premium of $169 in advance for April 2024 in March. The premium was split into two payments that came electronically from my bank. 1 for 84.50 on 3/11/24 and a 2nd payment of 84.50 on 3/25/24. On 3/20/24 I contacted Ambetter to let them know that I was offered health insurance from my employer that would go into effect 4/1/2024 so I needed to cancel my insurance plan. I did that through the ************** website. I spoke with one of their representatives on 3/29/24 to start the process of refunding the premiums that I had already paid. He said he requested a refund and I should receive the credit back to my bank account within 3-5 business days. He gave me a reference number of **********. When I did not receive my refund within 5 business days I called Ambetter back around 4/10/24 and was told that it does not take 3-5 business days - it takes 7-10 and I should be receiving the refund sometime that week. When I did not receive my refund by that Friday, I called them again on 4/12/24 and was told that they do see the refund request was made and I just had to wait, essentially. I called again the following week when I still had not seen the refund in my bank account and still was told that the request was done and that it takes 7-10 business days and to keep waiting. That time I was given a reason why it was taking so long which was that they are running behind with the refund process. I called again on 4/29/24 when I still had not received my refund explaining it has been 30 days now that I am waiting! I was told the same thing as all the times before but no one can tell me when I will get my money back! The rep I talked to that day said he would forward my issue to an escalation team that would call me back within 3-5 business days to discuss this issue. He gave me reference# *********. Today is 5/6/24 the 5th business day and as of 3:02pm I have NOT received a phone call NOR do I have a refund in my bank account. I just NEED my money back!

  

  Business Response

  Date: 05/08/2024

  Ambetter from Buckeye Health Plan received your grievance on 05/07/2024 concerning ******** ****, BBB Complaint Case# ********.  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.
  
  An Ambetter representative reached out to ******** **** at ###-###-####, on the BBB complaint; however, there was no answer, and the representative left a voicemail.  We will be sending a detailed response directly to ******** **** addressing BBB Complaint Case # ********.  If you have questions, please call us at ###-###-#### (TTY/TDD ###-###-####).
  
  Respectfully,
  
  ******* *******
  Member Relationship Liaison, Ambetter

  

  Business Response

  Date: 05/31/2024

  ***************
  
  Dear Ms. ****,
  
  We are in receipt of the above-referenced complaint as of 05/07/2024.  Ambetter from Buckeye Health Plan (“Ambetter”) insured you with an Ambetter Everyday Bronze + Vision + Adult Dental, bronze level, on-exchange plan effective 01/01/2024-03/31/2024.  The base rate of this policy was $446.97, with an advance premium tax credit (APTC) of $278.00, leaving a monthly member responsibility of $168.97.  This policy is currently paid through 03/31/2024.  Your member ID  ***********.  This policy provided coverage for you individually.
  
  In the complaint received, you requested a refund for premium payments made totaling $169.00 after you canceled your Ambetter coverage due to accepting new insurance with your employer.
  
  Per our phone conversation 05/10/2024, a refund has been in the amount of $169.03 and sent to:
  **** ********** ** ** ****** ** *****
  
  Please allow 7-15 business days for receipt of this refund check.
  
  Please feel free to reach out to me directly at ###-###-####, should you have further questions regarding this
  matter.
  
  
  Sincerely,
  ******* ******
  Member Relationship Liaison
  Ambetter Health

  Customer Answer

  Date: 06/04/2024

  I still have not received the check as of yesterday 6/3/2024 which would have been the 15th business day. Originally ****** told me I should receive it by 5/29/2024.
  
  Regards,
  
  ******** ****

  

  Business Response

  Date: 06/07/2024

  Good morning,   Enrollment Resolution: The member is termed on policy ********* effective 3/31/2024 per Voluntary Withdrawal. The member was issued a refund in the amount of $169.03 via check on 5/14/2024. Per the billing department the member will need to allow up to 30 business days to receive the check, and if check is not received after that time a new request can be submitted and member will need to provide a valid mailing address at that time. Checks can not be sent via ****** 

  Thank you,

  ***** ******

  Grievance and Appeals Coordinator 

  Buckeye Health plan

  Contact # ###-###-####

  Customer Answer

  Date: 06/08/2024

  I accept the business's response to resolve this complaint.
  
  Regards,
  
  ******** ****

• Initial Complaint

  Date:03/14/2024

  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 have insurance with Ambetter Buckeye. They are my Primary insurance. They are showing that ******* ****** is my primary insurance. On 2/12/24, I faxed a letter and a copy of a letter from ******* ****** showing that coverage expired with ******* ****** on 11/30/21. (******* ****** was through my employer at the time). I was informed that it would take 30 days to get corrected. I called this morning to check the status of it and I was told by the foreign rep that he logged my comments and that it would take 30 days to get corrected. I told him that I called last month and they told me it would take 30 days. WE ARE AT 30 days. I have been dealing with this issue since the end of December. Every time you speak to them - they always tell you 30 days. There is no one else you can talk to except customer service - who are all foreign. They are very hard to understand. I am soooooo frustrated. All my Doctors offices are calling because they want payment. I am stressed. I have Multiple Sclerosis and broke my femur on December 24th. I need to get this fixed ASAP!!! I was on Medicaid prior to having to get Ambetter-Buckeye.

  

  Business Response

  Date: 03/22/2024

  **************
  We are in receipt of the above-referenced complaint as of 03/15/2024. Ambetter from Buckeye Health Plan (“Ambetter”) insures you with an Ambetter Standard Silver, silver level, on-exchange plan with an effective date of 01/01/2024. The base rate of this policy is $758.24, with an advance premium tax credit (APTC) of $684.00, leaving a monthly member responsibility of $74.24. Your member ID is ***********. This policy provides you with an individual coverage.

  
  In the complaint, you stated you have received multiple claim denials citing a coordination of benefits (COB) issue and suggesting that you have a primary insurance other than Ambetter. You stated you only have Ambetter and you sent a letter to Ambetter on 02/12/2024 proving you no longer have a Medical Mutual policy, which terminated on 11/30/2021. You mentioned contacting Ambetter Member Services numerous times regarding the claim denials; however, every representative you spoke to advised your account was noted and to allow 30 days for the update. You further state that, when you asked to speak with a supervisor, they were unable to help you. You stated the letter regarding termination of your Medical Mutual policy was submitted to Ambetter two months ago. You are seeking assistance resolving this issue, because your providers’ offices are demanding payments from you.

  
  We have updated your Coordination of Benefits (“COB”) in our system as of 03/18/2024. Medical Mutual Insurance has been voided from your account and all your claims for 2024 are currently being reprocessed. An Explanation of Benefits (“EOB”) will be provided to you as the claims are processed.

  
  Some of your claims for 2024 needed to be rekeyed to new claim numbers to allow processing. A list of the affected claims can be found on page two of this letter.
  Your interactions with Ambetter Member Services have been sent for review. Coaching will be provided to individual agents as necessary.
  We apologize for the inconvenience.

  
  Please refer to the table below for original and rekeyed claim numbers. All claims are set to pay as of the date of this letter.
  Original Claim
  Provider Name
  Date of Service
  Total Charges
  New Claim
  ************ ***** ***** ******** ******* ************ ************ ***** * ***** ******** ****** ************ ************ ***** * ***** ******** ****** ************ ************ **** ******** ******** ******* ************ ************ ***** * ***** ******** ****** ************ ************ ***** ***** ******** ****** ************ ************ ***** * ***** ******** ****** ************ ************ ***** * ***** ********* ****** ************ ************ ***** ***** ********* ****** ************
  Should you have additional questions regarding this matter, please do not hesitate to reach out to me via telephone (###-###-####) or email (********************************.
  Regards,
  ******** ************
  Member Relationship Liaison
  Ambetter Health

• Initial Complaint

  Date:07/14/2023

  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.

  On June 29, 2023 I purchased Health insurance from Ambetter Buckeye Health on the Market Place website. I paid $47.84 I went to our pharmacy on July 9th to get my prescriptions and the insurance wouldn't go through. I have been trying since then to get an answer from Ambetter and all i get are foreign speaking people who I can barely understand give me a ticket number that when I call back with it, they say it is invalid. I am seeing much of the same complaints from many of the companies listed on the market place so I'm not sure how or why they are allowed to scam so many people and nothing being done about it.

  

  Business Response

  Date: 07/19/2023

  Good afternoon, We have been advised by member per email on 7/19/2023 "The are now paying for my prescriptions, so I guess my issue has been resolved" Thank you!  and Ambetter Pharmacy has advised  "This appears to be resolved. Member has paid claims on dos 7/14/23".

  Thank you, 

  ***** ******

  Grievance and Appeals Coordinator 

   

   

   

• Initial Complaint

  Date:07/05/2023

  Type:Customer Service 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.

  The Member Service line provided by Ambetter Buckeye at phone number ###-###-#### is absolutely horrendous and completely incompetent. Every time I call to ask even the simplest of questions, I end up spending no less than 2 hours on the phone, and I have yet to speak with someone who doesn't speak broken English and understands my questions.

  You will sit on the phone listening to scripted questions and answers, and they are instructed to apologize and say thank you after pretty much every sentence. Nothing gets accomplished in a timely fashion, and you can expect to sit on hold multiple time throughout the conversation so they can look things up. It is absolutely maddening!

  The last 3 people I spoke with have horrible phone reception and I can barely hear them. Ambetter Buckeye Member Service is a nightmare, and it continues to get worse year after year. I have been a member for many years, and this is my biggest complaint with this Company. I like the health care coverage and the health rewards, but if you call to ask whether a breast MRI is covered for high-risk patients with dense breast tissue, don't expect to get a answer that leaves you confident that you have actually received a CORRECT answer.

  When and IF I actually do get through and request to speak with a "Care Manager Specialist" (you apparently must specify this if you want to speak with anyone else with a higher ranking), I do FINALLY manage to get my questions answered.

  HOWEVER, getting transferred to a "Care Manager Specialist" is a huge challenge in itself. Member service does NOT want to transfer members to a Care Manager Specialist, for whatever reason, and must demand to be transferred. Most of the time, even this doesn't work.

  At this point, I'm not even sure where to turn. I stared my communications with Member Services today at 1pm, and now that it is almost 4:30pm, I have yet to receive an answer to my very simple, basic question. I will be cancelling my membership at year end!

  

  Business Response

  Date: 07/12/2023

  Good morning, I have spoken with Ambetter member ******** ***** and advised her I have sent a request to our Enrollment Department concerning the coverage of an MRI Mammogram.  Once I receive a reply, I will advise her of my findings.  Please allow an additional 10 days for a response. 

  Thank you,

  ***** ******

  Buckeye Health Plan

   

  Customer Answer

  Date: 07/18/2023

  I accept the business's response to resolve this complaint.
  Regards,
  
  ********* *****

• Initial Complaint

  Date:03/21/2023

  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 had a Health Plan with AM Better from May 1, 2022 through December 31, 2022. I called AM Better and cancelled the policy on 12/6/2022 to cancel reference number ********** confirming the cancellation. AM Better continued to charge my credit card for January & February's 2023 premium's. I have now called AM Better 10 separate times spending 8-10 hours trying to get a refund of those premiums back. The dates I have called are listed below: 12/6: Cancelled policy, 1/27: 8:12 a.m. spoke to Maria, 2/9; 6:08 p.m.; 2/24 9:30 a.m., 2/24 10:21 a.m. spoke to *****, 3/9 at 1:40 spoke to Jordon, 3/9 at 2:06 p.m. spoke to ****, & 3/21 12:10 p.m. spoke to ****** and 3/21 at 12:24 p.m. spoke with ******. During each call I have been told I would receive a refund within 7-10 business days. I did receive January's refund on Feb 3. But as of today I have not seen the second months refund. All agents above refused to connect me with a supervisor to discuss the issues and try to resolve the problem. I have health insurance plan with Blue Cross Blue Shield as of January 1, 2023. I have offered to provide a copy of my member card to prove this but nobody cared. I do not understand why they would refund one month with 7 days but not the second months. I am retired and the $814.93 becomes an important income I need to live on. If I withheld my premium I would have been immediately cancelled by them but they have no problem holding my money that they have no right to keep. Any Assistance you can provide would be appreciated. Sincerely, ***** ********

  

  Business Response

  Date: 04/09/2023

  *******************
  Buckeye Health Plan has completed our review of the complaint received from member ***** ******** who was a member with our Ambetter Marketplace plan. Please see the following information regarding and the outcome of our investigation.
  NAIC # - *****
  Phone – ###-###-####
  Ambetter Essential Care 1-Standard Bronze
  Policy Type – On Exchange
  Thank you for allowing Buckeye Health Plan Ambetter time to investigate the member’s complaint. The member’s complaint narrative states: On 12/6/2022 I call AM Better to cancel my health insurance plane as of 12/31/2022. I had made arrangements for another carrier as of 1/1/23. I spoke with Maria at 8:12 a.m. on 12/6. She provided a cancellation reference number of ******** to confirm my request for cancellation. On January 27th I noted that AM Better had again charged my credit card for an additional premium ($814.93) on 12/26/2022 for January's premium. When further investigating I realized they had also charged my credit card on 1/27/2023 another monthly premium ($814.93) for February's premium. I called AM better to request a refund of both months premium since I was no longer a member of their health insurance program. I was given a reference number for this call *********** They told me they would escalate the refunds due to me and I could expect a refund within 7-10 working days. On Feb 3 I received a refund for one month back on my credit card. But not the second months. I decided to wait few days to make sure the refund for the second month to make sure maybe it was in progress. I called AM Better again on Feb 9th at 6:08 p.m. to again inquire why I had not received the second months refund. I was told again they would file an appeal and request audit to escalate the claim with underwriting and I should be seeing a refund again. I called AM Better again on Feb 24th at 9:30 a.m. to inquire why it was taking so long to process the refund. I was told the exact same thing as the previous calls. They made contact with the review board and the refund was in process. The agent Jamie said I should have no more problems and a refund should issue within 7-10 days. Reference number **********. On March 9th I called again spoke to ****** at 1:40 p.m. to AGAIN inquire about my refund. When he started to give me the same replies as the previous phone calls, I told him that it was unacceptable, and I wanted to speak with a supervisor or manager. This agent proceeded to hang up on me. I again called AM Better on 3/9 at 2:06 p.m. and spoke with ****. Again, explained my continual problems. She said she felt she determined what the problem was that the Marketplace Agent had never cancelled the policy and until that was done AM Better could not cancel it in their system. We called the Marketplace Agent to confirm I had called them previously to cancel and we spoke to ******. She confirmed I had called on January 27, 2023 and cancelled. **** asked her to cancel it again and to send it in so she could then proceed with her cancellation. **** told me she would handle the remaining paperwork needed to complete the cancellation on her end and I could expect a refund within 5-7 business days. I again called today on March 21st to inquire what was going on not receiving any refunds yet. Today I spoke to ****** at 12;12 p.m. This call was discounted at 12:23 when I requested to speak to a supervisor. I called back immediate at 12:24 p.m. and spoke to ******. Again, went through the full ordeal only to be told he would get with audit and file an appeal and request an expedited refund. When I said this was not acceptable, I again wanted to talk to a manager or supervisor he would not connect me. Kept telling me what he could do to help me, but it was everything I had been told in the past six calls. He then called the Marketplace Insurance to again verify I had cancelled the policy. This was confirmed by them but said it was in review by their audit department and they had 30 days before they had to render an opinion or change. I have literally spent more than 8 hours trying to get MY money back from these people with no luck. I then called the credit card company to file a complaint with them. They will not do anything unless I get something in writing from AM Better saying I cancelled the policy and due a refund. Which I attempted to do after speaking with the credit card company. When I called AM Better, they refused to provide this. Refund of the second months premium for February which they should not have charged me since I cancelled the policy as of December 31, 2022.
  Buckeye Health Plan Ambetter Billing & Enrollment Department reviewed the member’s complaint and concluded. After further review the member was charged on 12/15/22 and on 1/26/23 in the amount of $814.93 for each payment. The reason is the marketplace never provided us with a cancellation file for the 2023 enrollment. The member was refunded on 2/2/23 and on 3/23/23 back to their visa card. A refund could not be issued until the account was canceled. The member was canceled per HICS case *********** on 3/23/23 which was also when the second refund was submitted. We are not able to provide a cancellation notice at this time as one has not been generated. A request has been sent to billing to generate the cancellation notice; this will be provided once its available. On 3/31/23 ***** ***** Grievance & Appeals Coordinator with Buckeye made an outreach call to the member at ###-###-####. The member confirmed the refund was received on 3/24/23.
  This will conclude our investigation. Additional documentation attached***** **** **** **** **** **** ***** ******

  Please let me know if you have any questions pertaining to this resolution, or if you need additional documentation.
  Sincerely,
  ***** ******
  Grievance & Appeals Coordinator II
  Buckeye Health Plan
  Phone – ###-###-#### Ext *****
  Fax – ###-###-####

• Initial Complaint

  Date:02/27/2023

  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.

  My coverage is currently suspended because Ambetter is trying to charge more than my monthly premium. I have contacted them on numerous occasions, to be hung up on numerous times. I even had someone on the line that was trying to reach the marketplace to verify my premium and he hung up when the guy got on the line. I have been told that they have taken care of the situation on numerous occasions, and nothing has changed. I now have a cyst on my leg that is infected and need to see my doctor. I can't afford to pay out of pocket.

  

  Business Response

  Date: 03/03/2023

  From: ***** ****** <************************>
  Date: Thu, Mar 2, 2023 at 7:11 PM
  Subject: [SECURE] FW: You have a new message from the BBB of Central Ohio complaint #19440848. Member ******
  To: Better Business Bureau <[email protected]>
  Cc: Buckeye State Hearings and Complaints <[email protected]>
  
  
  
  
  Good afternoon,  May we please have additional 10 days (3/16/2023) for BBB# 19440848 Member ****** ******.  We have requested a copy of the 5 calls member made to the marketplace . 
  
  
  
  
  
  Thank you,
  
  
  
  
  
  ***** ******
  
  
  Grievance & Appeals Coordinator l
  
  
  BHP_RGB-New Logo4349 Easton Way, Suite 200
  
  
  Columbus, OH 43219
  
  
  Office: ###-###-####
  
  
  Toll Free: ###-###-####
  
  
  Email: ************************
  
  
  
  
  
  
  
  
  CUSTOMER EXPERIENCE INFORMATION
  
  
  Customer Information:
  ****** ******
  4770 Duke Drive, 4770 Duke Drive, 195
  Mason, OH 45040
  Daytime Phone: 15134843902
  E-mail: ***************
  
  
  
  
  The details of this matter are as follows:
  
  
  Complaint Involves:
  Service Issues
  
  
  Customer’s Statement of the Problem:
  
  
  My coverage is currently suspended because Ambetter is trying to charge more than my monthly premium. I have contacted them on numerous occasions, to be hung up on numerous times. I even had someone on the line that was trying to reach the marketplace to verify my premium and he hung up when the guy got on the line. I have been told that they have taken care of the situation on numerous occasions, and nothing has changed. I now have a cyst on my leg that is infected and need to see my doctor. I can't afford to pay out of pocket.
  
  
  
  
  
  
  
  
  Desired Settlement:
  Finish the Job
  
  
  
  
  
  The consumer provided the following when submitting the Complaint to BBB
   Ambetter SS.jpg
  
  
   Marketplace.jpg

  

  Business Response

  Date: 03/15/2023

  TMarch 10, 2023
  ****** ******
  4021 Brandychase Way Apt 368
  Cincinnati Ohio 45245
  Member ID Number: U9512822701
  Dear ****** ******:
  
  This letter is in response to your grievance (complaint) that you filed with BBB of Central Ohio 19440848 on 2/27/23 pertaining to: Enrollment & Eligibility.
  
  The Enrollment Department reviewed your complaint narrative and concluded. The member is Enrolled in the 2023 span effective 1/1/23 with a policy rate amount of $1030.97, an APTC amount of $0.00 and a OH state subsidy of $0.00; leaving a member responsible amount of $1030.97 was received 1/26/23, and the member is currently paid through 2/28/23. A payment of $1030.97 is due by 2/28/23 to be paid through 3/31/23. Member’s welcome packet was sent on 1/5/23 and an ID card was sent on 2/1/23. Enrollment has been updated to receive care.
  
  Buckeye Health Plan Customer Service Department reviewed the member’s complaint narrative and concluded. Please see attached call report.
  
  
  Sincerely,
  ***** *****
  Grievance and Appeals Coordinator. Ell us why here...

• Initial Complaint

  Date:02/16/2023

  Type:Billing 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 turned 65 in Dec and was told to end my Ambetter from buckeye health plan because my ******** would take over starting Dec 1st.

  I call Buckeye on 11-23-22 to cancel my health plan effective 11-30-22, I was not given a conformation number over the phone. I received a letter from Ambetter about this issue on 12-2-22 of cancellation, the letter is dated 11-27-22.

  Ambetter took monies out of my bank account on 11-30-22 in the amount of $187.95. I had no idea till I got my bank statement in the mail that they in fact took the $187.95 out without permission. I called Ambetter on 1-12-23 at 8:32am about this same issue, I was on the phone for 34 mins and was given a conformation

  # ******** and was told check would be 7 to 10 days, No check came.

  On 1-24-23 I called Ambetter again on this issue and was on the phone 41 mins this time and was given another conformation # ********** I was told 7-10 days for the check, I waited till 2-16-23 and still no check in the mail.

  Today 2-16-23 I called Ambetter again over this issue of returning my $187.95, so far I have been transfer to two people and been on the phone so far one hour and ten mins and still getting the run around with no answers. I was on the phone today for one hour and ten mins and was given a 3rd conformation # I-96617729 and this time I was told 3-5 business days and I am not falling for this run around for a four time.

  There for I am filing this complaint against Ametter from Buckeye health plan.

  My past account info is:: ****** ********** ***** *********** *** ********* **** ****** Plan name- ****************** Member ID - # *********, Policy-# ********.

  All I want is what is mine the monies they stole from my bank account for almost 3 months in the amount of #187.95. Thank you

  

  Business Response

  Date: 03/28/2023

  ****** ********** ***** *********** ****** ********* ** ***** ****** ** ****** ***********
  Dear ****** **********:
  This letter is in response to your Grievance (complaint) that you filed with The  Better Business of Central Ohio on March 13, 2023, pertaining to: Your enrollment status with Buckeye Health Plan Ambetter.
  Based on our review, on 3/14/2023 the Enrollment Department with Buckeye has reported the member shows to be termed effective 11/30/2022 for policy *********.The  members policy has been updated with a term date of 11/30/2022 to match the marketplace systems. A refund request has been submitted in the amount of $187.95. Allow 7 to 10 business days for processing. 
  
  If you have any questions, please contact ***** ***** at ###-###-####  Monday through Friday, 8am until 4:30 pm. Sincerely,
  ***** *****
  Grievance and Appeals Coordinator

  Customer Answer

  Date: 04/10/2023

  Mr. ****** ********** called BBB stating the matter has been resolved - his money was returned to his account on 3-16-23

• Initial Complaint

  Date:01/17/2023

  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 went to see a doctor and checked the website for ambetter and even called them to make sure the doctor was in network. They were so we went to the doctor and when the doctor billed the insurance they did not except because they say the doctor is not in network. This happened in March of 2022 and here it is January 2023 and I filed an appeal and ambetter still will not budge. The doctor is still listed on their website as being in network and nobody will help me to resolve this situation so instead my doctor bill got sent to a collection agency and I ended up having to pay it. It was wrong of ambetter to give me the runaround for almost a year and still no answer. Every time I call I get somebody else and they say it takes 30 to 45 days for an appeal and I got a letter in the mail saying that they're still working on it. This is ridiculous and I want it resolved.

  

  Business Response

  Date: 02/11/2023

  Good afternoon,  The following was sent to members email address: ken*********@gmail.com:

  Good afternoon Ms. *********,  Please see attached letter with more details concerning your BBB # ********.   ********* states member has been removed from the agency and will no longer be contacted by their Care Payment team,   the refund was approved today, (2/8/2023) The member can expect to receive payment within 7-10 business days.
  
  Thank you,
  
  ***** ******
  Grievance & Appeals Coordinator l
  **** ****** **** ***** *** ********* ** *****
  Office: ###-###-####
  Toll Free: ###-###-####
  Email: ************************