Complaints

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

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  Ambetter from Superior HealthPlan

  5900 E Ben White Blvd Austin, TX 78741-7502

• 

  Ambetter from Superior HealthPlan

  8431 Fredericksburg Rd Ste 340 San Antonio, TX 78229-3392

• 

  Ambetter from Superior HealthPlan

  PO Box 660144 Dallas, TX 75266-0144

• 

  Ambetter from Superior

  9461 Lyndon B Johnson Fwy Dallas, TX 75243-4537

  

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:06/28/2025

  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.

  Superior Ambetter incorrectly terminated my ***************** coverage. They state I "was only covered through March" And terminated my coverage due to "non-payment." I pay every month for the next month. Starting in December. $107.59 Paid December 9, 2024 for the month of January... then every month after for the next month.The problem started with my May payment for the month of June. They charged me 5 times when I tried to pay on May 16. I called Ambetter right after - they couldn't see any payments at all.The payments posted that weekend and I called them again. They still couldn't see the payments! I went to my bank, filed a dispute by calling, and they were going to investigate the 4 duplicate charges. Ambetter had me fax over my bank line transactions ( Where you could clearly see they charged me 5 times).Eventually, 4 refunds appeared in my bank account (Dated 05/22, Posted 05/23).I assumed it was handled - even though when I called Ambetter before I noticed the refunds, they started they didn't do refunds? Only credit?On June 5th, my Doctor calls and says my insurance is terminated. I call Ambetter - they say that I only paid through March, suddenly? That there's a lot of charge backs and reversals in my account? That is incorrect... their broken system even shows charges and refunds that don't make sense I spoke to the bank in person on June 5th, and they state they DID NOT do the 4 refunds which I was rightfully owed. They stated it was Ambetter themselves who did it. I also escalated this issue with Ambetter on June 5th, but they stated it could take 45 days to "address"I received a letter dated 05/27/2025 from my bank stating Ambetter refunded the 4 duplicate charges themselves.I also received several letters from Ambetter saying there were chargebacks and reversals when THERE WEREN'T. I have proof of every payment made ever. Ambetter is making up those "chargebacks" Or their system had a major error I have proof of all payments

• Initial Complaint

  Date:05/28/2025

  Type:Order Issues
  Status:

  UnansweredMore 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 by Superior HealthPlan ********************** Puts Profits Over Patients Ambetter by Superior HealthPlan has shown blatant disregard for my health and well-being by repeatedly denying access to a medically necessary prescription ******* despite worsening labs, doctor-recommended treatment, and documented medical limitations.I am a disabled individual who suffered a stroke, leaving me immobile and unable to exercise. I have pre-type 2 diabetes (glucose levels rising steadily: 6.3 ? 6.5 ? 6.6), high cholesterol, and no tolerance for stimulant-based weight loss options. My doctor has submitted multiple prior authorizations for *******, a medication known to be effective in preventing the progression of diabetes and managing weight. Despite this, Ambetter refuses to approve it on the basis that I am not yet diabetic or do not meet their BMI cutoff as if they're eagerly waiting for me to get sicker before they consider treatment.Ive contacted Ambetter directly. My doctor has fought for me. Even insurance advocates tried to push this forward. Nothing works. Ambetter has chosen to ignore medical facts and common sense in favor of rigid, profit-driven policies.This is not healthcare. This is willful neglect. Ambetter should be held accountable for their pattern of delaying care until patients are sicker, costlier, and trapped in chronic conditions that could have been prevented. I am filing this complaint with the ***************************** as well and urge the BBB to investigate this pattern of unethical denial.

• Initial Complaint

  Date:05/08/2025

  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.

  Am better from Superior health plans de authorized my physical therapy after a surgery that required it. They then stuck me into an appeals process that they say can take 45 days. During this time I cannot receive the health care I need. I am unable to use any other provides as well.

  Business Response

  Date: 05/20/2025

  Hello,

   

  we had sent the member a letter that is dated 05/05/2025. thank you and have nice day.

• Initial Complaint

  Date:04/16/2025

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

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

  Answered:

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

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I have called twice now with 4 hour holds and as I was being told I would be expected to make a third 4 hour hold call, they hung up the phone on me. I can't afford to keep staying on these extremely long calls and I believe they're doing this to avoid paying me what they owe me under the guise of, "its out of our hands." They say my address is pulled from DEERS and it cant be changed, but my address in DEERS is accurate, up-to-date and has been before this issue began. They refuse to send checks to my new address in *****, so the checks get sent back. The 2 of 11 checks that were correctly forwarded to my current address were for less than what I was owed and I was told they have no understanding of why that's happening. I'm refusing to cash any checks that are not for the full amount. They have no POC to contact them via email and are putting up an unrealistic barrier (4 hour hold times) to prevent people from claiming what they're owed. People shouldn't be expected to keep taking 4 hours out of their day every time an error is caused on their end. The checks I'm seeking to have sent to me are below:60183052 - $178.51 60189477 - $178.51 60151326 - $178.51 60189336 - $178.51 60151054 - $178.51 60235614 - $922.80 60217796 - $1,083.16 60282317 - $23.32 60269502 - $369.12 60151234 - $178.51 60182911 - $178.51 Total: $3,647.97

  Business Response

  Date: 04/24/2025

  Hello,

   

   I am unable to locate this member. Please provider member name/ *** and Member ID.

   

   Thank you 

• Initial Complaint

  Date:04/09/2025

  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.

  This company has reported to the *** that I received insurance from them from the month of May till December 2024 , I have never signed up for insurance from them and have insurance from my work all year round , and now the *** is saying that I owe them $1500 because this company reported that they gave me credit and I have never paid them or signed up for service from them

  Business Response

  Date: 04/11/2025

  RE: Complaint ID ********
  
                 Dear ******* Rarrosa,
  
  Thank you for forwarding the above referenced correspondence received from your office on 4/10/2025.
  
  Superior HealthPlan (Superior HealthPlan Network/Superior HealthPlan, ***** is a licensed health care insurance company/health maintenance organization in ******  We are bound by federal privacy laws to protect the identity and health information of our enrollees, and ensure all communications from our office is appropriate. 
  
  To facilitate the use and/or disclosure of an enrolled persons protected health information (PHI), Superior HealthPlan must have a signed authorization from our enrollee granting the approval to use or release any information to your office.  We have no authorization allowing Superior HealthPlan the authorization to communicate with the BBB about this person.
  
  We apologize that we are unable to respond to your office on this issue.  Please be assured that we are addressing all applicable concerns detailed in the correspondence you forwarded, upon confirmation that the individual named in your correspondence is enrolled with our health plan.  However, for the reasons stated above,Superior HealthPlan will communicate directly with our enrollee to address and resolve his/her concerns. 
  
  We will look into the complaint from our enrolee and send an answer in writing. This letter will:
  * Give them the answer to their complaint.
  * Give them the reason for the answer, either medical or their member contract or handbook terms.
  * Give them the specialty of any physician or provider who reviewed their complaint.
  * Give them the process and timeline to file an appeal.
  * Give them the deadline for Ambetter Health to answer their appeal.
  We will mail the answer to our enrollee complaint within 30 days of getting their complaint.
  
  
  Sincerely,
  
  
  **** *.
  Grievenance & Appeals Coordinator

  Customer Answer

  Date: 04/12/2025

  Complaint: 23184448
  
  I am rejecting this response because:
  
  Regards,
  
  ****** *******

• Initial Complaint

  Date:04/04/2025

  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.

  It seems that it's so easy for random people to just get health care and use my address when they don't live here.The real issue is how they want so much information that I cannot provide in order to help, but refuse to use Member ID's or policy numbers which is the only thing I have. I want them to stop letting people use my address without verifying if they actually reside here. Trying to tell them ***** ******** member ID *********** Policy # ******** doesn't live at my address. I don't even know anything about the person other than they are fraudulently using my address to obtain health care.I've been receiving her mail for the last nearly 3 years and I always return to sender. I've lived here for 6 years and never has a ***** ******** lived here. I tried to file a complaint with their ethics hotline. They created a case # ************ which got closed out and I heard NOTHING regarding this. Clearly that doesn't work.All I want is anything regarding ***** ******** to stop coming to my residence.

  Business Response

  Date: 04/07/2025

  4/7/2025

  Better Business Bureau

  ******* *******,

  
  RE:23163361
  
  Dear ******* Tarrosa>,
  
  Thank you for forwarding the above referenced correspondence received from your office on 4/5/2025
  
  Superior HealthPlan (Superior HealthPlan Network/Superior HealthPlan******) is a licensed health care insurance company/health maintenance organization in *****. We are bound by federal privacy laws to protect the identity and health information of our enrollees, and ensure all communications from our office is appropriate.
  
  To facilitate the use and/or disclosure of an enrolled persons protected health information (PHI), Superior HealthPlan must have a signed authorization from our enrollee granting the approval to use or release any information to your office. We have no authorization allowing Superior HealthPlan the authorization to communicate with the BBB about this person.
  
  We apologize that we are unable to respond to your office on this issue. Please be assured that we are addressing all applicable concerns detailed in the correspondence you forwarded, upon confirmation that the individual named in your correspondence is enrolled with our health plan. However, for the reasons stated above, Superior HealthPlan will communicate directly with our enrollee to address and resolve his/her concerns.
  
  
  Sincerely,
  
  
  **** *.

  Grievance & Appeals Coordinator

  Customer Answer

  Date: 04/07/2025

  Complaint: 23163361
  
  I am rejecting this response because:
  This is a political way of saying your are washing your hands of a situation that was wrongfully created by not confirming your members address and allowing them to partake for years. 

  The correct course of action is to very your members address with a utility bill like one from the power company. 

  I'm tired of the mail coming from your business for someone who does not exist at my address. The only course of action to resolve the case is to fix this address issue. 

  Regards,
  
  ****** ********

  Business Response

  Date: 04/08/2025

  Hello,

  We received your complaint submitted on 4/5/2025. 

  We will look into your complaint and send you an answer in writing. This letter will:
  
  * Give you the answer to your complaint.
  * Give you the reason for the answer, either medical or your member contract or handbook terms.
  * Give you the specialty of any physician or provider who reviewed your complaint.
  * Give you the process and timeline to file an appeal.
  * Give you the deadline for Ambetter Health to answer your appeal.
  
  We will mail the answer to your complaint within 30 days of getting your complaint.

  Thank you for telling us about your complaint. We will not be unfair to you because you complained. We want you to be happy with your health plan.
  Sincerely,
  Complaints Department
  Ambetter from Superior HealthPlan/ **** *.
  
  Ambetter from Superior HealthPlan includes EPO products that are underwritten by ************************, and *** products that are underwritten by Superior HealthPlan, ***** which are Qualified Health Plan issuers in the ********************** Marketplace. This is a solicitation for insurance. 2023 Superior HealthPlan****** ************************. All rights reserved.

   

  Customer Answer

  Date: 04/08/2025

  Complaint: 23163361
  

  Do not consider this as a rejection since the options to choose from is very limited.

  Until the result from the last correspondence is seen, I cannot allow for this case to be closed.

  This should remain open until then.

  
  Regards,
  
  ****** ********

• Initial Complaint

  Date:03/12/2025

  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.

  The company assigned a *** that no longer works at the facility. When I changed pc February 27, they did nothing so I could not go to my new doctor appointment. Finally cleared that up then company tried say my doctor was not taking new patients that is a lie, even shows on member portal doctor is taking new patients. After finally getting that problem solved next one is Ambetter used wrong address for my doctor even though on their web page clearly shows correct address. Then today was told again he is not taking new patients. This is after 2 days of on and off phone calls company even called my doctor. I have not been able to go see a pcp because of Ambetter neglect of not scamming me

  Business Response

  Date: 03/26/2025

  Hello,

   

  I have attached the correspondence above. Please see attached document. Thank you.

• Initial Complaint

  Date:03/07/2025

  Type:Billing Issues
  Status:

  UnansweredMore 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 was doing my income tax for 2024 and it was rejected because i did not know that I had a 1095-A through the **************** Marketplace which i find odd because I pay for insurance through my employer. The 1095-A shows I received health services In May, June, August, September, October, November, and December while I was on *************** with ***** ISD which I pay for and do not need Marketplace assistance. It is under the Marketplace policy number ********. It also shows me living at my old address, however I have not lived there for over two years. This policy is fraudulent and I am hoping the BBB can assist me with this. Do I need to file a report for fraud? Please let me know. Thank you in advance for your assistance.

• Initial Complaint

  Date:03/05/2025

  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 signed up for the marketplace on 10/31/2024, and selected Ambetter as my provider. I am not very familiar with the marketplace, but I needed insurance for a specific medical treatment I receive and their plan covered said treatment. From November to the end of 2024 I paid $47 and some change for the policy. Then on January 1, the company debited my account for $******. I checked with both the marketplace and Ambetter about this as my premium was supposed to be $0 in 2025 due to my financial situation changing. I am a single mother of 2 children and I was on unemployment. The draft took half of my check and caused me to go overdrawn and pay fees. The company refunded this money on January 7, 2025. Then on 2/3/2025 the company again debited my account (without my consent, knowledge, etc) for ******. I called the company and they explained I would have a refund within 7-10 business days. I began recording the calls between the agents and I at this point as something seemed odd. I was told 4 times my money was being credited, then told I would receive a check via mail. Finally, this week I called back and was told $517 was my amount for my January 2025 premium, solely. I explained that I had to choose between buying food or paying this and I could not afford it nor did I authorize it. I was on the phone and have been for hours trying to resolve this only to be put back in circles. The only thing I know is I NEVER authorized the company to take more than $47 from my account. I have had to report the company to my banking institution as fraud. It looks like I am not the first individual the company has done this to, I hope Im the last. The purpose of this is to provide affordable insurance to impoverished families and here you are taking money people need for food without even batting an eye.

  Business Response

  Date: 03/13/2025

  Hello,

  We are confirming receipt of this complaint. Ambetter will work directly with the member to resolve their complaint. 

• Initial Complaint

  Date:03/01/2025

  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.

  They took money from ******* account that was not signed off on or agreed to! I spent many hours for 2 weeks on the phone with many different employees trying to get my money returned! The amount taken was $423.13 on Jan 31 but went thru on Feb 3rd. the amount they were suppose to return was all except for the agreed on amount of $86.13 The last call I was assured it was going to be returned in a 3-5 business days. The $336.64 was put in our account and I thought it was settled. Until that same amount was just taken out! Turns out my bank fronted it and they deducted it. I filed a claim with my bank but I did not know the bank was who put the money back in my account. So still to this day 3/1/25 I have not received a refund from Ambetter and this has been happening since 1/29/25. I called to stop & dispute this amount before they took it and they did not stop it like they told me they did! I have spent many hours and days and stressed over this. I want my money retuned!! Let me say how I have been pushed around and told different reasons for this by everyone Ive spoken to! They tried tell me this was from Nov 2024 when I did not have this insurance then. I was also told that all they could do was not charge me again until April 2025. I did not agree to this!!!! I was very persistent that they returned the money as they caused me to be late on my rent because of this huge amount that I was not expecting to come out! The original start date was Jan 13 2025 and my insurance was going to begin Feb 1 2025. So I would have made two payments in total of the $86.49 on 1/13/25 & 1/31/2025

  Business Response

  Date: 03/25/2025

  Hello,

  We are confirming receipt of complaint. After review, there is currently an open complaint being worked that was initially received on 03/12/2025. We will work directly with the member to resolve their issue. 

  Thank you.