Ambetter of Peach State Health Plan
Reviews and Complaints

They are HORRIBLE. Laziest people. I have needed a CPAP machine for 8 months. They are slow. They are irresponsible. They are harming me.

I pay $179 per month for this insurance and all of the Doctors listed as in network that I have called does not accept Ambetter. Can't find an ob, dentist because their list of Drs is a joke, no one seems to accept this insurance

I have been with Ambetter for years! Now I relocate to Phio and I have had nothing but bad things going on with this company! They are charging me over what my *** is! I call they hang up on u! They tell you they will call you back and NEVER DO! I cannot even go to the Dr because they have my account messed up and won't fix it but keep asking for more money! I think I need a lawyer

SCAM! Was on phone with Ambetter for 2 hours while they kept putting me on hold trying to resolve a *** that should have been 100% covered. Each time agent kept saying let me put you on hold to read. But never had an answer for me. Then after and hour escalated to supervisor who also put me on hold for another 1/2 hour with no new results. Why would anyone work for a company knowing they arent being honest?! DO NOT USE AMbetter!

Ambetter care is the absolute worst health insurance. Their specialists tried to tell me the doctor sets my co-pay value and they can charge me what every they want and I am responsible to pay for it. I have made multiple calls on issues of non-payement for 2yrs and they have no information. Every call is like starting over and no urgency or help provided. When they are tired of working with you they just hang up and put you back in the customer service que. They say they are looking into non-payment for claims and never work out the issues. If I could give them zero stars I would.

On Jan 1st, 2022, Ambetter debited *** from my checking account, which was my rent money. I didn't sign up for *** care for this year. I called Ambetter on Jan 4th and was told it would take *** business days for the refund to be issued. Today is the 14th business day and no refund has been issued. I called today and a very unprofessional agent picked up my call. I could hear a *** and she transferred me to a number that has nothing to do with Ambetter without informing me I am being transferred and to which department. I called back and the second agent hung up on me.

So called customer service has no knowledge of how insurance works and regularly gives me wrong answers on my coverage. In addition, on 11 different conversations with various " customer service " representatives, I am told by each they will have my explanation of benefits mailed to me, along with drug formulary, member handbook, and providers list. None of it has ever been mailed as promised. Provider names I have been given over the phone by customer service as in network, tell me when I call for an appointment, they will not take ambetter.
In over 30 years of various health insurance companies , ambetter has been the worst experience I have ever had.

Ambetter has failed me as a health insurance company. I'm a type 1 diabetic sense birth, and I've become very insulin resistant. I'm dependant upon the omnipod system to deliver my insulin. But even with my doctor sending high priority authorizationa and trying to rush, ambetter refuses to give me any answers and continues to tell me it will be 15 business days for a prior authorization to go through. Leaving me without my much needed prescription for far too long, crippling my wallet and my health. Not to mention hours wasted daily trying totalk on the phone only to be told they can't do anything. How can an insurance company not have control of its own services? What if it was an emergency room authorization? This one was already labeled an emergency.

I have had Ambetter for 7 yrs. For the past several years I've had the same primary in network doctor. For 2022, I signed up for one of Ambetter Wellstar plans on healthcare.gov. It was more affordable. Being it was Ambetter, I assumed my doctor would continue to be in network. Now after my daughter saw our primary several times, the *** said she is not in network. The doctor gave us no indication they were aware of that and I just went the other day for my well-women visit. I received no information indicating my doctor was no longer in the WellStar network of Ambetter. If in fact this billing is accurate. Now I will have probably ***k in charges to pay myself. This is not a good look Ambetter. I'm contacting my doctor and calling Ambetter and going to file a complaint. I deserve my healthcare to be covered after 7 yrs. with them and to not be fooled that some Wellstar plan is a better deal.

I was impressed with them back in 2019 but when they went up on their premium I had to switch and this is when the medical fraud started. I went to the emergency room back on October 22 and October 25 and paid my portion that was due back then. I received no bills electronically nor in the mail from Wellstar. However, as of recently I get all these charges from those two visits popping up and the representative says they were in collections. Ambetter went back and redid the claim and their portion they changed it so I would be charged but only after I decided not to use their insurance for 2022. I call it fraud because how can you go back and take back what was already done and not to mention I know nothing about it. Now I have $288 I didnt owe only because this company want to get back at me for not wanting to pay their high premiums. If necessary I guess I have to take them to court but this is now the worst insurance company ever. A big scam

How do you possibly have an A+ rating? The phone line system is a total joke. The website states that customer service phone lines are available "8 am to 8 pm" conveniently leaving out 'only monday - friday'. And when you call in, you have to wait for the computer to list all the options before you make a selection, and if you press any button during the reading of options, your selection will be 'invalid', and you have to start the whole process over. All of this is of course just the issue of being able to contact someone about my real problem, which is about why the CVSminuteclinuc closest to me is not listed as a provider on the website. The other closest two are listed, but I don't have a car and public transportation doesn't go out that far. CVS says they take my insurance, but that I should call my provider directly to make sure - and of course I cannot because its Saturday and theres nobody to answer the phones! I can hope that my primary care physician can squeeze me in sometime next week but all I need is a throat swab with a possible culture and a scrip for antibiotics. This should not have to be a whole ordeal.

I was an Ambetter member in [protected]. I overpaid my account and I have been informed this June, 22, 2021 that a refund needs to be issued and it can take 30-40 business days. I called yesterday to follow up on the refund and everything started going down the hill. I called Ambetter, in GA, but Darrell after putting me on hold, transferred me to marketplace. After I talked to a marketplace representative, who was just as confused as I was, I called Ambetter again. This time I talker with DeAsia, who seemed willing to help and update my address (the reason why I never got the refund - I suppose). Now let me tell you are making at attempt to call them, you are being asked for the last 4 digits of SSn, phone number (!) , date of birth, zip code etc. Each time. After I talked to DeAsia I found out the refund was never requested in June, 22, as I was told then. Nobody did it. She could not tell me why. She started changing the address in my file, but the phone got disconnected. No call back, nothing. I called today again to verify if that address was changed or not. I talked to a lady who again,could not get her name, but of course, the phone call got disconnected again. I called one more time, asking for a supervisor, because at this point this is getting ridiculous. While I was on hold to speak to a supervisor, the phone call got "disconnected "one more time. After at least 5 calls I was not able to talk to a human being till the end. At this point I start to believe they hang up and me and do not want to do their job. This is laziness at its best. This is absolutely unbelievable. I am supposed to get a refund for $372.33 and I want a supervisor to get back to me ASAP.

I have had Ambetter since February. I Went to my new PCP, complaining of knee pain, thyroid issues. Got sent for an X-ray which I had already had with my previous orthopedist when I was still working. I was told she was going to order an ultrasound- nope got an X-ray that was normal My knee is huge, swelling on all sides, cant sleep because of pain. Since that was normal the doctor thought I would just be ok without a diagnosis- Im, Not! Also, still havent met my deductible so all this is coming out of my pocket! Finally they agreed to order an MRI- Ambetter denied it and wanted me to see a physical therapist or a chiropractor- Without a Diagnosis !Finally was told by Ambetter I could see an orthopedist. Got referral, went to see orthopedist who said within 5 minutes he suspected a meniscus tear and I needed an MRI. Got that scheduled only to be canceled the day before my appointment because they still havent gotten my prior-approval back! Called customer service at *** to be told they had almost 2 Weeks to give approval! I voiced concern that my mother had bone cancer. The time before when I called, I got some customer service rep who had an appalling lack of grasping the English language. I know they are hoping people give up out of frustration but theyve got the wrong person- they also put you on hold for at least 10 minutes each time youre placed on hold! This is just wrong- I am a retired medical lab/physician office employee. No approval should EVER take this long! And since the premium is almost $300 a month and each visit is $216 every time until my $3700 deductible is met, its ridiculous! Big fail, Georgia insurance commission! If this turns out to be something really serious, Im going to start at the top at Ambetter and *** anyone connected with this- total disregard for patient care!

I removed my husband from our Ambetter plan on September 30th so that he could go on *** in October. On September 30th, I was told by a customer service rep that I could continue on the same plan through the end of the year. I met the deductible in April. I was told the deductible would remain status quo. My understanding was that any visits would continue to be covered at 100% by Ambetter. They failed to remove my husband effective 9/30 and kept him on the plan through 10/31. A second mistake that we paid for. My first claim after removing my husband from the plan was not covered in full. I received a *** from the provider for $898.60. Not only did I pay a higher premium for November and December, but I am also responsible for this exorbitant balance to the doctor. I talked with no fewer that *** customer service reps regarding the issue. Most couldn't understand my situation, others dropped my calls. A few agreed that I had met the deductible. I was told to file an appeal which I mailed in to the *** address. I followed up to see if it had been received. As nothing showed in the system, the customer service rep said it was best for her to file one electronically. Based on several follow up calls, no one saw either appeal in the system I was supposed to get a response within 30 days on the appeal. In January I reached out to the parent company, Centene located in ***. In my first conversation with a senior executive, I was told we would come to an amicable resolution. I was stonewalled in this process with the executive with her shifting blame to Marketplace. The rep didn't deny what I was told over the phone in September, as the phone calls are recorded. She said no monetary change could be made. I was looking for Ambetter to pay the claim in full. Essentially, the employee would get a slap on the wrist and retraining. As the customer, I got no "resolution" and am very dissatisfied.

It should have a negative 5 star rating. I have been a member since April fools Day of 21. Because I became permanently disabled and now on SSD, I am not eligible for Medicare until Sept 2022. I make too much for Medicaid ( never had, worked hard all my life ) but too little to get anything but a Marketplace plan. 08/03 I had problems at primary, Ambetter said I had not paid my August premiums, not only was I on autopay, but could see the correct last 4 of card I was using. I received bills that said $ 7.33 owed then there was a - &7.33 beneath it. When I called billing system that said I owed nothing. I had been seeing my primary Dr for over a Year, but had to find another Dr because Ambetter called billing leaving a nasty voicemail that made her verbally combative and in self-protection mode. After 3 phone calls it seemed I owed $ 6.66 from May ? I had to pay $ 150. to be seen, still having problems getting my money back. If that was not enough, at least 5-6 Dr's offices I have called no longer take Ambetter and consistently tell me they wish they would get their system updated. Ambetter knew they had an ITT issue ,but did not inform anyone so I am sure thousands of people had problems. Today I tried going to an urgent care, couldn't, they were not in system, all I have is a sinus infection, I need a shot and steroids, Sudafed does not work, I am prone to these so I know what to do. Went home tried using Teladoc, they too are having problems with Ambetter's I was told to call Ambetter ( third time today )and ask for a REAL TIME ACCOUNT, called Mike with Ambetter, told me, yeah we have been having a problem with Teladoc but you do have it, you just cant use it, or pay money upfront and then Ambetter would reimburse me? I am not an idiot, nor would I trust a company that cannot keep their programs up and running. And or inform their customers they were having problems in their system. I do see a class action lawsuit associated with this company, if they have been in business for so long, then why are they having so many issues? And the new Primary I found in the APPROVED PROVIDERS AFTER CALLING 5, well they only treat " well " people, I guess they think a sinus infection is a contagious disease, next they will be telling me so are hemorrhoid's, that they are an airborne pathogen. What kind of people are these folks at Ambetter and the Dr;s that they have. So I am here suffering with a severe sinus infection, because of sub-care performance of a group of people who do not like their job. Most days you call, I wake up someone, literally, they are sleeping when they should be working, please believe I can tell when someone just woke up, I am a 62 year-old woman. Since this is Governmental, does anyone monitor these people? Its sad and pathetic, I was in Iraq from 03-06 working to support the Military, worked since I was 15, and this is the best USA can do for me/us?

I was charged for 3 months of health care. I was unable to make payments for the months of *** and February due to the company not being able to access my account online or over the phone. I therefore did not have healthcare coverage. I called numerous times starting in December to make a payment over the phone since my account was unable to be found online. I had a member ID number and *** could see that I had signed up, but the representatives could not access my account either in order for me to make a payment via phone. The payments for *** and February were supposed to be removed, and I was told this would happen. However, I was charged for both of these months of coverage (when I was unable to use the insurance because I did not have a card) and I need to be refunded. When I called yesterday the representative said she sent over a request to billing and that I would need to wait *** business days for a POSSIBLE refund of the $754 I was charged. I could not make my first payment of $377.38 until the middle of February, which was for coverage in the month of Mach. I was also informed when signing up for this health coverage that prescriptions would be $27 and my birth control ended up being $130 so I am unable to take it.

I called ambetter customer service on august 23, 2022 about my monthly premium being higher than what I owe for the month. I pay $192 a month but my bill shot up to $400 even though my payments are up to date. After speaking to them they sent my account for auditing and I was to check back in *** business days. After that I called marketplace to see if it had to do with my tax credit amounts (I received health insurance through marketplace) but they confirmed that everything is up to date and I should still only owe $192 per month. So I called today (Tuesday) but apparently the audit came back that I still owe 400 and the reason she gave me for that is that its their policy, she even confirmed on her end that payments are up to date so I really only should owe $192 but she kept insisting on my bill and not giving me any reasons for why I owe that much. I asked to speak to her supervisor but she kept avoiding the question but I kept insisting and eventually she gave an excuse that theyre unavailable and theyd tell me the same thing, she refused to connect me to her. I have a suspicion that theres something fraudulent going on there. I refuse to pay until this issue is resolved. I have uploaded proof of the transaction for July and the current monthly bill from ambetter.

Ambetter *** is the most unprofessional member service I have ever experienced. I paid over my balance in attempts to pay down what I owed, thinking that the payments were not going through. It turns out that they were, there was a glitch in their system that did not reflect my payments on my balance. I went without insurance for this year until January 12th even though I paid over my premium. I missed prescription doses that I should not have had to. The customer service were very reluctant to do their job and in many cases very rude and dismissive. It is now February 11th and I have still not received a refund or compensation for the days I had no access to my insurance. I am also in danger of having my insurance suspended again because I refuse to pay them more money when they still owe me. I am currently on the phone with member services attempting to get this resolved once again, I have been put on hold. I asked why I was being put on hold and was not given an answer and then immediately put on hold anyway. Now they are saying that my refund nor audit went through a month ago, and that they will have to request again. I asked why it did not go through, they gave me no answer. I asked for the persons name and they refused to give me a full name, only initials. There is no longer a reason to trust that I will receive my refund nor any services that I pay for.

I had met my deductible in June . Healthcare.gov called and said they had to redo the policy to reduce the premium, so I agreed. Well, AMBETTER decided to restart my deductible in the middle of the year of me having the insurance plan because they reduced the premium I did not change my plan and they should not have restarted my deductible. So I had to call in and they agreed and fixed it back to all but $60 of it even though I had met my deductible before they lowered my premium. I have had to call these people 20 times to try and get it straightend out and they refuse to do so. I have met my out of pocket *** but they refuse to put a green checkmark by that because the $60 is still showing owed on the deductible and it should not be but I have met my out of pocket *** and they are paying all of my benefits at 100%. AMBETTER also owes me points for tests I have completed and for getting the *** AND FLU vacciene and a HBA1C test and kidney tests. The give these points a s an incentive. they have cheated me out of over *** points. I have called numerous times and sent emails and nothing has been done. i cant take it anymore, they are stressing me out. This is a mess and I am tire of having to argue with doctors that I have met my out of pocket because they cant seem to see it on their end or not trained to see it..I have already met my deductible and *** out of pocket and AMBETTER needs to fix it now..

Since Nov 17th, trying to get me and my sons information loaded into the system at Ambetter. Per HCE, all done on their end. Now up to Ambetter. On Nov 17th my wife filled out an application on the Healthcare.gov website, for me and my son to get insurance. We chose Ambetter 11 for medical and dentaquest for Dental. We were placed into 2 separate groups as we weren't able to be put into the same group. The dental part was correct. The Ambetter situation, not so much. My wife has called 4 times and spoken with reps who continue to tell her to wait it out for updating. Now its February, still no insurance, I have medical issue that I need addressed. Everytime I call to get a supervisor involved (which by the way was the suggestion of the HCE, as they say everything is perfect on their end), we get no one to ever pickup and after holding for 50 minutes or more, are conventley hung up on. This is irritating and i dont have time to hold for hours on end with no resolution. The initial issue seemed to have been that me and my son have the same name and therefore the system was identifying us as the same person. My name and birthday was put under my son's SSN, and so were the charges for both premiums. I was never put into the system at all. Now neither of us are in the system. I'm VERY ANGRY at this point as I have been more than patient. I NEED to see a doctor and I NEED THIS INSURANCE ISSUE FIXED. Please please help me!

Ambetter denied coverage for two "out of network" visits to healthcare providers for Covid-19 testing. According to Section 6001(a) of the FFCRA and Section 3202(a) of the CARES Act, by denying coverage for this visit, Ambetter is in violation of Section 319 of the PHS Act. I sent appeals to "Ambetter Member Appeals Dept" in Atlanta, GA at the address provided on their "Denial of Claim" letter. I mailed appeals on two seperate occasions - in August and November . I heard nothing so called today (January 25). Member Services rep "Curtis" informed me that I had heard nothing because I sent my appeals "to the wrong address" (I had used the address sepecified under "how to file an appeal" on Ambetter's denial letter). I was told by Curtis, today, that I should resend my appeals to PO Box 5000 Farmington, Missouri XXXXX. I looked this up on Ambetter's website and discovered the Missouri address (given me today by Curtis) is for PROVIDER appeals, not CONSUMER appeals. If I refiled my appeals at this address I will no doubt be told that I had filed at the wrong address because I am a consumer, not a provider. This is what is known as 'the runaround'. Ambetter has failed to adhear to its own written appeals protocol by failing to respond to two separate (correct) attempts to contact its appeals department. Continued denial of this coverage is in violation of United States Department of Health & Human Services mandates. Product_Or_Service: Covid-19 testing Order_Number: T189MPEXXXXX Account_Number: UXXXXXXXXXX

Ambetter said that they sent out a letter to my address because they need some additional information that I need to send in information concerning the total income for my household from the year 2021. I contacted my employer to get the info that I needed to send to the marketplace. The only way that my employers *** allow you to obtain this info is through a link that does not allow you to print out. I contacted the Marketplace to give the link that was provided to me by my employers but marketplace said that they had no way to down load this info. and it was close to the deadline to submit it so I asked to speak with a supervisor who extended it for 30 day which allowed me time to get it. during this time Ambetter took $883.00 from my account because I was enrolled auto pay. the reason they said that the $883.00 was taken was because the information that i submitted to the marketplace wasn't submitted in time I was enrolled in a tax credited insurance plan through the *** administration. after I spoke with the escalating team at ambetter they refuse to refund my money even after I spoke to a representative that told me all I had to do was to get the market place to submit the proper documentation and I would be able to get the money refunded marketplace even assured me that after the send over the referrals that my money would be refunded. The money that was taken from my account caused me a hardship and fallen behind in my bills that money was for my monthly expenses if i could afford $883.00 to pay for a single policy monthly I would not need insurance.

I was diagnosed with lupus by my PC months ago through bloodwork, and was previously diagnosed with rheumatoid arthritis 25 years ago. I've been desperately trying to get into a rheumatologist for 5 months. Due to my health and I'm no longer as mentally sharp, I don't feel comfortable driving to *** or in heavy traffic, and I panic. I'm widowed and my only child is busy working during the day, and planning a wedding. I've been turned down by 3 Drs that were supposed to be in Ambetter's network. The closest rheumatologist I can find to take me is in ***. There is 3 rheumatologist listed on Ambetter's site that are in network near me, but *** no longer takes Ambetter, because Ambetter was not paying her. When I called about Dr. *** in ***, it's a family practice and they haven't heard of him. When I've called about *** in Stockbridge, that office is closed and they refer me to the *** office. I also tried Dr *** in Peachtree city, (45 mins away) and they won't let me make an appt. I'd prefer to see *** in Stockbridge. I'm familiar with that area and can drive to it. Please help me get into a specialist near me that I can drive to. Also, several Drs have sent in numerous request to ambetter for a preferred prescription of budesonide for several years. I'm a severe asthmatic. Budesonide is the only thing that works in keeping my asthma under control. The Pulmicort, qvar, and advair inhalers do not work well for me. I really need to be able to take budesonide. Thank you for any help you can give with these issues.

I want to cancel my policy due to payment being lost and they cannot locate it. I signed up with Ambetter 2/27 and paid for the policy at that time $362.42 and it has cleared my bank account. I received notification via email that payment had not been made and that I needed to make the payment in order for the plan to be effective. 3/1 I called and spoke with Alexa at Ambetter to provide my confirmation number that payment had been made, she did not see the payment and she issued a payment tracer and that reference number is I-XXXXXXXX. 3/3 I spoke with Kenya and she also issued a payment tracer I-XXXXXXXX. 3/5 I spoke with Stephanie and she advised that the payment had been located and would be applied to my policy within 48 hours. 3/9 I spoke with Shelia and she saw the NOTES that indicated the payment has been located, however, it has not been applied to the policy. Shelia stated that she did not know when the payment would be applied and that I would not have coverage until it was applied. 3/10 I spoke with Kaylor and she stated payment had not been found and suggested I stop the payment with my bank and start over. 3/10 I spoke with Andrina and she submitted a request to cancel the insurance policy. Two reasons for cancelling, one is I was TOLD my doctor was in network with Ambetter only to find out from my doctors office that they ARE NOT in network - so that is a lie - and that they have been trying to get removed from their list for over a year now. Reason two is due to my doctors not being in network I do not want their policy. I want to cancel the policy and I want my money back. This is a scam insurance company and no one seems to know anything about anything. I DO NOT WANT TO DO BUSINESS WITH THEM! PLEASE HELP!

I went thru the Heathcare.gov system *** 2 years ago and in Jan *** the form of Ambetter Insurance out of ***. I have a chronic debilitating illness so it was a relief to finally get help. My insurance number is U94159599-01. I have faithfully paid my insurance premium each month since then even though it is difficult to find a provider with the thought being some is better than zero. Because of my illness I only have inconsistent work history but still, manage to pay. In late August , I was relocating from ***, *** to ***, *** since my Mom was moving and I had ***here else to go. I phone Ambetter and informed them and was told they would do a change of address and in fact, I begin to receive my bills at the *** address and pay them. Yesterday I went on line to change my new primary Doctor *** that I have found one and was unable to do so, WHen I phoned for help I was told that whoever assisted me to do that address change should have in fact changed me to . This did not happen and since I do not work for the agency I would not have a way to k*** this. I was helped by a young woman but after an hour was disconnected and no return call Over the course of the evening yesterday I phoned 5 times without help. Today I spent 2 hours with a medical helper named *** on their customer sercive line who "excuallted the issue case number I78272596782 and told I would hear back but she was not sure when. I was also told I may get any doc visit I may have had pushed back and have to pay in full. I did each thing I was supposed to do along the way and again have been paying my premium as directed the whole time. PLEASE HELP ME I need my insurance and do not k*** where to turn. This group is not calling me back, blaming each other and I need assistance. I dont k*** if I should call the news people or the insurance commisioner or if you can help

I had service done on 7/21 and before I even went in I called Ambetter to make sure that this would be covered and they told me yes. When I got to the place I also asked do they take Ambetter and they said yes. Next thing you I am getting a ***. I could the company that billed me because I was confused and did not know why I had a ***. So they told me for the exams that I had and I told them that they told me it was covered, so I are you able to tell me the doctor and they did and I told them I never heard of nor did i ever see this doctor. Then they told me that he was the one that read the results and he is out of network. I said why would they have someone who it out of network read my results when I took the time to make sure that i was in network, that's not right. The person said let me have them run it though again for you.I call again maybe a few weeks later to see if it went through and nothing happen so I explained the whole thing over again and this person said that they will try and run it through again and to call my insurance and tell them what happen. I did, so the person that I spoke with at Ambetter said they will run it again.So i get another *** and here we go again, I am trying my best to get the cleared up because I do not need anything on my credit that I work hard for. I call the Dr. *** that billed me and they tell me that it was put in wrong that he does take Ambetter and they will run it thru again and still nothing. So I call Ambetter today again (1/24/2022) spoke with someone for about 5 minutes and disconnect never calls me back even when she asked me for my number in case we get disconnected, I waited before I called again and spoke to someone else about what was going on and she was no help at all. That call dropped and never called back either. I never saw this doctor and the doctor takes Ambetter so why am I getting a ***. This needs to be cleared up ASAP. They don't seem to care at all.

Ambetter has given me a partial approval for a required surgery. Their approval agency, Turning Point, requested documentation from my surgeon, ***, regarding replacement substrate for my spinal fusion. That was provided twice. My Dr's *** has each confirmation sheet. Next Turning Point says there is a 5 day time limit and the issue is now with Ambetter itself. So, I start calling Ambetter and get no where. My surgery was supposed to be May 24th, it is now June 7th and they are still giving me the run around. My Dr. has filed an appeal and other than a few days to allow the appeal to go through the system, I have called every business day to check on this. You cannot get to anyone who can directly tell you anything. I do know that Ambetter has asked for paperwork and it has once again been faxed twice. Surprise surprise, they claim they don't have it. They have moved past the point of incompetence. No one is that incompetent. At this point there is no other answer for their behavior other than intentionally lying and dragging their feet. I've spent over 20 hours on the phone with them trying to address this since May 20th. Nothing has changed. I consider this a breach of contract and to leave an insured person with daily pain like this should be criminal but I'm sure our government would never hold them accountable for anything. At any rate, I demand for this to end with an immediate authorization. Even when I get it, I'll still be waiting nearly a month for my surgery because that is how far out they are scheduled. This is affecting every aspect of my life including my mental health. This is a routine surgery. Oh, one final thought. My neck injury is affecting my spinal cord. Each medical provider has directed me to a neurosurgeon but brilliant Ambetter ran the authorization by an orthopedic surgeon. If I wanted the opinion of an orthopedic surgeon I'd have gone to one. He has no business contradicting a neurosurgeon in this.

I was paying $8 for insurance through a credit through marketplace. I was provided the credit for being on unemployment due to the pandemic. I am a nurse and our specialty surgery site took a major hit. I woke up dec 16 and had been charged $374 charge which caused my account to be overdrawn a week before Christmas. I immediately contacted Ambetter when they opened at 8, since the charge was still processing the agent said she couldnt see it or refund me. She suggested calling my bank. I called my bank and nothing could be done. I called ambetter the next day crying letting them know I have 2 babies and its a week before Christmas. The first agent requested a refund but said it would take *** days. I called my bank agsin and was told the merchant could reverse the charge and allow me access to the funds that were being incorrectly held. I called ambetter again and asked for a supervisor. The guy begged to let him help me and after a long hold, he came back and started talking about my benefits like really. You left me on hold and clearly didnt hear my issue. I request a supervisor and he transferred to a line that hung up. I call back and spoke to a female agent who was really sweet and attempted to help however after holding over 37 minutes she informed that she couldnt do anything to expedite the refund request so I again requested a supervisor Ill need to be put on hold she did keep coming back to let me know that I was still waiting for a supervisor but after 40 minutes I had to feed my babies I hung up. I did let her know that I have newborn babies and that it is one week before Christmas not only was that 300 and something dollars intended to buy gift it was intended to get us food and pay bills until I go back to work January 1. She was very empathetic but just unable to help after holding I finally just gave up and hung up. I am so stressed and suicidal over the lack of urgency concerning my only money. I will tweet to *** followers on social media

Ambetter forced my hospital to cancel a prescheduled operation and lied about the reason why In December my doctor at Emory Orthopedics scheduled a sacroiliac hip injection in order to resolve a chronic pain condition. I was told that Ambetter, my insurance, would only allow scheduling for this procedure in the last half of the month, even though I was hoping to get it as soon as possible to stop the pain. The operation was scheduled for 1/25. I paid the hospital $1600 for it in advance. Today (1/22), at the last minute, the hospital told me that the procedure would have to be canceled because Ambetter could not precertify it in time. I immediately called Ambetter. The Ambetter rep told me that it was the hospital's fault for submitting the approval request too late (1/11) because they needed a full 14 days to precertify, but that if the hospital called to make the request "urgent" then maybe it could be expedited, but that as the patient I could not expedite it myself. I asked for a supervisor call back. No one called me back. The record of my phone call was "I-XXXXXXXX". I then called the hospital. They told me that they had submitted the preertification request on 1/4, but Ambetter's system was down and it was Ambetter's fault that it was not precertified in time, and that there were also several other Ambetter patients in my same position whose operations and procedures now had to be cancelled. They also told me that Ambetter's claims about the precertification process were completely false, and that Ambetter refused to expedite a request without risk to a patient's life or limb. So since my hip injection could not be expedited, it would have to be cancelled and rescheduled pending certification, and Ambetter had lied to me. Ambetter lied about a supervisor calling me back. They lied about the expedition of precertification process. Ambetter's certification procedure and customer services are completely dysfunctional and abusive. As a result of their failure and lies, I have to live longer in unnecessary pain, waste a whole day struggling with healthcare bureaucracy and completely change my schedule around an operation that I have no idea when I can reschedule for yet.

I have contacted this company 6 times in the span of a month simply to get a letter stating that my insurance ended with them December . Every representative I have spoken to was incompetent. Either they gave me incorrect information, or disconnected. They sent out the wrong letter twice, and 3 times I called and asked for a supervisor and not one would come to the phone. They would claim to all be busy, but they weren't too busy to give the rep instructions to come back and forth to the phone to tell me, but would never get on the phone directly. My company cannot finish processing my insurance application until they have a letter of termination from Ambetter which I just can't seem to get. Instead, they keep sending me letter of coverage verification. The reps are incompetent, the supervisors don't give a *** about customer issues, insurance, and surely not my health. Meanwhile, I have been having to go to the emergency room for health issues or just deal with it at home because I have no insurance and cannot get any until I get a letter from them. I am BEYOND FURIOUS and this is completely unacceptable. I regret ever dealing with this company at all because clearly they do not have the customer's best interest in mind. I spoke to the sixth representative today, who was nice but I was on the phone with her for almost an hour waiting for a supervisor that never came and just told the rep to tell me that I would just have to wait because she, the supervisor, was busy. But clearly not too busy to pass messages. This rep said she would send out another letter, a third one today. The problem with that is it takes at least a week for it to get here, and I have already been given am extension to get information into my company for insurance and by the time the letter gets here, that deadline may be up. And who knows if they even send the correct one this time. I am at risk of having absolutely no insurance for the year, all because of this irresponsible company. I asked if she could fax the letter to the benefits specialist where I work, and the rep said no because she is unable to do it. A supervisor, who would not come to the phone, has to approve it or send it. So basically I am screwed and this company is the WORST. Product_Or_Service: health insurance Account_Number: UXXXXXXXXXX

My medical insurance has failed to provide me with an medical maxillofacial options since August ! Since August I have been trying to get a medical Maxillofacial provider through my medical insurance with Ambetter. I have worked with over 30 reps and supervisors! I have issued multiple grievances. Ambetter has incorrectly submitted my grievance and continue to delay helping me. They close grievance and continued to respond to my grievances by giveinv me dental providers. I have an order from my PC for a maxillofacial surgeon not a dentist and not a orthodontist. I have a better medical! It's not there leagal right to try to guess what kind of doctor I need! The have sent me closed grievances that are referring me to a dentist. I do not have ambetter dental and once again I do not need a dentist. That is completely different. Ambetter only has one provider that takes Ambetter which is emory. However emory terminated me because I wanted to know why my benefit didn't cover something and they were withholding claims from my insurance so I never got to see a denial response. I needed a mouth splint and there doctor submitted an order in February for one and no one ever contacted me back. I went back from another appointment in June and he reorder the claim. Once again a moth went by mother happened . Ambetter ignored my called and emails. Then one day I got a hold of an Emory supervisor and they told me I had to pay out of pocket. They would not explain why. I wanted to understand my benefits and why my insurance never had seen the claim or pre authorization and that was because they were withholding claims and breaching their contract that they have with Ambetter. I spoke with them for less than 5 before the financial office deemed me as an issuer. I asked to review my benefits and asked them to send it to my insurance so I would know atleast why it would be denied. They wouldn't and I was terminated. Ambetter kept stringing me along claiming that they were helping me. They continued to lie. Ambetter - Rep after rep told me I would be covered for the procedure. Not until October or November did someone inform me that my benefits would not cover it. Either way emory should have sent the claim/ authorization and I would have know. However ammbetter should have known my benefits! Once again Emory deemed me as a problem because when I asked why I had to pay $1000 out of pocket after meeting my out of pocket and deductible. Just today I received another grevience response from ambetter through snail mail from dec 17th. They said that I was terminated from Emory for my " behavior" and gave me more dentist to see. I don't have dental insurance! I have medical with Ambetter and I need a maxillofacial surgeon! I am tired of this! I am paying premium after premium on time every month and they are failing to provide me with a medical doctors. I have the right to a single case agreement and they continue to tell me they will find someone and give me more dentist! A maxillofacial surgeon is medical and is not a dentist! I spent over 50 hours on the phone trying to fix this! No help!