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Business Profile

Health Care

Ambetter from Home State Health

Complaints

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Complaint Details

Note that complaint text that is displayed might not represent all complaints filed with BBB. See details.

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Complaint Status
Complaint Type
  • Complaint Type:
    Product Issues
    Status:
    Answered
    Ambetter is refusing to provide me with Evidence of Creditable Coverage for my dental. My portal has been cancelled. I have been with Ambetter for 5 years. I am not using Delta Dental Insurance and cannot prove I have had dental insurance for the last 5 years. My policy number is: ********, Member ID number *********. Date of Birth: **********

    Business response

    01/27/2025

    Ambetter from Home State Health Plan received your grievance on 01/13/2025 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 spoke to ******* ****** on 01/14/2025 and advised they will be assisting him with his concerns. We will be sending a detailed response directly to ******* ****** addressing BBB Complaint Case # ********.
  • Complaint Type:
    Order Issues
    Status:
    Answered
    Ambetter illegally signed me up for their insurance and I didn't know about it until express scripts told me.

    Business response

    11/08/2024

    October 30, 2024

    Better Business Bureau

    Serving Eastern & Southwest Missouri & *****************

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

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

     

    Re: ****** ********

    Complaint ID: ********

    To Whom It May Concern,

    Ambetter from Home State Health (Ambetter) received your grievance on October 24, 2024, concerning Ms. ****** ********, BBB Complaint Case# ********.  Due to federal and state privacy and confidentiality 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 has attempted to contact Ms. ******** to discuss her concerns on 10/25/2024 and 10/30/2024; however, they were unable to reach her, and voicemails were left with our representatives direct contact information.************************************************************************************************************************************************************************************************************************************************************************************* We will be sending a detailed response directly to Ms. ******** addressing BBB Complaint Case # ********. If you have questions,please call us at ************.

    Respectfully,

    ***** *****

    Member Relationship Liaison

    Ambetter


  • Complaint Type:
    Billing Issues
    Status:
    Answered
    In Feb. 2024, I switched my chiropractor to an Ambetter provider. I have 26 visits under my plan. From the beginning, I had trouble with Ambetter and the provider's claims. I eventually got my first bill (which was intial visit and 1st adjustment) straightened away and cleared. The next 4 visits, dated 3/05/24, 4/22/24, 5/06/24, and 5/20/24, were all denied for reasons like Out of Network, Incorrect Billing Code per DCM manual, or incorrect NPI#. I contacted Ambetter multiple times and they said there was a glitch on their end that occurred with the 03/05/24 invoice submission and it would be corrected within 30 days. The remainder would also be fixed as there were no such errors with the invoices, it was all on their end and my account would be credited with the amounts I had paid for these deductibles. This began in April 2024 and has continued through today. I have been through multiple levels of customer escalations and have spent over 20 hours on the phone with Ambetter, to no avail. A grievance was filed with them on my behalf in July. I received a letter on August 16 dated August 12, 2024 that stated the grievances on the 3 denied claims (4 visits) had been decided in my favor and my account would be updated in 12 to 24 hours. It's been another 6 weeks. I have traveled up several levels of customer escalations with no resolution. Now I'm connected with ****** at their "SWAT TEAM" who stated they will fix all my problems immediatedly. That started on 09/09/24 (with them telling me another 10 business days was all they need). But nothing happens. Each level just says they have between 10 and 30 business days to take action and then they never resolve. They reach out occasionally to say nothing has happened. When I call back, I have to start at the bottom and try to get back up to the appropriate escalation team, which always takes an hour. They are trying to block me from meeting my deductible amount! It's clear they have no intention of fixing these problems.

    Business response

    10/16/2024

    Ambetter from Home State Health (Ambetter) received your grievance on 09/20/2024 concerning Ms. ***** ****** BBB Complaint Case# ********.Due to federal and state privacy and confidentiality 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 spoke to Ms. ****** on 09/24/2024 and advised they will be assisting her with her concerns. We will be sending a detailed response directly to Ms. ***** addressing BBB Complaint Case # ********

    Customer response

    10/18/2024

    I was contacted by Esmaa at the ************** (main office) for Ambetter on 08/24/24, who said she would be taking over my case after receiving the BBB complaint notification and I would no longer need to be in contact with the **** team or any other escalation team at Ambetter. She gave me her direct line number and told me she would be providing detailed updates for me every few days and have resolution of my issue by 10/03/24, the BBB deadline. As of today, 10/18/24, I have NEVER heard back from her again, in spite of leaving several messages for her during this time. Her voice mail says she will receive notice of the call whether you leave a message or not. I have left messages each time with zero response. In the meantime, ********* from the **** team had still been reaching out. It appears that 2 of the 3 claims involved have now been processed thanks to his efforts and as of 10/14/24 show status "not ready".  The original March 5, 2024 claim now shows "Denied" and "not ready", where it showed "Processed" on the date he contacted me. ********* declared that all my problems had been solved on 10/14/24 and that I would not be contacted again, but it does not appear so at this writing. The deductibles from the 04/22/24 and 05/20/24 claims show as applied to my account, but nothing for the 03/05/24 claim. 

    Business response

    10/18/2024

    Ambetter from Home State Health (Ambetter) received your grievance on 09/20/2024 concerning Ms. ***** ****** BBB Complaint Case# ********. Due to federal and state privacy and confidentiality 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 spoke to Ms. ****** on 09/24/2024 and advised they will be assisting her with her concerns. We will be sending a detailed response directly to Ms. ***** addressing BBB Complaint Case # ********.

    Customer response

    10/27/2024

    I previously sent more information to this forum as follows on 08/26/24: I was contacted by Esmaa at the ************** (main office) for Ambetter on 08/24/24, who said she would be taking over my case after receiving the BBB complaint notification and I would no longer need to be in contact with the **** team or any other escalation team at Ambetter. She gave me her direct line number and told me she would be providing detailed updates for me every few days and have resolution of my issue by 10/03/24, the BBB deadline. As of today, 10/18/24, I have NEVER heard back from her again, in spite of leaving several messages for her during this time. Her voice mail says she will receive notice of the call whether you leave a message or not. I have left messages each time with zero response. In the meantime, ********* from the **** team had still been reaching out. It appears that 2 of the 3 claims involved have now been processed thanks to his efforts and as of 10/14/24 show status "not ready".  The original March 5, 2024 claim now shows "Denied" and "not ready", where it showed "Processed" on the date he contacted me. ********* declared that all my problems had been solved on 10/14/24 and that I would not be contacted again, but it does not appear so at this writing. The deductibles from the 04/22/24 and 05/20/24 claims show as applied to my account, but nothing for the 03/05/24 claim. 

     

    Since the previous writing, I was contacted by Esmaa at Ambetter on 10/23/24, saying that she personally had worked on my file to get the claims processed, which I know not to be true, as it was Christian from the **** team.  She said she would continue to contact me until the third claim had processed and finished.  However, the day after I spoke with her, my 04/20/24 claim ALSO started showing as "denied" and "not ready," making it now 2 of the 3 claims that have failet YET AGAIN!  And my deductible, which was showing as having been met on 10/17/24, now shows that I have $33.95 balance remaining as of 10/24/24 since they backed out yet another of the initial claims that I filed a BBB report for!  So nothing has really been accomplished since my initial complaint. I do not want my claim to be closed, as they have done nothing.  I was under the impression that by replying here I was updating the info on my claim! I will write to the BBB again. ***** *****.

    Business response

    10/28/2024

    Ambetter from Home State Health (Ambetter) received your grievance on 09/20/2024 concerning Ms. ***** ****** BBB Complaint Case# ********.Due to federal and state privacy and confidentiality 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 spoke to Ms. ****** on 09/24/2024 and advised they will be assisting her with her concerns. We will be sending a detailed response directly to Ms. ***** addressing BBB Complaint Case # ********.

    Customer response

    10/29/2024

    Complaint: 22308393

    I have reviewed the business' response and am rejecting it because:

    I have submitted a current and valid HIPAA form indicating my agreement for the details of my case to be discussed by Ambetter from Home State Health with the Better Business Bureau. This was signed and dated by me on 10-17-24 and returned to the BBB.  There should be no reason that Ambetter cannot disclose whatever details are appropriate to prove their point, other than that they have given me no resolution on this.

    On 09-24-24, I received a call from Esmaa at Ambetter's St. ***** office indicating that she had been assigned my BBB complaint and would be updating me via detailed message every couple of days as to the status of my claim, which would be resolved within the BBB's timeframe of 10-03-24 for conclusion.  I did not hear from Esmaa again for almost a month, even though I left messages requesting the promised updates on more than one occasion.

    In the meantime, I continued to be contacted by Christian from Ambetter's "SWAT TEAM," with whom I had been working prior to Esmaa's "involvement."  On *****-24, ********* called to tell me that all 3 claims had been resubmitted, the previously paid deductibles had been applied to my account, and as soon as they were processed, everything would be finished.  Therefore, his job was done and he would be stepping out of the case. I checked my online account while I was on the phone with Christian and this was all true.  My deductible balance was now $0 and everything looked Ok. The 3 claims in question were "processing" and "not ready".  However, when I checked again a few days later, I saw that the 03-05-24 claim had again been marked "Denied" but still said processing.  

    On 10-18-24, I received my first ever call back from Esmaa at Ambetter corporate.  She attempted to take credit for getting my account "Fixed" except for that one claim that had errored out again, that should be taken care of shortly.  The other 2 claims were fine and should be showing updated EOB's in ***** days.  When I checked my account after the call with Esmaa, I saw that now TWO of the original claims had errored out, and I was now showing a balance due on my deductible of $33.95 since they had "un-applied" my previously paid deductible for the second claim (the March 5 claim deductible had never even been applied in the first place).  I called Esmaa again the next day to inquire about this new incredible mishandling of my account and communication with me, but she has not bothered to return my call as of today, 10-29-24.  I am not at all satisfied with Ambetter's "handling" of this matter.  It seems their new way out is to continuously ask my *************** to submit a "new" claim with "corrected" information (which their office verifies is not ever a correction on their part) and then tell me they have another 45 days to process the info.  SO NOTHING EVER GETS DONE.  I have no doubt that my 3rd claim will also error out shortly and even if it doesn't, I'm still basically in the same position as when I began calling Ambetter about this, over 5 months ago!  

    Sincerely,

    ***** *****

  • Complaint Type:
    Billing Issues
    Status:
    Answered
    I had contacted Ambetter the first time on Aug 21, 2023 to discontinue my coverage as my husbands work started offering health insurance. I was told my coverage was canceled. and that I would be refunded my premium paid for the next month and my auto-deduction was canceled. I noticed in September that Ambetter had again taken out premiums for the supposedly canceled. policy and called again on Sept 18, was told their computers were down and they would call me back later. No return call, I had to call on Sept 19. At that time I was told since I did not contact the health insurance marketplace on Aug 21 as well as Ambetter, my policy was still in effect. I was not informed on the Aug 21st call that I had to cancel through marketplace as well. So I had to pay for half a month of a policy I was informed on my Aug 21st call was canceled, even after I gave them the confirmation number I was given on the first call. I went through the additional steps of contacting marketplace to cancel the policy and was told I would receive the premium paid back. It should have been a refund from when I was told the plan was canceled and no further payments would be coming out of my bank account. So 2 months of premiums for a total of $2176.36. Instead I was told I would only be getting half of Septembers premium back and all of Oct for a total of $1523.45. I was told 7-10 business days. By the end of Oct I still had not received a refund so Nov 6 and Nov 7th I called and was informed it may be 3 months before I had a refund. Here it is Sept 2024 and I still have not received a refund even after my last phone call on 8-6-2024 where again it was supposed to be 7-10 business days.

    Business response

    11/07/2024

    To Whom It May Concern,

    Ambetter from Home State Health (Ambetter) received your grievance on September 17, 2024, concerning Ms.****** ****** ********** BBB Complaint Case# ********. Due to federal and state privacy and confidentiality 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 spoke to Ms.****** ********** on October 16, 2024, and advised they will be assisting her with her concerns. We will be sending a detailed response directly to Ms.****** ********* addressing BBB Complaint Case # ********.


    Respectfully,


    Esmaa *****
    Member Relationship Liaison
    Ambetter
  • Complaint Type:
    Customer Service Issues
    Status:
    Resolved
    I submitted an authorization request for this patient with Ambetters PA Department on 07/16/24. It has been 37 days and we still have not received a determination. I have called 21 times and submitted 6 escalation/expedited requests - the most recent as of today, 08/23/24. I submitted an emergency ticket on 08/22/24 and was told we would have a response within 24 hours. I called today, 08/23/24, to follow up since I had not heard from anyone and was told my ticket was closed and "forwarded" to another ticket with a 72-hour turnaround time. Every time *** asked to speak with a supervisor, I am put on hold for exorbitant periods of time and then told a supervisor is not available to take my call. They are effectively preventing this patient from receiving a medication she desperately needs. It is against CMS Compliance to take 40 days to review a standard medication authorization. My impression is that they are deliberately delaying approval to prevent claims submission. It is abhorrent and illegal behavior. I have submitted additional complaints with the ** DCI and CMS, as well as a direct grievance with Ambetter regarding this incident.

    Business response

    08/26/2024

    August 26, 2024
    Better Business Bureau
    Attn: Dispute *********************

    *****************************
    ********************************************************
    **************************
    Daytime Phone: **************

    Re: Authorization
    Complaint ID: ********


    To Whom It May Concern,

    Ambetter from Home State Health received your grievance on August 26, 2024 concerning

    Authorization, 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. We will be sending a detailed response directly to *****************************

    addressing BBB Complaint Case# ********. A member of the Ambetter from Home State Health

    escalation team will contact you within 2 business days.

    Sincerely yours,

    Executive Response Unit


    Customer response

    09/05/2024

    Better Business Bureau:

    I have reviewed the response made by the business in reference to complaint ID ******** and find that this resolution is satisfactory to me. 

    Sincerely,

    *****************************
  • Complaint Type:
    Product Issues
    Status:
    Answered
    I'm not longing becoming aware that Ambetter health insurance has illegal enrolled me in their plan in 2022 and I even called them on May 10th bet they're still trying to charge me a little over $700.00 and I already had the State of ***************** and ******** and they're trying to say that I went online in 2023 throw health insurance marking and the info that I provided it's public info and they have the right to contact me even though I didn't click on their link and when they told me that I can insure you that they unnoticeably used my name to commit Fraud Identity Theft and Forgery to claim me on their Tax Refund with the *** and I have notice that the *** is saying that I owe them a little over $143 thousand dollars and I talked to the *** the *** informed me that them and Social Security only shows office I was only receiving SSDI and not working I contacted Ambetter to talk to a Manager on July 17 2024 at 738 PM central time and the Representative intentionally disconnected without notice and I tried to call back at 740 PM and she block my call to prevent me from talking to the person who is in charge and that further more let's mr know that they hace something to do with the Fraudulent Act with getting money from the *** to get a TAX Refund and they're going to continue to do it as long as the Police State/Government Attorney all Judges entire *********************** and entire Legislation allow them to do Instead of arresting them for it including illegally by unnoticeably making people give them the right to contact anyone and be able to see people personal info and they're scamming people because the lawyers refuses to take on the case and Polices And State/Government Attorney *********************** and Legislation refuses to to their job

    Business response

    07/19/2024

    Better Business Bureau
    *********************************************************************************************


    Re: *****************************
    Complaint ID: ********


    To Whom It May Concern,

    Ambetter from Home State Health received your grievance on 07/18/2024 concerning ******************************BBB Complaint Case #********.  Due to federal and state privacy and confidentiality 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 spoke to Mr. ****************************** on 07/19/2024 and advised they will be assisting him with his concerns. We will be sending a detailed response directly to Mr. ***************************** addressing BBB Complaint Case #********. If you have questions, please call us at 1-855-694-HOME (4663) TTY: 711.

    Respectfully,


    *************************
    Member Relationship Liaison
    Ambetter Health
  • Complaint Type:
    Service or Repair Issues
    Status:
    Resolved
    Ambetter Insurance. Policy needs cancelled. Just get the run around when I call them.

    Business response

    07/03/2024

    Ambetter from Home State Health received your grievance on July 2, 2024, concerning *********************, BBB Complaint Case# ********. Due to federal and state privacy and confidentiality 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 spoke to ************************* and advised we will be assisting him with his concerns. We will be sending a detailed response directly to ********************* addressing BBB Complaint Case # ********

    Customer response

    07/12/2024

    Better Business Bureau:

    I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.

    Sincerely,

    *********************
  • Complaint Type:
    Billing Issues
    Status:
    Answered
    There are trying to collect on an ********************** ***** plan I did not solicit I have contacted them multiple times to eliminate there attempts to sell me ***** ********************** and they ignore my request I have Heath ******** through my husband's work and do not need there ******** and have never requested ******** from them they have sent a form 1095 A to the irs I have had to amend my taxes and send the 1095 B from my employers proving we have ***** ******** and they still ignore my request and send a bill and add another month's premium to the payment due I have never requested ******** from this company and I have never filed a claim with this company and the just won't take no for an answer the have caused us to pay an extra 1200 to the irs I have had to amend my taxes and I have contacted them multiple times and the still just keep sending a bill for premium I have uploaded our 1095B showing ******** from husband employer there monthly bill and disclaimer

    Business response

    06/04/2024

    Ambetter from Home State Health Plan received your grievance on 06/03/2024 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. Ambetter will be sending a detailed response directly to *************************** addressing BBB Complaint Case# ********. 
  • Complaint Type:
    Billing Issues
    Status:
    Answered
    Ive been paying Ambetter Home State ******* every month for insurance and they have refused to cover a single bill. I would not have paid for insurance had I known they would not cover a single bill from any doctor. Attached is my bill solely from my OBGYN, but they also refused to cover my therapy and medications. Ive called them multiple times throughout the year to resolve this issue, but they have been not helpful. As far as I can see, this business is a scam.

    Business response

    05/08/2024

    May 8, 2024
    Better Business Bureau  
    Serving Eastern & ****************** & *****************
    ***************************************************************************************************
    Re: *************************
    Complaint ID: ********

    To Whom It May Concern,

    Ambetter from Home State Health received your grievance on May 8, 2024, concerning ************************************************************ Complaint Case# ********. Due to federal and state privacy and confidentiality 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 has attempted to contact ***************************** to discuss her concerns; however, a voicemail was left with our representatives direct contact information. We will be sending a detailed response directly to ************************* addressing BBB Complaint Case # ********. If you have questions, please call us at *************.

    Respectfully,

    ***********************************
    Member Relationship Liaison
    Ambetter
  • Complaint Type:
    Billing Issues
    Status:
    Answered
    Co-pays for prescription drugs are detailed at $15 for generic and $30 for brand name drugs on documentation provided by insurance company. When you attempt to get a prescription covered my actual copay is over $1,000.

    Business response

    04/26/2024

    April 26, 2024
    Better Business Bureau
    *********************************************************************************************
    Re:***********************
    Complaint ID: ********
    To Whom It May Concern,
    Ambetter from Home State Health received your grievance on 04/22/2024 concerning ************************ BBB Complaint Case #********.  Due to federal and state privacy and confidentiality 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 spoke to Mr. ************************ on 04/23/2024 and advised they will be assisting him with his concerns. We will be sending a detailed response directly to Mr. *********************** addressing BBB Complaint Case #********.If you have questions, please call us at 1-855-694-HOME (4663) TTY: 711.
    Respectfully,
    *************************
    Member Relationship Liaison
    Ambetter

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