Complaints

• Initial Complaint

  03/20/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Ambetter has overcharged me on my 2023 Premium (took $329 for 13 months instead of for 12 months). I have made several phone calls asking for the return on the overcharge and all I get is the same run around with no resolution. I have made approx: 15 calls and have spent over 6 hours on the phone. Some member services say the amount was not sent back and others say it was sent on January 19, 2024 (they cannot keep to the same story). My online account with ********************** does say that $329 was returned but this has never reflected onto my bank account. I spoke to the bank and they confirm that there has never been an attempt to refund this money (they do see another attempt to take out another $329 on January 16, 2024 which would of been a 14th payment but the bank did not allow). I have offered proof to Ambetter that the money has not been returned by requesting to send them bank statements but they do not seem interested enough to give me fax and/or email information to send. This is considered theft. I want this money back NOW!!!! It was taken from me on December 19, 2023 and this situation has been going on for way too long.

  Business response

  03/26/2024

  Please see attached letter. The complainant is not a member of Ambetter from Coordinated Care (Washington health plan), and we are therefore unable to provide a response. We forwarded the complaint details to our affiliated health plan in ******* for further review.

• Initial Complaint

  03/03/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I pay over $400 a month for a gold plan. There are very few choices of providers within Washington state. If I wasoutside of Washington state, I would have regular ambetter coverage. This is ridiculous! Fix the political problem! I have an urgent care need right now. I have 0 options of in-network urgent care centers that are open on weekends or after 5. I'm not going to pay $300 to go to the *** So... I guess I'm just going to die if a kidney infection.

  Business response

  03/20/2024

  Please see attached acknowledgment letter.

• Initial Complaint

  02/17/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I had health insurance through coordinated care, and they covered my doctor ********* Then I had to get a new plan, a much more expensive plan , I stayed with Coordinated care because I thought they would continue to work with my doctor, but the "select" plan of coordinated care doesn't cover care from my doctor and they tried to just hand me off to another doctor *** never heard of. If health care is made confusing and difficult to get , a crime is being committed.

  Business response

  03/18/2024

  Due to confusion regarding the participation status of **************** primary care provider, we reprocessed the claim to pay as in-network. We contacted ************ via email to advise of these findings and action and provided him with a direct contact number to a liaison who may further assist with this issue should the need arise. Going forward, ************ will need to see an in-network provider, unless prior authorized, for services to be covered. Alternatively, he may choose to move to a different Ambetter plan with which ************ is participating. The liaison can assist with this as well. This response was also sent to ************ through his complaint through the Office of the Insurance Commissioner regarding the same concern.

  Customer response

  03/19/2024

   
  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.
  
  Though I still have serious distrust for the insurance industry and ambetter in particular and consider the processing the claim as it was in network shows those who manage this insurance company feel guilt and use these little accommodations to quiet those pointing out the real problem with the insurance industry. 
  
  Sincerely,
  
  *********************

• Initial Complaint

  02/12/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Began first month's coverage with Ambetter after selecting them through the ** Healthfinder website, but had not received any paper or email invoice for the second month. I attempted to sign in via their website, however the website login link kept redirecting to a registration page. This page rejected the information provided as "invalid", though I figured out it was because my account had already been registered. I was unable to access and submit payment in time, and attempts to call their automated member services hotline was rejected because it refused to acknowledge a now-canceled account.I literally just want to pay for my health insurance coverage, but Ambetter really has all the hallmarks of a scam and fraudulent organization. I have since figured out how to bypass the website issue, but there are no options to make payment, restore coverage, or appeal this decision. It appears to be in violation of the required 30 days notice before canceling coverage as indicated on the healthcare.gov website as well. *********************************************************************

  Business response

  02/13/2024

  Thank you for forwarding the complaint you received from Durin *******, BBB ID number ********. We received your correspondence on 2/13/2024.Due to federal and state privacy and confidentiality regulations, we are unable to disclose any protected health information, including, but not limited to eligibility, claims, and billing information. We will be sending a detailed response directly to Durin *******.

• Initial Complaint

  02/05/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  I received a **** form that stated that I had insurance through am better. I never took out an insurance through them . Someone started an insurance policy without my consent. I have had insurance through my employer for 5 years. This is fraud in listing someone for an insurance plan without my consent . This has already caused my income tax to be rejected . As I had already filed my taxes before this form was mailed. To me , just to figure out that its for an insurance I did not obtain. I would like a speedy recovery of a **** form that is voided. I did not obtain said insurance I have private insurance through my job.

  Business response

  02/06/2024

  Thank you for forwarding the complaint you received from ***************************, dated 2/6/2024, BBB ID number ********.  By reviewing the data you submitted, we believe you may have contacted the wrong health plan. It appears this member resides in ********* state and we have forwarded this complaint to the Ambetter health plan there. Please let the complainant know that they should contact us directly if they believe they have coverage through Ambetter from Coordinated Care in Washington state. Due to federal and state privacy and confidentiality regulations, we are unable to disclose any protected health information, including, but not limited to eligibility, claims, and billing information to the BBB.

  Business response

  02/07/2024

  Please see our attached response.

• Initial Complaint

  01/11/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  On 12/06/2023, I enrolled with Ambetter through the ** health plan finder website. I made a payment of $388.63 at that time on that website for my first month of coverage that was supposed to start on 01/01/2024. Upon payment on 12/06/2023, I received an payment confirmation email from Ambetter (attached). However, I keep getting unpaid notices. Before calling them to find out what was going on, I checked my bank statement to confirm that it was deducted from my account and it was deducted a day after (attached). Payment was made with my debit card (Mastercard). I called Ambetter on 12/26/2023 and provided the representative all of the attached info. He said that he would have to do a "payment trace" and that it would take 7 - 10 business days. Here's the interaction # that he provided I120881991. I followed up via secure message today (01/09/2024), requesting status update & got no response. I am leery about making any further payments them, as they cannot tell me what happened with my very first payment. Cancellation of my policy might have to happen.

  Business response

  01/12/2024

  Thank you for forwarding the complaint you received from ***************************, BBB ID number ********. We received your correspondence on 1/11/2024.Due to federal and state privacy and confidentiality regulations, we are unable to disclose any protected health information, including, but not limited to eligibility, claims, and billing information. We will be sending a detailed response directly to ***************************.

  Customer response

  01/18/2024

   
  Complaint: 21123965
  
  I am rejecting this response because:

  I still have not received the detailed response that Ambetter said that would be sending to me in regards to this complaint.
  
  Sincerely,
  
  ***************************

  Business response

  01/23/2024

  We are still investigating ********************** case and will respond directly to him as soon as possible.

  Customer response

  01/23/2024

   
  Complaint: 21123965
  
  I am rejecting this response because: I received a secure message in my Ambetter account on 01/18/2023, stating that they found my initial payment that was sent on 12/06/2023.  After reading their response here, now they say that they are still investigating this event.  Which message is actually correct?  I need to know if I have coverage or not due to their complete lack of communication between their company.
  
  Sincerely,
  
  ***************************

  Business response

  02/26/2024

  We have responded directly with ****************** on his complaint due to the confidential nature of health care services. If ****************** has further questions, he can contact us at ************ and reference case MMKTWA-126387.

  Customer response

  02/26/2024

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

• Initial Complaint

  12/28/2023

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I have call logs to prove my claim. This company is by far the cruelest I have come across. I called for four full months to get answers to my billing questions. Ive been hung up, told to cancel my policy, not responded to, ignored and feel completely tossed to the side. This company could not explain my financial ledger, escalate calls to management, explain ANYTHING coherently and so much more. It took my three months with over 10 hours of call logs to get the basic information from this. All I needed was someone to explain chargers to me. I thought I was being scammed for months. Id ask a representative if I was being scammed and they wound either laugh with no answer or just hang up!! I didnt go to the doctor for one entire year because of this company. What a shame on them!! NO-ONE should be able to sign up for this health insurance. They are a disgrace and should be absolutely ashamed of themselves. I was quoted $250 for a yearly premium because Im super poor but Ive paid a total of $828 for a yearly premium with no explanation of why!

  Business response

  12/28/2023

  Thank you for forwarding the complaint you received from Hayley ********************************** ID number ********* We received your correspondence on 12/28/2023.Due to federal and state privacy and confidentiality regulations, we are unable to disclose any protected health information, including, but not limited to eligibility, claims, and billing information. We will be sending a detailed response directly to Hayley ********

• Initial Complaint

  12/07/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  You agents keep hanging up on me before getting any info or why I'm calling.

  Business response

  12/07/2023

  Thank you for forwarding the complaint you received from ***************************, dated 12/7/2023, BBB ID number ********.  By reviewing the data you submitted, we believe you may have contacted the wrong health plan. It appears this member resides in ******** and we have forwarded this complaint to the Ambetter health plan in ********. Please let the complainant know that they should contact us directly if they believe they have coverage through Ambetter from Coordinated Care in Washington state. Due to federal and state privacy and confidentiality regulations, we are unable to disclose any protected health information, including, but not limited to eligibility, claims, and billing information to the BBB.

• Initial Complaint

  08/24/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  We are a FQHC. On 8/09/23 we received an email from ********************* stating they are a credentialing specialist collecting required documents for a contract update. The email was addressed to our clinic but listed a tax ID number which is not ours. The writer of the email requested we complete a disclosure of ownership and a roster of locations and practitioners, then email these and our COI and W9 by 8/18/23. The tax ID in the offending email is incorrect, the agency from which the email allegedly originated is in Washington state but our clinic is in *******, and no reputable credentialing specialist would expect sensitive information to be sent by non-secure email. Therefore we strongly suspect the offending email was a phishing attempt by a third party posting as an official from Coordinated Care Health. However, if this was indeed an actual representative we cordially request they correct their contact information for the organization with the tax ID listed in the email. We could not call the sender of the email as they did not list a phone number.

  Business response

  08/25/2023

  Thank you for forwarding the complaint you received from ****************** dated 08/25/2023, BBB ID number ********. We received your correspondence on 08/25/2023. Due to federal and state privacy and confidentiality regulations, we are unable to disclose any protected health information, including, but not limited to eligibility, claims, and billing information. We will be sending a detailed response directly to ******************

  Customer response

  08/28/2023

   
  Complaint: 20513242
  
  I am rejecting this response because:
  

  The response is clearly a standard form letter which indicates our complaint was not reviewed.  We are not requesting any confidential information.  We are requesting the other party either acknowledge that the offending email was a legitimate message but was accidentally sent to our organization, or that the offending email was not sent by them (and therefore is a phishing attempt from a third party).

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

  Business response

  08/30/2023

  We have sent a personalized response to Ms. Eshelbach at ********************************* addressing her concern on 08/30/2023.

  Customer response

  09/07/2023

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

• Initial Complaint

  07/13/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  For months now I've been having problems with them. The online portal tells me that I owe a specific amount and the bill they send me in the mail each month is always ridiculously higher than what online says I owe. I paid the higher amount one month and they said they would credit the overpayment to my account. But it's still happening. Every month I have to call them and have them audit my account. Each time they tell me that I only owe the smaller of the two amounts and not to worry about the other one. Now they've suspended my insurance because their system says I never paid the larger amount even though I am ALWAYS told to pay the smaller one and that they'll resolve the issue. This has been going on since February. I have never had this issue before this year. Every time I call and talk to them they audit my account and nothing ever changes.

  Business response

  07/18/2023

  Ambetter from ******** Health & Wellness is in receipt of the Better Business Bureau complaint dated July 13, 2023, regarding *******************************. Weve been in contact with *******************************. She will receive a letter from Ambetter from ******** Health & Wellness.

*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. ↩