Complaints

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:03/15/2024

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

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

  Answered:

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

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I did not send any funds to AMBETTER FOR HOME STATE HEALTH or pursue any coverage from this company, and received a 1095-A for ********* that I had to claim on my 1040 US individual income tax form which reduced my refund ******* and I did not pay these premiums in. When reported to Health Insurance Marketplace they said several people reporting the same agent signing people up fraudulently, his name is *****************. I did not find out until I filed my taxes for 2023 that this has happened. My resolution is to cancel the Health Insurance Marketplace, and receive the funds that this has cost me on my taxes *******. I need this reported to the *** that I never paid any funds to the Healthcare Insurance Marketplace and never received any or used any of the features provided from this company. I have EOB.s to prove it.

  

  Business Response

  Date: 03/18/2024

  March 18, 2024
  Better Business Bureau
  ******************
  ************************
  Re: ***************************
  Complaint ID: ********
  To Whom It May Concern,
  Ambetter from Home State Health (Ambetter) received your grievance on 03/18/2024 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 left a voice mail message for ***************************, on 03/18/2024 in an effort to be of assistance to her regarding her concerns. We will be sending a detailed response directly to *************************** addressing BBB Complaint Case # ********. If you have questions, please call us at **************.
  Respectfully,
  *******************
  Sr. Member Relationship Liaison
  Ambetter Health

• Initial Complaint

  Date:03/03/2024

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

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

  Answered:

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

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Ambetter has canceled my policy in error and are unwilling or unable to work with me to resolve this simple matter. They have left me without insurance and unable to see my PCP.

  

  Business Response

  Date: 03/08/2024

  Better Business Bureau
  Serving Eastern & ***************** & *****************
  ***************************************************************************************************
  Re: *********************
  BBB Complaint #: ********
  
  To Whom It May Concern,
  
  Ambetter from Home State Health Plan received your grievance on 03/04/2024 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 Mr. ********************* addressing BBB Complaint Case# ********. If you have questions, please call us at ************** (Relay 711.)
  
  Sincerely,
  *****************************
  Ambetter from Home State Health  

• Initial Complaint

  Date:02/29/2024

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

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

  Answered:

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

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Every year, I go through and decide which INS. coverage sounds the best. I've been with Ambetter 5-6 years. This year, though, THEY decided to fill out all of MY forms, THEMSELVES. NOW, all of a sudden, I have co-pays on various medications ($161!) - which I NEVER, I mean NEVER, EVER had before. Just a couple of days ago, I spent ALL DAY being bounced back and forth between Ambetter and the Marketplace.gov.... to the tunes of , "We can't do anything about it..." "We'll transfer you over to the people in charge that can..." "We can't do anything about it..." "We'll transfer you to..."Basically, b/c I was past/over some arbitrary, BS deadline... that Ambetter f****d up in the FIRST place! NOW, *I'M* supposed to be out-of-pocket... so far... $161.00.NObody knows anything EXCEPT... that it's "not their fault." To me, the whole mess was caused by Ambetter. Period. 1. They should NEVER have automatically reenlisted me into their scam program. Whatever dumb-ass plan they chose... that was just wrong! *I* wouldn't have picked that plan in a million years. 2. Why they took charge, over the boundaries/ins-picking, I have no idea.(?) I'm on a VERY fixed income... stemming from working for years and years at one of the poorest, desolate (public) high schools... (not only in **, but nationwide.) SO: Because Ambetter chose the "plan" they did........ NOW I'm just screwed... from my fixed, limited, paltry income from Disability... 3. b/c THEY chose the Wrong PLAN... and, I can only assume, so it'd make them the most PROFIT... PLUS, I never authorized it!!! 4. The MAIN btches: 1. I have ALWAYS chosen my own plans in the past. 2. I'm already down $161.00 and it's only Feb. 3! "THEY chose my plan... and it was the WRONG one (for me, anyway)... to bleed the most profit for them 5. I have copays on medications which I NEVER, EVER, EVER had before... WHICH is how it's supposed to be working. PLUS, that's how they're getting all of the subsidies from the ******

  

  Business Response

  Date: 03/01/2024

  Re: *****************************
  Complaint ID: ********
  
  To Whom It May Concern,
  Ambetter from Home State Health received your grievance on March 1, 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 has attempted to contact ********************************* to discuss his 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,
  ***********************************

  Customer Answer

  Date: 03/08/2024

  You can leave it closed. Getting a hold of two different parties did absolutely no good.

• Initial Complaint

  Date:02/16/2024

  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.

  My account has had an over payment of $980.01 for months. I called the company and requested a refund on 1-12-24 for $980.01, I was told by the company that I would receive my refund within 7-10 days. i called weekly because I still had not received my refund. On 2-16-24 I called and was told that my refund payment was mailed on 1-17-24 to someone who is not listed on my account and to an address not associated to my account. I was then told by the company I needed to wait an additional 7-10 days FOR A REFUND

  

  Business Response

  Date: 02/20/2024

  Re: ********
  ****
  Complaint ID: ********
  To Whom It May
  Concern,
  ******** from Home State Health received your grievance on February 16, 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 ********
  representative spoke to Ms. ********
  **** and advised we
  will be assisting her with her concerns. 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
  ********

  Customer Answer

  Date: 02/22/2024

  Complaint: ********
  
  
  
  I am rejecting this response because: ******** refuses to refund my money to ME. My refund should have been sent directly to me addressed to ******** **** to my address listed on my statements, not to someone else.
  
  
  
  
  
  
  
  Sincerely,
  
  
  
  ******** ****

  Customer Answer

  Date: 02/23/2024

  what clarification are you requesting

  

  Business Response

  Date: 02/23/2024

  Re: ******** ****
  Complaint ID: ********
  
  To Whom It May
  Concern,
  ******** from Home State Health received your grievance on February 16, 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 ********
  representative spoke to Ms. ******** **** on February 21, 2024, and will
  be sending her a resolution letter. We will be sending a detailed response directly to ******** **** addressing BBB Complaint Case # ********. If you have questions, please call us at ***** ********.
  Respectfully,
  ******** ******-*****

• Initial Complaint

  Date:02/15/2024

  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 have reached out to their ************************** in writing since November of 2023 I have called their ****** Services over 7 times my doctors office has reached out to their Provider Services channel as well to get this corrected and it is still not corrected. They have my doctor incorrectly listed as a Specialist when she is contracted as a PCP. Everyone in the practice is a PCP, Ambetter incorrectly coded her as a specialist, which means I would have to pay a specialist out of pocket cost just to see her for a routine exam which is suppose to be free for the Market Place plans. ****************************, MD NPI: ********** ***** ******************* LLC TIN: 13-4239966

  

  Business Response

  Date: 02/20/2024

  Re: *********************************
  Complaint ID: ********
  
  Ambetter from Home State Plan received your grievance on 02/16/2024 concerning *********************************, BBB Complaint Case# ********. Due to federal and state privacy and confidentially regulations, we are unable to disclose any protected health information, including eligibility, claims, and billing information, with anyone other than our members or their authorized representatives.
  An Ambetter representative spoke to ********************, on 02/19/2024 and advised they will be assisting her with her concerns.  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

  

  Business Response

  Date: 02/26/2024

  Re: *********************************
  Complaint ID: ********
  To Whom It May Concern,
  Ambetter from Home State Plan received your grievance on 02/16/2024 concerning *********************************, BBB Complaint Case# ********. Due to federal and state privacy and confidentially regulations, we are unable to disclose any protected health information, including eligibility, claims, and billing information, with anyone other than our members or their authorized representatives.
  An Ambetter representative spoke to ********************, on 02/19/2024 and advised they will be assisting her with her concerns.  We will be sending a detailed response directly to ******************** addressing BBB Complaint Case # ********.  If you have questions, please call us at **************
  Respectfully,
  *******************************

  Customer Answer

  Date: 02/27/2024

  Complaint: 21298514
  
  I am rejecting this response because:  They still do NOT have ************************* listed as a PCP to select.   They dont have the option of finding her in their PCP,she is not listed as a PCP in their system, and they continue to have an incorrect PCP listed under my account! (see attached).    NOTHING has changed this is why I involved the BBB because Ambetter internally is not resolving my complaint for MONTHS.  
  
  
  Sincerely,
  
  *********************************

  

  Business Response

  Date: 02/28/2024

  February 28, 2024
  BBB Serving Eastern & Southwest ******** and *****************
  *******************************************************************************************
  Re: *********************************
  Complaint ID: ********
  
  To Whom It May Concern,
  Ambetter from Home State Plan received your grievance on 02/16/2024 concerning *********************************, BBB Complaint Case# ********. Due to federal and state privacy and confidentially regulations, we are unable to disclose any protected health information, including eligibility, claims, and billing information, with anyone other than our members or their authorized representatives.
  
  An Ambetter representative spoke to ********************, on 02/19/2024 and advised they will be assisting her with her concerns. On 02/27/2024, the Ambetter representative spoke to ******************** and provided an update regarding her concern. We will continue to work with ******************** and we will be sending a detailed response directly to her addressing BBB Complaint Case # ********.  If you have questions, please call us at **************
  Respectfully,
  *******************************
  Member Relationship Liaison
  Ambetter
  

  Customer Answer

  Date: 03/01/2024

  Complaint: 21298514
  
  I am rejecting this response because:  Nothing has been corrected.  I looked at my profile on the Ambetter site this morning 03.01.24 (please see attached) still reflects an incorrect PCP.  Dr.************************* is not noted as my PCP.  Nor have I received any written confirmation from Ambetter that she is In Network and is properly coded as a PCP so I will not be charged for seeing a specialist.  I spoke with my doctors office and they have also reached out to Ambetter several times.  The fault continues to lie with Ambetter not properly managing their business.   

  Before I will accept this being resolved I need to see:  

  1)  Dr. ************************* listed as my PCP on their site.

  2)  A written confirmation from Ambetter stating she is In Network  and is coded as a  PCP.   

  If I dont gain this  I am at risk of getting billed huge amounts from Ambetter, I am already delaying all my medical treatments because I can't see my doctor and cant comprehend how much I have gone through already just to have a simple change corrected I cant deal with the thought of getting huge incorrect bills from Ambetter and having to fight their billing department next  when they have incorrectly coded my doctor.  It is 3 months into 2024 and it is still not corrected. Documentation shows I started this fight with Ambetter November of 2023!

  Thank you BBB for helping me !  Sad I had to reach out to an outside agency to gain help because internally Ambetter didnt care to respond and correct when I tired so many times. 

   

   

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

• Initial Complaint

  Date:01/31/2024

  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.

  Account was cancelled in august of 2023 and they continued to draft my account until I noticed it at the beginning of this year 2024 (my fault for not noticing). But, for 5 months they fraudulently drafted from my bank account. I tried to remedy the situation over the phone and not get the bank involved, but I was hung up on 4 times. The banks are now involved and are handling this because Ambetter outsources their call center to people who seem like they don’t care.

  

  Business Response

  Date: 02/01/2024

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

  To Whom It May Concern,

  Home State Health received your grievance on 02/01/2024 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 ******* *****, on 02/01/2024 and advised they will be assisting him with his concerns. We will be sending a detailed response directly to ******* ***** addressing BBB Complaint Case # ********. If you have questions, please call us at **************.
  

  Respectfully,

  **** *****
  Sr. Member Relationship Liaison
  Ambetter

• Initial Complaint

  Date:01/29/2024

  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.

  He called the health subsidy online and they sent him a brochure and when he called to enroll online, when he calls to get information they said they confirmed information that he never gave them. We don't think they are legit or accredited.

  

  Business Response

  Date: 02/08/2024

  Re: *******
  *****
  BBB
  Complaint #: ********
  To Whom It
  May Concern,
  
  Ambetter
  from Home State Health Plan received your grievance on 02/07/2024 concerning ******* *****, BBB Complaint Case# ********. Due to federal
  and state privacy and confidentially regulations, we are unable to disclose any
  protected health information, including eligibility, claims, and billing
  information, with anyone other than our members or their authorized
  representatives. Ambetter will be sending a detailed response directly to Mr. *******
  ***** addressing BBB Complaint Case# ********. If
  you have questions, please call us at ************** (Relay ***.) 

• Initial Complaint

  Date:01/10/2024

  Type:Sales and Advertising 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 been seen by several Dr and have put off having my shoulder rotator cuff repaired until last year ,it's has gotten so bad I don't have much movement in my arm and can't sleep due to pain even tried physical therapy and they said I had the worse case of frozen shoulder they had ever seen . I kept going until I could not do the exercises due to pain . Ambetter refuses my shoulder surgery because I smoke and they want me to go to physical therapy for 4 months .. I am a mechanic and can't work because of these dumb office workers think they know better . I suffer from depression now and don't know how much more I can take. .

  

  Business Response

  Date: 01/12/2024

  
  To Whom It May Concern,
  
  Ambetter from Home State Health Plan received your grievance on 01/11/2024
  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 ***** ******, on 01/11/2023 and advised
  they will be assisting her with her concerns. 
  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

• Initial Complaint

  Date:12/04/2023

  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.

  I paid my premium amount to Ambetter on Nov. 1, 2023. My coverage shows start date of Dec.1, 2023.
  None of my prescriptions are being processed, shown inactive member.
  Ambetter acknowledged that my payment was received and coverage should have been started.
  Had message in my inbox with Ambetter about vision care and I was eligible for 250 points for scheduling an eye appointment. I tried to schedule eye appointment and it shows inactive. So optometrist was unable to schedule an appointment.
  Called Marketplace and they listened in on a conference call with my permission and they also spoke with Ambetter representative and we could not get any answers or resolution to these problems, Ambetter has reported to Marketplace that I am an active member with active benefits but cannot give me an answer as to why benefits are not working and what can be done. Also they will not connect me to a supervisor. Marketplace representative had me place conference call to try and resolve these issues and we were on hold for one hour and twenty minutes and could not resolve. Was told may be resolved in 3-5 business days.
  I am insulin dependent and have high blood pressure as well as several other health related issues.
  This site asks how much money I paid which was 73.31 plus the subsidy the government pays which is over $800/month and starting in January my portion will be $139.56 with federal tax credit of $964

  

  Business Response

  Date: 12/11/2023

  Ambetter from Home State Health received your grievance on 12/05/2023 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 ***** *****, on 12/05/2023 and assisted her with her concerns. We will be sending a detailed response directly to ***** ***** addressing BBB Complaint Case # ********

• Initial Complaint

  Date:09/28/2023

  Type:Product Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

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

  Answered:

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

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I am **** ************, with Member ID ************ and Reference number *********. Regarding Interaction number **********, I called Ambetter on 09/14/2023 to request a refund of $1,544.44. This request stemmed from two separate payments I made on 08/29/2023, totaling $777.24, with confirmation numbers ******** & ********. Unfortunately, I paid for insurance after it was canceled, prompting my refund request.
  
  During the call on 09/14/2023, I was assured that the funds would be returned to my payment method within 3-5 business days. Today, September 28th, marks the 10th business day, yet I haven't received my refund. Despite making inquiries about the status of my refund, I haven't received any information. The reference number for today’s call 09/28 with Ambetter is ***********. The Service ID for a ticket that was submitted to obtain a status on my refund is ***********. The sole request is to have my money refunded, as previously promised.
  
  Thank you.

  Customer Answer

  Date: 10/02/2023

  Hi,

  Over the weekend, I received a check from Ambetter for the amount owed to me. I was never advised a check would be mailed, only that my initial method of payment, a CC, would be refunded, otherwise I would’ve waited longer and not filed a complaint. Please close the case as I am satisfied with the outcome.

  Thank you for all your assistance.