Complaints
Customer Complaints Summary
- 58 total complaints in the last 3 years.
- 10 complaints closed in the last 12 months.
If you've experienced an issue
Submit a ComplaintThe 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:09/19/2023
Type: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’m needing a surgery on my back which will be my 3rd and they have denied this surgery 3 times now. I’m in pain everyday and can’t do anything with my family. All I do is sit or lay in the house. I just want the surgery
Business Response
Date: 10/03/2023
Ambetter from Home State Health Plan received
your grievance on 09/19/2023 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 *** ****** ******Initial Complaint
Date:09/18/2023
Type: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 Home State Health has lost documentation that has been mailed and faxed into them. They have no record of the appeal documentation that I sent in for a denied prior authorization. I checked the insurance portal online to see that I had been approved for something. The dr office contacted me telling me that I was approved for the Omnipod 5. Upon sending the prescription to the pharmacy it was denied. I called Ambetter and was told that the wrong department had approved the PA and they would give me a decision in 24 hours. Ambetter Home state health also makes you use specific pharmacies and not local ones so it is harder to get questions answered.Business Response
Date: 09/21/2023
Ambetter from Home State Health received
your grievance on September 19, 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 Mr. ****** ***** and
advised they will be assisting him with his concerns. We will be sending a detailed response directly to ****** ***** addressing BBB Complaint
Case # ********Initial Complaint
Date:09/09/2023
Type: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.
Received a call from them at 10:30am on a Saturday. An automated message said to call the number that just called me to "finish and discuss my health insurance plan". I have never contacted them, attempted to sign up for their insurance nor have I ever heard of the company before the phone call. When I tried to call to get my number removed from their system no one answered and it wouldn't let me leave a message because the office is closed on weekends... imagine that. Almost as if they don't like get annoying weekend calls either.Business Response
Date: 09/18/2023
Ambetter from Home State Health Plan
received your grievance on 09/14/2023concerning ****** *********, 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 Mr. ********* to discuss his concerns; however, we have been unsuccessful in reaching
him. Three contact attempts will be made to reach Mr. *********. We will be sending a detailed response
directly to Mr. ********* addressing this BBB Complaint.Initial Complaint
Date:08/15/2023
Type: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.
Dec 15, 2022 We signed up for health insurance with Ambetter and made a payment for January and set up premium payments for auto draw from our checking account . In April we received a notice of suspension for non-payment. On April 28th I paid $3,395.04 and another $1697.52 to clear the balance and once again set up for auto draw. On August 1st we received a notice again for suspension so on August 5th I made a payment of $5092.56. I called on August 7th and the representative told me the previous representative although entering the 2 payments correctly had entered the routing number as the account number on the auto draw and the next 3 payments were returned. When I logged into my account on August 7th my balance jumped up to $10,185.12. My monthly premiums are $1697.52. For eight months should be $13580.16. Ambetter has taken 12/15/22 1597.52 3/6/28 3395.04 4/28/23 3395.04 4/28/23 1697.52 8/7/23 5092.56 $15277.68. I total payments were $1697.52,. They not only did not give me credit for my August 7th payment for $5092.56. but added an additional $5092.56 to my balance by rejecting the August 5th payment without giving me credit for it. After multiple phone calls and help from our agent over the last 2 weeks Ambetter has still not cleared our balance. Our agent says Ambetter might take up to another 2 weeks to investigate My son is not able get his ADHD medication.Business Response
Date: 08/31/2023
Home State Health received your grievance on 08/24/2023 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 08/18/2023 and to advised they had resolved his concerns. We will be sending a detailed response directly to ***** **** addressing BBB Complaint Case # ********.Initial Complaint
Date:07/07/2023
Type: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 Ambetter through the marketplace. I changed my income level which changed my DEDUCTIBLE only - NOT the plan itself. From January thru May 2023 I had approximately 2200.00 met toward my 2500 deductible. My deductible changed to 6000.00 when I reported an income increase. Ambetter started over at zero and did not include my previous claims. I tried calling on 7/7/23 and 1 time was cut off, 1 time I was hung up on, and twice while on hold for a supervisor the call was dropped. I need an explanation and resolution to the claims not being applied to the new deductible.Business Response
Date: 07/21/2023
See the attached response to BBB Complaint #********.
July 13, 2023
BBB of Eastern & Southwest Missouri & Southern Illinois
*** ** ********* *** ****
*** ****** ** *****
Re: ***** *********
Complaint ID: ********
To Whom It May Concern,
Ambetter from Home State Health received your grievance on 07/07/2023 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 has spoken to Ms. ***** ********* as of 07/13/2023 and advised her that he will be her contact regarding her BBB complaint. Ambetter will be sending a detailed response directly to ***** ********* addressing BBB Complaint Case #********. If you have questions, please call us at ************ (Relay ***.)
Respectfully,
***** ******
Member Relationship Liaison
AmbetterCustomer Answer
Date: 08/05/2023
I was out of town when the response was sent and unable to respond in a timely manner. I have repeatedly contacted Ambetter since my return home and have not received a resolution to this issue. I would appreciate this be reopened until I achieve a respectable resolution to the issue. Ambetter has not corrected the issue regarding my deductible and claims per their website and my portal. The federal marketplace who approves my eligibility tells me this is an Ambetter issue and needs to be corrected. I will move to legal counsel if I don't receive an agreeable solution.Business Response
Date: 08/09/2023
Ambetter from Home State Health received your grievance on 07/07/2023
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 has spoken to Ms. ***** ********* as of
07/13/2023 and advised her that he will be her contact regarding her BBB complaint. Ambetter will be sending a detailed response
directly to ***** ********* addressing BBB Complaint Case #********. If you
have questions, please call us at ************ (Relay ***.)Initial Complaint
Date:06/20/2023
Type: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 just signed on to Ambetter insurance last month. I owed them $137.92 which I payed by phone on June 15th 2023 confirmation # *********. When I payed that over the phone I set up an auto debit, which is supposed to draw 6-28 of each month. The Ambetter agent I spoke to on the phone gave me a reference # of ***********. I asked her to assure me that I would not be double billed which she did. Today I open up our bank account to see the identical $137.92 billed to the same account that already charged me the same previous amount on the 15th. Leaving my account almost over drafted. I called Ambetter customer service twice about this, and asked multiple times to speak to a supervisor to no avail. The money needs put back into my account immediately, before I incur any overdrafts. At this point I am contemplating dropping the insurance and taking my business elsewhere due to very poor customer service, and taking money out of my account without my permission.
The best answer I got from customer service was, that they could put the money back into my account in seven to ten days! When it auto drafts out on the 28th of this month i eight days which is unacceptable. Ambetter Insurance had n o trouble double billing me this morning. They need to put the funds back "now", before I am over-drafted by my bank.Business Response
Date: 06/29/2023
Please see the attached letter
June 22, 2023
****** ******** ******
*** ***** ********
*** ****** ** *****
*** ****** ******
********* *** ********
To Whom It May Concern,
Home State Health received your grievance on 06/21/2023 concerning ****** ******, BBB Complaint
Case# 20210741. 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 06/22/2023 and advised they will be assisting
her with her concerns. We will be sending a detailed response directly to ****** ****** addressing BBB
Complaint Case # 20210741. If you have questions, please call us at ###-###-####.
Respectfully,
**** *****
*** ****** ************ *******
********
***** ****** ****** *** ****** ** ***** * ************ ******** *************
****************************Initial Complaint
Date:06/19/2023
Type: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 Ambetter for Health Insurance for Jan., February, March, April and May. My monthly premium is $65.25. Although I am paid in full, I receive bills for vering amounts. I have called and made payments with my credit card. And I have sent checks. The address I sent checks to is, AMBETTER FROM HOME STATE HEALTH ** *** ********* ******** ** **********
Also they have my health insurance suspended and threaten to cancel. I am sending them a check today for June payment. Every time I have called them, they can never see that I have made a payment. I need the insurance.Business Response
Date: 06/27/2023
Re: ******** ******
Complaint ID: ********
To Whom It May Concern,
Home State Health received your grievance on June 20, 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 June 20, 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,
***** ********
****** ************ *******
********
ambetterhealth.comInitial Complaint
Date:04/21/2023
Type: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.
Ambetter from Home State Health has a My Health Pays Rewards program where health insurance members participate by earning points that can be used to purchase items or debit cards with points earned. I earned enough points to purchase a $100 My Health ********* debit card that I ordered on February 7, 2023 and was supposed to ship by mail on March 9, 2023. Today is April 21, 2023 and I haven't received the $100 My Health ********* debit card. I have made multiple calls to ************** and navigated through their phone site where multiple service representatives cannot provide any information about the $100 debit card. I would like Ambetter from home state health to send me the $100 they owe me.Business Response
Date: 04/26/2023
Please see the attached response to complaint number 19967603.
Customer Answer
Date: 04/28/2023
Better Business Bureau:
I have reviewed the response made by the business in reference tocomplaint ID ********, and find that this resolution is satisfactory to me.
Sincerely,
*************************Initial Complaint
Date:03/22/2023
Type: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 would like to cancel my insurance plan with this insurance. I do not want anything to do with this business. The doctor I go see will not accept *******r insurance. I want no further contact by this business and I want to cancel my insurance.Business Response
Date: 04/04/2023
******** from Home State Health (********) appreciates the
notification related to **** ********* concerns. ******** can confirm that
******** has spoken with **** ******* and the issue has been addressed.
******** would like to reiterate that enrollment and disenrollment or cancellation requests for the related plan is
handled through the Health Insurance Marketplace and related requests should be directed to the Health Insurance Marketplace.Initial Complaint
Date:03/21/2023
Type: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 receive Ambetter insurance through ***********. Since January they have been showing in their computer system that I owe a past due amount and my coverage has been canceled. Since I'm through *********** I don't have an amount owed. Due to this computer glitch on Ambetters part I'm unable to receive my life sustaining medication. Myself or my husband
have called them daily since 2/1. And they will not fix the issue. I just need help getting this problem resolved so I can get the medication I need.Business Response
Date: 03/29/2023
A response to the complaint is attached and the member may contact the number provided with any additional questions.
To Whom It May Concern,
Ambetter from **** ***** **** received your grievance on 03/23/2023 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 Ms. *****, on 03/24/2023 and advised they will be assisting her
with her concerns. We will be sending a detailed response directly to Ms. ***** addressing BBB
Complaint Case # ********. If you have questions, please call us at *************
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