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:06/12/2025

  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, ******** ***** ******, answered an advertisement on the TikTok social media application with my cell phone in the last quarter of 2024. The service advertised, was to help me obtain a lump sum usd, in the form of a check for signing up with ******** before the end of 2024. I answered a few qualifying questions over the phone and waited to hear the results, which turned out unfavorable to me ( 10% of the amount mentioned ) so I declined the services, thus recognizing a scam. Since I did not agree with the terms of the services and did not sign any documents showing consent, I believed that I had successfully thwarted the scammer scheme.With the help of social workers I obtained WellCare North Carolina ******** in January 2025. Member ID number.: ********. ******** ID number.: ************ am pleased and thankful to have ********. I did not seek supplemental insurance and never consented or agreed with any insurance other than ********************* I am aware that ambetter Of NC has deceitfully, illegally undermined my relationship with ********, among other unscrupulous and unlawful practices. When I contacted ambetter of NC, today, I was told that I would have to contact marketplace for any help with my complaint. When I attempted to speak with a marketplace representative today, I was repeatedly put on hold. For over 30 minutes each call until my call would finally be dropped, leaving me with only a dial tone.I am not a client of ambetter of NC. I never consented to any sort of agreement. I am not and never will be a client for their supplemental insurance *********** fact, I declined their services, and never signed any documents for them.I now formally declare myself free from any legal obligation and/or responsibility of any kind whatsoever regarding the illegal and unlawful activities committed by ambetter of NC. Any assumed or reported consent of mine was against my will. I demand that all their actions regarding me, be immediately reversed.

  

  Business Response

  Date: 06/12/2025

  Hello, 

  After further review, this is not one of our members. Thank you! 

• Initial Complaint

  Date:09/25/2023

  Type:Customer Service 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.

  Completed several rewards programs and redeemed some of my points originally asking for pre paid visa cards after 3 weeks I received an ambetter rewards card for the 75 dollars and was told I could use it to buy groceries in Walmart or Sam cclub after being embarrassed in Walmart because the card declining this card is useless and can't be used anywhere good luck with getting someone in costumer service to help you false advertising really thinking about contacting a lawyer for false advertisement!

  Customer Answer

  Date: 10/03/2023

  
  
  Better Business Bureau:
  
  
  
   I was able to use the card to pay my electric bill but it still does not work to use as advertised!
  
  
  
  Sincerely,
  
  
  
  Louisea Roseboro

• Initial Complaint

  Date:06/20/2023

  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.

  When I set up my online account with **********************, I accidentally typed ".con" instead of ".com" at the end of my contact email address. There is an edit button, so I tried to fix it myself and got an error message every time (I can't even tell you how many times I've tried to fix it myself on different browsers and even with their customer service reps over the phone over the last 6 months). I never received an email to authenticate my account because of this mistake, so my information apparently didn't "populate" in their system. I can't receive paperless billing either "due to an invalid email address on file." I have used Ambetter's secure messaging on my profile, spoken with numerous customer service representatives, and filed 2 grievances. The first grievance was not handled well -- I think whoever read it did not understand my issue, because they reset my account and I lost all of the secure messages I had with IT ticket numbers trying to figure out why nobody could edit my email. The second grievance gave me a phone number for somebody to "coordinate the review" and when I call it, nobody answers and there isn't a way to leave a message. I'm glad I seem to still have coverage, because my automatic payments are continuing to go through every month, but something as simple as editing my own contact information on my profile should not be so hard. The IT department at Ambetter should really be able to fix my email at the very least, but also fix the user interface to allow me to edit it myself. This is beyond frustrating because it seems like such a simple issue to fix. I chose Ambetter because it was a relatively cheaper option with good coverage, but I can say this one irritating issue has made my decision to never use them again for health insurance a very easy one.

  

  Business Response

  Date: 06/21/2023

  Hello, please see attached. Thank you! 

• Initial Complaint

  Date:05/16/2023

  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.

  3/16/2023 Transforminal injection with pain specialist. I have been receiving pain injections every 3 months in order to walk and to relieve excruciating pain from my lower back radiating down to my right leg with ********** blue shield with no issues for the past year at least. We changed to Ambetter in December because they sounded like a better insurance company. The morning of my appt I still did not have approval. I contacted Ambetter and was assured I would have approval by that afternoon so I had to pay half of the cost out of pocket which was $2,212.47. Ambetter did not decide until a month later and then denied the claim. I called and spoke to someone and appealed it and sent in old mris from 2021. I continued to follow up with Ambetter and my doctor. The doctor put I'm thru insurance 2 more times and it was denied. I spent many hours with different reps and kept getting the run around and was advised not to worry it would all be worked out. I ended up getting another declination letter. I emailed the North Carolina insurance ******** to help me. I sent them all of my mris and my neurologist even ordered new mris and I sent them to the n. Carolina ins gov ******** as well. Ambetter lied and said I never sent in any appeals and it was. It medically necessary. I can get all of my phone logs from my phone company which is many hours. I have mris to prove this injection is needed for my ability to walk and live. Without it I have no quality of life as they can just talk to pain specialist and read my mris. I went thru correct protocols and they lie and say I didn't do anything properly. I never got any responses from then until the woman from the n. Carolina ins. ******** got involved but it is not helping. I am paying them over $2k a month for insurance and they are denying me insurance needs over technicality that they lie about over he said she said but I can provide hours of phone calls to that company. They need to approve claim on 3/16 and going forward

  

  Business Response

  Date: 05/19/2023

  Hello. Please see attached. Thank you!

• Initial Complaint

  Date:05/10/2023

  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 was informed on April 28, 2023, that I had two active policies with Ambetter. This was news to me, one of them was free and the other covered vision and dental for a monthly fee. I requested the free policy be canceled, however, when I went to fill my monthly prescriptions that total at the least $500, I was told they were no longer covered due to my policy being inactive. At first, I figured it was just a mix up. After numerous, nerve - racking calls to Ambetter and Marketplace, Marketplace had to tell Ambetter that my policy was active when Ambetter didn't even have record of me ever having it!! So, now I'm being told I have to go without very important medications for what could be 30 days simply because someone at Ambetter didn't do their job properly?!! That just doesn't sound right to me.

  

  Business Response

  Date: 05/17/2023

  Hello. Please see attached. Thank you!

• Initial Complaint

  Date:04/25/2023

  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.

  I purchased Ambetter of North Carolina insurance plan from the health insurance marketplace. Prior to purchasing, I used their provider directory to confirm there was a local *** and a general psychiatrist. *************************** at ****** Family Medicine (***) and *************************** at ******************************* (psychiatry) were listed. Both of these practices are very local to me so I purchased the plan. I went to ******************************* for three separate appointments before I received an EOB stating that my claims were denied because the provider was out of network. I again checked the directory and sure enough it still said ******************************* was in network. I filed a grievance and they again denied to pay my claims. I just couldnt understand how this was happening so I decided to dig a little deeper. I discovered that the psychiatrist listed as practicing at FCA - ***************************, had actually been retired for YEARS. I had no way of knowing this as he was listed as active, in network and accepting new patients on the Ambetter provider directory. I have now been left with over $1000 worth of unpaid claims because Ambetter has fraudulently listed providers that are no longer in practice. Once I became aware of this, I decided that I also needed to verify that the *** I chose was actually in practice. I certainly didnt need anymore denied claims. Well, guess what!? *************************** does not work at the listed practice - ********************** and has not done so in years. So both of the local providers listed that encouraged me to purchase this plan, are NOT IN PRACTICE. I have since discovered, in the **** for a psychiatrist that IS practicing and in network that MANY of their listed providers are no longer practicing at the listed facilities. I feel that Ambetter is intentionally misleading individuals to believe that they have a larger network than they actually have.

  

  Business Response

  Date: 04/25/2023

  Hello. Please see attached. Thank you! 

  Customer Answer

  Date: 04/25/2023

   
  Complaint: 19977991
  
  I am rejecting this response because:

  I am still awaiting further communication. I have submitted screenshots of the inaccurate provider information. 

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

  

  Business Response

  Date: 05/08/2023

  Hello. Please see attached. Thank you! 

  Customer Answer

  Date: 05/09/2023

   
  Complaint: 19977991
  
  I am rejecting this response because:

  I am still awaiting the claims to be re-processed, I cannot verify that they will in fact be paid until they have been processed. Once I receive verification that my claims for ******************************* have been paid, I will consider my complaint resolved. At this time, without that verification I am not comfortable closing my complaint. I do appreciate the help that I have received from ******* and ******* regarding this matter and I do hope that theyre correct and my claims will be paid and I will be able to continue to see my psychiatric provider.

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

• Initial Complaint

  Date:04/13/2023

  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 had Ambetter medical insurance in ******* in ******* and February 2023. I paid my monthly premium of $35.85 by direct Auto-draft. ******* was paid on December 8, 2022. February was paid on ******* 26. I moved to ** where I kept Ambetter insurance. My new monthly premium was $47.78. I authorized auto-draft for each monthly premium. March was paid on February 28. On March 28 Ambetter should have only taken $47.78 but they incorrectly auto drafted $167.26 from me, an overpayment of $119.48. They charged me for ***** Feb., and March all over again and for ****** ($35.85(Jan) + $35.85(Feb) + $47.78(March) + $47.78(April) = $167.26.) I have called several different Ambetter phone numbers in an attempt to resolve this issue. I have called over 10 times. After all of my complaints and explanations, they credited me $47.78 on April 10. Unfortunately, they still owe me the difference of $71.70. ($119.48 overcharge - $47.78 credit = $71.70 still owed to me.) I have provided proof of this to them and explained it to them repeatedly to no avail. Thank God I have been able to cancel my insurance with them and switch to a much better company, however I do not plan on letting Ambetter get away with keeping the $71.70 they overcharged me. I know you cannot attempt to get the money back for me however I know you will accept and forward complaints about billing and customer service. I'm hoping when you forward this it will somehow get to someone who understands it and does the right thing and credits my account the $71.70, they overcharged me. Thank you so much for your help.

  

  Business Response

  Date: 05/01/2023

  Hello. Please see attached.

  Customer Answer

  Date: 05/01/2023

   
  Complaint: 19928312
  
  I am rejecting this response because: These idiots are sooooooooo stupid and incompetent, they can't even spell my name correctly. My name is ***** NOT ****** which is how they wrote it 3x. They have no customer service whatsoever; all of their so-called CSR are overseas and don't speak a word of English and don't understand it either. I have documentation and reference numbers and proof of the fact they overbilled me and still owe me a credit. Due to their overwhelming incompetence, I met with the Branch Manager of ********** this morning and they are now involved in getting the money back too. This company is a complete JOKE. I am going to give them so many negative reviews. They should be sued and shut down. No wonder they have sooooo many complaints filed against them. And it is a shame the BBB allows them to be considered a member in good standing. Ambetter, saying they contacted me is a complete lie. I have called them over 10 times trying to resolve this. They are WORTHLESS. Period. 
  
  Sincerely,
  
  *********************

  

  Business Response

  Date: 05/08/2023

  Hello. Please see attached. Thank you.

• Initial Complaint

  Date:03/17/2023

  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.

  3-15-2023, My wife was diagnose with a mass on her liver in the ** in *************, ** on Tuesday 3-14-23. The ** Dr recommended based on the ** scan he performed that we travel back to ** and see my wife ********************* primary care Physician . We travel back to ** late and met ****************************** at 8am. He ordered a ** scan with contrast that afternoon. *********************** office called to get approval. When ***** went for the scan, the Carolina ******* center said they required pre approval to file the insurance claim and no one at Ambetter could be reached. I mad over 50 calls to Ambetter, all of those calls went to a non english speaking person in *************** than could or would not help us. It was absurd. You could hear dogs barking in the background. I called my broker who placed me with Ambetter. He said he could not reach anyone and had no way of reaching anyone because they wont publish anything but the 800 number that goes to ***************. We had no choice but to pay the bill because no one at AMbetter would assist us. This company is a fraud! They have no intention of paying anything and no operational support staff that can assist with claims, pre approvals or support. The liver mass found on my wife could be life threatening and we cant get our **** insurer to answer simple questions. I intend to take legal action against them in ** and want to file a formal complaint with the ***************************

  

  Business Response

  Date: 03/17/2023

  Please see attached response for complaint ********. Thank you!