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Business Profile

Health Insurance

Ambetter From Western Sky Community Care

This business is NOT BBB Accredited.

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Complaints

This profile includes complaints for Ambetter From Western Sky Community Care's headquarters and its corporate-owned locations. To view all corporate locations, see

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Ambetter From Western Sky Community Care has 2 locations, listed below.

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    Customer Complaints Summary

    • 4 total complaints in the last 3 years.
    • 0 complaints closed in the last 12 months.

    If you've experienced an issue

    Submit a Complaint

    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.

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    Complaint status

    Complaint type

    • Initial Complaint

      Date:07/01/2024

      Type:Order Issues
      Status:
      Answered
      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 seemed to cancel their contract with my son's therapy provider where he has been receiving treatment for 2 and 1/2 years with no warning or explanation to the provider or us the customer. My provider can't get a hold of anyone to discuss the contract they did have and it's been over a week of phone calls and emails. This is the third time that ambetter has kept my son from receiving care from this provider. I need someone who knows exactly what is going on to call me and someone to get in contact with the provider. Ambetter still owes payment to them for previous therapy treatments and is now the reason my son's sessions have been put on hold till this gets figured out indefinitely. This company's behavior and mishandling of his care the entire time we've carried this insurance is deplorable.

      Business Response

      Date: 07/03/2024

      Hello,

      Please see the attached document relating to this complaint.

      Thank you,

      ****

    • Initial Complaint

      Date:02/21/2024

      Type:Billing Issues
      Status:
      Resolved
      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 request the following: ///

      (1) Documentation that Ambetter has not billed the federal government or any other entity for Missouri-based Ambetter health insurance on my behalf for the months of December, 2023 and January 2024. ///

      (2) If Ambetter did bill the federal government (or any other entity ) for Ambetter health insurance on my behalf for Dec 2023 and Jan 2024, then please provide a written statement that Ambetter will work with the federal marketplace to return this money to the federal government (or any other entity so paid). ///

      (3) Documentation of Ambetter's intent to coordinate with the federal government via healthcare.gov marketplace staff to correct my 1095-A for 2023 and as needed, also the 1095-A for 2024 (due in about a year). At present, my 1095-A for 2023 is wrong. Sirs, Ma'ams, as long as the 1095-A is wrong, my 2023 tax return cannot be correctly completed or for that matter, even electronically filed. ///


      Please see the attachment for a copy of what I wrote to Ambetter on January 11, 2024. I have had no response.

      Business Response

      Date: 02/20/2024

      Re: Ailan
      Chubb
      BBB
      Complaint #: ********

      Ambetter
      from Home State Health Plan received your grievance on 02/16/2024 concerning ***** Chubb, BBB Complaint Case# 21298165. 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 Ms. ***** Chubb addressing BBB
      Complaint Case# ********. If you have questions, please call us at ************** (Relay 711.)

      Sincerely,
      ****** ********
      Ambetter
      from Home State Health  

      Customer Answer

      Date: 04/08/2024

      -- The company (Ambetter Home State Health) recently responded with documentation indicating retroactive termination of my health insurance, for the period of Nov 30, 2023 through January 9, 2024.

      -- I believe all is on track for my federal tax form 1095-A to be revised.

      -- I am satisfied with the company's response. I need no further action from Ambetter with regard to this BBB complaint.

    • Initial Complaint

      Date:12/14/2023

      Type:Customer Service Issues
      Status:
      Answered
      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 son has a medical diagnosis deeming it medically necessary for therapy's relevant to his illness. He has been evaluated and approved by our hospital to begin therapy , that ambetter has once again denied. Conveniently for ambetter, the numbers I acquired per my last complaint are no longer working. I request someone from corporate, someone in the United States, to call me to explain why I have to go through every channel to get him approved FOR NECESSARY THERAPY REQUIRED AND REQUESTED BY HIS MEDICAL PROVIDERS TO ENSURE HIM THE BEST OUTCOMES FOR HIS QUALITY OF LIFE. READ THAT AGAIN PLEASE! I pay an egregious amount of money every month so I can get on the phone and get him approved for therapies that should be rightfully approved.

      Business Response

      Date: 12/21/2023

      Please see the attached document.

      To Whom It May Concern,
      Ambetter From Western Sky Community Care received your grievance on 12/18/2023 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 has attempted to contact Mrs. ****** to discuss her concerns; however, a
      voicemail was left with our representative’s direct contact information. We will be sending a detailed
      response directly to Mrs. ****** addressing BBB Complaint Case # ********. If you have questions,
      please call us at **************.

    • Initial Complaint

      Date:02/01/2023

      Type:Service or Repair Issues
      Status:
      Answered
      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 insurance for 2022. They approved and paid for physical, speech, and OT therapies for my son who has a medical diagnosis of autism, in 2022. In august 2022 they abruptly denied therapies, stating the provider had revoked their contract, which in reality the provider NEVER revoked their contract. The provider, provided proof they were still in contract with ambetter. This mixup in paper work is ambetters fault. The provider has been tirelessly working to get these matters corrected with ambetter by contacting a representative in Albuquerque NM, but so far it has taken over two months to correct paperwork, and get my son the therapy he NEEDS, therapies ambetter have been denying him, ambetter is neglecting his progress and medical needs that have been established and documented as necessary. As a paying customer of which over a GRAND a month is provided to ambetter, I, in return am receiving nothing in the form of medical care for my son, who has a documented diagnosis, that ambetter HAS already approved in the beginning of 2022. As a consumer I cannot get in contact with anyone through the ambetter hotline about this matter, I cannot get in touch with anyone handling the case on the providers end and at most they offered to send me a letter. I would like someone to explain how this is a decent and acceptable business practice. I want a real person, not a letter, to explain why neglecting my 3 year old son is acceptable to them, while they cash my thousand dollar check. I want someone to show me how it could take over 2 months and counting to correct paperwork when it is ambetters fault in the first place not the provider or the consumer. Besides the obvious negative emotions this brings about as the consumer the bottom line is it needs to be expedited, ambetter needs to correct the matter and continue to provide payment for my sons EXTREMELY necessary therapy, while they collect my money. This is an urgent matter!!!

      Business Response

      Date: 03/02/2023

      February 28, 2023

      Better Business Bureau
      Attn: Dispute Resolution Department
      **** ********* ****** **
      ***** *
      ************ ** *****

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

      To Whom It May Concern,

      Ambetter from ******* *** ********* **** received your grievance on 02/28/2023 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. We
      will be sending a detailed response directly to ****** ****** parent addressing BBB Complaint Case#
      ********. If you have questions, please call us at ************.

      Respectfully,

      **** *****
      Senior Member Relationship Liaison, Ambetter Health

    Ambetter From Western Sky Community Care is NOT a BBB Accredited Business.

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