Business Profile

Health Insurance

Ambetter from Fidelis Care

Headquarters

Complaints

This profile includes complaints for Ambetter from Fidelis Care's headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

60 total complaints in the last 3 years.
20 complaints closed in the last 12 months.

If you've experienced an issue

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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:04/30/2025
Type:Order 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 name is ****** *******, and my date of birth is ***********I would like to file a complaint against Fidelis Care. Its been 3 months since the initial request They are refusing to release my full medical records after I submitted a request for my complete medical history.Some employees appear to be getting paid under the table.Fidelis Care is lying to me and refusing to provide all the requested documents.I believe this situation may be tied to fraud.
Business Response
Date: 05/12/2025
*** *** ****
****** ******** ******
******************************
******************
Review ID: ********
To Whom It May Concern:
Fidelis is in receipt of your letter dated April 30, 2025 regarding a complaint filed by consumer ****** *******. 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. Fidelis appreciates that the Better Business Bureau has brought this matter to the attention of the Plan however, the Plan will address the concerns directly with the complainant.
Initial Complaint
Date:04/09/2025
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 called Fidelis to get insurance coverage. I was told my policy would start immediately if I paid $195.87 I did that on March 14th 2025. I received a letter in the mail on 3-20-25 that states i need to pay another $145.61 i paid that on 3-31-25. I went to use my insurance it's not valid. I never has insurance during this whole time. I call on 4-2-25. I was told I had a back balance I needed to pay but they won't tell me what it was or how much. They just keep telling me to pay the $195.87 witch is my premium. I asked for a supervisor she than tells me to contact New York state of health to change the active date from 3-1-25 to 4-1-25 so I do this. Newyork state of health says that they can't do that and I need to call Fidelis. So I have been back and forth with both Newyork state of health and Fidelis. I am out $341.48 the supervisor at Fidelis doesn't call back and I dont have insurance still. I don't know what to do other than dispute charges with my bank because I paid for something I don't have.
Business Response
Date: 04/23/2025
***** *** ****
****** ******** ******
******************************
******************
****** *** ********
To Whom It May Concern:
Fidelis is in receipt of your letter dated April 9, 2025 regarding a complaint filed by consumer ******* ***********. 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. Fidelis appreciates that the Better Business Bureau has brought this matter to the attention of the Plan however, the Plan will address the concerns directly with the complainant.
Initial Complaint
Date:03/18/2025
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 was enrolled in Ambetter from Fidelis Care from July 2024 to December 2024. Under my plans benefits, I was entitled to a gym membership reimbursement of up to $200 for this six-month period.I submitted my reimbursement application on time but was denied twice for allegedly not meeting the criteria. Initially, I mistakenly provided incorrect check-in records due to unfamiliarity with the process. However, upon realizing the mistake, I resubmitted the updated records. Despite this, Fidelis Care denied my application again, claiming I failed to provide the required proof of payment.I was confused by this denial, as I had submitted redacted brokerage account and credit card statements showing my payments: a monthly fee of $20.03 ($19.99 + tax) and an annual fee of $49. I also obtained and submitted the gyms payment log as requested by them. The log detailed my monthly payments in two parts: $15.03 and $5. Nowhere on the log was it indicated that the $5 was a credit card processing fee.After reviewing the payment log, Fidelis Care approved only $64.03 ($15.03 + $49) and denied reimbursement of the remaining $5, alleging that it was a non-reimbursable credit card processing fee. I repeatedly contacted Fidelis Care, provided further proof of monthly fee amount, and even resubmitted my application per a representatives instructions. However, Fidelis Care refused to reopen my case, processed the $64.03 reimbursement, and rejected my resubmission as a duplicate.I then called Fidelis Care to formally appeal the decision. Today, I received the Grievance Determination Notice, in which they denied my appeal, stating that I failed to prove the $5 was not a credit card processing fee. This accusation is unreasonablehow could I have preemptively disproven a fabricated claim? Nonetheless, the monthly fee payment was a direct withdrawal from my brokerage account, no credit card was involved!I hereby request Fidelis Care reopen my appeal and reimburse me the $5.
Business Response
Date: 04/01/2025
Fidelis is in receipt of your letter dated March 18, 2025 regarding a complaint filed by consumer ******* ***. 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. Fidelis appreciates that the Better Business Bureau has brought this matter to the attention of the Plan however, the Plan will address the concerns directly with the complainant.
Customer Answer
Date: 04/06/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

The business stated on 3/31/2025 that they would address the complaint directly with me but till today I haven't heard from them yet. If they are unable to propose a resolution based on my claim or provide a clear deadline to do so, then their response serves no meaningful purpose.
In order for the BBB to appropriately process your response, you MUST answer the question above.

Sincerely,

******* ***

Business Response
Date: 05/21/2025
Fidelis is in receipt of your letter dated May 12, 2025 regarding a complaint filed by consumer ******* ***. 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. Fidelis appreciates that the Better Business Bureau has brought this matter to the attention of the Plan however, the Plan will address the concerns directly with the complainant.
Customer Answer
Date: 07/26/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

Hi ********,

Sorry for the late response. Your email went to the spam and I just recovered it today.

I do not accept the business's response as it stopped responding to my email regarding the BBB complaint since May 12, 2025. My question remain unresolved.

See the attached email correspondence for your review.

Thank you for your time and assistance.

Best,
*******

In order for the BBB to appropriately process your response, you MUST answer the question above.

Sincerely,

******* ***
Initial Complaint
Date:03/10/2025
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.
My full amount has been paid there is no reason my insurance shouldnt be active I have health issues and cant have the proper testing done I need with out it its been 5 days battling with this company and they have no answers for me I had coverage for all of February they inactivated me with no contact of telling me so I have been under the impression I had coverage this whole time
Business Response
Date: 03/24/2025

Fidelis is in receipt of your letter dated March 12, 2025 regarding a complaint filed by consumer ****** *********. 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. Fidelis appreciates that the Better Business Bureau has brought this matter to the attention of the Plan however, the Plan will address the concerns directly with the complainant.
Initial Complaint
Date:03/05/2025
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 was notified by NYS Health that I didn't have coverage for the month of December. I was then billed for that month of Fidelis. I have been calling for almost 3 months. The calls have been super aggravating and have gotten nowhere. NYS of Health said they send over the documents to resolve but Fidelis claims they didn't receive. All the while being billed and adjusted incorrectly. There is absolutely no urgency on their part and no one takes ownership to resolve. They open a case (if that) and close and say sorry you had coverage. This process has been beyond frustrating to say the least. Even once resolved someone needs to take responsibility for these errors.
Business Response
Date: 03/18/2025
Fidelis is in receipt of your letter dated March 5, 2025 regarding a complaint filed by consumer ***** ******. 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. Fidelis appreciates that the Better Business Bureau has brought this matter to the attention of the Plan however, the Plan will address the concerns directly with the complainant.
Customer Answer
Date: 04/05/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

yes, it is same situation as the Child Health Plus. I thought I could resolve but seems like the only way anyone at Fidelis actually resolves issues is if it goes through the complaint channel. This complaint is for the parent plan Ambetter. I am just trying to have them remove the balance Due for December as I didn't have insurance for that month same as Child Health Plus (both Due to late payment). I paid out of pocket for all expenses and do not want a balance due on my record for a month I wasn't insured. Appreciate your asssitance.

In order for the BBB to appropriately process your response, you MUST answer the question above.

Sincerely,

***** ******

Customer Answer
Date: 05/05/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

Hi! Responding about reference ID number ********. As response to my claim someone went ahead and deleted my child health plus plan instead of the Ambetter plans balance from the portal and I cant get anyone on the phone to help me with this issue. Every time I reach out I get no assistance and no one takes any ownership. I dont understand how it can be acceptable for it to be run this way. I am completely frustrated and can never get the same person to follow through so I start the process over every phone call. At this point the ambetter plan is not resolved and i dont have access to my child health plus plan on the payment portal anymore.

Thanks for your assistance on these matters.

In order for the BBB to appropriately process your response, you MUST answer the question above.

Sincerely,

***** ******

Business Response
Date: 05/15/2025
*** *** ****
****** ******** ******
******************************
******************
****** *** ********
March 18, 2025
To Whom It May Concern:
Fidelis is in receipt of your letter dated May 5, 2025 regarding a complaint filed by consumer ***** ******. 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. Fidelis appreciates that the Better Business Bureau has brought this matter to the attention of the Plan however, the Plan will address the concerns directly with the complainant.
Initial Complaint
Date:02/21/2025
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 am writing to express my frustration and concern regarding the ongoing difficulties Ive encountered while trying to pay my familys insurance premiums for my children's health plans. Despite multiple attempts, I have been unable to successfully make a payment. The automated phone payment system is not in service, and I have been unable to use it.I have contacted Fidelis IT department several times in an attempt to set up an online account, but each time, their system rejects my account for no clear reason. With the payment deadline fast approaching, I am deeply concerned that my eight children will lose their *********** is beyond frustrating to face these issues with a health insurance company, especially when technology offers so many viable payment options. This situation feels like a failure of the system, and Im left questioning how a company like Fidelis can operate without providing a reliable means for customers to make payments.I urge you to resolve this issue immediately, as my familys health coverage is at risk.
Business Response
Date: 03/07/2025
Fidelis is in receipt of your letter dated February 21, 2025 regarding a complaint filed by consumer
****** ********. 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. Fidelis appreciates that the Better Business Bureau has brought this matter to the attention
of the Plan however, the Plan has addressed the concerns directly with the complainant.
Initial Complaint
Date:02/12/2025
Type:Service or Repair 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.
The company overcharged me on December 27 2024 for my February 2025 premium. I should have been charged ****** but was instead billed *******. I have called multiples times to resolve this and obtain a refund. I have spent hours explaining this issue every time to a new *** that claims to have no information on my previous calls. They have admitted it was an overcharge and keep claiming its being sent to finance for a resolution but nobody ever follow up and to date I have not been refunded.
Business Response
Date: 02/26/2025
Fidelis is in receipt of your letter dated February 12, 2025 regarding a complaint filed by consumer ****** ********. 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. Fidelis appreciates that the Better Business Bureau has brought this matter to the attention of the Plan however, the Plan will address the concerns directly with the complainant.
Customer Answer
Date: 03/05/2025
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 and the matter has been resolved.

Sincerely,

****** *********
Initial Complaint
Date:02/12/2025
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.
Fidelis Care continues to call me stating I have their insurance. I do not. I live in the *******, not in ********. They call frequently and interrupt my workday. I have had this phone number for over 25 years and it is evident by a simple ****** search that this number belongs to me. I have called the state of ********, I have talked to Fidelis Care several times, and they state that they are taking care of it. But, every few months, it starts again. It's been happening for probably 3 years. I am very tired of this. I was once given the woman's name that potentially gave my number. I think her number is ***, not ***, but they have not corrected this. This loses me time during my workday due to interruptions and time to repeatedly speak to someone regarding this. I am on the do not call list. I do not know how else to proceed.
Business Response
Date: 02/21/2025
Fidelis is in receipt of your letter dated February 12, 2025 regarding a complaint filed by consumer ******* ************. 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. Fidelis appreciates that the Better Business Bureau has brought this matter to the attention of the Plan however, the Plan has addressed the concerns directly with the complainant.
Customer Answer
Date: 05/05/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

I was assured this was resolved yet again and am AGAIN receiving phone calls.
In order for the BBB to appropriately process your response, you MUST answer the question above.

Sincerely,

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

Business Response
Date: 05/14/2025
Fidelis is in receipt of your letter dated May 5, 2025 regarding a complaint filed by consumer ******* ************. 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. Fidelis appreciates that the Better Business Bureau has brought this matter to the attention of the Plan however, the Plan will address the concerns directly with the complainant.
Initial Complaint
Date:02/06/2025
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 have a fidelis care dual access plan. In the hand book my dibeties supplies are supposed to be covered completely with 0.0 copay. On Jan 9, 2025 i was charged ***** and again on fed 6, 2025. I have called them a million times & being told different stuff. I also have new york state ********. Fidelis claims ******** is supposed to pay the copay that isn't covered for my medicine & supplies medicade says no... but in the hand book from fidelis itself states all my meters & strips are covered ??. I feel this is unfair on me & false info. I should need to fight this out at all. Im ********** & not fair. Fidelis should be calling medicade if they are supposed to pay also for being contracted in with them. Everyone giving different stories so no clue how or where to turn. All I know if says ?? covered in fidelis hand book
Business Response
Date: 02/17/2025
Fidelis is in receipt of your letter dated February 7, 2025 regarding a complaint filed by consumer ****** ****. 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. Fidelis appreciates that the Better Business Bureau has brought this matter to the attention of the Plan however, the Plan will address the concerns directly with the complainant.
Initial Complaint
Date:11/26/2024
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.
On April 1st, 2024, I had a severe diarrhea and I went to ****************** in ********, where I got Doctor's check up and treatment, at front desk I was told that they accept my insurance - Fidelis, but some time later I received bill from City MD in amount of $624.00, I called this office, they told me that Fidelis did not pay them. At the time of appointment I was collecting unemployment benefits since December 15, 2023, and I did not have any insurances besides Fidelis which I get from Marketplace, I was surprised that Fidelis Denied claim from City MD using excuse that I have second insurance, they even **** out my"second Insurance" name CareSource and added year (2022) for this not existing insurance, all of it was not true, because I did not work on April 1st. I tried to call customer service, and it was another torment: I could not reach anybody who could help me or give reasonable advice or explanation what should I do. I was given many different numbers: for *********** for Coordination of ******************** I even called Marketplace, etc. Maybe these customer service representatives just unprofessional or, maybe they have direction to use any excuses and not pay claims to save money...
Business Response
Date: 12/10/2024
Fidelis is in receipt of your letter dated November 26, 2024 regarding a complaint filed by consumer ****** ********. 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. Fidelis appreciates that the Better Business Bureau has brought this matter to the attention of the Plan however, the Plan will address the concerns directly with the complainant.
Customer Answer
Date: 01/09/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because:

Good morning,
Please see attached copy of the bill from CITY MD dated December 21, 2024, which means that Fidelis did not do anything to resolve this payment problem, and one more thing: when I was trying to login to my Fedelis account, it turned out that Fidelis blocked my account, and I don't have access to it.
Could you please re-open my case to get my medical bill processed correctly and competently.
Thank you .
****** ********

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

In order for the BBB to appropriately process your response, you MUST answer the question above.

Sincerely,

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

Customer Answer
Date: 02/07/2025
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID# ********, and have determined that my complaint has NOT been resolved because: I started to dealing with Fidelis regarding processing of the claim from Urgent Care since November 2024 by filing Appeal Request Form for Denial of Services, and after their response i realized that this "Member Services" department belongs to Fidelis and they are never going to help me because they belong to Fidelis and never will do anything against this company, that is why I appealed to Better Business Bureau, and all replays from Fidelis since then were excuses on privacy matter and promises to figure out with my bill processing, but why it takes soooooo long? Maybe it means that Fidelis just stalling for time, or employees not capable to do simple work...

[Your Answer Here]

In order for the BBB to appropriately process your response, you MUST answer the question above.

Sincerely,

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

Business Response
Date: 02/27/2025
Fidelis is
in receipt of your letter dated February 17, 2025 regarding a complaint filed
by consumer ****** ********. 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. Fidelis appreciates that the
Better Business Bureau has brought this matter to the attention of the Plan
however, the Plan has addressed the concerns directly with the complainant.

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Ambetter from Fidelis Care is BBB Accredited.