ComplaintsforAmbetter from MHS

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Initial Complaint
09/17/2024
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
During the months of approximately April/May of 2024 ambetter has advertised to their members that they could earn 300 rewards points if they have a kidney screening test performed. That was the only requirement for the points. So, I had this test done on May 8th 2024 and ambetter still refuses to issue the 300 rewards points to my account and they claim that it was for diagnosis purposes and not for preventive purposes but I do not now have any kidney related medical issues nor have I ever had such problems so the only reason that I had this test done was because they promised to issue 300 rewards points to anybody who did and now they are refusing to honor their advertised plan. The claim number for this test is X141MPEG4211.
Business response
10/17/2024
ACK Letter Provided 9/20/24
Customer response
10/17/2024
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID 22295844, and find that this response/resolution is satisfactory to me.

Regards,

Chuck Lane
Initial Complaint
03/25/2024
Complaint Type:
Service or Repair Issues
Status:
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.
Was promised a $600 spending card with funds loaded onto the card for monthly use starting in April at the time of enrollment
Business response
04/05/2024
Complaint ID: ********

To Whom It May Concern,

Ambetter from MHS received your grievance on 03/28/2024 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 attempted to contact **************** on 04/01/2024 and 04/03/2024 to discuss her concerns. Our representative was unable to reach ****************; however, our representatives direct contact information was left on **************** voicemail. We will be sending a detailed response directly to *********************** addressing BBB complaint #********. If you have questions, please call us at ************** (TTY/TDD **************).
*************************
Member Relationship Liaison
Ambetter
Customer response
04/06/2024
Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and have determined the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

[Provide details of why you are not satisfied with this resolution.]

Regards,

***********************
Initial Complaint
02/21/2024
Complaint Type:
Customer Service Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
On November 28, 2021, my son **** was born. There have been problems with the insurance company (Ambetter) and the hospital (************************** in ********, **) sending matching bills and explanation of benefits (EOBs) ever since.In August of 2022, I filed a BBB complaint (#********) against Ambetter because I had spent hours on the phone over the spring and summer of **************************** EOBs (because they were no longer available online on my son and wife's linked accounts) but 3 times I was promised EOBs would be mailed but they never showed up. I was told they couldn't email the EOBs to me, they could only be mailed. Then, thankfully, after filing a BBB complaint, I guess the BBB pressure made it possible to email me all the EOBs within a few days of filing the complaint.The new EOBs all claimed that I didn't owe the hospital for the associated charges because of a mistake in billing or prior authorization by the hospital.The situation remained the same for the next year.On 10-22-2023, I received a new statement from the ************************** that claimed the issue with Ambetter had been resolved and Ambetter had paid their part and now I owed my part.After talking on the phone with the hospital's billing department, I agreed to pay after I received a matching EOB from Ambetter. I waited a couple months, but no new EOB.On 2024-01-03, I emailed Ambetter requesting an updated EOB giving them all the available information from the hospital's claim. After 2 weeks of emailing, I finally understood that my wife had to request the **** I could not request an EOB on her behalf. She does not have an "Ambetter Account", everything was handled through my account in the past. So my wife called customer service on 2024-01-17 and was promised the EOBs would be mailed and arrive in 2 weeks. 1 month later, they still haven't arrived.I would like Ambetter to email me the EOBs relating to the hospital bill on the attached email from 2024-01-03.
This is not the same complaint as August of 2022, just the same parties (me and Ambetter) and the regarding the same bill.

In Oct 2023, Ambetter finally paid their portion of the cost of service from ****'s birth in Nov 2021. The hospital then sent me a revised bill for the amount still owed by me. But my old EOBs that were sent to me in August 2022 after the BBB complaint was processed are now invalid. I need new EOBs to show that Ambetter has processed the claim and paid their portion. This new EOB will also show the portion of the bill that is still owed by me. Without the new **** I have no way to confirm that the hospital is accurately charging me for my portion of the hospital services according to my insurance coverage at the time.
I am needing Ambetter to send me a new **** but when I emailed in Jan 2024 requesting the new **** I was told my wife needed to call. So she called on Jan 17, was promised an EOB in 2 weeks, but now 5 weeks later we've never received an EOB. I tried emailing the Ambetter customer service again but the person I'm dealing with now acts like they can't read the previous emails (I've attached to the BBB complaint) and has no idea what I'm talking about.
Can you please help me get Ambetter to send me the new EOB so I can pay the hospital? I just want this to be over, but I can't without the EOB.
Customer response
02/22/2024
This is not the same complaint as August of 2022, just the same parties (me and Ambetter) and the regarding the same bill.
In Oct 2023, Ambetter finally paid their portion of the cost of service from ****'s birth in Nov 2021. The hospital then sent me a revised bill for the amount still owed by me. But my old EOBs that were sent to me in August 2022 after the BBB complaint was processed are now invalid. I need new EOBs to show that Ambetter has processed the claim and paid their portion. This new EOB will also show the portion of the bill that is still owed by me. Without the new EOB, I have no way to confirm that the hospital is accurately charging me for my portion of the hospital services according to my insurance coverage at the time.
I am needing Ambetter to send me a new EOB, but when I emailed in Jan 2024 requesting the new EOB, I was told my wife needed to call. So she called on Jan 17, was promised an EOB in 2 weeks, but now 5 weeks later we've never received an EOB. I tried emailing the Ambetter customer service again but the person I'm dealing with now acts like they can't read the previous emails (I've attached to the BBB complaint) and has no idea what I'm talking about.
Can you please help me get Ambetter to send me the new EOB so I can pay the hospital? I just want this to be over, but I can't without the EOB.
Business response
03/05/2024
March 4, 2024

Better Business Bureau
2601 **************** #***A
************, ** 46241

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

To Whom It May Concern,

Ambetter from MHS received your grievance on 02/29/2024 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 03/01/2024 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 **************.
Customer response
03/05/2024
Better Business Bureau:
I have reviewed the response made by the business in reference to complaint ID ********, and find that this response/resolution is satisfactory to me.

I appreciate ******'s help on getting me the **** she did a fantastic job. But I definitely will never buy insurance through Ambetter again. It shouldn't require a BBB complaint to get an ***.

The problems I had getting the original *** for ****'s birth were ridiculous, which took 9 months after his birth and over 3 hours worth of phone calls with customer service and a ******************** complaint to get the *** for his birth. Then to have the same thing happen again after Ambetter processed the claim and paid their portion of the hospital bill 23 months after his birth, it took 4.5 months to get an *** with multiple emails and phone calls to customer service and finally another ******************** complaint. Ambetter's customer service help line is worthless. Depending on who I got on the phone to try to answer my questions, I got a different answer on why I hadn't or couldn't receive the ***. The people who promised to send an *** in 2 weeks or less never came through (3 separate times was promised this on the original *** issue and 2 times on the 2nd *** issue).

Regards,
***** *****
Initial Complaint
02/03/2024
Complaint Type:
Billing Issues
Status:
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.
I switched my healthcare insurance 12/23 due to wanting to obtain healthcare coverage for the pcp doctor that I trusted with my healthcare issues from Anthem (he is not a part of their network and the doctor I saw office personnel wasn't good and most of the doctors listed in Anthem healthcare network don't accept the insurance) back to Am Better ( I used their services 3/22 -5/22 it was cancelled due to nonpayment and the reason for nonpayment is I was dealing with my mom dying from cancer and ended up moving to ******* ********* to take care of her. I did ask about whether I owed anything from my 2022 account and was told no by the agent I made my payment to). I have been making my payments on my **** coverage but is unable to use it because there is a billing issue from my 2022 coverage policy (it doesn't show that I owe any money but for some reason my account is remaining suspended despite it showing no money due for either 2022 or ****). Community Health Network (where my doctor work) is unable to verify my healthcare coverage because my account is suspended. I spoke with AmBetter agents 12/23/23,1/28/24, and 2/2/24 in regard to this issue and have been redirected to Healthcare Market 1/28/24 and 2/2/24 who stated that my insurance is shown as active in their system. I managed to get transferred to ********************* 2/2/24 but was mysteriously disconnected when I was about to be given the incident number so that I can follow up on my complaint and I was not given at ANY TIME a direct number to the ********************* when I asked. None of the agent would give me their agent number for me to be able to identify them if I had any issues with their services. The only conversation reference I was able to receive 2/2/24 from agent ***** (doubt that is actually her name) is the incident number I124749724 before she transferred me to ******** in ********************* around ****pm central time 2/2/24. I do have health issues that warrants coverage needs.
Business response
02/09/2024
February 7, 2024

BBB of Central *******
***************************************************** A
************, ** 46241

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

To Whom It May Concern,

Ambetter from MHS received your grievance on 02/05/2024 concerning Billing, 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.

Ambetter representative has attempted to contact ****************** to discuss her concerns; however, there was no answer. 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 ************** (TTY/TDD **************).

Respectfully,
Member Relationship Liaison
Ambetter
Initial Complaint
01/30/2024
Complaint Type:
Product Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
My doctor ordered blood tests for me last year. My previous health insurance would have cost me $2400 for them. Since healthcare.gov indicates that some tests would be free, I signed up through the .gov website and signed up with Ambetter starting Jan 1st ****. The first week of January, I called Ambetter and was told I would have to meet my deductible first before Ambetter would pay. I again consulted the .gov website and saw again that basic tests should be free under ALL plans. Through the Ambetter web portal I submitted an email asking the most cost effective way to get blood tests. I got an auto-response indicating a response within 24 hours. Two weeks later - no response. I looked for another email address and found one that responded that I should use the web portal for email. I called Ambetter again and talked to ****. After 15 minutes of questions and asking **** to slow down in talking because I couldn't understand him, he gave me a place to go for blood tests. I called that place and they DON'T do blood tests. I am frustrated beyond belief!!!!
Business response
02/05/2024
February 2, 2024

Better Business Bureau of Central *******
***************************************************** A
************,** 46241

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

To Whom It May Concern,

Ambetter from MHS received your grievance on 01/31/2024 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 02/02/2024 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,

Member Relationship Liaison
Ambetter
Customer response
02/05/2024
Better Business Bureau:
I have reviewed the response made by the business in reference to complaint ID ********, and find that this response/resolution is satisfactory to me.

Regards,
***********************************
Initial Complaint
01/03/2024
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I had a plan with ambetter for 2 years that was about $38 a month for the first and went down to about $32 for the second. By the end of the second year, I got a letter saying that my plan was going to go up to over $80 a month so I decided to re-enroll in a different plan. The one I chose said it was about $45 a month so I picked that one because it was better and would be less than the plan I had would be going up to. When I enrolled, my portal then said I was gong to be paying $6.35 a month and I was pleasantly surprised. Since then, however, the last three pay cycles have all been different prices per month, in heavily increasing amounts. I think this is completely ridiculous and feels very fraudulent. I will be cancelling my plan asap. Tired of these awful insurance companies!
Business response
01/12/2024
January 11, ****

*************************
6557 S *****
************ 47874

RE: Better Business Bureau complaint #********

Dear **************,

We are in receipt of the above-referenced complaint as of 01/03/****. Ambetter from MHS Health Plan ************************ insures you with an Ambetter Focused Silver, Silver Level, on-exchange plan effective 01/01/****. The base rate of this policy is $390.35, with an advance premium tax credit (APTC) of $317.00, leaving a monthly member responsibility of $73.35. This policy is currently paid through 1/31/****. Your member ID is ***********. This policy provides coverage for you individually.

In the complaint received, you stated your plan premium changed drastically from the estimated amount you saw when completing the estimator online. The amount you saw online was approximately $40.00 and the **************** Marketplace (Marketplace) determined your premium to be $73.35.

Monthly premiums are determined by the Marketplace based on the personal and financial information provided on your application, and not by Ambetter. If there is any discrepancy with your premium, please contact the Marketplace directly at **************. Per our phone conversation on 01/10/****, I advised the estimator is only an estimate,and that the Marketplace ultimately determines your costs; however, I have made note of your concern. I am also including a copy of the **** renewal letter sent to you by Ambetter on October 23, 2023, for your reference.

You have been provided with my direct contact information, should you have further questions regarding this matter.

Sincerely,
*****************************
Member Relationship Liaison, Ambetter
Customer response
01/12/2024
Better Business Bureau:
I have reviewed the response made by the business in reference to complaint ID ********, and find that this response/resolution is satisfactory to me.

Regards,
*************************
Initial Complaint
12/04/2023
Complaint Type:
Service or Repair Issues
Status:
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.
I started my medical insurance with ambetter on November 1st 2023. When I was enrolled in my plan I made it a point to make sure that outpatient ********** services were available for substance use disorder through the place that I attend my outpatient. I was assured that all ********** Services were covered as long as the provider was in network. However upon processing of my insurance coverage the medical provider contacted me to tell me that they had received paperwork saying that ********** Services were not covered. I have tried to call ambetter about this 3 different times. The first 2 times I was assured that I was covered. The 3rd time, when I asked to speak with someone from Behavioral health authorizations, I was put on hold and told I was being transferred to the behavioral health authorization Department and really they were just putting me back through to the exact same customer service department. Every single customer service representative gave me the phone number that I had literally just dialed to reach them and told me that it was for the ***************************** When I brought this to their attention they were completely clueless and had no idea about anything to do with Behavioral Health. I finally asked for a supervisor and was told that they were 'in a meeting.' So I can't speak to anyone from ****************** can't speak to a supervisor.. 6 people that I spoke with told me that it was covered, the last one told me that it wasn't & that I would have to change my plan. The 2nd to last person said if I did change my plan it would take 3 to 5 business days. However when I went to change my plan I was told it wouldn't start until January 1st. They are literally in business just to make money. They do not give a hoot about their customers. I want to speak to someone who can actually tell me what it is that I need to know and do something about the fact that I was told repeatedly that this service would be covered.
Business response
12/08/2023
12/6/2023

BBB of Central *******
********************************************br>Ste. 103 A
************,** 46241

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

To Whom It May Concern,
Ambetter from MHS (Ambetter) received your grievance on 12/5/2023 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 attempted to contact ****************** on 12/6/2023 but was unable to reach her or leave a voicemail as her mailbox is full. [TS1] 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
11/29/2023
Complaint Type:
Order Issues
Status:
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.
In May of 2023, my health coverage through the marketplace was erroneously cancelled by one of their representatives. Since then, my coverage was reinstated and I had been paying, Ambetter, a monthly premium to continue with my health insurance. However, after logging into my account in November of 2023, I saw that my coverage was cancelled. One of Ambetter's representatives stated it was due to a "voluntary cancellation" of benefits made back in May. Mind you, that issue was resolved, and benefits had been resumed in June. I was directed to play a game of phone tag between the marketplace and Ambetter, as no party wanted to take responsibility for my coverage being cancelled yet again. Finally, an Ambetter rep was able to escalate my case within their department and it looked like my coverage was restarted on 11.29.23. However, when I logged back into my account later that evening, it states that my coverage has been cancelled. I'm confused why no one can tell me who has access to my account, or who continues to cancel a policy that should be active and one that I have been diligently paying towards all year. This is our health on the line and it doesn't sound like the marketplace, or Ambetter is taking this seriously.
Business response
12/05/2023
To Whom It May Concern,

Ambetter from MHS received your grievance on 12/01/2023 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 ****************** to discuss her concerns; however, she was not available, and 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,

*************************
Member Relationship Liaison
Ambetter
Initial Complaint
11/03/2023
Complaint Type:
Sales and Advertising Issues
Status:
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.
August 24, enrolled for insurance and paid my premium. HAD to pay the first premium to even move forward. September 1, insurance takes effect.October, paid premium. Go to doctor and my insurance is suspended. Balance online says I owe $0.00 Call and they tell me I havent made payment. They LOST my payment from August 24. On phone for 50 minutes for them to tell me they need to submit a ticket for a payment placer. Takes **** days! I had email confirmation for this payment with a confirmation number, it came out of my bank account! In the mean time I have no insurance that I paid for.
Business response
11/10/2023
11/07/2023

Better Business Bureau
************************************************* 103 A
************, ** 46241

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

To Whom It May Concern,
Ambetter from MHS received your grievance on 11/03/2023 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 11/03/2023 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
06/18/2023
Complaint Type:
Billing Issues
Status:
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.
My healthcare coverage was dropped by Ambetter January 31, ************************************************************************************************************************************* October during open enrollment. When I attempted to inquire about this through their call system, one call was disconnected, the 2nd call I was told to call the government exchange-which I did and was told this was an issue with Ambetter and then the third call I requested to speak with a manager, I was informed that wasn't possible. Each call to get any of this info required 30 minutes to 2 hours of hold time. Call Ref #'s BIP3379535 and I-********. Policy #U9527301201. The total amount charged for 2022 was $10,372.32. December 2022 bill shows a $9836.14 credit and the charge for the month of Jan 2023 for $864.36. It's been over 6 months with no refund. The January 2023 billing statement no longer shows the rolling credit. The call service employees were never able to tell me why my coverage was dropped or why they continued to bill me. They did inform me that it was not possible to retro any of the coverage even though they were collecting premiums. I did ***** my health coverage with Ambetter for 2023 and they ***** to bill the same card as previous. Ambetter needs to refund the 11 months of premiums that they charged without providing coverage. $854.36 X 11 mo = $9507.96 The statement does show a credit of $9836.14. I'm not sure where the discrepancy lies. l Thank you in advance.
Business response
06/22/2023
06/22/2023

Ambetter from MHS
P.O. Box 441567
************, **, 46244

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

To Whom It May Concern,
Ambetter from MHS received your grievance on 06/22/2023 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 ****************** to discuss his concerns;however, we have been unsuccessful in reaching him. Three contact attempts will be made to reach ******************. 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

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