ComplaintsforAmbetter from MHS

• Initial Complaint

  11/29/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Ambetter will not cancel my coverage and keeps billing me. I enrolled this spring in ACA heakthcare via Ambetter after stopping my fulltime job. This fall I started a new job. My insurance was to kick in November 1st so I called to cancel on October 20th. They seemed to accept my cancelation and then said I had to cancel with the Marketplace as well and transfered me to them who also processes my cancelation. We then got billed mid November for our novemer and december coverage. My wife and I have called several times and tried to cancel but they keep giving us different reasons why they can't cancel us and won't zero out our balance. I can't get anyone intelligent on the phone. They acknowledge I paid in full through October 31st and they acknowledge that I called on Oct 20th to end my insurance but then give me the run around on why my service has not been ended. I recorded my call to them today inwhich I was on the phone for 45 minutes and got nowhere. Sometimes they say that I can't cancel with them until I cancel with the Marketplace but then I tell them that I did cancel with the Marketplace and the Marketplace acknowledges my cancelation at which point they pivot to some other random line of reasoning that gets nowhere. Between my wife and I we have **** on tge phone for probably 4 hours and our coverage is still not cancelled and they are saying we owe 2 months of coverage.

  Business response

  11/30/2022

  Please see attached acknowledgement.
  
  Thank you,

  
  ***************************
  Project Coordinator II, Grievance & Appeals
  QI, Grievance & Appeals Department
  ************, IN
  Preferred Contact Teams
  *********************  |  mhsindiana.com
  

  Transforming the health of the community,
  one person at a time.

  
  

  Customer response

  11/30/2022

  
  

  The response was that due to privacy concerns they would be responding to me directly rather than through BBB. I will await their response but to me this sounds fishy. 

  1: This has nothing to do with my health where privacy laws may apply and everything to do with them continuing to charge me after I cancelled service.

  2. I initiated the process through BBB and don't see how they can choose to settle it outside of BBB channels and monitoring.

  
  

  Maybe I'm wrong and I will be happy with the response I get but I'm skeptical at this point.

  
  

  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

  08/08/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Ambetter has never given me an explanation of benefits (***) for all of the claims from the hospital (************************** in ********, **) for my wife (***********************) from her giving birth to my son **** on 2021/11/28.The online application does not allow me to access the *** for my wife (***********************). ****** *** from November/December is occasionally accessible online, so I have downloaded the *** for his bills that were processed. I can access my children and I's ***, but for some reason my wife's *** are unavailable on the online application. I discussed the bills and *** with Ambetter and Hospital in Jan-April of 2022 to try to get all the information and billing sorted out so that I could pay the bills. In late spring, or early summer of 2022, my wife and I began receiving debt collection calls, letters, and texts. I want to pay my bills, but I need the *** from Ambetter to verify billing amounts.I have called Ambetter (3) times to try to get copies of ****** and ****** ***s for bills from ******************* of 2021. I have been told every time that Ambetter will print the bills and send me copies in the mail in **** business days. I have never received any ***s in the mail from the (3) requests. The (2) times, after the initial call, that I called and requested the ***s, the people I spoke to from Ambetter on the phone could see that I had previously submitted the request, but gave various reasons why the request had not been completed. Each time they would say that they would contact the "back room" to have them mail me the ***s because they couldn't personally access them. Always promised to have the ***s delivered in **** business days. The following are the dates and reference numbers (RN) for my requests for ***s to Ambetter that are all yet to be resolved:1. Spoke with Ynna D. on 4/29/22, RN I76447442 2. Spoke with Cani on 6/1/22, RN I78431711 3. Spoke with Lisandro on 7/5/22, RN I80418791 I just need Ambetter to process bills and send ***

  Business response

  08/09/2022

  Response Attached.  Thank you. 

• Initial Complaint

  05/09/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I had to see my orthopedic specialist Oct 20, 2021 and again on Nov 18, 2021. My ******* ************************* was with Tri Health and Ambetter has paid his bills in the past. After going to my appointment I found out that his practice was bought by Beacon Orthopedics. I was unaware until after my follow up visit in Nov that Beacon accepts Ambetter Buckeye but not Ambetter MHS, which I have. To the current date **************** is still listed as in network with Ambetter MHS. Ambetter has refused to pay so I filed an appeal. This is the 4th time I've had to appeal with Ambetter to pay bills. I received a letter Nov 23, 2021 that my grievance was received. I received a letter Dec 21, 2021 stating that my doctor would be paid and I would be updated once it was completed. I received no word from Ambetter. I have followed up with phone calls to Ambetter every month, sometimes twice a month. They finally paid my **** from Nov 18, 2021 but they have not paid Oct 20, 2021. I called again and according to Ambetter I had to appeal again and I have another case number. CLI-*******. I should not have to work so hard to get bills paid, especially when their website is what I have to go by. I would like Ambetter to pay the **** from Oct 20, 2021 without question which is $341.00. After all, they paid the Nov 18, 2021 ****. I have received numerous answers from the agents on the phone when I call and no one is willing to help get this resolved. Also, since I've been with Ambetter, my member ID is not recognized on their phone system.

  Business response

  05/23/2022

  
  May 23, 2022
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  151 **************. Suite 2020
  ************, **  
  
  Re:  Ambetter *** Member
  Complaint ID: #********
  
  To Whom It May Concern:
  
  Ambetter from MHS received your correspondence on May 23, 2022,concerning BBB Complaint Case # ********.  Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will be sending a response directly to the member, BBB Complaint Case # ********.
  
  If you have questions, please call ** at (Ambetter from MHS ************, TDD/TTY ************
  
  Respectfully,
  *************************
  *************************, MBA
  Senior Manager,
  Grievance &Appeals
  
  
  
  550 **************.,Suite 101
  ************,**  46204
  Direct ************
  Toll-Free:**************
  Fax: **************
  ********************** I mhsindiana.com
  

  Customer response

  05/29/2022

  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. 
  
  I spoke with a representative from Ambetter and again I had to file another grievance to get this **** paid, which will take another 3-4 weeks.  The doctor is within network, but for a few weeks last October he was transitioning into another practice and that's when I had my appointment.  
  
  Regards,
  
  *******************************
  

  Business response

  06/07/2022

  Good Morning,

  I just tried to call you, in regards to your complaint. Please feel free to call me at ***********************. In the meantime, I am going to look further into your case, to see if there can be a better solution.

  Thank you,

  ***************************, Grievance Coordinator.

  Customer response

  06/11/2022

  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. 
  
  Representatives from Ambetter have contacted me, but they are not willing to make any changes to pay my ****.  The customer is penalized because a Doctor's ******** is bought by another company.  Within a 2 week period the Tax ID number was not within network, however, in network before and after that period.  He continued to show in network on the Ambetter website.  I do have to accept the fact that they will not pay the ****.  One representative did try to help with the cost by enrolling me in a health award program that gives money back to help pay bills.  That was the only time in my history with Ambetter that someone tried to work out a problem.  
  
  Regards,
  
  *******************************
  

  Business response

  06/14/2022

  June 14, 2022
  
  Better Business Bureau
  Attn:Dispute Resolution Department
  151 *************************************************************************  
  
  Re:  Ambetter *** Member
  Complaint ID: #********
  
  To Whom It May Concern:
  
  Ambetter from MHS received your correspondence on June 14, 2022 concerning BBB Complaint Case #********. Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will be sending a response directly to the member, BBB Complaint Case # ********.
  
  If you have questions, please call ** at (Ambetter from MHS ************, TDD/TTY ************.
  
  Respectfully,
  
  ***************************
  
  ***************************
  Project Coordinator II, G&A, Grievances
  
  
  
  550 ****************** #***
  ************, ** 46204
  Direct ************
  Internal 20616
  ********************* |  mhsindiana.com
  There is always a reason to smile, and if not, BE one!

• Initial Complaint

  05/06/2022

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  My mother passed away in December, I have spent countless hours on phone calls trying to terminate her insurance. After theyd already taken 2 payments out of her account. I have provided them with everything I need to prove that I am executor of her estate and to get it taken care of.I have finally received a letter for termination of her account, but now they wont talk to me about how the refund is being issued. They have my name on her account, but say Im not authorized to receive that information. The account they were getting payments from has been closed, so we need a check cut. But they wont speak to me, they keep putting me on hold for over an hour until I get disconnected.It shouldnt be this hard to deal with a deceased family members affairs.

  Business response

  05/23/2022

  May 23, 2022
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  151 **************. Suite 2020
  ************, **  
  
  Re:  Ambetter *** Member
  Complaint ID: # ********
  
  To Whom It May Concern:
  
  Ambetter from MHS received your correspondence on May 9,2022. concerning BBB Complaint Case # ********.  Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will be sending a response directly to the member, BBB Complaint Case # ********.
  
  If you have questions, please call us at (Ambetter from MHS ************, TDD/TTY ************
  
  Respectfully,
  *************************
  *************************, MBA
  Senior Manager,
  Grievance &Appeals
  
  
  
  550 **************.,Suite 101
  ************,**  46204
  Direct ************
  Toll-Free:**************
  Fax: **************
  ********************** I mhsindiana.com
  

• Initial Complaint

  05/01/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I can not get my durable medical supplies approved through my ***************** Ambetter. I have been waiting since April 8th for the next to approve and every time I call I am on the phone for hours with the rep only to get a different reason each day why they cant . Im told I have to call and get information they need but I can not talk to anyone but the customer service rep . I have ask for a supervisor on several occasions with no luck . My deductible is ***** and I will. Never meet that if they wont approve my supplies for my diabetes . I am paying out of pocket right now because Im out and this will not go to deductable . So unfair for a insurance company tp treat people this way . I have been told by the customer service I had to go through edgepark pharmacy., I was also told after checking status that I needed a PA, then Im told PA is void . Another call Im told Dr is not in network, then item not covered ,then Dr *** is wrong , Now they say Edgepark is not in network . Im beyond frustrated and need help to get this company to cooperate .

  Business response

  05/23/2022

  
  May 23, 2022
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  151 **************. Suite 2020
  ************, **  
  
  Re:  Ambetter *** Member
  Complaint ID: # ********
  
  To Whom It May Concern:
  
  Ambetter from MHS received your correspondence on May 14, 2022,concerning BBB Complaint Case # ********.  Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will be sending a response directly to the member, BBB Complaint Case # ********.
  
  If you have questions, please call us at (Ambetter from MHS ************, TDD/TTY ************
  
  Respectfully,
  *************************
  *************************, MBA
  Senior Manager,
  Grievance & Appeals
  
  
  
  550 **************., Suite 101
  ************, **  46204
  Direct ************
  Toll-Free: **************
  Fax: **************
  ********************** I mhsindiana.com

• Initial Complaint

  01/25/2022

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  We looked into Ambetter after receiving information from the health insurance exchange, and had been enrolled with CareSource for a couple of years. We contacted Ambetter to inquire if our doctors and medications were covered, and were assured they were. We relied on this information when signing up, and upon receiving our information packet and link to online network and coverage database, discovered that our medications and doctors were NOT listed. We made 14 calls over the next 30 days, and were told "Doctors come and go on the plan, and formularies change". When we shared the recorded calls from a few days earlier stating otherwise, we were "transferred", and eventually the call was dropped. We signed up for their program to earn rewards for taking health quizzes, getting a flu shot, etc., and when we had accumulated enough points, redeemed them for a $100 **** card, and a $25 **** card. We were assured they would arrive within "4-6 weeks". We dropped Ambetter at the end of our one year enrollment, and made over 40 calls about the $125 worth of gift cards which we never received. As an investigative journalist, I was discussing this issue on the air one evening, and received over 100 messages within 30 minutes from folks in similar situations with them. Several class actions are pending against Centene, Ambetter and MHS, and we will be filing our own suit for both compensatory and punitive damages in less than 30 days if we do not receive the $125 in gift cards as promised multiple times, and compensation of at least $550 for the inordinate amount of time to contact the useless customer service team. They were all very nice, but did absolutely nothing to correct their errors. We have the recorded calls, documents, and the draft of a lawsuit which will be filed on February 15th, 2022 if we do not receive what was promised. We will also be doing a follow up story on how MHS handles this matter the end of February. If lawsuit is filed, the damages are over $1800.

  Business response

  04/13/2022

  April 13, 2022
  
  Better Business Bureau
  Attn: Dispute Resolution Department
  151 **************. Suite 2020
  ************, **  
  
  Re:  Ambetter *** Member
  Complaint ID: ********
  
  To Whom It May Concern:
  
  Ambetter from MHS received your correspondence on 04/13/2022 concerning BBB Complaint Case # ********. Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will be sending a response directly to the member, BBB Complaint Case # ********.
  
  If you have questions, please call us at (Ambetter from MHS ************, TDD/TTY ************
  
  Respectfully,
  
  *************************
  *************************, MBA
  Senior Manager, Grievance and Appeals
  *** & Ambetter from MHS
  
  550 ******************, Suite 101
  ************, ** 46204
  Direct: **************************
  Toll-Free: **************
  Fax: **************
  ********************** I mhsindiana.com

*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. ↩