ComplaintsforAmbetter from Sunflower Health Plan

• Initial Complaint

  10/07/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  AMBETTER says the Date was 07/17/2023. I clicked on a Marketplace Advertisement that stated you could get up to $2000 sent to your mailbox to help with groceries, rent, make a payment on your vehicle and so on. when an agent came on the other end, they said let's get you qualified. I gave my credentials and qualified as the agent said. Then I asked about the money. then I was told to listen to a recording and it went so fast , I was not sure what I was signed up for. I went home that evening , did some research and found out it was for a health subsidy that Ambetter Sunflower Health got to cover health insurance, I was then to present covered by my husbands Union 101 operating engineers health plan since 2022-2025. I clicked on the Advertisement the next day ,I told the agent on the line what they were doing is fraudulent and false advertising , to CANCEL what they signed me up for or I would report them to the FTC, AG, and any other organization I can think of, if they did not CANCEL. TAX time we had to pay IRS $2273.00 for a Premium Tax Credit plus $22.00 Interest as the agent did NOT CANCEL the policy as told to do. Ambetter, ******** Oscar care and Marketplace are ran by the Government. Whoever is behind this health insurance continues to enroll me in this health care program and the only organization to get back to me is the Attorney Generals Office saying they can not help it is the government. I know my rights and enough laws Ambetter and the others involved along with the IRS, Kansas Insurance Commission have received complaints. To date the cost and research of laws and mailing and delivering complaints has cost us $5,574.00 + add interest at 9.75 % My time trying to get this CANCELED involves 50+hours and counting. The agent never asked if I had coverage or if I was married. AMBETTER has not paid one cent for my health care as I recently had an MRI and ongoing health problems. I will deliver documents in person on Monday to *** * ****.

  

  Business response

  10/14/2024

  Please see attached. Thank you.Ambetter from Sunflower Health Plan (“Ambetter”) received your grievance on 10/10/2024 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 10/11/2024 to discuss her concerns but was unable to reach her. An attempt to leave a voicemail was made, but a notification was received indicating *** *******’s voicemail has not been set up. We will be sending a detailed response directly to *** ******* addressing BBB Complaint Case #********. If you have questions, please call us at ***** ********.

  Customer response

  10/16/2024

  
  Complaint: ********
  
  I am rejecting this response because:  Ambetter has not paid any of my health care needs and sent a 1095 to I.R.S.  WE WANT THAT MONEY BACK PLUS PAID FOR THE TIME IM OWED DEALING WITH THIS. 

  I HAVE A FILE COPIED OFF JUST NEED A FAX NUMBER OR EMAIL TO MAIL IT TO YOU.  I WAS TAKING FILES TO TOPEKA OFF BBB , BUT DID NOT MAKE IT HAD OTHER THING TO TAKE CARE OF. SORRY.

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

  

  Business response

  10/23/2024

  Please see attached. Thank you.Ambetter from Sunflower Health Plan (“Ambetter”) received the rejection notification of our response concerning ****** ********* BBB Complaint Case #******** on 10/16/2024. 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 continued to try to contact *** ******* via phone and email to discuss her concern, but outreach attempts have been unsuccessful. If you have further questions, please call us at ***** ********.

• Initial Complaint

  04/04/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I have been a loyal customer for 2 years now and this year decided to up to a "Gold Plan" so I had less of a copay on my monthly medications. Now my medication, lisdexamfetamine, has been out of stock everywhere for the past two months. I have made over 10+ calls to ambetter and was told if I got a prior authorization in place for name brand vyvanse 40mg that they can make an exemption so I can get it for the same co-pay cost of generic ($30). The pharmacy has filled it but every time they run the script it says the cost is $366.00 still. I've called back to ambetter another 5+ times and have been getting the run around, some people say that they can't do that and some say that it shows in the notes that I can get name brand for $30. I pay $450 per month just to have this "Gold Plan" I can not afford to pay an additional $366 just for 1 medication. The shortage of generic all over is completely out of my hands and I am extremely frustrated that the company I pay over $5400 a year won't help out a customer on one of their top tier plans. It is super disappointing that healthcare companies care more about saving a buck than helping out loyal customers who rely and trust them with their health. I just wanted to be able to get my meds at a reasonable cost for the time being until the shortage is over and I will gladly go back to generic. That way I can quit wasting days each monthly checking every pharmacy in my area to see what they have in stock.

  

  Business response

  04/08/2024

  Please see the attached letter. Thank you.

  To Whom It May Concern,
  
  Ambetter from Sunflower Health Plan received your grievance on April 5, 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 spoken to *** ******* ********* and advised we 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

  04/08/2024

   
  Complaint: ********
  
  I am rejecting this response because:  I am still waiting to hear back from Ambetter to resolve this.  The response they gave was just them letting me know they got my complaint and will get back to me.
  
  Sincerely,
  ******* *********

  

  Business response

  04/11/2024

  The letter that was uploaded on 04/08/2024 is merely an acknowledgement that *** *********** case is recognized and is in progress. An Ambetter representative has personally reached out to *** ********* regarding his concerns and will continue to work with *** ********* on a resolution going forward. Once again, 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. 

• Initial Complaint

  02/08/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I have Ambetter insurance and within the last 3 months it has changed 3 times for over a year it was the same but when I started using my insurance my coverage changed in Dec I used Teladoc I have Hep C and need to start taking medication and when the doctor sent me for test my policy changed the doctor I was seeing is no longer covered only DO s are and they aren't licensed to treat me my records are in an account I can't access because my insurance doesn't cover it can they do that can they change my coverage when I start using it its not fair

  

  Business response

  02/20/2024

  **** ****** ***** ******* ** *****
  
  February 20, 2024
  
  Better Business Bureau
  ******* ********* ***** ******* *** ****** ****** * ** **** ***** * ****** ****** ** *****
  
  Re: ******* *****
  Complaint ID: ********
  
  
  To Whom It May Concern,
  
  Ambetter from Sunflower Health Plan received your grievance on February 8, 2024, concerning ******* *****’s
  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 spoken to Ms. ******* ***** and advised we 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

  03/08/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  Ambetter will not stop trying to withdraw funds from my bank account. I do not have coverage with them any longer. I stopped an attempt in January and again in February and have just received an email demanding payment in March. I have made repeated phone calls in which they assure me my plan was canceled (December 31) and they will not try to collect the premium.

  

  Business response

  03/21/2023

  To Whom It May Concern,
  Ambetter from Sunflower Health Plan received your grievance on 03/10/2023 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.
  An Ambetter representative spoke to ******** ***** on 03/20/2023 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 *************

• Initial Complaint

  03/02/2023

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  This seems to be a systems and potentially an IT problem. I put in a first monthly premium payment on the 26th from the link to Ambetter's site to pay immediately after enrolling on healthcare.gov. If Ambetter's IT would include providing payment confirmation numbers, this whole problem could have been avoided, but because the fields just clear out after the payment goes through, you are left having paid with no confirmation. When the payment wasn't registering after having cleared our bank, I believe, on the 27th, I called and provided them with the payment reference number, which they tried doing a trace for, and claimed they could not find the payment. I have sent them proof of payment from our bank, and their idea is to do another payment tracer that could take up to 7-10 days. I have prescriptions I need to fill and health care I badly need to receive having multiple conditions that without insurance for months, I haven't been able to receive adequate care for. I need a solution and my payment recognized so my insurance can start faster than 7-10 days. Ambetter seems very skilled at taking payments, but not great at remembering who actually paid them, or in fact, providing the services paid for. What concerns me here also, is the number of similar complaints I have seen online, with people paying, and Ambetter not applying those first payments, or in some cases, even with proof of payment, cancelling insurance on people who had paid their premiums regularly and had proof that they had. If there is anything you can do to help them speed up their process (they've already had days to get this payment, and ample proof that its been made), I am willing to provide you with the proof of payment, and any other information needed. I would appreciate any help possible.

  

  Business response

  03/17/2023

  To Whom It May Concern,
  Ambetter from Sunflower Health Plan received your grievance on 03/03/2023 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.
  An Ambetter representative spoke to *** **** on 03/03/2023 and 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,
  ****** ******
  

  Customer response

  03/17/2023

  [A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
  Better Business Bureau:
  Though I did not receive an attachment to view how Ambetter responded to the BBB in the message that asked me to view that, and cannot verify that I find that response satisfactory, they did eventually after multiple calls and this complaint find the payment I had made and attached it to my profile. Would recommend folks google Ambetter's history and history of lawsuits before trusting them just because they are on the marketplace. At least look carefully at how their history within your state. I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  Regards,
  ***** ****

• Initial Complaint

  03/01/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  My health coverage ended with them on 12/31/2022 as of today 3/1/2023 they are still automatically withdrawing a premium out of my bank account which is causing me to be overdrawn. I have called 4 times and each time I am given a cancelation # and told automatic withdraw is turned off and yet the next month they take money and I overdraw, This month the price more than doubled. So far they owe me $124.82 just in premiums and $90 in overdraft fees. This has been a nightmare! They run me around in circles and nothing gets done. I want my money back including the overdraft fees returned and the insurance that I had switched from and no longer want or use stopped.

  

  Business response

  03/02/2023

  To Whom It May Concern,
  Ambetter from Sunflower Health Plan (“Ambetter”) received your complaint on 03/01/2023 concerning ***** ***** *******, BBB Complaint Case# 19517637. 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.
  An Ambetter representative left a voicemail for ***** ***** ******* on 03/02/2023 with their direct contact  information and will be assisting them with their concerns. We will be sending a detailed response directly to ***** ***** ******* addressing BBB Complaint Case # ********. If you have questions, please call us at ************** **** *****

• Initial Complaint

  02/16/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  Ambetter of Kansas by Sunflower Health is owned by Centene Corporation, I was unable to find a contact address for them nor were they listed as a business in the BBB directory. My Member # is *********** (confidential), please. In early January there was an error regarding the amount of Health Insurance Premium that was taken out for my market- place health insurance. I was able to resolve getting the monthly premium fixed going forward for the remainder of the year and request a refund of $ 564.77 from January's premium which is now zero. Per my call in to customer support ************ on 1-25-23 and was told that the refund would be deposited back in my checking account (where it was debited from past six months for premium) and would take 5-7 business days to receive. I received a statement showing the credit for the amount above and reflecting the premium change only within that timeframe. I've called in to customer support multiple times as follows: ******** ** ******* * and credit was forthcoming and put back in checking account 2-3-23/ No Confirm # but refund was being issued within 5 biz days and put back in checking account 2-8-23/ Was given a ID #-I ******** * * ******* and that refund was processed and sent out 2-10-23/ Was told refund check was sent by mail 2-2-23 (never received) I* * ** ******* & refund would be put back in checking account The process has been frustrating and given different the different confirmation numbers and delivery methods. Your assistance would be greatly appreciated. Thanks, ***** * *******

  

  Business response

  02/16/2023

  
  ****** ******** ****** ***** ******* ********** ********** *** * ******** *** **** *** ****** ** ***** *** ***** ******* ********* *** *********** ** **** ** *** ********
  Ambetter from Sunflower Health Plan received your grievance on 02/14/2023 concerning Heath *******, 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.
  
  An Ambetter representative was in contact with Mr. ******* on 02/15/2023 to offer further assistance with resolution of his complaint.  Mr. ******* declined at the time of outreach but has been provided with the representative’s direct contact information to assist him with his concerns should it be required going forward. We will be sending a detailed response directly to Mr. ******* addressing BBB
  
  

• Initial Complaint

  02/08/2023

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I purchased an Ambetter plan through the Marketplace on 11/14. After realizing that my providers are not in-network, I promptly canceled on 11/15 and was told that my refund would "automatically be issued in 7-10 business days" to the of $333.47. I gave Ambetter more than enough time to handle their automated process and received no prompt refund. I called customer service on 12/13 for 33 minutes. I was told a case would be created and that my refund would "automatically be issued in 7-10 business days" to the of $333.47. After allowing more adequate time, I called customer service on January 16th, was placed on hold after explaining the situation, then was hung up on after 20 minutes. I immediately called back on January 16th for 24 minutes, to which I was told a case would be created and that my refund would "automatically be issued in 7-10 business days" to the of $333.47. On January 18th, I called customer service to make sure a case was actually created, and the representative said that he would put me on hold for a supervisor since he couldn't tell what was going on. After 77 minutes, I was hung up on. I called back the end of January and got ahold of the only customer service representative who seemed helpful, ******. She agreed that this has gone on way too long and gave me a case number of **********. I called back to customer service on February 6th for 15 minutes to which I was told that 1) the representative could not even LOCATE the original transaction and 2) was oblivious to the case number I was referencing. He offered no solution, not even yet another case. I am getting NO WHERE with this company and they have $333.47 of my money (and have for almost 90 days)! What a broken process! The customer service is horrible, their record keeping system appears to be inadequate, and they are thieves. All I want is my money back and I've wasted so much time!

  

  Business response

  02/15/2023

  To Whom It May Concern,
  Ambetter Sunflower Health Plan received your grievance on 02/10/2023 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.
  An Ambetter representative has attempted to contact *** ***** to discuss her concerns; however, we
  have been unsuccessful in reaching her. 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 *************

  Customer response

  02/16/2023

  [A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
  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. Shortly after submitting this complaint, I received a call from Ambetter as well as a refund that I had been waiting many months for.
  Regards,
  ***** *****

• Initial Complaint

  01/30/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I had originally got this insurance to help pay for therapy, however they upped the bill so I canceled. however recently I found out they're still making me pay for premium. Even though they said my account was canceled.

  

  Business response

  02/02/2023

  To Whom It May Concern,
  Ambetter from Sunflower Health Plan received your grievance on 01/30/2023 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.
  An Ambetter representative left a voicemail for ******* ******* on 01/31/2023 with their direct contact
  information and will be assisting them with their concerns. We will be sending a detailed response
  directly to ******* ******* addressing BBB Complaint Case # ********. If you have questions, please call
  us at ************** **** *****

• Initial Complaint

  01/13/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I first contacted the company ambetter several times to ensure that the services I required were covered in my plan. I wanted to have Std testing done, which I was told on two separate occasions on the phone that it was fully covered with no deductible, or out of pocket cost if the provider was in-network. I was also informed that preventative care was covered with no out of pocket cost/deductible. After getting my yearly physical (preventative) and STD tests done (also preventative, no symptoms shown, no worries about having one) at all I was going as a preventative measure, they then denied both claims and refused to pay anything on either visit, even though both times I went the clinic was fully in-network. Ambetter claims that I was insured by ***** but has yet to make a simple phone call to ascertain if I actually was covered by **** as my primary insurance at the time these services were provided (which I was not). I contacted **** immediately after hearing why these claims were denied and was informed by **** , on the phone and through a confirmation email that I was indeed not covered at the time of services, nor had I been for months and months prior to the services being rendered. I am now unable to view claims as I have signed up for different insurance and dropped ambetter due to complete and total lack of customer service for a simple thing such as getting a physical and STD testing and being charged almost two thousand dollars. I have tried to contact ambetter customer service reps dozens of times now and this is a last resort to me but I cannot seem to reach a competent person who understands what they are talking about. I paid for my ambetter insurance, was told these services were covered, went to an in-network provider, and am still being denied coverage months later. My name is ***** ******, email is ********************** ************ Please rectify this situation. Your customer service reps have done nothing.

  

  Business response

  01/25/2023

  To Whom It May Concern:
  Ambetter from Sunflower Health Plan received your correspondence 1/13/2023 concerning Complaint ID
  ********. 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 with anyone
  other than our members or their authorized representatives. Ambetter will be sending a detailed response directly
  to *** ***** ****** addressing BBB Complaint Case# ********. If you have questions, please call us at ****** ******** ****** *****

*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. ↩