Ambetter misled many policyholders into thinking that their physicians were in-network. The policyholders complained that the Ambetter website keeps rejecting their insurance. Despite Ambetters claims and provider list shows, zero doctors, offices, or hospital accepts the insurance. Ambetter policyholders are also reporting that they have difficulty finding medical providers that accept Ambetter insurance.
Centene is one of the country’s largest Health Insurance Marketplace providers. Under the Affordable Care Act, its Ambetter suite of insurance products is available to Illinois consumers as an alternative. Ambetter plans are promoted with the concept that excellent healthcare is best given locally, and the company provides a long list of in-network doctors who allegedly accept Ambetter insurance.
However, many customers in Ambetter-covered areas have discovered after purchasing for insurance that the universe of local physicians and health care providers who accept Ambetter is far smaller than advertised. Customers have claimed that Centene falsifies their list of in-network Ambetter physicians, leading them to believe that they can continue seeing their regular doctor with Ambetter health insurance when they can’t.
When Congress passed the Affordable Care Act (ACA), it mandated that every state set up an exchange to buy individual health insurance premiums. The Affordable Care Act also requires plans to maintain a suitable network of providers in quantity and type.
Ambetter’s plans
While all of Ambetter’s plans include adequate preventative care coverage and some vision and dental benefits, it’s challenging to get a complete picture of its various plans:
- The website makes it tough to access information like the annual maximum out-of-pocket limit and co-pays;
- The cost of a plan and the amount of a deductible varies by program;
- Its location determines the availability of a product;
- The number of persons on the program and other demographic variables, such as age, impact the cost.
Ambetter has received an overwhelming number of one-star evaluations. In these Ambetter reviews, customers complain about having trouble getting medication and treatments approved for coverage, resolving claims, being frustrated with customer support, and locating an in-network provider.
Other complaints on Ambetter include:
- Waiting for long hours in hospitals and end up not being able to use Ambetter insurance once admitted;
- Phones are always disconnected;
- Representatives giving out false information to clients;
- Clients were promised to get a refund that was not fulfilled; and
- Clients complain about their very high deductibles and pay vast amounts of money for monthly premium subscriptions only to receive nothing in return.
Meanwhile, Burg Simpson is looking into a possible lawsuit against Ambetter on behalf of Ohio clients who have had similar complaints.
Buckeye Health Plan, a subsidiary of the insurance carrier Centene Corporation, offers Ambetter health plans (Ambetter Balanced Care and Ambetter Secure Care) through the Health Insurance Marketplace (Health insurance Exchange). According to the company, the Ambetter product from Centene Corporation has been purchased by nearly 1.5 million people across the country.
