ComplaintsforAmbetter from Sunshine Health

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Initial Complaint
08/08/2024
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.
My kids have FL CMS ******** plan w/ Centene. We've desperately tried to get reimbursed for a covered benefit for 4 mos w/ 5 different calls, a complaint filed, & it's still gone nowhere. I've never had such a bad experience in my life, & it's not limited to their ******** plan either, as my spouse has *******'s Ambetter plan & had to file a separate complaint months ago because of the nightmare we went through. *******'s process for requesting the benefit in question is ancient - no documentation online, have to call member services to find out how to submit, then email a receipt to one of their email addresses. Problem is they don't reply to emails sent to this address, and they say they have no way to confirm emails were received, so they give the customer no way of knowing their request is being processed or any status updates. I waited 1 mo after sending to the 1st address & after hearing nothing, called back to learn the 1st rep gave the wrong address! (not a typo but completely wrong). They then gave me a 2nd email address. I sent receipt & waited another month, heard nothing, called back & found out the 2nd address too was wrong! I then received a 3rd address (a 40 char long email addr!) & sent it. They told me it'd take 60 days (!) to receive a reply. It's now been 60+ days with NOTHING. Not only that but I filed a complaint about this whole issue w/ Centene after speaking w/ manager (S178599076 ******************* reference: i136396072) & was told I'd receive letter in mail about complaint. It's now been 2 mos & still no letter/reply on my complaint! In a separate issue earlier this year, I previously called 5 different Centene agents. 3 told me my kids needed referral to see specialists for services to be covered & 2 told me I did NOT. My *** told me I did NOT. I still don't know the right answer. Agents are horribly trained, unwilling to say "I don't know, or let me check on that" and instead quickly give false info w/ complete confidence!
Business response
08/07/2024
Please review the attached acknowledgement letter.
Business response
08/12/2024
Better Business Bureau
Attn: Dispute Resolution Department
*********************
*************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 8/12/2024 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 respond directly to the consumer.

If you have questions, please call us at ************** (TDD/TTY **************).
Thank you,
Initial Complaint
07/29/2024
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.
I called marketplace on February 2023 for insurance quotes, I had a phone conversation with a broker from the company called Ambetter from sunshine health which the broker took all my information but not my social security number, I told him I couldnt afford it and was not interested. Following week I received a bill, I never paid it, so I didnt have insurance.I had my taxes done in March of this year, I received a letter from the *** saying that I will be paying instead of receiving funds because I had insurance from Ambetter. Today I spoke to a representative from market place, she apologized and told me that a lot of brokers are committing fraud just to make their commissions She also told me I had to wait about 30 to 40 days just to receive a letter to prove I never had insurance with that company.
Business response
07/30/2024
Better Business Bureau
Attn: Dispute Resolution Department
*********************
*************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 7/30/2024 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 respond directly to the consumer.

If you have questions, please call us at ************** (TDD/TTY **************).
Thank you,
Customer response
08/15/2024

Complaint: 22062949

I am rejecting this response because:
IRS is making me pay taxes on health insurance due to Ambetter. scamming consumers just to make commission
IRS is not accepting this letter!
I did call for a quote but never agreed, to their health insurance, due to it being Expensive.
I need a letter from Corporate or whoevers in charge, stating I ***********************, never had Insurance from that company,

Sincerely,

***********************
Business response
08/21/2024
Better Business Bureau
Attn: Dispute Resolution Department
*********************
*************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 8/16/2024 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 respond directly to the consumer.

If you have questions, please call us at ************** (TDD/TTY **************).
Thank you,
Initial Complaint
07/24/2024
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.
Not a single ENT doctor on Ambetters guide actually takes the insurance. I have called every office. Only one said they accept Ambetter but not Ambetter Sunshine Health, which is what I have. Very few doctors accept this insurance within my county or even the neighboring county. All I want is to switch to a different provider now because Ambetter clearly is completely useless for me. I chose it specifically for a specialist that I wanted to see, but now that I am no longer seeing them I can barely find help with any other medical issue. It wouldnt be as bad if the doctors they say take the insurance actually did.
Business response
07/24/2024
Better Business Bureau
Attn: Dispute Resolution Department
*********************
*************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 7/24/2024 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 respond directly to the consumer.

If you have questions, please call us at ************** (TDD/TTY **************).
Thank you,
Initial Complaint
07/24/2024
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I filed health care reimbursement forms and Ambetter claims my address on the forms submitted did not match the address on file which is simply not true. I have continually tried to update my address through their member portal as well as on the phone via multiple phone calls. Ambetter denied my reimbursement form claims stating "incorrect address and address on member portal does not match the address on the reimbursement forms". Again, I see my address matches in the system to what I submitted on the claim forms. I filed a grievance to have my reimbursement forms checked without me spending 10 dollars to mail them an additional time to Ambetter and just received a grievance acknowledgment letter today that states I filed a grievance for a "delay in updating my member information." The grievance is supposed to be because Ambetter needs to reviews my member reimbursement forms again and to acknowledge the address is actually matching and for my claims to be properly filed and reimbursed. I am seeking reimbursement for 3 mental health-related visits from my long-term care provider. I expect and appreciate a prompt response to this complaint from Ambetter as well as the proper reimbursement for the visits I paid for as I have been trying to get these forms acknowledged in a timely manner with no resolution in sight. Every time I call Ambetter I get told no one has access to the updated grievance and I am growing tired of the phone calls getting me nowhere. Ambetter has the reimbursement submission forms already and I'm re-attaching my receipts below.
Business response
07/24/2024
Better Business Bureau
Attn: Dispute Resolution Department
*********************
*************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 7/24/2024 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 respond directly to the consumer.

If you have questions, please call us at ************** (TDD/TTY **************).
Thank you,
Customer response
08/05/2024

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. They have contacted me directly to resolve the issue.

Sincerely,

*************************
Initial Complaint
07/16/2024
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.
I signed up for new coverage in *******, to start 8/1/2024. At the time of sign-up, I paid the $414.12 in advance for the first monthly premium. On 7/15/2024, for some unknown reason I was charged an additional $2,896.32. Upon reviewing my invoice, I see a charge for "invoice adjustment," which means nothing. I spent over an hour on the phone with customer service, all for them to tell me they couldn't figure anything out, there was no supervisor possible to connect me with, and all they could do was submit a request for a refund, which, IF I get it, could take 7-10 business days. It is completely unacceptable, and I need the refund now. I don't know in what universe it is acceptable to charge someone an extra $3k and expect them to have enough in their account to cover that and/or not need the money for 7-10 days.
Business response
07/16/2024
Better Business Bureau
Attn: Dispute Resolution Department
*********************
*************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 7/16/2024 concerning (*****************************; , BBB Complaint Case 21996251).Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.

If you have questions, please call us at ************** (TDD/TTY **************).
Thank you,
Customer response
07/23/2024

Complaint: 21996251

I am rejecting this response because:
It has been a week and they STILL have not returned my $2900 they illegally took from my account. I have gotten another call that they are looking into it but that is completely unacceptable at this point.

Sincerely,

*******************************
Business response
07/23/2024
Better Business Bureau
Attn: Dispute Resolution Department
*********************
*************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 7/23/2024 concerning (*****************************; , BBB Complaint Case 21996251).Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.

If you have questions, please call us at ************** (TDD/TTY **************).
Thank you,
Customer response
07/23/2024

Complaint: 21996251

I am rejecting this response because: I have not heard anything further from the company and I just received a letter in the mail that my coverage was terminated for nonpayment, after I paid my premium AND they charged an additional unauthorized $2900. I will be taking legal action if this is not resolved immediately.

Sincerely,

*******************************
Business response
07/24/2024
Better Business Bureau
Attn: Dispute Resolution Department
*********************
*************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 7/23/2024 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 respond directly to the consumer.

If you have questions, please call us at ************** (TDD/TTY **************).
Thank you,
Initial Complaint
06/30/2024
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.
Paid for care service never got cards nor able signin to website to retrieve electronic cards. Dr ******** called to verify insurance didn't exist. Pulled from account.
Business response
07/01/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 7/1/2024 concerning (***********************; , BBB Complaint Case 21924197).Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information. We will respond directly to the consumer.

If you have questions, please call us at ************** (TDD/TTY **************).
Thank you,
Initial Complaint
06/12/2024
Complaint Type:
Product 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.
None of the doctors listed in ambetters network actually accept it. Customer service absolutely no help. This reeks of a scam. Its as if Im paying for health insurance that doesnt exist.
Business response
06/17/2024
June 17, 2024

Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 6/13/2024 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 respond directly to the consumer.

If you have questions, please call us at ************** (TDD/TTY **************).
Thank you,
Initial Complaint
05/29/2024
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 am writing to formally lodge a complaint regarding an issue with the billing for my visits to my primary doctor, which occurred on August 9 and October 27, 2023. These visits were supposed to be covered by my health insurance. However, my claims were declined because ********************** (TGH) included procedures that should not have been part of the bill. These procedures or referrals did not match the services provided by my primary doctor.After discovering this issue, I promptly contacted Ambetter and ********************** to rectify the error. I was assured that the bill would be corrected to reflect only the services provided during my primary doctor visits. Unfortunately, instead of resolving the issue, TGH sent me a bill for $190.This situation has caused me considerable stress and inconvenience, as I trusted that my health insurance would cover these routine visits. I am requesting an immediate review and resolution of this matter. Specifically, I ask for:1.A thorough investigation into why the incorrect procedures were included in my bill.2.Reversal of the $190 charge and correction of the billing to reflect only the covered services from my primary doctor ****************** that future claims will be accurately processed in accordance with my coverage plan. I trust that Ambetter Insurance will handle this matter with the urgency and attention it warrants. Please contact me if any additional information is required to resolve this issue. I look forward to a prompt resolution. Thank you for your immediate attention to this matter. Besides, a poor customer service from ********************** because most of time that I was calling they hang up my call.Sincerely,
Business response
05/31/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 5/30/2024 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 respond directly to the consumer.

If you have questions, please call us at ************** (TDD/TTY **************).
Thank you,
Initial Complaint
05/23/2024
Complaint Type:
Customer Service 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.
This company presents itself as a health insurance but consistently denies claims and makes patients wait exceedingly long for needed care. Ive been waiting 6 months now for an mri on my foot
Business response
05/08/2024
Please review the attached acknowledgement letter.
Customer response
05/08/2024
Complaint: 21678941

I am rejecting this response because:

Company doesnt do anything but reject claims n stall.

Sincerely,

***********************
Business response
05/31/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 5/25/2024 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 respond directly to the consumer.

If you have questions, please call us at ************** (TDD/TTY **************).
Thank you,
Initial Complaint
05/22/2024
Complaint Type:
Customer Service 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 am bussiness owner who sees Ambetter sunshine patients. Tax ID: **********. we have been conracted with them since May 2023. Someone screwed up contracting uploads. they have not paying us medical claims costing more than $10K between May 2023 to September 2024. These insurances companies do not care if patients struggles or medical office struggles to keep up their bills. when we emailed them, they reply whenever they wants. we have been asking for resolution of this since may 2023. They still have not done anything. Ambetter needs to get thrown away from FL state as health insurance from market place. They are not good for their patients or medical providers.
Business response
05/23/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 5/22/2024 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 respond directly to the consumer.

If you have questions, please call us at ************** (TDD/TTY **************).
Thank you,

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ComplaintsforAmbetter from Sunshine Health

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