Health Care Referral
Ambetter from Sunshine HealthThis business is NOT BBB Accredited.
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Complaints
Customer Complaints Summary
- 128 total complaints in the last 3 years.
- 31 complaints closed in the last 12 months.
If you've experienced an issue
Submit a ComplaintThe complaint text that is displayed might not represent all complaints filed with BBB. 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.
Initial Complaint
Date:05/20/2023
Type:Service or Repair IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- 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.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
suddenly now my simply healthcare ******** claims/precriptions are being denie because they say ambetter is my main insurance, which i never recalled applying for in august of 2022, so i have contacted ambetter and they say the plan has been cancelled as of 1/31/2023, but why is simply still saying i have ambetter and i am just getting the complete run around, where my medical bills for 2023/prescriptions so far this year are not being covered by simply because they say i still have ambetter which is not true and i have not been able to see doctors or get and medications needed for the last two monthsBusiness Response
Date: 05/30/2023
May 30, 2023
Better Business Bureau
Attn: Dispute Resolution Department
*****************************************************************************
Re: *************************
Complaint ID: ********
To Whom It May Concern:
Ambetter from Sunshine Health received your correspondence on 4/24/2023 concerning (*************************, BBB Complaint Case 20084821).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 ** at ************** (TDD/TTY **************).
Thank you,Initial Complaint
Date:04/27/2023
Type:Billing IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- 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.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
I am very computer literate, so there should be no problem setting up Auto-Pay for my premiums. As a matter of fact, I set it up in May 2019 and it ran like clockwork until September 2022. Then somehow the payments stopped being made and the only time I find out is when it's 2 months premiums due and I get an email. I have attempted 4 times to update my credit card (which hasn't changed in well over 2 years), but somehow the payment history I finally found on their horrible website says they are trying to charge a card that was lost in a stolen wallet and replaced in May of 2020. It's been deleted off their site since right after that, when I entered the new card number. I have no clue why they suddenly went off the rails and tried to charge an old card instead of the default card listed on my account on their website. Going to "manage autopay" just shows the correct card that should be getting charged. Calling **************** gets a recording that just sends you in a circle from "Do you want to talk to Payments? Do you want to hear your current balance? Do you want to make a payment?" over and over until I screamed so loudly that my throat is still sore. They need to have better functionality on their website and to have some way for customers with problems that can't be solved online to speak with a human who might be able to find the problem (or at least get the message to the proper department). I just want to fix the problem. I don't want anything from them except for someone to help me fix my AutoPay to work properly so I don't keep being told I owe 2 months premiums out of the blue.Business Response
Date: 05/08/2023
May 8, 2023
Better Business Bureau
Attn: Dispute Resolution Department
*****************************************************************************
Re: ***********************
Complaint ID: ********
To Whom It May Concern:
Ambetter from Sunshine Health received your correspondence on 4/28/2023 concerning (***********************, BBB Complaint Case 19991671).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 ** at ************** (TDD/TTY **************).
Thank you,Initial Complaint
Date:04/24/2023
Type:Product IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- 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.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
Ambetter/Ambetter Sunshine Health offers rewards for health assessments taken online regarding nutrition, exercise and wellbeing. The website indicates that the money rewards can be used to pay for co-pays, co-insurance or buy medication. Since year 2022 I have been making attempts to obtain my Health ************ card related to all the numerous quizzes and videos I have taken at the Rewards page of Ambetter's member website. It is my understanding that I am entitled to receiving the money rewards in a **** card. To this date, even after several requests I have not received my rewards **** card which should have well above ***** points to be redeemed. I have made several, countless requests to Ambetter's **************** in the past two years. I get the same answer every time I call, that a **** card was sent to me in the mail, or that a **** card will be 'resent', or simply, that they are having technical difficulties in their ******************* On February 23, 2023, I sent Ambetter a letter via Certified Mail Returned Receipt Requested (copy attached), listing all the dates in which I called and who I spoke with in follow up of the Rewards I have earned in the past two years, so I can use that money to pay for overdue co-pays and co-insurance of doctor's visits required by the same health plan. To this date, I have not heard from Ambetter, neither have I ever received anything in the mail. I am a current member and demand that my Rewards be paid immediately so I can use it to pay for overdue co-pays and co-insurance. Thus, I defer this problem to this Bureau. Thank you in advance for your assistance.Business Response
Date: 04/26/2023
April 26, 2023
Better Business Bureau
Attn: Dispute Resolution Department
*****************************************************************************
Re: ***************************
Complaint ID: ********
To Whom It May Concern:
Ambetter from Sunshine Health received your correspondence on 4/24/2023 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 ** at ************** (TDD/TTY **************).
Thank you,Customer Answer
Date: 04/27/2023
Complaint: 19977863
I am rejecting this response because as of April 27, 2023, Ambetter Sunshine Health has not sent me the rewards I am due and owed as a result of all the health assessments I filled out in years 2022 and 2023. On April 26, 2023, I did receive a call from an Ambetter customer representative who informed me that they are investigating why I have never received the Rewards, however, no solution was offered to me. I still demand the delivery of my rewards from Ambetter Sunshine Health.Sincerely,
***************************Business Response
Date: 05/08/2023
May 8, 2023
Better Business Bureau
Attn: Dispute Resolution Department
*****************************************************************************
Re: ***************************
Complaint ID: ********
To Whom It May Concern:
Ambetter from Sunshine Health received your correspondence on 4/24/2023 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 ** at ************** (TDD/TTY **************).
Thank you,Customer Answer
Date: 05/09/2023
Complaint: 19977863
I am rejecting this response because as of this date, Ambetter has not provided me with an answer as to why I have not been given my Rewards card. ***********************, a representative from Ambetter has called me on May 4, 2023 at around 11:10 am EST, and indicated to me that she does not know why I have not received a Rewards card in the mail. She claims that a Rewards card was mailed to me in February of 2023, however, she has no proof of mailing and/or a tracking number for it. Also, she indicated that that card "mailed" shows as unactivated in their system. As I mentioned in my original complaint, I have never received any cards in the mail from Ambetter in the past two years. When I asked *********************** if it is possible for Ambetter to expedite the mailing of a new card (if one was indeed ever mailed), she added that their system does not allow her to do it so. I also asked *********************** about the status of my Rewards for year 2022 and she also had no answer for it. The call ended with no solution being offered by the representative. In conclusion, as of this date, I remain with no response or solutions from Ambetter.
Sincerely,
***************************Business Response
Date: 05/16/2023
May 16, 2023
Better Business Bureau
Attn: Dispute Resolution Department
*****************************************************************************
Re: ***************************
Complaint ID: ********
To Whom It May Concern:
Ambetter from Sunshine Health received your correspondence on 4/24/2023 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 ** at ************** (TDD/TTY **************).
Thank you,Customer Answer
Date: 05/17/2023
Complaint: 19977863
I am rejecting this response because the Business has not contacted me with a solution. I have not received a phone call, nor email or letter in the mail with a response.As I indicated in my previous responses to this Bureau, Ambetter has contacted me to say they acknowledge there is a problem within their company but offered no solution. I never received my rewards **** card in 2 years. Ambetter owes me money for the rewards assessments I have taken in the past two years but Ambetter refuses to pay me.
Ambetter is still not in compliance.
Sincerely,
***************************Initial Complaint
Date:04/11/2023
Type:Service or Repair IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- 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.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
Ambetter from Sunshine Health has published that our provider, ****************************************, MD is in their network of medical providers. We have many patients that chose Ambetter as their insurance because they wanted to maintain our provider as their primary care physician. I have personally called to speak to their credentialing department and they were not accessible by phone. I spoke to their customer service to confirm that our provider was in their network, and they confirmed it with me. We haven't contracted with Ambetter from Sunshine Health. We have even tried to bill Ambetter for visits for our Ambetter patients, and they were denied due to ****************************************, M.D. being out of network. Ambetter is falsely advertising our provider as being part of their network. I question what they stand to gain except, of course, additional patients on their ********* with no choice but to select another primary care physician that is in their network. I can provide complaints from patients if necessary. Please see the attached false advertisement on the Ambetter website taken today that says that ****************************************, MD is in network and is accepting new patients.Business Response
Date: 04/19/2023
April 19, 2023
Better Business Bureau
Attn: Dispute Resolution Department
*****************************************************************************
Re: **************************************
Complaint ID: ********
To Whom It May Concern:
Ambetter from Sunshine Health received your correspondence on 4/11/2023 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
Date:04/02/2023
Type:Delivery IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- 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.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
In September of 2020 I had a precancerous lump removed from my breast. I was told I would need to alternate between an MRI and Mammogram/ultrasound every 6 months for the remainder of my life.In January 2023 Ambetter became my insurance company. The only doctors I can go to under the plan are Centrum Health.In January of 2023 I saw ********************************* at Centrum Health as my primary care physician. He went over my history and ordered the required MRI for me. At Centrum Health any ****** must be faxed over from the referral department (even if a referral isn't needed). The referral department has gone over the doctors head and decided that I don't need an MRI so they are refusing to send over the order.That was 8 weeks ago. I am now 2 months passed my required MRI and am extremely concerned for my health.I have called Ambetter several times for help. The "help" consists of calling Centrum. Centrum then placates Ambetter and gives all kinds of reasons for the "mistake", and tells them they will send over the order. They don't. When I personally follow up with Centrum I am told that they WILL NOT send over the order that the doctor wrote, because the referral department says I don't need one. Nor will they release the doctors order to me.Finally I called Ambetter and filed and escalation. I was told if my grievance was deemed "justified" I would hear back the next day. Otherwise in 30 days I would receive a letter in the mail denying my escalation.I have not heard back. Every day that passes is a an increase risk to my life. I don't have any more time to waste.I need Ambettter to step in and have the doctors ****** released to them so that I can get the **** If the doctor ****** an MRI, and the insurance says it is covered, the "referral department" should not get to go over everyones head and make life and death decisions.Business Response
Date: 04/10/2023
April 10, 2023
Better Business Bureau
Attn: Dispute Resolution Department
*****************************************************************************
Re: *************************
Complaint ID: ********
To Whom It May Concern:
Ambetter from Sunshine Health received your correspondence on 4/2/2023 concerning (*************************, BBB Complaint Case 19886167).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 Answer
Date: 04/12/2023
Complaint: 19886167
I am rejecting this response because:
Sincerely,
*************************Ambetter has not contacted me directly and now in response to my complaint, Centrum health is not only refusing to send in the *** orders but refusing to refil my perscriptipons. I am trying to navigate to other pcp groups under Ambetter, they are not accepting new patients, ate far away, or have appointments months down the road. Entering month 5 past date of required ***. and my prescriptions will run out next week.
Initial Complaint
Date:03/31/2023
Type:Service or Repair IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- 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.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
During 2020, I was enrolled as an Ambetter member. In February, I received an email advising that a new EOB was available. Upon entering the portal, the Claims section advised that I could only see claims 24 months back. Upon reaching.As I may be responsible for related costs, it is both my right to access this and illogical to consider that an email would be sent advising to log in, and it would be inaccessible. This is an unconscionable business practice.After contacting the overseas customer support number and being transferred Tia supervisor, I was eventually connected with a U.S.-based rep who pulled up the attached claim.It looks like Ambetter clawed back some of the claim made for a visit to the *** Two additional notifications of new EOBs were provided at subsequent dates. Many calls yielded no results. The first agent to provide an EOB advised that I would ALSO get it in the mail. However, I never did.Ambetter staff member ****** refused to provide an extension or employee number, stating that this was the company policy. During prior calls to Ambetter this has member been the case. Eventually supervisor **********, provider her ID ******. Dans was *******. It was only after additional requests that she advised the first letter of her last name. This is terrible customer service.They can look up call reference number i98269604 and I-********. My member number is on the claim form.Business Response
Date: 04/10/2023
April 10, 2023
Better Business Bureau
Attn: Dispute Resolution Department
*****************************************************************************
Re: *************************
Complaint ID: ********
To Whom It May Concern:
Ambetter from Sunshine Health received your correspondence on 3/31/2023 concerning (*************************, BBB Complaint Case 19878470).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 Answer
Date: 04/13/2023
Complaint: 19878470
I am rejecting this response because:Similar complaints, with agencies in the medical field, have yielded results that reflected a more forthcoming attitude. While it is understandable that there is information that is confidential. The overall framework, and willingness to assist is easily presented in a manner that adheres to both HIPAA requirements, that and reasonable policies of any organization. BBB agents are experts in complaints and resolution, and I ask you to consider how some businesses prefer to not discuss this, within the eye of scrutiny of the BBB, so that they can be more manipulative and better impose policies designed to shield the company from any responsibility. If they truly take the position of so strictly protecting information of members of the public, then the scope of what is ethical and required should reflect that, when they are providing resolution to myr questions. Please forward them my response and post this so that others can be aware when they are making their selection of an insurance provider,
Sincerely,
*************************Initial Complaint
Date:03/17/2023
Type:Billing IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- 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.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
Ambetter from Sunshine Health is continuously spamming me about an account that I never made. It keeps saying I owe a payment of zero until after 1 year. It shows a policy number (********) and member ID ************* for an account I never made. They did this without my consent. Until I got the letters, I had never heard of the company. I called them to delete my account and ** still getting letters in the mail. These started last month.Business Response
Date: 03/29/2023
March 28, 2023
Better Business Bureau
Attn: Dispute Resolution Department
*****************************************************************************
Re: *********************************
Complaint ID: ********
To Whom It May Concern:
Ambetter from Sunshine Health received your correspondence on 3/18/2023 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
Date:03/15/2023
Type:Sales and Advertising IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- 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.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
Ever since September 2022 I could not get help to access my account on the insurance website. Tried repeatedly and in January called to cancel but the insurance took ******* out of account. I took 1 week to tell them I did not want their insurance. After 30 days ******* was in my account from them. I have tried repeatedly to have them tell me why they took ****** from me. No luck. I need to know why I had to paid almost $600 to them.Business Response
Date: 03/28/2023
March 28, 2023
Better Business Bureau
Attn: Dispute Resolution Department
*****************************************************************************
Re: ***************************
Complaint ID: ********
To Whom It May Concern:
Ambetter from Sunshine Health received your correspondence on 3/16/2023 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 Answer
Date: 03/29/2023
Complaint: 19601958
I am rejecting this response because: I am way too angry to talk to them. They send me document why they took $600 out my account and they know why address. They is all I need with you.
Sincerely,
***************************Business Response
Date: 04/11/2023
April 11, 2023
Better Business Bureau
Attn: Dispute Resolution Department
*****************************************************************************
Re: ***************************
Complaint ID: ********
To Whom It May Concern:
Ambetter from Sunshine Health received your correspondence on 3/16/2023 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
Date:03/15/2023
Type:Product IssuesStatus:ResolvedMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- 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.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
on 2/23/23 I enrolled in ambetter through the healthcare.gov. I made a payment of *****. On 2/26/23 I cancelled enrollment and went with another insurance. I was told by ambetter refund would be placed on my card in **** days. Called on 2/27/23 spoke with **** she confirmed refund was in progress. Called 3/7/23 spoke with **** he also said 7 to 10. 3/14/23 spoke with ***** she said ****** was processed on 2/27 ,informed her I have not received it. She insisted I had gotten it. Very rude and would not let me speak. at 8:40am on same day spoke with ***** she esculated to ******* and they would contact me in 24 hr. no call, called on 3/15 spoke with Algin same run around. I just want the money I paid back and no more lies Reference# from 3/14/23 I-******** and 3/15/23 ref# I-********Business Response
Date: 03/23/2023
March 23, 2023
Better Business Bureau
Attn: Dispute Resolution Department
*****************************************************************************
Re: ***************************
Complaint ID: ********
To Whom It May Concern:
Ambetter from Sunshine Health received your correspondence on 3/15/2023 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 Answer
Date: 03/29/2023
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.
Sincerely,
***************************Initial Complaint
Date:03/15/2023
Type:Service or Repair IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- 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.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
I could never get help with getting on their website since last August (2022). In January (2023) they took out $2100.00 out my account. I called immediately about this and it took 1 week to cancel this insurance. When they returned any money it was just *******. I have tried to get them to tell me why they took $600.00 out it returned but they won't tell me or send me a bill or anything.Business Response
Date: 03/29/2023
March 28, 2023
Better Business Bureau
Attn: Dispute Resolution Department
*****************************************************************************
Re: ***************************
Complaint ID: ********
To Whom It May Concern:
Ambetter from Sunshine Health received your correspondence on 3/16/2023 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,
Ambetter from Sunshine Health is NOT a BBB Accredited Business.
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