ComplaintsforAmbetter from Sunshine Health

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Initial Complaint
11/11/2022
Complaint Type:
Product Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
In September of last year, I bought health insurance with Ambetter for Sunchine Helth. I was receiving a tax credit from the government to help me pay the insurance for $420 a month, and the insurance was also charging me $420 a month to my bank account. They were charging me double in March of this year. They sent me a letter that my insurance was canceled due to underpayment. A month before I went to some laboratories and I came out HIVpositive and after a few weeks they canceled me, they did not pay the laboratories or other claims that I had. Ambeetter own me more thaf 20000$ be charge to my bank account
Business response
11/14/2022
November 14, 2022

Better Business Bureau
Attn: Dispute Resolution Department
4411 ****************************************************************** 33407

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 11/11/2022 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 respond directly to the consumer.

If you have questions, please call us at ************** (TDD/TTY **************).
Thank you,
Customer response
11/16/2022

Complaint: 18390288

I am rejecting this response because:

Sincerely,

***************************
Customer response
11/18/2022
***Consumer Response***
***See Attachment***
Business response
11/23/2022
November 23, 2022

Better Business Bureau
Attn: Dispute Resolution Department
4411 ****************************************************************** 33407

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 11/11/2022 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 respond directly to the consumer.

If you have questions, please call us at ************** (TDD/TTY **************).
Thank you,
Customer response
11/29/2022

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. And i want to know when ambetter going to pay me the 20000$ the get from my account with out my permiso and dont cover my hiv treatment o bilss.

Sincerely,

***************************
Initial Complaint
10/28/2022
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 have been dealing with an invoice issue with Ambetter for the past 2 months. My July invoice was charged correctly. In August, I was supposed to be charged $34.80 but was instead charged $195.31. After this charge I called member services and spoke with someone on the phone. They said they would move the claim to higher *** and open an investigation. It has been a month since then with no correspondence. I just checked my invoice for September. It says I owe $0.00 but that they are going to bill me $145.10 on 9/20. They are closed for the weekend so I cannot call them back to complain until Monday. This is absolutely ridiculous. They owe me almost $200. They keep charging a copay for my prescription (that I confirmed with them was 100% covered) and then not updating the claim page on my account so it looks like there have been zero claims. This company is a fraud.
Business response
11/02/2022
November 2, 2022

Better Business Bureau
Attn: Dispute Resolution Department
4411 ****************************************************************** 33407

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 10/31/2022 concerning (***********************, BBB Complaint Case 18039404).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
10/24/2022
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.
September 5th 2022 is when I made my initial phone call to Ambertter of Sunshine Heath ******** service in regards to a rewards card with the value of $200 that I had redeemed. That day I was told a request would be put in to have a new card issued to me because it was closed (no reason explained why). Since that Phone call I called back 3 times to follow up. i was provided with the same response a request is being put in to the back offices to have the card reopened. On 10/17/22 I received a voicemail from a women (no name) stating that she would like to speak with me in regards to the card being shipped to me. She requested that I call back to the phone number **********************, with reference # S-********* . I called the number several times and put in this extension and the phone call just hangs up. On 10/20/22 I called the phone number, but did not put in the extension; I spoke to a gentlemen who said that this women says she put in a request (just like the last 2) , but he will put in a request as well, and to call back the next day to follow up. I gave it a few days and followed up on 10/24/22 where I spoke to 3 different people who sent me to 3 different automictic line, until finally speaking to another gentlemen who would take my reference number and help me. He told me that none of the people I spoke to put in and request, and that he will put in the request. I requested to speak to someone who can actually looks at these request. he informed me there is no person to talk to, and that the card is closed and honestly I will never have accesses to these funds. He said he will put in the request and then the phone hung up.
Business response
10/31/2022
October 31, 2022

Better Business Bureau
Attn: Dispute Resolution Department
4411 ****************************************************************** 33407

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 10/24/2022 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 respond directly to the consumer.

If you have questions, please call us at ************** (TDD/TTY **************).
Thank you,
Initial Complaint
08/29/2022
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.
"unknown reasons" my a** Everyone is dropping you, including service providers. I'll be doing the same the first chance I get.
Business response
08/30/2022
August 30, 2022

Better Business Bureau
Attn: Dispute Resolution Department
4411 ****************************************************************** 33407

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 3/23/2022 concerning (*************************, BBB Complaint Case 17793897).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
08/30/2022

Complaint: 17793897

I am rejecting this response because: Ambetter stated that they cannot respond here due to federal law. This is not true because my complaint does involve any personally identifiable information. The business is simply attempting to avoid accountability by saying that they cannot respond on a public forum. The business should note that I will not be responding to any phone calls, text messages, or emails outside of this platform.

Sincerely,

*************************
Business response
08/31/2022
August 31, 2022

Better Business Bureau
Attn: Dispute Resolution Department
4411 ****************************************************************** 33407

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 8/31/2022 concerning (*************************, BBB Complaint Case 17793897).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 consumer have questions, please call us at ************** (TDD/TTY **************).
Thank you,
Customer response
09/01/2022

Complaint: 17793897

I am rejecting this response because:
The response doesnt require any personally identifiable information. There is no violation of privacy laws by responding here. I have not received an adequate response directly from Ambetter.

Sincerely,

*************************
Business response
09/06/2022
September 6, 2022

Better Business Bureau
Attn: Dispute Resolution Department
4411 ****************************************************************** 33407

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 8/29/2022 concerning (*************************, BBB Complaint Case 17793897).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
09/06/2022

Complaint: 17793897

I am rejecting this response because:
Ambetter has not yet attempted to reach me by email as requested.
Sincerely,

*************************
Business response
09/06/2022
September 6, 2022

Better Business Bureau
Attn: Dispute Resolution Department
4411 ****************************************************************** 33407

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 8/29/2022 concerning (*************************, BBB Complaint Case 17793897).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
09/07/2022

Complaint: 17793897

I am rejecting this response because:
I have not yet been contacted by Ambetter directly by email.

Sincerely,

*************************
Business response
09/07/2022
September 7, 2022

Better Business Bureau
Attn: Dispute Resolution Department
4411 ****************************************************************** 33407

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 8/29/2022 concerning (*************************, BBB Complaint Case 17793897).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
09/08/2022

Complaint: 17793897

I am rejecting this response because:
I still have not received any direct communication from Ambetter via email as was requested.

Sincerely,

*************************
Business response
09/09/2022
September 9, 2022

Better Business Bureau
Attn: Dispute Resolution Department
4411 ****************************************************************** 33407

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 8/29/2022 concerning (*************************, BBB Complaint Case 17793897).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
09/12/2022

Complaint: 17793897

I am rejecting this response because:
Ambetter still has not responded to me directly by email.

Sincerely,

*************************
Business response
10/04/2022
October 4, 2022

Better Business Bureau
Attn: Dispute Resolution Department
4411 ****************************************************************** 33407

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 8/30/2022 concerning (*************************, BBB Complaint Case 17793897).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
10/05/2022

Complaint: 17793897

I am rejecting this response because:
Once again,
Ambetter has not personally responded to me as they said they would do.

Sincerely,

*************************
Business response
10/10/2022
October 10, 2022

Better Business Bureau
Attn: Dispute Resolution Department
4411 ****************************************************************** 33407

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 8/30/2022 concerning (*************************, BBB Complaint Case 17793897).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
10/11/2022

Complaint: 17793897

I am rejecting this response because:
As this is probably the 10th time I have given this response, let me say it again:
AMBETTER HAS NOT MADE ANY ATTEMPT TO CONTACT ME.

FUCK OFF,

*************************
Business response
10/20/2022
October 20, 2022

Better Business Bureau
Attn: Dispute Resolution Department
4411 ****************************************************************** 33407

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 8/30/2022 concerning (*************************, BBB Complaint Case 17793897).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
10/21/2022

Complaint: 17793897

I am rejecting this response because:
Once again, Ambetter did not do anything that they said they did / were going to do.

Sincerely,

*************************
Business response
10/21/2022
October 21, 2022

Better Business Bureau
Attn: Dispute Resolution Department
4411 ****************************************************************** 33407

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 8/30/2022 concerning (*************************, BBB Complaint Case 17793897).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
10/24/2022

Complaint: 17793897

I am rejecting this response because:
My answer is the same as it has always been. Ambetter has not contacted me about this yet.

Sincerely,

*************************
Customer response
10/24/2022

Complaint: 17793897

I am rejecting this response because:

I wish Ambetter was as responsive to their customers actual healthcare needs as they are to replying with these BS copy and paste responses.
Sincerely,

*************************
Initial Complaint
11/08/2021
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.
AmBetter health insurance has been awful when it comes to my mother's care. My mother had surgery on November 2nd for a knee replacement. The hospital (Holy Cross) sent over all of the information necessary to AmBetter for them to provide me with home care. They informed me that on November 3rd someone would be coming in and calling from our insurance to provide us with home care so that my mother can shower, do her PT, change bandages, and receive her medication ( one is an injection in her stomach). On November 3rd, nobody came, no calls were received, and I ended up on urgent care with my mother so that they could provide her with her blood thinning shot and change her bandage. After multiple calls to Holy Cross - Orthopedic Department- I was informed there was nothing they can do as they had sent over the paperwork around 3 times. AmBetter denied receiving any paper work for about 3 days. Eventually, through Holy Cross' social worker Zita, her liaison with AmBetter said that the paperwork was indeed approved. I had to re-call AmBetter said it would take over a week to simply process the paperwork, when my mother was coming home November 2nd from her surgery and needed home care the next day (Nov 3rd). AmBetter claimed that they only received standard care paperwork and therefore we would need to wait 15 days because the hospital did not claim the paperwork to be of urgency. My mother had to call 911 on November 2nd, was taken to urgent care at MD Now on November 3rd, and ended up at the ER on Mount Sinai on November 5th. Along with this, my mother has not been allowed to shower for 5 days because the hospital refuses to allow her to shower until home care is here. AmBetter has increased our stress and therefore delayed my mother's ability to recover after surgery due to their inability to provide the necessary care. Along with this, they have put her at an increased risk for medical complications and have made decisions that are detrimental to her health.
Initial Complaint
10/29/2021
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.
Am better insurance has denied or partially paid almost all claims. For well visits for my children they did not cover them, when ALL insurance is supposed to cover well visits. When trying to call, no one knows what is supposed to be done and one operator tried to argue saying a well visit is not covered; even though it clearly states well visits ARE covered as part of the plan we had! They lie about coverage and we had to pay out of pocket for expenses that SHOULD have been covered. They should be charged with false advertisement of their benefits; falsely denying claims; overcharging customers; and should ultimately lose their license to supply insurance. I'd love to join a class action lawsuit against them for the money we had to pay out of pocket that they should have paid but did not!
Initial Complaint
10/21/2021
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.
After waiting over 3 month for Ambetter to cover my knee MRI finally went in and got it done had to pay my deductible which was $175 and which finally has me meet my yearly deductible paid this and this service was done on Sept 16th Medical Claim #U264MPEXXXXX #U264MPEXXXXX But since sept 16 this deductible that was paid is still not showing now after weeks I finally get an appointment for therapy and the place tells me I have a **** deductible that has not been met because of course Ambetter has not updated this and Ambetter say they have to send it in for further investigation in the accumulator dept and it will take up to 30 days now I have to miss my appointment and keep waiting and continue with pain until they decide to update this or the other option is to pay the 175 and get it reimbursed which I'm sure will take months like everything else they do and when you speak to their agents they hang up on you or just go round in circle this company is a mess and agent need training
Initial Complaint
10/16/2021
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.
Ambetter insurance has not paid for 40 health insurance claims. They claim that I had another insurance active, which I did not. Over the course of the last 5 months, I have tried to contact them to re-process my claims and they always say that I need to wait 30 days for them to process, which never ends up happening. They owe my health care providers over $50,000 that they refuse to pay, causing my health care providers to send me collection notices.

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