ComplaintsforAmbetter from Sunshine Health

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Initial Complaint
05/03/2024
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
Extremely frustrated with Sunshine Health healthcare plans, both **************************** plans. Issues:1) The covered in-network provider lists are HORRIBLY out of date. As one example, there were 8 covered providers on their list, & I spent over an hour calling all of them just to find out 6 of them do NOT take Ambetter. One person said they hadn't taken it for years. I feel publishing these inaccurate/poorly maintained coverage lists is bordering on fraud, because they're used to market plans to people like me who then purchase health insurance, only to find out it was a bait & switch and far less providers are covered.2) I've had nearly a dozen different customer service agents in foreign call centers give out blatantly incorrect information, possibly lying. In my Ambetter plan, I was told by 2 agents that two unrelated procedures require pre-authorization, but learned from my Dr. they did not, wasting time, and in another example, an agent told me that they can't give me a list of covered x-ray/imaging providers, and I needed to get pre-authorization then contact a company they partner with first, *************************** ***** I believe, and they couldn't give me a provider unless I have a pre-auth tracking number. My Dr. told me this was backwards, that I needed a provider selected first. So I called *** and they told me the Sunshine agent was wrong, *** doesn't have provider lists. In another example on MMA for my kids, I called 5 different agents and 3 told me I needed a referral to see specialists for the services to be covered and 2 told me I did NOT. My Dr. 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 give false info. I also requested a member advocate which I never received.I asked how I can escalate/file complaints on these issues & was told only option to mail an appeals form, unrelated to my issues. And no way to talk to a manager.
Business response
05/07/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 5/3/2024 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
05/07/2024
Ambetter has said they will update my local provider lists, and escalate issues and feedback on the providers list and customer service to higher levels. I am hopeful improvements will get made.
Initial Complaint
04/30/2024
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 have been trying to get help from Ambetter in regards to my plan and coverage since March 19th. There is a major issue with a referral my doctor made that I was made to understand would be covered under my plan, but I am now being told I will have to pay OOP until my deductible is met, which is absurd. I would be cheaper for me to NOT have insurance at all. I have asked to be connected to someone in the management team and only ever get sent to "escalation" where they will NOT help or give me a direct line. This is the ONLY provider on the marketplace for *******, how is this not illegal? For a company who gets HUNDREDS of dollars from me every month, which means at least thousands, if not more, from all of the customers, there HAS to be a way to speak to a member of leadership, but no. When I do talk to the "escalation" team, they also will not connect and say they will "schedule a call back" but I am never called back by anyone who knows what they are talking about. I have spoken to at least 8 people at this point, 3 or 4 "escalation" members, and still have no resolution, help, or understanding as to how they can say I won't be covered, and now I can't get any help or any healthcare - even though I AM PAYING For it every month. I do not know how this is legal.
Business response
05/07/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 5/1/2024 concerning (******* Day, 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
04/29/2024
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.
Dear Ambetter (Florida Sunshine Health),I am writing to address a billing issue with my recent enrollment.On the *** website, I selected Ambetter (Florida Sunshine Health) for my family's health insurance coverage. I carefully reviewed the plans and paid the initial premium on April 10th, 2024, for coverage starting *** 1st, 2024.I recently received a bill that did not reflect my initial payment of $670.82. When I contacted customer service, I was informed that ********************** bills "a month in advance." I explained that receiving a bill for *** seems incorrect because my coverage doesn't begin until *** 1st. Additionally, if billing is truly done in advance, then the current bill would be for ***** not ***.The representative offered to file a grievance, but the situation seemed concerning. I don't feel like she had concern for my issue? It feels as though I am being billed twice for the same month (***).For your reference, I have attached a copy of the bill and the receipt for my initial payment, which is currently not reflected in your records. No critical information is contained in the documents, and you should have all you need regarding the account. My coverage begins on *** 1st, 2024, and I have already made the corresponding payment. Following this payment schedule, my next payment for ****** coverage would be due at the end of *** 2024. I did send an email to customer service and no one responded. I thought it would be best if I involved the Better Business Bureau as a matter of public record. I kindly request that you investigate this discrepancy and ensure my account accurately reflects the initial payment. Please confirm the corrected billing schedule to avoid any future confusion, and send a new bill with the correct billing period.Thank you for your time and attention to this matter.Sincerely,*************************
Business response
05/06/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 4/29/2024 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
04/25/2024
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 have met my deductible and max out of pocket for my insurance premium but this insurance company refuses to acknowledge that. They have made an error on their claim reporting and they have no applied multiple out of pocket payments that I have made to my actual out of pocket / deductible. I have tried to explain this to their employees / associates multiple times and none of them are able to assist me and are confused. I have asked to speak to a supervisor multiple times but the employees are trained to tell you that supervisor would give the same answer. What? How do they know what another person let alone their superior would say? That makes zero sense and when I ask to speak to the supervisor they always say none are available and they don't have a voicemail or an email that they are allowed to provide and I can't hold for one. Just to call back another time and ask and try to get one available. No matter what time I call or what day I call they tell me this same ridiculous response. This is a government backed health insurance program and I'm appalled they are allowed to run their health insurance company this way. I have attached screen shots of my claims that have been paid out and you can CLEARLY see there were payments of $6,845.55 that the accepted but didn't apply to my deductible. They have only applied one single payment of mine towards my deductible and it was on 03/01/2024 for $6,864.55. There are over $15,000 in other charges they have not applied to my deductible. Which maxes out at $9,500 so there is no reason I should have any remaining payments for healthcare except my monthly premium for the rest of the year. I need a supervisor to contact me from his company because I am unable to reach one through their phone support and they have no email or online chat support. I am not 2 months past due on my medication and it's a tier 3-4 drug and I'm in extreme pain and discomfort.
Business response
04/26/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 4/23/2024 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,
Customer response
04/27/2024

Complaint: 21624530

I am rejecting this response because: No one has resolved this matter for me. I was left a voicemail which I responded to within minutes and the associate was already in a meeting. I left a message with the customer service associate you initially answered the phone call. They didn't give me any option to leave a voicemail. I guess they only work via internal tickets for the customer relations rep to follow up with the client. I called back a couple more times throughout the day and was told the same thing she is still not available and they would send her a message to follow up with me.

There needs to be a better sense of urgency to resolve this. This is a medical issue for me not having my medication for almost 2 months now.

Sincerely,

*****************************
Business response
05/06/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 4/29/2024 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
04/25/2024
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 is my insurance company and they blatantly refuse to send me an insurance card. I don't know how this is considered fair or even legal but thats what they've told me, twice. My insurance company before this one had no problems sending me cards every year. But not SUNSHINE. I don't need health insurance but if I did I would definitely pick a different company.
Business response
04/26/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 4/23/2024 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
04/22/2024
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.
Ambetter has overcharged me on my 2023 Premium (took $329 for 13 months instead of for 12 months). I have made several phone calls asking for the return on the overcharge and all I get is the same run around with no resolution. I have made approx: 15 calls and have spent over 6 hours on the phone. Some member services say the amount was not sent back and others say it was sent on January 19, 2024 (they cannot keep to the same story). My online account with ********************** does say that $329 was returned but this has never reflected onto my bank account. I spoke to the bank and they confirm that there has never been an attempt to refund this money (they do see another attempt to take out another $329 on January 16, 2024 which would of been a 14th payment but the bank did not allow). I have offered proof to Ambetter that the money has not been returned by requesting to send them bank statements but they do not seem interested enough to give me fax and/or email information to send. This is considered theft. I want this money back NOW!!!! It was taken from me on December 19, 2023 and this situation has been going on for way too long.
Business response
04/26/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 4/23/2024 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,
Customer response
04/29/2024

Complaint: 21610671

I am rejecting this response because:
I tired for a few months calling & speaking directly with Ambetter, accumulative I spent over 6 hours of phone calls only to receive the run around & each person I spoke would only offer to do the same thing which did absolutely nothing. I do not have a problem with speaking directly with Ambetter but I did my due diligence and beyond trying to do that with no results. The documents I attached clearly shows that $329 was taken from my bank account unauthorized & my documents show that I was over charged. I want this resolved immediately & the only acceptable outcome is the return of the $329 that was stolen. No more run arounds. Until the money is sent back to me I will not request that this case be closed.
Sincerely,

*************************
Business response
05/07/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 4/30/2024 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
05/07/2024

Complaint: 21610671

I am rejecting this response because: Ambetter is suggesting more run around as they did when I contacted them to resolve this previously. I understand and accept the fact that they can only speak to me directly regarding any personal information but even their contact information that they are providing in these communications through the BBB are the same phone numbers that I called and was constantly put through a loop every single time. As the documents I submitted PROVES Ambetter took out $329 unauthorized and have not returned it into my bank account. That is and will be the only resolution to this matter and i expect MY MONEY to be returned immediately. Ambetter may contact me if need be but with only a resolution no more run around, soon as I see that happening again I will hang up that phone call.

Sincerely,

*************************
Initial Complaint
04/22/2024
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.
Past few months I have been receiving billing statements from Ambetter Health for a Health Plan that I DID NOT SIGN UP FOR. I believe that I was a victim of identity theft and someone else used my information to sign up for this plan. I am being billed for $933 a month for something I DIDN'T SIGN FOR OR HAVE A REASON TO DO SO. I am a 100% rated Disabled Veteran FULLY COVERED BY THE VETERANS AFFAIRS HEALTH PLAN. According to their billing statement I "owe them" $1866 for two months. I do NOT believe it is fair to send a person a billing statement for SOMETHING THEY NEVER SIGN UP FOR (and have NO reason to).Prior to receiving these billing statements, I have NEVER RECEIVED ANYTHING ELSE FROM AMBETTER HEALTH. I have NEVER used this Ambetter Health Plan in any situation, due to the fact that I DIDN'T SIGN UP FOR THE PLAN AND NEVER RECEIVED ANYTHING.
Business response
04/25/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 4/23/2024 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
04/16/2024
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.
Ambetter denied a claim that they previously approved last year. The claimed I had a different silver plan . I was unaware when I signed up that there was more than one silver plan and that this **************** is applied to our deductible only even though hes in network.
Business response
04/17/2024
Better Business Bureau
Attn: Dispute Resolution Department
*****************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 4/17/2024 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
04/17/2024

Complaint: 21582683

I am rejecting this response because:

Sincerely,

***********************
Business response
04/19/2024
Better Business Bureau
Attn: Dispute Resolution Department
*****************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 4/18/2024 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
04/19/2024

Complaint: 21582683

I am rejecting this response because:

Sincerely,

***********************
Initial Complaint
04/11/2024
Complaint Type:
Order Issues
Status:
Unresolved
The business responded to the dispute but failed to make a good faith effort to resolve it.
Please see the attached/uploaded Word document that includes all of the details of my complaint. I did not include these details here because it will surpass the character limits set forth of 2000 characters..
Business response
04/12/2024
April 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 4/12/2024 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,
Customer response
04/17/2024
Complaint: 21564938

I am rejecting this response because:

According to Ambetter from Sunshine Health's response, "Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information.":
My feedback: This complaint has nothing to do with my "health information" that I understand is protected under federal and state privacy and confidentiality regulations. Instead, it has everything to do with FRAUD and charging a customer unknowingly by withdrawing funds from his personal bank account WITHOUT his consent.

According to Ambetter from Sunshine Health's response, " We will respond directly to the consumer.":
My feedback: Ambetter from Sunshine Health has NOT responded directly to me, the consumer, as of 17 April 2024.

Sincerely,
************************;
Business response
04/19/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 4/18/2024 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
04/26/2024

Complaint: 21564938

I am rejecting this response because:
To allow the BBB to help further in resolving my complaint with Ambetter from Sunshine Health, I have attached here a completed and signed HIPAA Release Form.
Also, I did receive a call earlier this week from ******* (Ambetter's Member Advocate Team) and I re-explained the reason of my complaint, but I have yet to see any corrective actions on their part, let alone a simple follow up call to provide an update.
Thank you.
Sincerely,
*************************
Business response
05/06/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 4/12/2024 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,
Customer response
05/21/2024
Complaint: 21564938

I am completely rejecting the last response because:

According to Ambetter from Sunshine Health's response, "Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information.":
My feedback: This complaint has nothing to do with my "health information" that I understand is protected under federal and state privacy and confidentiality regulations. Instead, it has everything to do with FRAUD and charging a customer unknowingly by withdrawing funds from his personal bank account WITHOUT his consent. In addition, I have submitted here a signed HIPAA Form allowing permissions to discuss my personal information in an effort to help resolve this complaint.
According to Ambetter from Sunshine Health's response, " We will respond directly to the consumer.":
My feedback: Ambetter from Sunshine Health has NOT responded directly back to me (after their initial contact), the consumer, as of 21 May 2024.

Sincerely,
************************;
Business response
05/22/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 5/21/2024 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
05/28/2024

Complaint: 21564938

I am rejecting this response because:
The issue reported in this complaint has not been resolved by Ambetter from Sunshine Health as of yet. However, ******* from their Member Advocate Team, did reach out last week and after several call attempts between us, we finally talked on Friday, May 24th. She requested that I provide Ambetter a copy of my bank account ************************ showing their "fraudulent" charge so I have attached a copy of my September 2023 bank account ************************ to this update.
And to reiterate;
According to Ambetter from Sunshine Health's response, "Due to federal and state privacy and confidentiality regulations, we are unable to disclose any personally identifiable information or protected health information.":
My feedback: This complaint has nothing to do with my "health information" that I understand is protected under federal and state privacy and confidentiality regulations. Instead, it has everything to do with FRAUD and charging a customer unknowingly by withdrawing funds from his personal bank account WITHOUT his consent.
According to Ambetter from Sunshine Health's response, " We will respond directly to the consumer.":
My feedback: Ambetter from Sunshine Health reached out last week and I am hoping this complaint will be resolved soon.
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
04/09/2024
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.
We canceled our insurance policy with Ambetter through healthcare marketplace effective 1/1/2024. They charger us over $1188.09 And after several phone calls and promises to return our money they still refuse to pay our money back. We spoke Hiro on 4/9/24, ***** prior to that both in escalation department. Most recently Interaction # I-*********. They keep 10 business days since January 2024! They are also stating that they are still primary insurance provider for my family and making it difficult for me to get medical care necessary for my life. I need help getting my money back and for them to send a written letter stating they are NOT my insurance provider effective January 1, 2024
Business response
04/12/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 4/10/2024 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
04/12/2024

Complaint: 21552990

I am rejecting this response because: As of today they still have not reached out to me nor did they provide any contact information on who will be addressing my issue, how they will be addressing my concerns, when they will be contacting us and providing a vague response to our request for refund!

Sincerely,

*****************************
Business response
04/18/2024
Better Business Bureau
Attn: Dispute Resolution Department
************************************************************************************************

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

To Whom It May Concern:

Ambetter from Sunshine Health received your correspondence on 4/17/2024 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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