ComplaintsforAmbetter of Illinois

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Initial Complaint
07/02/2024
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.
On 03/01/2024 my daughter, *************************** was in rolled with Ambetter of Illinois. My daughter requires oral surgery under general anesthesia and hospital monitoring. ****** was scheduled for surgery with *** and ************************************************** in *******, **. I was told that she needed a referral because she was out of network. I was then told that she needed prior authorization. Extra information was given and I was told after arriving at to the hospital that the claim was still denied. I was then told that this claim would never be approved because the facility is out of network and they would never pay for this medically necessary procedure for oral extractions in the OR. My daughter had Autism, tachycardia and asthma which put her at risk when beeing sedated in a dental office. I was then told by ambetter that they would find a provider for her within the network. I received a call back that evening stating Ambetter did not have a provider for her within the network and that a Single Case Agreement could be made. I was then told that an appeal needed to be done for the authorization that was previously denied. My daughter has been in agony for several months an is in need for this procedure to be done. Please help me to get this matter resolved Urgently. Her next scheduled surgery date is 07/11/2024.
Business response
07/30/2024
Hello,
Please see attached response letter.
Thank you,
*********************************
Senior Manager, Compliance
Initial Complaint
05/09/2024
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.
Ambetter was my health insurance provider in the year of 2023.I had set to change my insurance effective January 1st of 2024.Due to illness ( Strep Throat ) I received lab testing accruing to the amount of $919 at ********************* urgent care of *********, ***They denied the hospital payment saying that my account was not active and that I was not an active account member due to not paying for the month of December as my date of lab service was on December 22, 2023.After researching what Ambetter meant, I reviewed the auto debit history through their website. Throughout the entire year their charges were inconsistent and were faulting from the terms and agreements that I had accepted when applying for auto debit.Rather than charging my card accurately on the agreed monthly payment date, They were making the transactions at random intervals.This lead me to also notice, not only were they not abiding by their terms and agreement to auto pay, They had been randomly refunding monthly payments in July, September, and October. some of these refunds were double the monthly cost and refunded instead of being charged. Ambetter then did charge the correct amount at the end of October, and then again on December 30th. My lab tests were on December 22nd. They have been trying to say I was no longer an active member as of November, yet continued charging my card after the month of November. This issue is entirely at their fault for software issues with their billing system. They will not resolve the issue with the hospital and have lied repeatedly to me over the phone. They asked for payment to resolve the one month delinquency which was caused by their payment system. I paid over the phone and was instructed to has the hospital bill them again when the payment appears on my bank statement. I did exactly that just to see they refunded that amount 3 days later with no explanation why and continue to refuse the billing claim to the hospital.
Business response
06/05/2024
Hello,
Please review the attached response letter.
Thank you,
*********************************
Senior Manager, Compliance
Initial Complaint
03/27/2024
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.
So the so the *** is rejecting my tax return because they sent in a form to have them reject my taxes remind you they're telling me that I do not have an account with them then when I give my social security number then they say well you do have an account with us or had an account but the account was canceled so why is the hole on my account so I'm expecting them to release my account from the *** that they have rejected my account because of them in fact I was told in 2020 that I had no account as well
Business response
04/10/2024
Hello,
Please see attached for a response.

Thank you,
*********************************
Senior Manager, Compliance
Customer response
04/12/2024

Complaint: ********

I am rejecting this response because:

Complaint number ******** concerning and better of Illinois which have 1095 a form on me but telling me that I do not have insurance with them or they have no record of any payment for the last following tax year or for any year of that matter call *************************** three times on the matter some type of district manager got no response now my taxes are being held up because they saying that I have a 1095 a form with them gave me a fake number to their billing department that does not respond at one while two years ago or 3 years ago they told me that I had to cancel online went online to cancel but it took me in a loop for counseling out their services so there was no way to cancel out the service and they telling me that it automatically renews every year by itself now I have to file taxes and cannot do so

Sincerely,

***************************
Business response
04/19/2024
Hello,
Please see attached letter.

Thank you,
*********************************
Senior Manager, Compliance
Initial Complaint
03/26/2024
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 got this insurance they said I qualified. Not even talk about my income or anything 12 bucks a month I assumed they knew my situation I qualified. Well I go get my taxes done now they say I owe 8grand I tried 2 drop them shortly after I got them and I keep getting bills and Im so in debt from Covid by 30k this insurance is a scam they should have told me was cost me a ton in taxes I would have never done it I have no clue what I paid thats fine its what I owe thats gonna kill me. Plz help!
Business response
04/01/2024
Hello,
Please see attached response letter.

Thank you,
*********************************
Senior Manager, Compliance
Initial Complaint
03/16/2024
Complaint Type:
Delivery 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 APPLIED FOR A HEALTH INSURANCE AND PAID THE ***** OF ***** UP FRONT AND YET TO HAVE RECIEVED ANYTHING FROM THE PROVIDER .******** I CALL I SEEM TO GET THE SAME ANSWER THAT I WOULD RECIEVE MY ID CARDS AND WELCOME PACKAGE IN SEVEN DAYSTO10 DAYS BUT THESE HAS TO COME
Business response
03/28/2024
Hello,
Please see attached response letter.

Thank you,
*********************************
Senior Manager, Compliance
Initial Complaint
02/11/2024
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 canceled my health insurance with Ambetter effective 12-31-2023. I confirmed 2x by calling that It was canceled, I called the market place to make sure they knew and I called Ambetter again to make sure I was taken off auto pay. Additionally, my online portal says its canceled. Today I received a letter with an insurance card and stating I have been charged a monthly payment and so has the government. This is unacceptable, and this is actually my 3 complaint about Ambetter.. even after I cancelled with them, they are still a problem in my life. I have proof of cancellation via letter, I want to be refunded, I want the government refunded so I dont get in trouble and I want confirmation of cancellation by being contacted directly by a supervisor.
Business response
02/21/2024
Hello,
Please see attached for the response letter.
Thank you,
*********************************
Senior Manager, Compliance
Initial Complaint
01/03/2024
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 health insurance thru market place in 2023. After receiving 1000's of unwanted calls. Since signing up I have received multiple calls from market place confusing me about my plan. It has changed 3 times before 1st of January. Only for me to find out that my coverage has canceled due "to a change". What changed in 2 mths? I was told the plans change yr to yr. Even tho when I signed ** in Nov 2023 and was told my insurance would go thry ****. I recieved ins. cards for ****. Now I'm uninsured and my phone will not stop ringing with the same reps with the same lieing deception they continually tell you and continue to call 20 times a day! I have asked not to be called by the insurance company are marketplace. I am on the national do not call list that these swaddling swine, disrespectful no cuth sales reps refuse to stop calling! Yes I want to file a complaint
Business response
01/25/2024
Hello,
Please see attached response letter.
Thank you,
*********************************
Senior Manager, Compliance
Initial Complaint
11/21/2023
Complaint Type:
Product Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
Seeking to obtain a refund of premiums ($553.04) for a deceased family member so that I can execute her estate. Originally contacted AmBetter of Illinois on April 29 (4 days after the family member's death) to cancel her policy, but her account was direct debited anyway on May 1 for that month's premium. Have made 9 calls to the company during the past 7 months, totaling over 3 hours of phone time with various representatives - each time having to explain the issue over and over again. Have been told everything from "a check has been mailed" to "the refund was transferred to her bank account", yet have received nothing. Here is the deceased family member's information ***************************** ************************************************************************************ Ambetter Policy ID: *********** Previous AmBetter customer service ticket numbers on this unresolved issue I-********* I-********* I-********* I-********* I-********* I-*********
Business response
12/06/2023
Hello,
Please see attached response.
Thank you,
*********************************
Senior Manager, Compliance
Customer response
12/09/2023

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
11/18/2023
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 am owed a refund from Ambetter of Illinois for over $6,000. I have made three formal recorded phone calls and been told repeatedly the check has been processed and mailed to me. It is now nearly 8 weeks since my original inquiry and not only has the check not been delivered, my policy was also cancelled. I am being defrauded plain and simple.
Business response
12/04/2023
Hello,
Please see the attached response.
Thank you,
*********************************
Senior Manager, Compliance
Customer response
12/08/2023

Complaint: 20889746

I am rejecting this response because:
The refund was not paid, the account was not reestablished, the FRACTION of the refund they claimed had "already been sent" has not been. Further legal action will be explored at this time.

Sincerely,

***********************
Business response
12/19/2023
Hello,
Please see attached response letter.
Thank you,
*********************************
Senior Manager, Compliance
Customer response
12/23/2023

Complaint: 20889746

I am rejecting this response because:
My account was set to auto-pay for my monthly premium. The "glitch" in the Ambetter system put in a $6,000 credit from which - UNBEKNOWN TO ME - was used to draw my auto-payments from. Ambetter seems to have no problem finding out that the credit was a glitch yet my account has been CANCELLED for "failure to pay premiums" which is as I have stated not possible since it was on auto-pay. So i am now without health insurance and unable to pay for my needed medications because Ambetter has cancelled my account because of THEIR ERROR.
This is an unbearable nightmare and I hope you never know the pain of being unable to afford life-saving medications because of a "computer glitch" no one will take responsibility for. Looking forward to a half-assed email from ****** using double speak as he tells me it's my fault I have no coverage. Merry Christmas, I bet yours is better than mine.
With extreme disappointment and illness,
***********************
Business response
01/05/2024
Hello,
Please see attached response letter.
Thank you,
*********************************
Senior Manager, Compliance
Initial Complaint
10/18/2023
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.
They owe me 50 dollar credit (!which they admit.) Been waiting two years after dozens of calls. Each time they say money will be sent soon.
Business response
11/01/2023
Hello,
Please see the attached response letter.
Thank you,
*********************************
Senior Manager, Compliance

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