Complaints

• Initial Complaint

  02/03/2025

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I am just trying to get a ************ Provider and the information that Ambetter of Illinois keeps giving me is incorrect, does not take Ambetter of Illinois or the doctor does not exist. I have called 5 times trying to get accurate information from them, and each time I was assured that they took Ambetter of Illinois, just to be more false information. Now I am waiting for them to call me back with a doctor they have called themselves and confirmed takes their insurance, while I go down their emailed listed of doctors trying to find one.

  

  Business response

  02/11/2025

  Hello,

  Please see attached response letter.

   

  Thank you,

  ******** ********

  Senior Manager, Compliance

• Initial Complaint

  11/12/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I was/am insured with Ambetter of Illinois for about two years. I called their customer support line a few weeks ago in order to cancel as I had secured coverage with another carrier after starting a new job. The service ***resentative refused to cancel my insurance and stop autopay unless I provided him my full credit card number and CVV code. I refused to provide that information because it's not safe and nobody needs the full credit card number in order to stop autopay. I eventually got the *** to move on and he said he'd cancel my insurance, and then I just now received another monthly statement like a month later indicating that I'm still being charged and my insurance is still active. I think they still haven't cancelled my account despite my request and my new insurance. 

  

  Business response

  11/19/2024

  Hello,

   

  Please see attached response letter.

   

  Thank you,

  ******** ********

  Senior Manager, Compliance

• Initial Complaint

  11/09/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I was referred to this website by the marketplace in Illinois. I purchased insurance with them and they denied a PET scan. They asked my doctor to do a prior auth. He had to do a peer to peer consult for the prior authorization. It was denied. They sent me a letter saying I could appeal, and it was denied because I had to have cat scans first. I had plenty of records showing I already did the cat scans. I called three times and followed the directions on the letter to request an appeal. I was passed off to the imaging place the first time and the imaging place man told me that he told the insurance agent I could not file an appeal with the imaging place. The agent named **** transferred me to the imaging place anyway. I called back. Spoke to *****. I told him what happened and that I need to file an appeal. I read him the letter that Ambetter sent me. He told me the doctor needed to do the prior auth. I again explained my doctor did that already and Im callling to file an appeal. He would not let me and the call ended. I called back a third time and asked for a supervisor. I explained what happened. I again, third time, stated I needed to file an appeal, and an urgent appeal that, according to the letter, should have been decided in 48 hours. She told me I owed a past due balance. I didn't. I pointed out 3 times my premium was paid in full every month, and told her I was paid up until the end of November. So since that didn't work, she filed the appeal. I never heard anything from them, and was not granted the appeal and 48 hours has now passed. My doctor does not want to deal with this company, and pointed out it should never take this long and this much to get a PET scan approved. My labs show cancer. I've done the cat scans that *** requested be done in order to grant the approval for the PET scan. I asked several times to be able to submit the proof that the cat scans were already done. I was not allowed to do so. This is my life. This is death.

  

  Business response

  12/09/2024

  Hello,

  Please see attached response letter.

   

  Thank you,

  ******** ********

  Senior Manager, Compliance

• Initial Complaint

  08/20/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I had contacted the Ambetter customer service agents on July 25th to cancel health insurance. I was informed I would receive a letter in 5 to 10 business days. That never came and they have charged me again. I now have another month they want to charge me for and I attempted to dispute as they have the call on record. I was told that they had handled it, I just want to not have to pay for something I was told was canceled. They even verified on 8/16 over the phone that I had a cancelation request on July 25th.

  

  Business response

  10/15/2024

  Hello,

   

  Please see attached response letter.

   

  Thank you,

  ******** ********

  Senior Manager, Compliance

• Initial Complaint

  07/02/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  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

  More info

  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

  More info

  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

  More info

  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

  More info

  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

  More info

  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

*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. ↩