Complaints

The 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:01/03/2024

  Type:Service or Repair Issues
  Status:

  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 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

  Date: 01/25/2024

  Hello,

  Please see attached response letter.

  Thank you,

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

  Senior Manager, Compliance

• Initial Complaint

  Date:11/21/2023

  Type:Product Issues
  Status:

  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.

  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

  Date: 12/06/2023

  Hello,

  Please see attached response.

  Thank you,

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

  Senior Manager, Compliance

  Customer Answer

  Date: 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

  Date:11/18/2023

  Type:Service or Repair Issues
  Status:

  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 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

  Date: 12/04/2023

  Hello,

  Please see the attached response.

  Thank you,

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

  Senior Manager, Compliance

  Customer Answer

  Date: 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

  Date: 12/19/2023

  Hello,

  Please see attached response letter.

  Thank you,

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

  Senior Manager, Compliance

  Customer Answer

  Date: 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

  Date: 01/05/2024

  Hello,

  Please see attached response letter.

  Thank you,

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

  Senior Manager, Compliance

• Initial Complaint

  Date:10/18/2023

  Type:Product Issues
  Status:

  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.

  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

  Date: 11/01/2023

  Hello,

  Please see the attached response letter.

  Thank you,

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

  Senior Manager, Compliance

• Initial Complaint

  Date:08/03/2023

  Type:Product Issues
  Status:

  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.

  my ID is ********* for this company I have called 6 times since April and have spent countless hours with this company trying to get my money back after paying my premium and having my coverage cancelled after payment was taken out of my account.each time I called I was assured the problem would be fixed and I would recieve a call back telling me the issue was corrected but of course no one has ever called me.the last time I called we did a 3 way call with the marketplace and was told I would recieve a refund in 30 days. I was given a reference of S-********* and I was told the billing department would be contacted and a refund of $350.26 would be issued.

  

  Business Response

  Date: 08/07/2023

  Hello,

  Please see attached response letter.

  Thank you,

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

  Senior Manager, Compliance

  Customer Answer

  Date: 08/10/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********,  I have contacted a gentleman at their headquarters as requested and I am supposed to receive a response by 8/15/23
  
  Sincerely,
  
  *************************************

• Initial Complaint

  Date:05/30/2023

  Type:Service or Repair Issues
  Status:

  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.

  For the past 1.5 years Ambetter has put every barrier possible to my fertility care. They have no in-network providers, they took 5 months to complete a single case agreement, they still deny claims included on the single case agreement. Additionally, Ambetter denied medication for IVF that is on my plan. In Illinois it is unlawful for Ambetter to not provide this care, but they get away with it by putting up these barriers. I have had to fight relentlessly for fertility care. Right now they are denying two medications:Progesterone in oil and Estradiol patches. I previously worked with a liaison named ******* who was very helpful but my case was passed to **** and now Im getting misinformation and the run around. Regarding the patches I was given 8 to cover a month, but my doctor wants me to have 60 a month. I was told by the liaison L that my provider needed to do a peer to peer to peer review to try and get the dose amount requested covered, but when they called to schedule they were told that wasnt an option and told to go a completely different route that we have already tried.Regarding the progesterone in oil, my provider was told by liaison L to fill out a form, but that was the wrong form. After finding the right form and providing more information it was still denied stating I need try the progesterone pill but I was already prescribed 2 different progesterone pills, I am supposed to take all 3 forms of progesterone. There is no try this first and see because I only have one chance as Ambetter said they only cover one IVF cycle.To resolve this I need all the proper doses of medication covered. I need Ambetter to cover all the claims as laid out in my single case agreement. I need a rep that is as knowledgeable as liaison V, or I need liaison V back on my case. I have spoken to a lawyer and also plan on taking action with the Illinois department of insurance. Please fix this before it gets that far -**** member ID ************

  

  Business Response

  Date: 06/06/2023

  Hello,

  Please see the attached response letter.

  Thank you,

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

  Senior Manager, Compliance

  Customer Answer

  Date: 06/12/2023

   
  Complaint: 20118171
  
  I am rejecting this response because: I still do not have approval for progesterone in Oil or Estradiol patches.

  Additionally, new codes need to be added to my single case agreement. As of right not they are pending waiting for approval from a medical professional at Ambetter. My procedure for the embryo transfer is Thursday. I have done the trigger shot and started hormones(both of which I paid of out pocket for so I could start) There is no turning back if I dont get the embryo transfer Thursday, I would have to start completely over and lose the money I have paid out of pocket for meds and my body would be completely thrown off. 
  

  Please expedite the approvals of the codes for the procedure on June 15th 2023 and please work on getting me the meds I need moving forward.

  IVF is a complex process that needs codes added frequently and also needs to be completed on a strict timeline with a womens menstrual cycle and hormones. Ambetter needs to do better, they choose not to have any in network providers, so they need to work faster for single case agreements and codes added. PERIOD 

  Sincerely,

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

  

  Business Response

  Date: 06/29/2023

  Hello,

  Please see attached response letter.

  Thank you,

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

  Senior Manager, Compliance

• Initial Complaint

  Date:05/01/2023

  Type:Service or Repair Issues
  Status:

  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.

  My Marketplace Insurance Provider, AmBetter is denying all the claims that pertain to my wife's pregnancy. She has a legal right to and a medical necessity to be observed by the ***** office twice a week. AmBetter denies claims dated 4/17/23 for *******************, 4/26/23 for ***********************, 04/21/23 for ********** ****.All claims are valid and have to be covered under my plan under preventive care with my plan. My wife is 39 and is due on 5/26/23 for a baby to be born. Why is my plan not covering these claims?They keep denying these claims illegally.

  

  Business Response

  Date: 05/16/2023

  Hello,

  Please see attached response letter.

   

  Thank you,

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

  Senior Manager, Compliance

  Customer Answer

  Date: 05/17/2023

   
  Complaint: 20003124
  
  I am rejecting this response because: The company violated the federal law by dropping our insurance mid-pregnancy. I intend on pursuing this further
  
  Sincerely,
  
  *********************************************

• Initial Complaint

  Date:04/22/2023

  Type:Service or Repair Issues
  Status:

  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.

  My insurance is unusable. Last year I tried finding a pediatric urologist for my son who has kidney issues. Every doctor listed on their website does not take Ambetter. I called multiple times and filed multiple reports from them. They either hang up on me or tell me they will find a doctor and call back. They never did. That was like 9 months ago. I recently called to find a dermatologist for myself and the same problem occurred. No doctor on their list takes Ambetter. Some doctors they list dont even perform the duty I need. I feel like no business takes that insurance and they just put random doctors on the website. Then when I call for help and to complain they keep me on the line for two hours and hang up on me when they cant help me and get frustrated. I thankfully was able to put my son on another insurance and find a doctor. If I hadnt then my son STILL would have not seen a doctor about his kidney issue. That is unacceptable and can be criminal. What if his issue worsened and he became ill? What do I pay for insurance for only to not be able to find a doctor? I still need a doctor for my self but do not know what to do. Im assuming there are multiple complaints about this company. I dont know what else to do.

  

  Business Response

  Date: 05/01/2023

  Hello,

  Please see attached response letter.

   

  Thank you,

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

  Senior Manager, Compliance

• Initial Complaint

  Date:04/17/2023

  Type:Billing Issues
  Status:

  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.

  On February 15th 2023, I paid my march premium of 458 dollars for Ambetter. Ambetter claims this payment was refunded to me or "voided" on February 21st, 2023. I never received a refund from my credit card. They then charged me 917 dollars (double my premium) in March due to the "voided" payment, which I paid in full with autopay on march 25th. Therefore, I have paid my March premium twice. After numerous phone calls and a three-way conference call with Ambetter and my credit card company, in which ambetter explained the Feb 15th charge was voided, ******** confirmed that I never received a refund. Citibank therefore gave me a conditional credit for the February 15th payment after I disputed the charge (see march credit card statement). Ambetter is now citing a "chargeback" on march 18th (a SECOND refund) and is yet again, claiming I owe 917 dollars for this premium and next month's premium. Ambetter has suspended my insurance until I pay. Ambetter also suspended my insurance last month too despite paying my premiums on time, every time. Despite hours of phone calls and requesting audits, this has not been resolved. I have attempted to escalate multiple times. About half of my calls are dropped with no callback or sent to Marketplace, which cannot resolve my issue. See all credit card statements attached.

  

  Business Response

  Date: 04/24/2023

  Hello,

   

  Please see attached response letter.

   

  Thank you,

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

  Senior Manager, Compliance

• Initial Complaint

  Date:03/28/2023

  Type:Customer Service Issues
  Status:

  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 started coverage with AmBetter effective 1/1/2022 and have been dissatisfied of the service received from this company. This would be the first and last time obtaining coverage through AmBetter and Marketplace. They never updated my name and they never cancelled when I had initially cancelled October 2022. I requested this multiple times with AmBetter and Marketplace yet every time I called in they always stated there was no notes on this. And then when they stated they were going to escalate the concern and then I would receive a call back from someone I never did. This is very disappointing especially since I was penalized due to improper paperwork showing I had coverage for the full year. Plus I continue receiving letters of non payment as well and I do not understand why if I cancelled back in October of 2022.

  

  Business Response

  Date: 04/06/2023

  Hello,

   

  Please see attached response.

   

  Thank you,

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

  Senior Manager, Compliance

  Customer Answer

  Date: 04/07/2023

   
  Complaint: 19862883
  
  I am rejecting this response because the message or attachments cannot be open. It does not load anything. 
  
  Sincerely,
  
  ***********************

  

  Business Response

  Date: 04/25/2023

  Better Business Bureau of ******* & Northern Illinois
  ********************************
  Ste 2000
  *******, ** 60601

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

  
  To Whom It May Concern,
  Ambetter of Illinois received your grievance concerning ***********************, BBB Complaint Case # ********. Due to federal and state privacy and confidentially regulations, we are unable to disclose any protected health information, including eligibility, claims, and billing information, with anyone other than our members or their authorized representatives.

  
  An Ambetter representative reached out to *********************** on 04/06/2023 but was unable to speak with her and left a voicemail with the representatives direct contact information. We sent a detailed response directly to *********************** addressing BBB Complaint Case # ********. If you have questions, please call ** at ************** (TTY/TDD **************).

  
  Respectfully,
  *****************************
  Member Relationship Liaison, Ambetter

   

  Customer Answer

  Date: 04/25/2023

   
  Complaint: 19862883
  
  I am rejecting this response because: I did receive a call from ******* and did speak with him. On his end he does not see the cancellation but he has advised its been corrected but then when moved the call with Marketplace they had to correct on their. Market place has yet to send correct **** health form. I don't have time to consistently call and check in. 
  
  Sincerely,
  
  ***********************

  Customer Answer

  Date: 05/23/2023

   
  Complaint: 19862883
  
  I am rejecting this response because:

  I have not received a voice-mail aside from ambetter about anything. The last time I spoke with anyone was with ******* and multiple representatives within the Marketplace. 

  Last I was advised that I was going to receive a call back upon further research. 

  
  Sincerely,
  
  ***********************