Business Profile

Health and Wellness

Ambetter From PA Health & Wellness

Complaints

This profile includes complaints for Ambetter From PA Health & Wellness's headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

23 total complaints in the last 3 years.
8 complaints closed in the last 12 months.

If you've experienced an issue

Submit a Complaint

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:10/02/2023
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.
Company failed to get my transportation set up and I had to reschedule 2 times causing me not being able to get the proper care for my broken foot thats broke in 3 places. I'm not able to walk currently...
Business Response
Date: 10/13/2023
October 13, 2023

BBB serving Metro Washington DC and Eastern Pennsylvania
50 West North Street
Bethlehem, PA 18018-5789
RE: *******************************
Complaint ID: ********

To Whom It May Concern,

Pennsylvania Health & Wellness acknowledges 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. Pennsylvania Health & Wellness will contact ******************************* and will be sending a detailed response directly to ******************************* addressing BBB complaint case# ********. If you have any questions, please call us at ************** (Relay ***.)

Thank you,

*******************
Sr. Compliance Analyst, Pennsylvania Health and Wellness
Initial Complaint
Date:08/15/2023
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.
I cancelled my policy before it started. After requesting a refund I was told 2-5 days originally. Then that turned into 7-10 it has to be review by billing then that turned into 30 days or more. I would like my 599 dollars back asap. This is ridiculous I can't get a straight response from this company. Everyone has different time frame and excuse.
Business Response
Date: 09/01/2023
August 30, 2023

Better Business Bureau of Pennsylvania
520 E Main Street
Suite 100
Carnegie, PA 15106

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

To Whom It May Concern,

Ambetter from PA Health & Wellness plan received your grievance on August 28, 2023, concerning ***************************, BBB Complaint Case # ********. Due to federal and state privacy and confidentiality 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 has attempted to contact ******************************* to discuss her concerns; however, a voicemail was left with our representatives direct contact information. We will be sending a detailed response directly to *************************** addressing BBB Complaint Case #********. If you have questions, please call us at **************.

Respectfully,

***********************
Member Relationship Liaison
Ambetter
Initial Complaint
Date:05/09/2023
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.
As a member of Wellcare by ******* of Pennsylvania,I received marketing materials to sign up for the "My Wellcare Rewards program in 2022. When you complete eligible health-related activities you earn rewards to be redeemed for gift cards. I signed up for the program,completed the eligible health related activities, and earned the rewards.But I was not given the $40,$50,and $25 gift cards as promised. This was false advertising.
Business Response
Date: 05/16/2023
This complaint is a duplicate BBB complaint previously received and resolved under BBB complaint ID: ********. As resolution, the member was sent the gift cards she was eligible for via email on 5/2/23.
Customer Answer
Date: 05/16/2023
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

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.

Regards,

***********************
Initial Complaint
Date:04/26/2023
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.
DESCRIPTION OF LEGAL MATTER: In early April I signed up for insurance through the Pennsylvania marketplace ******. The insurance was supposed to start 5/1, and the information is all there on ******, however Ambetter Pa claims to have no record of me in their system, despite their system taking my money. This after they previously rejected my application for insurance in January, causing me to have to resolve a bunch of ******** (my previous insurance) hoops before I could sign up again. I am now having serious gastric problems and can’t get care because my insurance is in limbo. Nobody is showing any urgency to resolve the problem while I’m getting sicker everyday.
Customer Answer
Date: 05/04/2023
I would like to add to my complaint that, without contacting me the company refunded my premium and has no record of my account. When I called the customer service they couldn't find my account either. Please see the screenshots attached. The bottom photo is of ****** showing my status as enrolled.

Thank You,

**********************;
Business Response
Date: 05/08/2023
05/05/2023

BBB serving Metro Washington DC and Eastern Pennsylvania
50 West North Street
Bethlehem, PA 18018-5789

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

To Whom It May Concern,
Ambetter from PA Health & Wellness received your grievance on 05/03/2023concerning ***********************, BBB Complaint Case# ********. Due to federal and state privacy and confidentiality 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 has attempted to contact **************** to discuss his concerns; however, we have been unsuccessful in reaching him. Three contact attempts will be made to reach ****************. We will be sending a detailed response directly to *********************** addressing BBB Complaint Case # ********. If you have questions, please call us at **************.

Respectfully,

*************************
Member Relationship Liaison
Ambetter
Initial Complaint
Date:01/21/2023
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.
I was a member last year in 2022 paying $40 a month, I moved to New Jersey in 2023 and DID NOT RENEW. I even told them and marketplace repeatedly that the new plans $350 a month was insanely expensive and that I wasn't interested. They renewed my policy to one that costs $350 a month WITHOUT MY CONSENT! now I am recieving a $900 bill that I refuse to pay. I called and explained several times why I will not be paying. Number one I never asked for it, two I specifically told them NOT TO RENEW! Three o asked to cancel multiple times after I discovered the renewal AND THEY STILL KEPT BILLING ME ! I am ready to hire an attorney over this because of this ends up on some collections page I will be suing ambetter.
Business Response
Date: 01/30/2023
January 30, 2023

Better Business Bureau serving Metro Washington DC and Eastern Pennsylvania
Attn: Dispute Resolution Department
50 West North Street
Bethlehem, PA 18018-5789

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

To Whom It May Concern,

Ambetter from Pennsylvania Health & Wellness received your grievance on 01/25/2023 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 spoke to *** ******* on 01/26/2023 and will be assisting him with his concerns. We will be sending a detailed response directly to Steven Gladney addressing BBB Complaint Case # ********. If you have questions, please call us at 1-833-510-4727 (TTY/DD 1-833-510-4727 relay 711)

Respectfully,

*************************
Member Relationship Liaison, Ambetter
Customer Answer
Date: 02/03/2023
[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]

Complaint: ********

I am rejecting this response because: this is not related to my personal heth matters this is pertaining to unauthorized billing.

Regards,

***************************
Business Response
Date: 03/17/2023
March 17, 2023

Better Business Bureau serving Metro Washington DC and Eastern Pennsylvania
Attn: Dispute Resolution Department
50 West North Street
Bethlehem, PA 18018-5789

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

To Whom It May Concern,

Ambetter from Pennsylvania Health & Wellness received your grievance follow up on 03/17/2023 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 spoke to *** ******* on 03/13/2023 to discuss his concerns regarding his complaint and *** ******* no longer wants to receive phones calls about this matter. We will be sending a detailed response directly to ****** ******* addressing BBB Complaint Case # ********. If you have questions, please call us at 1-833-510-4727 (TTY/DD 1-833-510-4727 relay 711)

Respectfully,

*************************
Member Relationship Liaison, Ambetter
Initial Complaint
Date:12/29/2022
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 just signed up for insurance. They never sent me list of participating doctors, or policy, so I phoned customer service on Dec 12 2022 to ask them to snail mail or email me info. At 1:49pm I spoke with ”******” (not sure of spelling; he spoke English with a non-American dialect). He took my information, then refused to send me info, I asked him to transfer me to a supervisor and he said he would but put me on hold, there was music in the background at first then went dead after a few minutes, after a long time nobody had answered so I hung up. I called back again at 2:07 and spoke with somebody with a female voice named “****” who also refused to help, didn’t speak for a minute so I asked her if she was there and she said hello hello I can’t hear you, then I told her I would file a complaint if she continue to ignore me, she shut up while I was talking so obviously she heard me but then she said hello I can’t hear you again, I hung up.
Business Response
Date: 12/29/2022
The individual noted in the complaint is not a member of an Ambetter from Home State Health plan. It appears the individual resides in Pennsylvania based on what was included in the complaint.
Business Response
Date: 01/18/2023
January 9, 2023

BBB serving Metro Washington DC and Eastern Pennsylvania
50 West North Street
Bethlehem, PA 18018-5789

RE: **** *****
Complaint ID: ********

To Whom It May Concern,

Ambetter from Pennsylvania Health & Wellness (“Ambetter”) received your grievance on 01/06/2023 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. Ambetter contacted **** ***** on 01/09/2023 and will be sending a detailed response directly to **** ***** addressing BBB complaint case# ********. If you have any questions, please call us at 1-833-******** (Relay ***.)

Thank you,

********* *******
Member Relationship Liaison,Ambetter
NAIC: *****
Customer Answer
Date: 01/23/2023
[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]

Complaint: ********

I am rejecting this response because:
1. Per my phone call with ********* two weeks ago, she said she would snail mail me a paper copy of my policy. I have not received it.
2. It is ridiculous that ********* invokes a confidentiality issue in her written response to the BBB. My issue has nothing to do with any health issues; it is about not receiving a copy of the policy. What is she hiding?
3. I tried to phone her on both numbers I have for her. Her "direct number," ************, does not work. Her other phone number, ************, I get a recording identifying it as ******** Health Plan (not Ambetter). What's going on?
I am asking the BBB to intermediate and ensure that she sends me a paper copy of my insurance policy.
Regards,

*******************
Business Response
Date: 02/02/2023
February 1, 2023

BBB serving Metro Washington DC and Eastern Pennsylvania
50 West North Street
Bethlehem, PA 18018-5789

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

To Whom It May Concern,
Ambetter from PA Health & Wellness received your grievance on 01/06/2023 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 spoke to ************** on 02/01/2023 and will be assisting her with her concerns. We will be sending a detailed response directly to ******************************* addressing BBB Complaint Case # ********. If you have questions, please call us at ************** (Relay ***).

Respectfully,

*****************************
Member Relationship Liaison, Ambetter
Customer Answer
Date: 02/08/2023
[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]

Complaint: ********

I am rejecting this response because:

What a crock. ****** phoned me a couple weeks ago and promised that he would snail mail me a copy of my policy with all the small print, and that I would receive it by last week. Which I never did. He then phoned back and left a message to call him which I did and I left a message and never heard back from him. Then I got tired of the phone tag and left him a message to just send my policy, and to email if he needed more information from me (which he shouldn't. What other info could he possibly need?) I'm just asking for a copy of my policy, why is this so difficult for him?

This bbb non-response is the first time I've heard from him in a while.

And again, he uses the pathetic excuse that he cant discuss insurance information to avoid responding to the bbb. But this has nothing to do with the contents of my policy, it is simply that I never received a copy of my policy, which he promised to send and lied.
Regards,

*******************
Business Response
Date: 03/17/2023
March 17, 2023

BBB serving Metro Washington DC and Eastern Pennsylvania
50 West North Street
Bethlehem, PA 18018-5789

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

To Whom It May Concern,
Ambetter from PA Health & Wellness received your grievance on 03/10/2023 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 will be assisting her with her concerns. We will be sending a detailed response directly to ******************************* addressing BBB Complaint Case # ********. If you have questions, please call us at ************** (Relay ***).

Respectfully,

*****************************
Member Relationship Liaison, Ambetter
Initial Complaint
Date:12/15/2022
Type:Order 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 have been trying to get resolve a claim denial for the past six months. My provider has also been trying to resolve this issue with Ambetter. She has gotten different agents over the past six months and was at first told she was not in network, then she was told she was in network and I needed an authorization from my PCP. My PCP sent the authorization. Then my provider was told that she needed to fill out a form and then the claim would be paid. She sent the form but then was denied again. When I call them, the agents don't seem to understand me and just repeat information that I can see on the website. They do not seem to have any record of the calls from my provider. When they cannot help me they tell me they are "checking something" and put me on hold until I am disconnected. It is very frustrating to not be able to call and get consistent and reliable information. I would like to be able to talk to someone who can resolve this for me but it seems to be impossible to talk with anyone at this company.
Business Response
Date: 01/03/2023
01/03/2023

BBB serving Metro Washington and Eastern Pennsylvania
50 West North Street
Bethlehem, PA 18018-5789

Complaint ID: ********

To Whom It May Concern:

Ambetter from PA Health & Wellness received your correspondence 12/20/2022 concerning Complaint ID ********. Due to federal and state privacy and confidentiality regulations, we are unable to disclose any protected health information, including, but not limited to eligibility, claims, and billing information. We will be sending a detailed response directly to our member. If you have questions, please call us at ************** ( Relay ***).

Thank you,

*****************************
PA Health& Wellness
Customer Answer
Date: 01/25/2023
My complaint against Ambetter has not been resolved. I received a call from ****** ******** a few weeks ago and he said he would get back to me at the end of that week and I have not heard back from him. This supports the reason I made the complaint in the first place. Ambetter is unresponsive to calls from members and providers and says that they will look into things and then never get back to either the member or the provider. I would like you to continue to help me resolve this problem.

Business Response
Date: 02/02/2023
02/01/2023

BBB serving Metro Washington DC and Eastern Pennsylvania
50 West North Street
Bethlehem, PA 18018-5789

Complaint ID: ********

To Whom It May Concern:

Ambetter from PA Health & Wellness received your additional correspondence on 01/30/2023 concerning **** ******, Complaint ID # ********. Due to federal and state privacy and confidentiality regulations, we are unable to disclose any protected health information, including, but not limited to eligibility, claims, and billing information.

An Ambetter representative spoke to *** ****** on 01/25/203 and will continue to work with her to address her concerns. We will be sending a detailed response directly to Member Name addressing BBB Complaint Case # ******** once a final resolution is reached. If you have questions, please call us at [Health Plan Phone Number from bottom of State letterhead. We will be sending a detailed response directly to our member. If you have questions, please call us at 1-************ ( Relay ***).

Thank you,

Andrew R*******
PA Health& Wellness
Initial Complaint
Date:09/26/2022
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've been attempting to get continued authorization for my prescribed medication. I spent 4 hours on the phone today, was rudely spoken to, and after tens of customer service agents and managers I was told "there's nothing we can do." If this issue is not fixed expeditiously I will begin withdrawal from my skin disease medication, and all I need is a simple authorization. They're refusing to speak with my prescribing doctor and have made a simple error in how often the medication is supposed to be taken. The only option I was given was to pay out of pocket (close to $15,000) for my medication, and MAYBE I can get refunded for it. This entire experience was unprofessional, mentally taxing, and stressful beyond belief. In addition, there was no direct line given for claims. I was told to give a call back number in case the call was disconnected. I was disconnected numerous times, and did not receive a single call back. Please help me. Thank you.
Business Response
Date: 10/03/2022
October 03, 2022
To Whom It May Concern,
Ambetter of Indiana (“Ambetter”) Health Plan received your grievance on 09/29/2022 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. Ambetter contacted ******* ******* on 09/03/2022 and will be sending a detailed response directly to ******* ******* addressing BBB Complaint Case# 18131411. If you have questions, please call us at 1-877-687-1180 (Relay ***.)

Respectfully,

Daniela K****
Member Relationship Liaison, Ambetter
Initial Complaint
Date:07/25/2022
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.
I applied for health insurance on April 25th after a life changing event. I was approved and given insurance on 6/22, effective 7/1. Upon sign up, my first months premium was paid. Days later I received a bill saying my payment for July was applied to June and I now owe for July and August. I was not a member in June nor was any service or product sold or delivered. Upon calling on July 11th, I was told to pay the extra fees or lose my health insurance, instead of the company fixing it. When I call AmBetter, I am hung up on. ****** has filed a dispute on the charge but there is no progress. I have spent hours on the phone over this and cannot afford to waste any more time when the company should fix this error easily.
Business Response
Date: 08/23/2022
August 16, 2022
To Whom It May Concern,
Ambetter from Illinois received your grievance on 08/16/2022 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. We will be sending a detailed response directly to *** ******* ***** addressing BBB Complaint Case## ********. If you have questions, please call us at 1-833-510-4727 (Relay ***.)
Respectfully,
Julissa C*******.
Member Relationship Liaison, Ambetter
Initial Complaint
Date:07/07/2022
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 Ambetter based on the number of healthcare providers they have only to find out that they are all either no longer accepting Ambetter, their contact information was incorrect, or they are misclassified. For example, under psychiatry, there are 10 doctors listed. They all belong to a drug and alcohol inpatient rehab center that has no outpatient service. This is the same for psychology. It is essentially impossible to get any kind of mental health care with this plan unless you check in inpatient. This is a hazard to people who already suffer from mental stress because it adds more hopelessness to whatever their situation may be.
Customer Answer
Date: 08/10/2022
I have not yet received a response from the business.
Business Response
Date: 08/25/2022
August 24, 2022
To Whom It May Concern,

Ambetter from PA Health & Wellness received your grievance on 08/23/2022 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. We will be sending a detailed response directly to Justin Darcy addressing BBB Complaint Case# ********. If you have questions, please call us at 1-833-510-4727 (Relay ***.)

Respectfully,

Olivia B*****
Member Relationship Liaison, Ambetter

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Ambetter From PA Health & Wellness is BBB Accredited.