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    ComplaintsforAmbetter from Superior HealthPlan

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    Complaint Details

    Note that complaint text that is displayed might not represent all complaints filed with BBB. See details.

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    Complaint Status
    Complaint Type
    • Complaint Type:
      Service or Repair Issues
      Status:
      Answered
      I have a serious infection in my right leg that requires surgery to correct. My doctor submitted an authorization request along with the proper documentation to show the need for the procedure. However, the insurance company, Ambetter, has been dragging their feet about approving the procedure. The request was marked urgent yet they have yet to approve it even though they have had it for 4 days.

      Business response

      08/16/2024

      Hello,

      I am unable to locate member, please provide member ID or DOB. 

    • Complaint Type:
      Service or Repair Issues
      Status:
      Answered
      Ambetter fraudulently ***orted that I was enrolled in their health insurance from 1/1/23 for one month and I have been unable to file my taxes for 2023 until this matter is properly resolved. Here are the facts:1. I was enrolled in their health insurance through the Marketplace in 2022. Made one visit to a provider and the service was so terrible, I never used the insurance again.2. During the Open enrollment period at the end of 2022, I went back to the Marketplace to see if there was better insurance with other companies. Found none and spoke specifically with Ambetter on the phone to not renew my plan. I remember the person I spoke to was upset because I said their insurance was terrible.3. When I electronically filed my taxes, it was immediately rejected. I called IRS Help and I was told I had health insurance in 2023 for 1 month and got a tax credit of $1190. I indicated I did not have insurance in 2023 with anyone. I was advised to call the Marketplace. They checked to see who was the agent on my account and found there was none. They therefore filed a fraudulent claim against Ambetter.4. Ambetter subsequently responded to me via a contradictory letter which started by saying that they have 'granted' my retro-active cancellation and then followed that statement by saying they have denied my retro-active cancellation. 5. I called them and spoke to one of their **** who checked and could not find any evidence that I had re-enrolled with them. There was a 3-way call to the Marketplace and I was told that I would hear from them in 45 days. Needless to say, I have heard nothing from them.6. Ambetter also claimed in the letter to that I paid them $58.85 on 04/07/23 which is a whole lie. Why would I pay them anything when I never had insurance with them in 2023? Their *** could not find this as a payment to them.If Ambetter has done this to me, they have done it to other people as well. I will not stop pursuing this until this matter is resolved.

      Business response

      08/07/2024

      Hello,

      We are in receipt of member's issue. Superior HealthPlan will work directly with the member to resolve their complaint. 

      Thank you,

      Customer response

      08/09/2024

      Complaint: 22083004

      I am rejecting this response because: ************************* from Ambetter called me yesterday 8/8/24 and left a voice mail message on my house phone asking me to return her call. This was the ** (transcribed) that she left: "Good morning my name is ****************'m calling with Superior Health Plan this message is for **************** if you can please return my call my number is **************. You may reference account number our as in ****** ********. Thank you and have a wonderful day."

      I called today 8/9/24 at 9:00 AM and did not get off the phone until 9:58 AM. I was not able to speak to ************** and received a constant run-around going from ****** to ****** because ************** did not leave her extension number. Eventually I got a *** on the phone who was kind enough to make an attempt to reach **************. It took me being on hold for all of 9 minutes. She told me that ************** would not be able to talk to me, but she said that she had filed a ticket, and I will hear from them once the ticket is addressed.

      I have gone through all of this with Ambetter, since April 2024; the tickets, the waiting, the no resolution and the not taking responsibility for a mistake they made. I have gone through the Marketplace complaining about this and they are the ones who classified it as fraud. I have been on a 3-way call with another Ambetter *** and the Marketplace as well in May 2024. They found no agent on the account. Nothing. Now it seems that ************** is taking me back to this same place. Meanwhile, I cannot file my taxes because incorrect info was sent to the **** (I filed an extension with the *** until October 2024.)

      This is frustrating and wrong, so I have no choice but to go public (TV, social media, etc.) to bring awareness to this (I am absolutely certain I am not the first ****** this has happened to) and seek resolution from the courts. 

      Regards,

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

      Business response

      08/13/2024

      Hello,

      We are in receipt of your complaint. Your complaint is currently being reviewed per initial complaint received on 08/02/2024. Please allow 30 days for a complete resolution.

    • Complaint Type:
      Sales and Advertising Issues
      Status:
      Answered
      Ambetter Lied to the consumers about the subsidy card. They were promoting A $6400 subsidy to help with medical bills, household bills, etc. in fact, they just wanted to consumers to sign up with their Ambetter health plan. I called them and they told me I had to look at videos and read articles to get some points. That was never stated anywhere. They are false advertising their product for people to sign up. It should be against the law.

      Business response

      07/05/2024

      Dear ***************************,

      Thank you for forwarding the above referenced correspondence received from your office on 7/1/2024.

      Superior HealthPlan (Superior HealthPlan Network/Superior HealthPlan, ***** is a licensed health care insurance company/health maintenance organization in *****. We are bound by federal privacy laws to protect the identity and health information of our enrollees, and ensure all communications from our office is appropriate.

      To facilitate the use and/or disclosure of an enrolled persons protected health information (PHI), Superior HealthPlan must have a signed authorization from our enrollee granting the approval to use or release any information to your office. We have no authorization allowing Superior HealthPlan the authorization to communicate with the BBB about this person.

      We apologize that we are unable to respond to your office on this issue. Please be assured that we are addressing all applicable concerns detailed in the correspondence you forwarded, upon confirmation that the individual named in your correspondence is enrolled with our health plan. However, for the reasons stated above, Superior HealthPlan will communicate directly with our enrollee to address and resolve his/her concerns.


      Sincerely,


      Grievance and Appeals Coordinator

      **********

      Customer response

      07/08/2024

      Complaint: 21926381

      I am rejecting this response because:

      Regards,

      ****** English

      Business response

      07/11/2024

      Hello,

      Complaint was filed on 07/01/2024 unde complaint number MMKTTX-284054. Acknowledgement letter was sent by mail to member, and once rsolution is received a resolution letter will also be sent to member.

       

      Thank you,

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

      Customer response

      07/12/2024

      Complaint: 21926381

      I am rejecting this response because: I would for the BBB to handle this case. I am very disappointment on how the company is misleading the consumers.

      Regards,

      ****** English
    • Complaint Type:
      Service or Repair Issues
      Status:
      Answered
      I have had an active policy with Ambetter since April 2024. This week it was abruptly cancelled. I called AmBetter on Tuesday, June 25, 2024 due to a change to my insurance status from ACTIVE to CANCELLED. I was made aware upon my monthly visit to my Doctor. I have made all my payments. After speaking with a representative and telling her that I had my HealthCare marketplace application and premium credit approvals on hand as well my EOB statements from April through June, and my PAYMENT HISTORY along with confirmation #s, she told me she had to speak to the "escalation department". I was on hold and spoke with the same representative several times in between holds. She ended up apologizing and saying the policy was in fact active and they were submitting a ticket to update the system as they had confirmed they received all my info from Marketplace. At this point I have attempted reaching out to find out what is actually taking place? My payments for ****** May and June have been returned with a date of June 27, 2024. Yet I also received a new EOB dated June 26, 2024. I need to refill my insulin prescription soon, therefore at this time am concerned whether I will not be able to tend to my medical needs due to this unexpected and unrequested disruption to my insurance services. The customer representative was as helpful as she could be, however, this is very frustrating as i have not received any email correspondence or anything in writing to reassure me that this is not a case of fraudulent activity. What boggles me the most is I have EOBs and my insurance ID cards showing my policy which I have been using since April 2024, and my claims have been being approved, yet my account info NOW shows as never having had a 2024 policy. I

      Business response

      07/03/2024

      Dear ***************************,

      Thank you for forwarding the above referenced correspondence received from your office on 7/1/2024.

      Superior HealthPlan (Superior HealthPlan Network/Superior HealthPlan, ***** is a licensed health care insurance company/health maintenance organization in *****. We are bound by federal privacy laws to protect the identity and health information of our enrollees, and ensure all communications from our office is appropriate.

      To facilitate the use and/or disclosure of an enrolled persons protected health information (PHI), Superior HealthPlan must have a signed authorization from our enrollee granting the approval to use or release any information to your office. We have no authorization allowing Superior HealthPlan the authorization to communicate with the BBB about this person.

      We apologize that we are unable to respond to your office on this issue. Please be assured that we are addressing all applicable concerns detailed in the correspondence you forwarded, upon confirmation that the individual named in your correspondence is enrolled with our health plan. However, for the reasons stated above, Superior HealthPlan will communicate directly with our enrollee to address and resolve his/her concerns.


      Sincerely,


      Grievance and Appeals Coordinator
      **********

      Customer response

      07/08/2024

      Complaint: 21921388

      I am rejecting this response because: I have called Ambetter and marketplace. On Tuesday, July 2, **** from Ambetter Escalation confirmed to Marketplace that my account was cancelled despite nobody requesting the cancellation, not me, not Ambetter and not the Marketplace. He also confirmed my account was in good standing and all my payments were up to date. ******* with marketplace was extremely helpful and submitted the request to reinstate. Then today, Ambetter had no history of this conversation. We called marketplace again and now they are saying the policy cannot be reinstated because it was terminated due to non payment. This is not correct. They also do not have any record of the policy I have been using for the months of April, May and June of 2024. They are referencing a policy from 2023. Then during the call they could no longer hear me and i could hear the Ambetter representative say she was calling me back to get me on the line but that was not true either as my line never rang. I was on the phone with them hearing their conversation. Marketplace representative said that as i was no longer on the call they could not continue the discussion and everyone hung up. I am beside myself! I do not know what to do at this point. I have spent hours and hours on the phone with Ambetter and am getting the run around. Last Tuesday's call was the first time there was a glimmer of hope and now today they has been shot. I do not understand if this is due to their compromised system or retaliation because of the BBB complaint i filed? But this is absurd. My effective policy which i have record of is not showing as never having existed, and they say that my payments were all rejected due to NSF. (MY BANK RECORDS SUPPORT MY PAYMENT HISTORY). Please advise me on how to proceed at this point? Does BBB provide legal support or do i reach out to an attorney on my own? I am at a lost for words. 

      Regards,

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

      Business response

      07/11/2024

      Hello,

      Complaint wa filed under complaint number MMKTTX-280055. ****** was sent to member acknowledging complaint. Once completed, a resolution lette will also be sent. 

       

      Thank you,

       

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

    • Complaint Type:
      Delivery Issues
      Status:
      Answered
      Subject: Complaint of Misrepresentation and Breach of Promise by Ambetter To Whom It May ********* am writing to formally lodge a complaint against Ambetter regarding their deceptive practices and failure to deliver on their promises, which constitutes a clear case of bait and switch.Upon enrollment, I was explicitly assured that I would receive a card preloaded with funds to cover the cost of a gym membership, as well as additional cash to be used for purchasing medications, groceries, and other incidental expenses. However, despite these assurances, I never received the promised cards.Subsequent communications with the company revealed that they had no intention of sending me the card as initially promised. This constitutes a blatant misrepresentation and a breach of the agreement made at the time of enrollment.I urge Ambetter to address this matter promptly and provide a satisfactory resolution. Failure to do so will compel me to consider further action, including but not limited to, filing a formal complaint with relevant regulatory authorities and seeking legal remedies.

      Business response

      06/24/2024

      Hello,

      Superior has received your complaint. We have forwarded to the corresponding department where the member resides. We do not handle complaints for members that are outside of ******

    • Complaint Type:
      Service or Repair Issues
      Status:
      Answered
      I was enrolled in Ambetter insurance. I cancelled the plan, but they enrolled me in the insurance plan again without my permission and knowledge. This is causing problems with me enrolling with my county's hospital healthcare plan. I cannot enroll until Ambetter's insurance has been removed. I have called two times to cancel the plan and received a termination letter. However, they re-enrolled me in their insurance again. I want to the plan to terminated and put on a do not contact list! If this continues, I will fill complaints with *************************** the *** and the Texas ************************ next.

      Business response

      06/10/2024

      Hello,

      Superior has received your complaint and will be working directly with the member to resolve their issue. 

      Thank you. 

    • Complaint Type:
      Billing Issues
      Status:
      Unanswered
      Pretty much had a plan through ACA with ambetter for health insurance. End of last year I called to re enroll. They asked "did you like your service?". As I had no complaints at the time I said yes and they said "ok we will keep you in the same insurance plan.". I didn't know this and no one told me, but am better raised their rates for my plan by $85 a month....not one person informed of the increase. That is quite the price increase for a monthly payment , but to not make sure the customer knows is messed up. I can't afford monthly payments, and even if I could, how would I know? So some months went by and no messages, texts, phone call or anything. They just dropped me.
    • Complaint Type:
      Product Issues
      Status:
      Answered
      I am owed a refund of $2906. It was processed on May4th and maled on the 10th. I was PROMISED it would be to me in 7-10 days after being told at one point it would come direct deposit, finding out on another call, they don't do direct deposits on refunds. Today I was told to wait 30 to receive the check and after 30 days, they would cancel the check and process a new one. I am getting absolutely no where with this company, just a constant run around.

      Business response

      06/12/2024

      Hello,

      I am confirming receipt of your complaint. This complaint has been routed to the designated state due to details provided are for a member that resides outside of *****. For future reference, please submit complaints for Ohio residents to the following email address: 

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

      Thank you!

    • Complaint Type:
      Service or Repair Issues
      Status:
      Answered
      Around the third quarter of 2023 I became a member of Ambetter health insurance while residing with my son in ********, **. I was consistent with this health insurance company and they informed I that if did not call to cancel my health care policy, it would remain in effect. Unfortunately, in January of 2024, while at my childrens mothers house in *******, **, I suffered a stroke and was hospitalized at ******************************** and was still being covered by Ambetter with no problems. After my release from the hospital, I was being treated with a physical therapy center provided by Ambetter health and attending all appointments. I was requesting to be seen by a neurological specialist but Ambetter was only able to provide areas which were one hour one way travel time and I am no longer able to drive because of my stroke. As of 24 April, 2024, Ambetter was still in constant communication with me and helping me to find a suitable neurologist, meanwhile, I was attending my physical therapy appointments directed by Ambetters referral. Upon my return from visiting my mother in ********* for the weekend, on 28 Apr 2024, he there was correspondence present which was dated on 19 April 2024 stating Ambetter had terminated my coverage without cause. This is a significant problem being there was no warning or notice sent that there was going to be any cancellation or I had committed any policy violations. It seems there were no coverage problems until I suffered a stroke and actually needed to utilize this insurance. There are strong reasons to believe I was dropped from this insurance company simply because I suffered a stroke and had actual medical needs which needed to be attended to. As of now, I am unable to reenroll in marketplace, as per their correspondence, until the next open enrollment which isnt until November. This has placed ****** stress, mental anguish, and significant problems on my rehabilitation.

      Business response

      05/08/2024

      Dear *********************,

      Thank you for forwarding the above referenced correspondence received from your office on 5/1/2024.

      Superior HealthPlan (Superior HealthPlan Network/Superior HealthPlan, ***** is a licensed health care insurance company/health maintenance organization in *****. We are bound by federal privacy laws to protect the identity and health information of our enrollees, and ensure all communications from our office is appropriate.

      To facilitate the use and/or disclosure of an enrolled persons protected health information (PHI), Superior HealthPlan must have a signed authorization from our enrollee granting the approval to use or release any information to your office. We have no authorization allowing Superior HealthPlan the authorization to communicate with the BBB about this person.

      We apologize that we are unable to respond to your office on this issue. Please be assured that we are addressing all applicable concerns detailed in the correspondence you forwarded, upon confirmation that the individual named in your correspondence is enrolled with our health plan. However, for the reasons stated above, Superior HealthPlan will communicate directly with our enrollee to address and resolve his/her concerns.


      Sincerely,


      ****

      Grievance and Appeals Coordinator

      Customer response

      05/09/2024

      Complaint: 21647301

      I am rejecting this response because:

      This does not answer the complaint. Simply stating that I have no authorization on file when clearly, as seen from my complaint to the BBB that I have initiated, I have authorized the BBB to conduct an inquiry into this matter. If an additional authorization was needed, it should have been provided in the companys response along with information for submission of the form. Please upload it in response to this rejection therefore it can be immediately signed. 

      Regards,

      *********************
    • Complaint Type:
      Service or Repair Issues
      Status:
      Answered
      I have ambetter as my health insurance. They previously approved a claim for medication that I need to have any quality of life. They told me it was approved until September and that I wouldnt have any issues getting the medication again. Now that Im trying to get a refill they are denying the claim and telling me there isnt anything they can do to help me. I have called and talked to numerous people and have just gotten more and more frustrated about the way Im being treated. Whether I was nice or mean, I was still told they will not help me and I will no longer get a medicine I need. Ive been to the hospital because Im in such bad shape without this medication and they still refuse to help. I pay so much money each month for this plan and I want my money back because theyve not helped me this entire time. Im literally paying for a program that does not help or care for its members. This is insane. Im over here fighting for my life due to health issues and Im basically being blown off and just transferred to different people with no help. And they talk to me like I have no idea whats going on. I think I should get all my money back and a weeks worth of my pay because ** constantly missing work due to the fact that I do not have this medicine. Im also open to insane infections because without the medication I have open sores all over my body and ambetter doesnt care AT ALL.

      Business response

      05/01/2024


      Thank you for forwarding the above referenced correspondence received from your office on 04/24/2024.

      Superior HealthPlan (Superior HealthPlan Network/Superior HealthPlan, ***** is a licensed health care insurance company/health maintenance organization in ******  We are bound by federal privacy laws to protect the identity and health information of our enrollees, and ensure all communications from our office is appropriate. 

      To facilitate the use and/or disclosure of an enrolled persons protected health information (PHI), Superior HealthPlan must have a signed authorization from our enrollee granting the approval to use or release any information to your office.  We have no authorization allowing Superior HealthPlan the authorization to communicate with the BBB about this person.

      We apologize that we are unable to respond to your office on this issue.  Please be assured that we are addressing all applicable concerns detailed in the correspondence you forwarded, upon confirmation that the individual named in your correspondence is enrolled with our health plan.  However, for the reasons stated above,Superior HealthPlan will communicate directly with our enrollee to address and resolve his/her concerns. 


      Sincerely,


      **********************
      Grievance & Appeals Coordinator I

      Customer response

      05/01/2024

      Complaint: 21620072

      I am rejecting this response because: BBB is not asking for any protect health information and the insurance company is trying to hide behind HIPAA laws. Due to the way Ive been treated and the way they have dismissed me, told me straight up that Im s*** out of luck, and that they are actively refusing to help me which is causing permanent disability in my body and causing my body to more quickly deteriorate. The only way this issue will every be resolved for me is if they take responsibility for treating me horribly and causing me to miss work which is causing me to lose income and on top of that causing my disability to be so bad that my doctor is worried about my condition due to me being unable to access a medication I need. Ambetter needs to own up to the mistakes they have made and admit to how horrible I continue to be treated by the company. I want money to cover hospital visits, missed work and the mental/physical anguish they have put me through, I will not accept anything less. And the more they beat around the brush pretending they did nothing wrong and refusing to make this right, the more money I will ask for to solve the mater since I still have received my medication despite me, my doctor and my doctors pharmacist explaining the need for the medication. So at think point I feel I am entitled to $15,000 to cover medical expenses due to being unable to access my medication, to cover misssed wages and pain and suffering. 


      Regards,

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

      Business response

      05/06/2024

      Dear *********************,

      Thank you for forwarding the above referenced correspondence received from your office on 5/2/2024.

      Superior HealthPlan (Superior HealthPlan Network/Superior HealthPlan, ***** is a licensed health care insurance company/health maintenance organization in *****. We are bound by federal privacy laws to protect the identity and health information of our enrollees, and ensure all communications from our office is appropriate.

      To facilitate the use and/or disclosure of an enrolled persons protected health information (PHI), Superior HealthPlan must have a signed authorization from our enrollee granting the approval to use or release any information to your office. We have no authorization allowing Superior HealthPlan the authorization to communicate with the BBB about this person.

      We apologize that we are unable to respond to your office on this issue. Please be assured that we are addressing all applicable concerns detailed in the correspondence you forwarded, upon confirmation that the individual named in your correspondence is enrolled with our health plan. However, for the reasons stated above, Superior HealthPlan will communicate directly with our enrollee to address and resolve his/her concerns.


      Sincerely,


      ****
      Grievance and Appeals Coordinator

      Customer response

      05/07/2024

      Complaint: 21620072

      I am rejecting this response because: I have tried to return phone calls for days and I keep getting told no one knows what Im referencing and I just need to wait for another call back but no one ever calls back. Im tired of playing phone tag with a company that has no intention of making things right. Someone needs to fix this, NOW. Because every single time I call people make me feel stupid and act like I have no idea what Im talking about, which is a running theme with ambetter apparently. So if youre going to call in the middle of the work day and then have no way for me to call back other than the regular member services line, I will continue to decline your responses, because at this point youre not doing anything to remedy the situation, you guys are trying to run from it. 

      Regards,

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

      Customer response

      05/07/2024

      Complaint: 21620072

      I am rejecting this response because:

      I have tried to return phone calls for days and I keep getting told no one knows what Im referencing and I just need to wait for another call back but no one ever calls back. Im tired of playing phone tag with a company that has no intention of making things right. Someone needs to fix this, NOW. Because every single time I call people make me feel stupid and act like I have no idea what Im talking about, which is a running theme with ambetter apparently. So if youre going to call in the middle of the work day and then have no way for me to call back other than the regular member services line, I will continue to decline your responses, because at this point youre not doing anything to remedy the situation, you guys are trying to run from it. 

      Regards,

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

      Business response

      05/13/2024

      Dear *********************,

      We have received this complaint initially on 5/1/2024. We will respond to the member to provide the final resolution of the issue. The member will receive a letter, which will:

      * Give the member the answer to their complaint.
      * Give the member the reason for the answer, either medical or their member contract or handbook terms.
      * Give the member the specialty of any physician or provider who reviewed their complaint.
      * Give the member the process and timeline to file an appeal.
      * Give the member the deadline for Ambetter Health to answer their appeal.

      We will mail the answer to the member complaint within 30 days of getting their complaint.

      Sincerely,
      Complaints Department
      Ambetter from Superior HealthPlan/ SS

       

      Customer response

      05/14/2024

      Complaint: 21620072

      I am rejecting this response because:

      That is not enough. My medicine was APPROVED and you STOPPED filling it because of whatever reason. No matter what you say, the medication should have never been declined in the first place for the refill because it was ALREADY APPROVED. Im not sure what youre not understanding about that. So you explaining your process means absolutely nothing to me. You guys caused permanent joint damage. I quite literally will never be able to do what I was doing prior to this because you guys decided that you werent going to fill a medication that was APPROVED MARCH 18th. 
      I dont want a letter in the mail, I want my money back and I want one weeks pay for all the days I missed from work due to you guys being the RUDEST insurance company I have ever dealt with. I also want damage pay for my pain and suffering at AMBETTERS HANDS. Because you guys dropped the ball and I was quite literally told Im not going to do anything to help you. So unless I get the monetary compensation Im asking for. I will take this to court. Your little letters do not mean a thing to me. Because the medication was APPROVED. And you guys just wouldnt fill it. 

      If you will not give me my money back and pay what I am owed for missing work and for my now permanent joint damage, I will get a lawyer and I will *** the company. Because regardless of me being angry on the phone (which I am 100% allowed to be considering I was being denied a medication that provides me a quality of life and stops joint damage) but regardless, you guys should have done your research and a women I spoke to regarding the is*** even said all they had to do was open up a different program that the entire company has access too, and they would have seen that it was approved. 

      So your little letter means nothing to me because I have hard proof that the people I talked too simply did not want to do their jobs which is clear from the Im not going to help you while Im bawling my eyes out in the most excruciating pain Ive ever felt. 
      I want monetary compensation. And I hope to God that you or your family never experiences what I did, because it was the most brutal thing Ive ever done. And even the folks at my doctors office have said ambetter is the worst insurance to work with because you guys deny everything regardless of what it is or what its for or if the patient could benefit from it. Because my entire patient record was sent and you guys still said I didnt need the medication. 

      money or I ***. 

      Regards,

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

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