Complaints
Customer Complaints Summary
- 33 total complaints in the last 3 years.
- 11 complaints closed in the last 12 months.
If you've experienced an issue
Submit a ComplaintThe 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:02/27/2025
Type:Service or Repair IssuesStatus: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.
Called am better to figure out primary care provider. They only have a list of providers from Peace health who is declining to schedule until August. I am 55 years old and running out of my medication. The customer service is non existent in this company. The representatives are rude and not helpful. I asked to speak with a supervisor , they said they will call, they never did. Any time I am calling I am dealing with hangs up and putting me on hold for no reason. All medical offices say call your insurance to verify and these people cannot provide me a list of providers. The ones that are listed on their website are wrong. So please explain what am I supposed to do in this situation?Business Response
Date: 03/04/2025
Please see attached response letter. We will address the complaint and respond directly to the consumer.Customer Answer
Date: 03/04/2025
Complaint: 23000658
I am rejecting this response because:they are saying that they will address the issue and so far they have not. We received a call from ****** who told me she would be sending an email with a list of providers yet there is nothing that was received . This insurance doesnt havE enough providers and they dont have correct information listed online!
Sincerely,
***** CherkashovaBusiness Response
Date: 03/31/2025
We sent an email to the complainant on March 4, 2025 which included a list of 12 in-network providers near her home. We sent the referenced email and provided the same information (including the list of providers) through the Office of the Insurance Commissioner as well. The complainant was also provided with direct contact information for her assigned liaison, ******, should she have any further questions regarding this matter. Due to state and federal privacy laws, we are unable to provide additional information here.Initial Complaint
Date:02/12/2025
Type:Billing IssuesStatus: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.
Complaint Against Ambetter from Coordinated Care Fraudulent ******************* of Care I am filing a complaint against Ambetter Insurance Coordinated **************** for fraudulent enrollment under Memb ID#***********, unauthorized charges, denial of legitimate claims, and severe harm to my health and finances.Fraudulent ************************* Charges I am legally blind, disabled, and a ******** (Provider One) recipient under **************************** Plan for years. My ******** covers me and my minor son at no cost. In January 2025, Ambetter fraudulently enrolled me and my son without consent, canceling my *********** a result:I received a $1,824.90 bill ******** #***********) from Ambetter for an insurance plan I never signed up ****** critical medications were denied, forcing me to pay $642 out-of-pocket at Amazon *********** medical appointment was canceled, leaving me without healthcare access.Despite multiple calls, Ambetter refuses to send a termination letter to reinstate my ******** with United Healthcare, leaving me in limbo.Denial of Legitimate **************** for **************** Ambetter denied payment for my wifes November 29, 2024 visit to **************************** (listed in-network at the time), leaving us with a $714 bill. They falsely claimed the provider was out-of-network.Consequences Loss of healthcare: I cannot receive critical medical care or medications.Severe financial harm: Fraudulent enrollment resulted in a total $3,180.90 in wrongful charges.Emotional distress & risk to my life: As a disabled individual, lack of healthcare puts me in serious danger.Resolution Sought 1.Immediate termination of my fraudulent enrollment.2.Confirmation letter to restore my ******** benefits.3.Refund & removal of all charges ($1,824.90, $642, and $714).4.Accountability for Ambetters fraudulent practices.This is urgent, as my health is at severe risk. I have supporting documents available upon request.Business Response
Date: 02/18/2025
Please see attached response letter. We will resolve the issues raised directly with the consumer.
Thank you.
Initial Complaint
Date:01/24/2025
Type:Service or Repair IssuesStatus: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.
Calls come all day long...they know I have health insurance, and they are just trying to sell me an Amebtter policy. My name is on the do not call list FOR YEARS. Every day, I field 6 or 7 calls from each provider, which is Ambetter. I will not change my insurance policy from ******* Blue, and you still keep calling. So, now I will record EVERY phone call, and have you prosecuted for fraud. (Fraud is when you say you aren't selling something, but then try to sell me a policy.)I am DONE with you.Business Response
Date: 02/03/2025
Please see attached response letter. The complainant appears to reside in ******* which is outside of the service area for Ambetter from Coordinated Care and as such this complaint does not pertain to this business. We forwarded this complaint on to the Ambetter health plan in *******. Florida ********************** plans are issued by a separate entity other than Ambetter from Coordinated Care.Initial Complaint
Date:01/21/2025
Type:Billing IssuesStatus: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 keep sending me a bill for over $3000. And I don't even have any account with them plus I have wrote them a letter telling me, I'm not responsible and I want a copy of the original agreement and they have ignored that and continue to send me bills for 3000 and some odd dollars.Business Response
Date: 02/03/2025
Please see attached response letter. Ms. ****** received invoices from an affiliate health plan in ********. We forwarded this complaint to that states for further review and resolution directly with the complainant.Initial Complaint
Date:01/10/2025
Type:Service or Repair IssuesStatus: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 paid the full deductible $7500.00 ********************* said that after i paid the deductible, they would pay all fees afterwards but i was charged co-pay insurance costs that total to over an additional $4000. And they gave me the run around on why i was charged that. They said it is my responsibility to contact all the doctors and have them call the insurance company. They gave me a reference number but i called the insurance company back and gave them the reference number and they said it was an invalid number. They said they could only discuss the bills with the patirnt, my wife but she is deceased. They know she is. I sent them a death certificate but they said cant talk to me. Its bad enough that i lost my wife but then to be cheated by the insurance company is outrageous.Business Response
Date: 01/29/2025
Please see attached response letter. We do not show Mr. ***** as a member of any health plan issued by ********************** ****************. It appears that Mr. ***** may be a customer of our affiliate health plan in *******. We forwarded this complaint to that health plan for resolution directly with Mr. ************Initial Complaint
Date:12/17/2024
Type:Customer Service IssuesStatus: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.
The health care provider dropped my wife's PCP without any notification. We cannot load it back, after escalation to a Tier 2 supervisor was told it would be done on the backend and it may take 7-10 business days. This was after 7 attempts to have the tier 1 member service agent escalate. Now, December 17, 2024, still no PCP showing on the policy. Called member services, they could not assist, requested escalation to supervisor, none available. I asked to file a grievance for the supervisor not following through, I didn't have a name, I asked to file a grievance on the 2nd phone call, was placed on hold and after almost 45 minutes was disconnected.Business Response
Date: 01/28/2025
Please see attached response letter. This issue was resolved directly with the consumer and through a similar complaint filed with the Office of the Insurance Commissioner.Customer Answer
Date: 01/28/2025
Complaint: 22701471
I am rejecting this response because I'm the one who followed up on getting this issue resolved. I was able to escalate to a manager who confirmed they made the change, noting that the first ********* attempt to make the change must have failed. A proper response would have been 1) what is being done to correct the consumer concern that the Tier 1 who was being concurrently trained was told not to escalate to a supervisor and 2) why this took 2 attempts with no feedback when the first change failed. I spent hours trying to resolve a somewhat simply issue and this is consistent every time I contact member services. It's quicker to either scan the hard copy booklet or search the .pdf booklet online.
Sincerely,
******* FaithInitial Complaint
Date:12/14/2024
Type:Service or Repair IssuesStatus: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.
Automatic withdrawal has been set up 5 times on my wifes ambetter account. Do we have to set it up over and over and over and over and over and over and over again each month or is the concept of automatic withdrawl too huge to grasp? Its when you take ALL of our info for automatic withdrawl and STOP losing it. Please call ************ with an English speaking representative. That is my wifes number.Business Response
Date: 01/28/2025
Please see attached response letter. Ambetter from Coordinated Care health plans are available only for residents in Washington State. As Mr. ***** does not appear to be enrolled in any health plans issued by **********************, and has indicated a contact address in ********, we forwarded his complaint to our affiliate health plan in that state for further investigation and resolution directly with the consumer.Initial Complaint
Date:12/10/2024
Type:Billing IssuesStatus: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.
Yeah my insurance company has always been star plus superior health. Someone hacked their account and set me with ambetter texas and they told me it was canceled in February 2024. Well, now I'm getting a bill saying ambetter did not cancel it and I never received a letter. Idk how to get ambetter to remove my name and information. I've always been through star plus superior health, now I'm getting bills stating ambetter is my primary health when it is NOT. I need help because ambetter was supposed to cancel my name. I never even applied for ambetter because I am through star plus. Now I'm getting bills and idk what to do. Star plus is saying I'm still insured by them, meanwhile certain ** offices are saying ambetter is the insurance. HelpBusiness Response
Date: 01/28/2025
Please see attached response letter. The complainant is not a customer of **********************. Her contact information indicates that she resides in *****, and we have forwarded this complaint to our affiliate health plan in that state for further investigation and they will resolve the matter directly with the consumer.Initial Complaint
Date:12/02/2024
Type:Service or Repair IssuesStatus: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 are getting paid almost $700 a month to basically pay nothing. They have been pulling my chain all year, I have had to file a complaint at the ************************** and they are still pulling my chain. Ambetter was purchased with the sole purpose of covering my ****** shots which they have yet to cover. They always have an excuse as to why they aren't paying. First it was because it had to be denied through **** first, which was a load of doodoo because Ambetter is now my primary insurance not my BCBS. I proved to them in September that they are the primary yet they keep denying the claims.Then, they decided they were going to deny because the "claim was not submitted within required timeframe". Yes, it was submitted but they denied it saying it had to me rejected from **** first in order for them to pay. By the time it came back to them "it was out of timeframe". They have yet to pay any of my bills before September of this year and I noticed just this morning that they have denied both October and November's bills even though one set of shots covers all out of pocket and deductibles.Business Response
Date: 01/09/2025
Ambetter from Coordinated Care received your grievance concerning ****** ********* BBB Complaint Case# ********.Coordinated **************** does not serve Ms. ********* as she is not enrolled in any Washington State health plans. We forwarded her complaint to her health plan in *******, and they will contact her directly to resolve her concerns. We are unable to provide additional information regarding any case outcomes due to ***** privacy requirements.Initial Complaint
Date:09/04/2024
Type:Service or Repair IssuesStatus: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 spent 2 days on the phone with Ambetter seeking to get an appointment with a doctor in the next couple of months. Ambetter's list of doctors is deceiving, because after calling 5-10 providers they don't take this insurance or new patients. After multiple calls to Ambetter, I was finally given a number for a doctor to get an appointment, but this doctor can't be found on their provider list and after calling again I can't assign the doctor as my PCP. This insurance service is stealing my money because I can't get even the simplest of services.Business Response
Date: 10/11/2024
Please see attached response letter.
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