Review Time
I pay $950/month and Ambetter covers NOTHING! I am paying for all of those people who don't pay a dime yet get EVERYTHING covered! Greed will only get you to 1 place. Hell!
Coverage went up by $400 a month, I called a customer service rep and they said my rates would stay the same unless I did a manual change but I she was uninformed or I was lied to. Not only this, but they are extremely hard to get a hold of for questions, and most stuff my family needs seems out of network. Even the in-network reccomended healthcare providers inside the portal are out of date and innacurate. What a disaster
I have spent a cumulative 10 hours trying to book a simple first appointment with in-network physicians with this company. Ambetter lists which physicians are accepting new patients, but you don't know this is true until you call to make an appointment. You can't just book with a different physician if you're not assigned to them. So you have to make that change first. Then you call to book an appointment, and that physician isn't accepting patients either. Their directory needs an update or the doctor's office needs to be communicating with the insurance company. For all the tech tape and phone calling I had to go through just to discover all this is beyond unacceptable for the cost of the much better than average insurance plan I bought. In the end, I'm scheduled to be seen by a Resident, which I appreciate is still good medical care, but it's NOT the experience of care I thought I was paying for. I'll be terminating my policy to find healthcare another way. The only redeeming feature was the kind customer service from 1 individual.
Due to changes in insurance options implemented by the current government, I had to switch my health insurance for 2026. As a self-employed person, I purchase my insurance independently each year. Silver tiers are no longer available, leaving only Gold or Bronze plans.
I chose Ambetter because their Gold plan appeared to have a lower premium than my previous insurer. Within just two weeks, trying to access my prescribed medications turned into an incredibly stressful and time-consuming process. Coverage was repeatedly denied, prescription costs were significantly higher than advertised, and getting clear answers from customer service was nearly impossible.
Before January 15, I canceled Ambetter and returned to my previous insurance despite the higher premium. The amount of stress, uncertainty, and wasted time was not worth it.
I would strongly caution anyone considering Ambetter: expect coverage denials, higher-than-expected prescription costs, and poor customer service.
The service was extremely disappointing. I attempted to reach the 24/7 Nurse Line listed on my card, but the number was incorrect. Instead, I was connected to another department that was unhelpful in directing me to the right place. I was passed around to three different phone numbers and received assistance far too late. Given my medical condition, I was not provided with the help or advice that I pay for and desperately needed at that time. It’s incredibly disheartening to experience such treatment while dealing with physical pain.
Ambetter feels more like a scam than a service. Their costs are high, with steep co-pays and deductibles, and they often deny coverage for necessary services. I paid over $500 a month for a plan this year, faced a deductible exceeding $6,000, and encountered issues at every step. When I had a medical emergency and needed to visit the ER, they sent me a letter insisting I should have gone to a walk-in clinic instead. If they had taken a moment to assess my situation, they would have realized that was not a suitable option. The situation worsened when I checked the 2026 plans; a comparable plan jumped from $500 to nearly $900 monthly. That was unaffordable, so I chose not to enroll. Yet, Ambetter enrolled me without my approval and charged me. It's been over a week, and despite numerous calls, my refund has not been processed. Ambetter’s service is truly disappointing.
You're faced with subpar medical professionals and may have to travel long distances for effective healthcare. If you're seeking psychological support, this option isn't advisable. For routine check-ups, it may suffice, and there are incentives for watching healthcare videos. However, be cautious of potential charges after receiving care and larger fees at the year's end. Thanks to the representative.
They use customer service from India which every time my husband and I have called in they are almost completely unable to be understood through their very thick accents. I've mailed in multiple authorized contact forms so that my husband could speak on my behalf when I am at work and yet somehow, they "never received them".They keep increasing the premiums for their plans while at the same time decreasing what those plans offer showing they would rather just collect money than actually offer a decent product to consumer. -10/10 Biggest scam ever that only exists because the ACA subsidies made the majority of their plans free to no cost.
This company deserves less than one star. This is theft and I’m extremely pissed! Do yourself a favor and go with ANY other company! The only reason I enrolled with them in the first place was because even though the coverage SUCKS on the front end, it’s great on the back end if you end up in the hospital. I unfortunately do quite a bit. I am a type 1 diabetic, and I have been getting the same medication with them for a year. Nothing has changed. My plan hasn’t changed, my premium hasn’t changed, etc. All of a sudden, the pharmacy is telling me that a pre-authorization is needed for my medication. This is medication that is keeping me alive by the way, it is medically necessary, and now I will be out of medication in 3 days. You might be wondering why I waited so long to get a refill, but again…no pre-auth was ever needed. I have a call in to my doctor but tomorrow is Friday, they say they can take up to 48 hours to get back to you, and I will run out of medication by Sunday. According to the customer service rep…pre-authorizations can take up to 72 hours JUST FOR A DECISION TO BE MADE. We all know how that goes. I’m sure after 72 hours, it will still be denied. The icing on top of the cake was that I called Ambetter to ask why it had changed and nobody could give me an answer. The first girl I talked to kept putting me on hold just to come back and say, “so I see here that that is a non-formulary prescription and so Ambetter won’t cover it. The good news is that after you get a pre-authorization from your doctor we will “. First of all, you can’t guarantee that. Second, that’s not what I asked you! I got angry after about 30 minutes on the line with this girl. I asked to speak to a supervisor. She says “my supervisor is in a meeting right now”. Yeahhhh. Okay. So I said “I don’t care. Get them out of the meeting”. She kept telling me they were in a meeting and couldn’t take my call. I then told her I needed to be transferred to someone else, and she then said “I’m the only one available to take your call”. I lost it at this point and I said “I know you’re not the only person available at that company. You can either transfer me to someone else or I will hang up and call back to reach someone else that way”. She put me back on hold for another 5 minutes or so and then transferred me to someone who claimed to be in the resolution department. I’m not going to go into what all we talked about, but it didn’t resolve anything. She ended up telling me that I could pay for my medications out of pocket and then if my pre-authorization went through and was accepted, I could then apply for a reimbursement from Ambetter. I just laughed at this point and said “does that actually work?” She couldn’t answer me. The part that’s theft is that I asked her about my deductible. I only have $130 left until I reach it, however, that’s only because I paid over $1,000 to a third party medical company for some diabetic supplies. My entire year of paying for my medications at the pharmacy WAS NOT BEING COUNTED TOWARDS MY DEDUCTIBLE. I have proof of that as well. I asked this girl if I could just pay the $130 over the phone and move on. She sarcastically said “that’s not how deductibles work”. To which I said “no you’re right. They’re supposed to be counting all of the prescriptions I’ve been paying for up until now, and yet here we are “. She told me that if I paid out of pocket for a prescription that was over $130, that my deductible would make it only cost $130 max. I then asked about this prescription in question. She treated me like I was a moron which…yes, sorry. Should have been specific apparently. She said “that medication isn’t covered!” I said “yes, I got that part. I meant after this pre-authorization goes through. It’s non-formulary, so even with a pre-authorization, should that be counting towards my deductible once approved?” (We all know health insurance companies have loop holes for everything). All she said was a sarcastic “sure”. Really? Yeah. I’m done. Do better Ambetter. There are people who need medications to survive. I understand not covering all of them but at the very least answer people’s questions. As a business owner myself, I can honestly say, this is not the way to gain customers or their loyalty. You need to hire people with customer service abilities. Also, Ambetter has been cutting people checks left and right due to not paying things the way they should (look it up!) If I have proof that my deductible hasn’t been met yet and I’ve been paying towards it all year, they’re about to be in a world of hurt. I have a call into my lawyer as we speak actually. Just steer clear of this company. There are so many better options for mediocre health insurance.
Ambetter health insurance doesn't deserve a 1 star. The worst insurance ever. They customer service just lie to get you off the phone. They won't let you talk to a supervisor or manager. I have been waiting for a refund check for over 2 months. I moved over 1 year and 6 months never have a problem getting their mail monthly for billing and when they don't want to pay my doctor bill but haven't received my refund check yet. So I called like 8 times and each representative has something different to say but won't let you talk to a supervisor or manager. Well yesterday I received an ambetter letter stating they want pay my doctor bill but today when I call, all of a sudden my address in their system is changed to my old address, the address I changed over 1 year ago but I'm getting their mail at my new address for over 1 year. They are so full of shit and I'm reporting them for keeping my refund check for no reason. I'm calling market place and healthcare commission over ambetter. They are lying and they are never getting money from me again. I suggest anyone else to stay away from them because no one accepts them because they don't pay. I wish I would get another bill from them.
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