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.
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