Availability depends on location. If you need an x-day half of the places listed in their network online DO NOT do x-days or do not accept Ambetter. I can't see my Rewards information, there are hardly any doctors available. Don’t delay, choose an Ambetter plan today – before Open Enrollment ends May 15. © Copyright 2021 Ambetter of Peach State. What kind of scam is this company running?! I never had problems finding a doctor nearby, it covered my prescriptions, reasonable co-pays and deductibles. © 2021 BestCompany.com LLC - All a primary care physician, specialist, etc.) What you need to know about the Coronavirus. If you are looking for another kind of insurance plan, like a short-term health insurance, Medicare, or Medicaid, you'll need to find another insurance carrier. On my plan they do not pay for pain management and regular doctors pretty much can't prescribe anymore so that is difficult since I'm in pain almost constantly. This is my second year as an Ambetter customer, and I plan to renew my plan with them for 2021. Ambetter was supposed to pay the rest or so they told me. < Back to Map Seasons Hospice & Palliative Care of Georgia PH: (855) 803-5289 We are a community-based organization on an ongoing mission to find creative solutions which add quality to life. DO NOT GO WITH AMBETTER-nothing is covered! The Ent asked for MRI on th brain , Ambetter did not approve the MRI . I called my insurance and they told me they would call me back, it’s been a week already and haven’t heard anything. I hope I don't get stuck with them next year because they are pathetic. There was never any communication and they continued charging my credit card each month! They are very friendly and helpful , i like them. Do not choose this company!!!! Payment Info; Forms and Documents; Welcome to Haven Obgyn. Was told to see my cardiologist ASAP. Access your secure provider information any time. I told her that was the confirmation number on the email from ambetter! Call our recommended rep over at I don't know where to start, I've been trying to cancel for the last 3 months that I've been getting invoices, first I never signed up since I already have insurance through my employer, then every single time I call to cancel I get transferred numerous times and end up in what they call the marketplace which says I don't have an account with them, so I call customer service and start back in the same loop. They have no business advising policyholders on their insurance products. I repeat denied a stress test to find out if my arteries had blockage. I use AM Better for doctor visits, preventive screenings, and medication only. They have united healthcare and have had so many problems. Dental coverage includes exams, cleanings, and screenings, overall, and vision benefits include yearly eye exams and glasses or contacts. After calling 25 different doctors, listes as "in network" through the Ambetter website. I was with Ambetter part of 2019. Attention: Ambetter is a very unpopular health insurance company. Could be a serious issue. Many of the extra features it offers also send the message that Ambetter wants members to get healthier and stay healthier. If you learn that the service you're seeking is not covered, you can still visit MinuteClinic and choose another method of payment. I am one of the ones the affordable care act has helped tremendously. They have a lack of even basic providers and I haven't been able to get the urgent treatment I need to be able to walk. I wish I had stuck with Kaiser because I would not be living on meds daily while I wait for the procedures I need. I love all my providers. This insurance is a joke! One thing I really like about ambetter is they have a rewards system that is not hard to do. Ambetter customer service is not very good. While this program is great, it's only available in some of the states Ambetter services. no one new what an HSA account was or what it was used for. With such a high number of 1-star reviews, you'll likely be better served choosing another insurance provider if you can. Dental benefits, for example, is not available in Texas, but vision insurance is. It's Centene's option for HIM plans, which are intended for people who don't have health insurance and maybe don't qualify for typical plans. They refuse to fill my medications, refuse to authorize the prior authorizations, they denied my hospital stay as not medically necessary when my Dr. admitted me himself. Now I have an appointment 45 minutes away, which I'm going to have to pay for. Those seeking vision coverage and dental benefits in addition to health insurance can find options through Ambetter. This money can go toward your next premium. They have no problem taking your 500 a month until you actually need to UTILIZE your coverage then it's so long sucker. Data points such as the annual maximum out-of-pocket limit and co-pays are difficult to find on the website. I never trust the doctor office staff nor the pharmacy staff to sue the due diligence. Professional Claim Payor Connections Commercial/Managed Care Plans February 19, 2021 They are terrible I have been on the phone every day for the last 5 days on hold for hours and when I write them they say " just call we'll straighten this out ". Have had same issues since the beginning. How is $2500 per month premium for my wife and me, $3500 deductible for each of us and a 30% co pay affordable? The awards program/rebate is useful for easy items (flu shot), but some of the other awards take too many hours to earn. For health plans to be on the Marketplace, they must be a qualified health plan that covers the essential health benefits listed in the Affordable Care Act. I was transferred 4 times to different people in sales that might know more than the other. That way, you can focus on your patients. Stay away from ambetter. Of course there are pros and cons to every plan, but I stick with Ambetter because the positives far outweigh the negatives. I have never had a problem getting authorization for drugs, but sometimes the pharmacies will actually lie (not Ambetter’s fault) and tell you,”It isn’t covered by your insurance,” when all you needed was a pre-auth. My neurologist really didn't like my insurance and kept telling me they wouldn't approve this or that and I quit seeing him. Bill Payment Patient Portal. I've been waiting for months and no one is interested in helping. transfereing me to ENT doc. On january 17th I presented my new card to my pharmacy for my refoill for high blood pressure medication, and was told my coverage had been 'cancelled' - so I had to pay in full for them. They have denied some but then approved it later all except for one. I don't take heart meds but do take blood pressure meds. What you need to know about the Coronavirus. Finding anyone would that take this insurance proved a challenge initially. and connect confidently with companies that deserve their business. The dental only had one provider that would accept the plan in my area and they are so bad I walked out, and will pay out of pocket. You’re dedicated to your patients, so we’re dedicated to you. Also, being kind to customer service goes a long way. Giving 1 star but the company doesn’t even warrant that. I have no complaint about the actual insurance but if you can't find a doctor it's worthless. Getting pre approval has been a nightmare. I’d put zero star if I could. I was bleeding a lot when I was 14 weeks pregnant and went to the nearest emergency. My dentist refused service on this basis. High cost over $1500.00 monthly w/ 16k deductible. To find out what kinds of plans these are, such as Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO), not to mention what prices and benefits you qualify for (like out-of-pocket expenses, copayments, deductibles, covered services specifics,and if you need prior authorization for certain medical services), you'll have to contact a representative. I had to have foot surgery this year so I had to meet my out-of-pocket. What a joke! Typical, they are great unless you need them insurance company. Meanwhile, they denied a back brace and stopped covering the pain medication I need to function. I used Ambetter three years ago and I have no complaints. The website isn't working properly. Members can track their claims 24/7 through the online portal, as well as connect with member services at any hour of the day. All rights reserved. THEY HAVE TOP DOCTORS. However, I am no longer eligible for health insurance through work so I had to go to the marketplace. Ambetter Secure Care has higher monthly premiums, but the lowest out-of-pocket expenses of the three plan types. I had coverage with them in 2020, and used it for vision, dental and general doctor checkups. I’m pregnant but there’s no OBGYN accepts this insurance. Contact us at 404-480-4308 or visit us at 2675 N Decatur Road, Suite 404, Decatur, GA 30033: Premier Orthopaedics and Sports Medicine Ambetter plans are available in a some states. I guess I’m cynical that way, because I used to work in healthcare. Each Ambetter member has access to an online portal through which they can make all of their payments, view healthcare plan benefits, and take care of logistics like obtaining a member ID card. They had charged me again! Actually , i lost right ear hearing , then after visiting the primary care doc. Its website primarily just explains the metal tiers (gold plan, silver plan, and bronze plan) as well as how essential health benefits are covered by every plan. Live in Citrus County FL. It's equal parts annoying and helpful. The Simplee online bill payment system makes it simple to pay your hospital, imaging, urgent care or physician bill. Horrible! How sorry is that for a health Insurance Company!!! My insurance is more than $500 per month for a single person. Not a controlled substance, just a generic anti-inflammatory for osteoarthritis. The customer service reps are always helpful and usually go above and beyond to help, most of my prescriptions and doc visits are 100% covered or have a super low co-pay, and there are plenty of doctors and nurse practitioners in their list of providers.. We’re dedicated to helping your practice run as efficiently as possible, which is why we always strive for prompt claims processing. I've been in pain over a month barely able to use my left hand & the only place who accepts the insurance and actually do the x-rays says it can take 2 additional weeks to get an appointment because it takes so long to get the green light from Ambetter so you'll continue to be in pain after calling tons of places to be turned down. Some companies provide this for enrollees to access their accounts right from their phones, making communication and logistics much easier. rights reserved They dropped my in the middle of life saving treatment with a Dr referral I HAD to use due to their terrible illegitimate coverage. It was not worth having the vision and dental. Overall, I like Ambetter 1000x more than past plans I've had, like Humana and BCBS, which were outrageously pricey AND retroactively denied coverage for life-saving treatments, leaving me over $30K in debt. Melvin Bullock, M.D. In my case, as of January 2021, they have deon neither, and I am now out of the blue, in the middle of a pandemic without health insurance. Let us help direct you to the right resources for paying these types of bills. Then another month to get the 2nd approval. This insurance also denied this coverage so I called them and they don’t know why i got denied when it says “ in network” like wtf? Ambetter offers 24/7 Nurse Advice Line and integrated health management to enhance members ability to get the most out of their medical care. They should have been taken down years ago. Set Up and Manage Payment Plans Online; Select a State While the price estimator is a helpful tool that can estimate your health care costs based on anticipated services, please know that it is not an exact, personalized cost figure. Ambetter has 'cancelled' my new policy for 2021 for no known reason whatsoever, which was purchased through the Marketplace but did not notify me, they returned my first month's paid premium online halfway through the month as if by doing so this made the customer just disappear. If you missed the enrollment period, you may qualify for a Special Enrollment Period after December 15, 2020 if you have a Qualifying Life Event. I noticed that the providers' actual billing staff cause most of the billing errors, not Ambetter. Customer service is terrible, cost is high, I have been trying to resolve an issue of overpayment for more than 60 days and get the run around, am told first person dropped the ball, I am taking care of it only to have the ball dropped again, 4 people no resolution no return calls from anyone. With Ambetter, you can rely on the services and support that you need to deliver the best quality of patient care. My OBGYN doctor transfered me to a different hospital for another ultrasound which also says “in net-network” in their website. Obamacare at its worst. This is the worst company I have ever had. My injections are authorized as far as I know (they wanted 5 weeks of PT, but I told them I'd done that, so they fixed it). No straight answers from Ambetter. Each payment rule is sourced by a generally accepted coding principle. M.Thomas Riddick, M.D. I have written to the CEO of the company as below, again, I recommend anyone do the same. If you pay your monthly premium, stay in network, and do not need surgeries, this plan will work for you, This company horrible they stopped my surgery that i had to opinions from 2 specialist stating that there is a need for this so u can walk this is a surgery that is needed they canceled my surgery less than three hours before I was supposed to have it I pay for all the things that I need to have surgery renting equipment and everything out of my pocket just to be told that they felt like I need to be in pain a little bit longer before I could get my hip fixed I tried to explain to them if I got my hip fixed then I could work and I wouldn't have to be on Social Security but they don't care I can't pay my bills or do anything I went from working as a nurse for over 22 years to not being able to work at all or stand and now I'm on a walking cane if I get my hip fixed then I will be able to walk work and take care of my household and I won't have to be on assistant I would think this is what you would want you would not want your customers or clients to be sick or sitting at home hurting when they don't have to be for you to sit in the office and tell me that I am not in pain and that I should be in a little bit more pain than this so I said maybe I should go outside and fall hard on the concrete and then they said they would fix my head really so I have to go outside and hurt myself for you to fix something that should be fixed anyways this is horrible this is supposed to be a company through Obamacare it sucks what's the point in having insurance if something's really wrong and you have went through all the precautions it took 3 years for me to get approved for surgery spine specialist because I did every other alternative that I could do besides surgery to help me now I'm in chronic pain constantly they say they don't want people to take opiates or get addicted but I have no choice but to take these medications because my insurance will not fix the problem so that I can get off of medication ridiculous, I am new to Ambetter, and I have never in my life experience the frustration of having to deal with them. I was covered in July. Was told there were plenty of providers in my county. The bad is that they require pre authorization but that's any insurance. Now with the another neuroglial clinic , i am suffering from the same scenario because , the doctor asked to redo one of MRIs we did. Plan cost and deductible levels vary among plans. It's just RIDICULOUS! Dental and vision coverage are available with Ambetter, but the benefits and availability of each are entirely specific to the state you live in and the type of health plan you choose. I had to cancel it right away and wasted my premium payment. With them. He said he would call me back, but did not. What happened?! The ENT transferred me to a neuroglial doc , which ordered 2 more MRIs and a some kind of special test And here it comes the tragedy. Ambetter hasn't provided this yet, making account management slightly less convenient than with other companies. They out to be shut down. Use our helpful resources to deliver the best quality of care. Ambetter is horrible. This rewards program promotes health and well-being among Ambetter members. You get points for flu shot, answering simple questions, watching health videos, etc. They have lots of perks that you can gain from a point system they have. Never get approved for any coverages. If you follow the rules of the Ambetter system, and make sure you use in-network providers, you won’t have to deal with appeals over billing later. Members can be reimbursed for gym membership payments as well. the result is the usual denial and the new advice was asking the doctor to do a call ( Peer to Peer call ) it means that the doctor must call the authorization department and ask for the doctor that gave the denial trying to explain to him the reasons for the MRI . Review clinical and payment policy information. When I called, the woman said the confirmation number that accompanied the email was wrong and there was nothing she could do to help me. Point out their own words, which is the very opposite of how it seems Ambetter treats its customers. Ambetter PA Health & Wellness Member and Provider Services Phone Number: 833-510-4727: Ambetter from Peach State Health Plan - Georgia: 68069: 1100 Circle 75 Parkway, Suite 1100, Atlanta, GA 30339: Ambetter Peach State Health Plan Member and Provider Services Phone Number: 877-687-1180: Ambetter from Silversummit Healthplan - Nevada: 68069 You will need Adobe Reader to open PDFs on this site. I kept calling Ambetter again and again so try to solve this issue. Peachtree Surgical & Bariatrics is a leading bariatric and general surgery practice in Atlanta, GA. Our experienced group of surgeons and staff are dedicated to the safest and most effective weight loss procedures for those suffering from obesity including gastric bypass, gastric sleeve, gastric banding and revisional bariatric surgery. THEY WERE REALLY WONDERFUL. Cancellations require a 30 day notice in writing so that the usered person can obtain another plan through the Marketplace as a special enrollment. Ambetter = Trash. Privacy Policy | Terms | Do Not Sell My Personal Information. They also have a great reward system where you get money back if you have the debit card. Alpharetta; Cumming; Roswell; Sandy Springs/Atlanta; Smyrna; 2 Endoscopy Centers. It’s no little matter either. I have worked in insurance for years, I know exactly what an HSA is, but each individual insurance company has different benefits. I would NOT RECOMMEND, One of the worst companies out there. I had to pay roughly $37,000 out of pocket each before they paid for both of us. It has received a 1.4/5 star rating from reviews left on Best Company. Roughly 88 percent of the Ambetter reviews on Best Company gave a 1-star rating. Pay a little more and get insurance that providers will accept. This company is breaking the law and getting away with it. Very dishonest company and try to get out of paying all claims. Horrible customer service trying to confuse all issues and rebilling claims so many times they try to get you to just give up. I mean, I had a lengthy convo with a rep who was absolutely outstanding and sweet. It's not like a small town or something. I don't understand, how you can work selling something and not know anything about it. This company is run by crooks and all around dishonest people. They required 5 weeks of PT before authorizing an MRI, with me paying 40% out of pocket for each session (I met my out of pocket max, so MRI was 100% covered). These guys are the absolute worst. Really wish I had seen this before switching insurance providers. No customer service..premium payment taken and never refunded..20 calls over 8 months..promised it was in the mail..last call statute of limitations of 180 days had passed..keeping my money..never let you speak to same person twice..nice but incompetent.. sad. Ambetter should be somewhat of a last resort when choosing an affordable health insurance company. They refused to cover the 3d mammogram, they refused to cover my stress test. They advised my dentist that we had an $8000 deductible and then advised my dentist they did not cover routine fillings. Really sad that you can pick based on your ZIP code and there weren't many good plans available. As usual Ambetter did not approve, the reason is i don't have a medical history that requires MRI - the sudden hearing loss is not enough reason and also they said that the doctor did not submit enough docs to get the approval , so its not approved. HOW CAN A COMPANY AND ITS REPRESENTATIVES AND SUPERVISORS NOT KNOW THIS ANSWER? don't waste you health with AMBETTR. Awful and stressful! Ambetter from Buckeye Health Plan - Ohio: Initial Claims: 180 Days from the DOS (Participating Providers). So, for the good: it's affordable, I've had good customer service experiences (once they accidentally denied a claim, saying it was out of network, but quickly corrected this after a phone call), my copays aren't bad (this is important as I'm chronically ill and frequently see multiple specialists), they have a free health coaching plan, and I absolutely love the providers I found. Then, their customer service reps gave nothing but inaccurate information. Please, if you care about your health and sanity, do not use this insurance. EOB are clear and they have a good incentive program to develop healthy habits. Ambetter DENIED. Under the Affordable Care Act they cannot cancel insurance except for non-payment or fraud/misrepresentation. In the 40 + years of dealing with health insurance companies they are the worst. Ambetter gave me 3, and not one was still an Ambetter provider. It's somewhat difficult to access specific information about the types of health plans Ambetter has. I am so happy that I chose Ambetter and not a cheaper company, because you really do get what you pay for, right? Have the Access Code located on your bill ready when you begin. THE COVERAGE HAS BEEN A LIFESAVER. Anyway, that's just mildly annoying. Have had same issues since the beginning. Moved from Ohio early this year. Our calls for virtual visits are generally between 8 am to 4 pm. Our top-rated physicians are equipped to handle all your medical symptoms. Haven Ob/Gyn located in Atlanta, Georgia is a small obgyn practice dedicated to providing personalized, top-quality medical care for women of all ages and in every phase of life. Even trying to change my primary doctor It has been impossible to find providers who will accept ambetter. Drop Ambetter asap and get in on that lawsuit! They're provider network is a little thin. Ambetter doesn't seem to care if you die. Now they are denying me apparently and are saying that I have to pay the full amount! These include Arkansas, Florida, Georgia, Illinois, Indiana, Massachusetts, Mississippi, New Hampshire, Ohio, Texas, Washington, and Wisconsin. This company desperately needs to invest in actually educating their sales department including the member services. But they DID NOT. They've done fine on small claims but I don't trust that they would honor a major one. As a reminder, our process is as follows, the day of your appointment, we will verify your insurance or call to collect payment if you are a cash patient. The customer experience with Ambetter was clearly the worst in my role as a consumer. You’re dedicated to your patients, so we’re dedicated to you. Find and enroll in a plan that's right for you.Â, Find everything you need in the member online account. If you don't live in any of these states, then you'll need to consider another insurance provider. Have an anesthesiology, emergency, pathology, or radiology bill? So much for the healthcaremarketplace.gov helping anyone out....all it did was cost me a bunch of money. Been with them several years and they are so-so, probably about like most insurance companies. I purchased a plan with vision and dental. I WOULD STILL BE WITH THEM, BUT THEIR RATES WENT UP ON THE OBAMACARE MARKET PLACE. Additional Bill Types. I had Ambetter in Georgia and it was great. Trusted Orthopaedic Surgeon serving Decatur, GA. I have been on the same ADD medication for 7 years changing to better and after a week of handing getting a prescription I still don't - no I can't I call in every day they ask me questions like "did you ask your Doctor for the pa and mba and a pb, " no I don't want any of those things are. The prices were affordable and the network was easy to navigate. Yes, some stuff is a real hassle, but I'm very satisfied with Ambetter. 90 Days from the DOS (Non Participating providers). I had to call several times trying to figure out if a particular service would be covered by my insurance and each person that I spoke with had a hard time finding it or had no idea what I was talking about. I was able to earn $250 this year easily that I paid my electric with. With telehealth, members can have phone or video access to in-network providers for non-emergencies. I have no complaints with them overall they have provided the needed care for My husband and I. I got a bill from a provider from something I got done back in July. Ambetter below. It took 4 months to get the first approval. You will spend hours on the phone with them over weeks, trying to get a simple prescription authorized for refill that you have been taking for years, because suddenly they will deny payment for it. Upfront, it's important to know that Ambetter is part of the Health Insurance Marketplace (HIM). The EFT payment schedule was incorrectly programmed resulting in a premature cancellation of coverage that had to be reinstated. Typically, scam to the government! I pay zero dollars for my medication (I take 9 a day) and copays for primary and specialists. Ambetter is the WORST insurance company you could ever use....do yourself a favor and pick anyone else! The following day it took 3 calls to Ambetter and 3 calls to the Marketplace to get NOWHERE.