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Ambetter Health Insurance Review

275 Customer Comments & Reviews - see all comments
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Ambetter is a health insurance company owned by the Centene Corporation, which is a multi-national healthcare company that provides programs and services to under-insured and uninsured individuals. Ambetter offers customers affordable health care plans in 14 states including Arkansas, Arizona, Georgia, Florida, Indiana, and Nevada, among others.
 
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Ambetter is Centene Corporation’s option for a health insurance marketplace, so it’s intended for individuals who lack health insurance, and possibly don’t qualify for traditional plans.

What’s Included in Ambetter’s Health Insurance Plans?

Ambetter health insurance plans offer prescription coverage, mental and behavioral health services, integrated care management, maternity and newborn care, 24/7 nurse advice line, Ambetter Telehealth, My Health Pays Rewards, and optional vision and dental coverage for adults.

The company has three plan options to choose from: Ambetter Essential Care, Ambetter Balanced Care, and Ambetter Secure Care, which are classified as bronze, silver, and gold, respectively.

The Ambetter Essential Care offers lower monthly premium payments, but higher out-of-pocket expenses, the Ambetter Balanced Care offers the best balance between monthly premium payments and out-of-pocket expenses, and the Ambetter Secure Care has higher monthly premium payments, but limits your out-of-pocket expenses.

Each plan has a different type of coverage and payment, but all of them include essential health benefits such as emergency services, hospitalization. outpatient or ambulatory services, preventive and wellness services, maternity and newborn care, pediatric services, mental health and substance abuse services, and laboratory services, among others.

Final Thoughts

Overall, Ambetter offers flexible healthcare options that fit different budgets and needs, with a few perks like the company’s My Health Pays Rewards, which allows customers to pay for medical expenses with the money they earn through the program, a 24/7 nurse advice line, and Ambetter Telehealth, which provides 24/7 phone or video access to in-network providers for non-emergency health issues. Additionally, Ambetter members can manage and pay for their account online, and the company’s website offers helpful tools like a provider search engine, and educational articles for those who want to learn more about insurance.

Having said that, Ambetter health insurance also has its drawbacks, like the fact that it’s only available in 15 states, you must sign up during the open enrollment period, and that the company may have stricter requirements to qualify than other traditional insurance companies, so customers should keep this in mind before purchasing.

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275 Customer Comments & Reviews

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DJS
9/16/2019
This company is a joke. After denying the original claim, for emergency services in the ER, the provider filed a claim dispute. Took Ambetter 10 months to review the claim dispute, which they denied again. The timeframe to resubmit a new claim has passed. Now I’m stuck with bill.

Michelle H
9/9/2019
After a recent 48 hour stay in the Emergency Room and PVU floor at IU Health Methodist Hospital in Indianapolis, Indiana I received two letters that my coverage would be denied as "not medically necessary." The Medical Director who denied my coverage was Dr. Daniel Hayford, a Pediatrician. He does not have the medical knowledge to make that decision. I have a congenital heart defect and was admitted by a seasoned On-Call Cardiologist and my personal Cardiologist. If Dr. Daniel Hayford and Ambetter read the paperwork submitted by the Hospital they would be aware of my heart defect. As their denial letter states "there is no evidence of heart failure." Please rethink having Dr.... Read More

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Rselvidge
9/4/2019
Worst, look around the internet for reviews. I bought this insurance off the marketplace, they deny every claim and force you to fight them.

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Linda
8/17/2019
My Husband went for a physical at our in network doctor they sent him to the lab in the same building downstairs , little did we know until we received the bill all labs for physical was out of network. Unbelievable I called and they said we should have investigated the lab our in network doctor recommended , even though our wellness screening were suppose to be covered. Also they changed our co pay for office visits in the middle of the year without notifying us. Doctor went from 20.00 to 35.00 specialist went from 40.00 to 80.00. I appealed these labs and copays, was told" denied" they have the right to change your policy at any given time during the year. Be ware this Insurance is... Read More

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Melissa S
8/16/2019
This company is a scam. They are HORRIBLE. We have had nothing but major problems and very, very bad customer service overall. I have been on the same ADD meds since 2017. We switched to Ambetter on the exchange for 2019 due to their co-pay for this med being $50. They immediately started denying my medications, and basically said that whatever my doctor had prescribed did not matter; I would not be able to get my medication unless I tried a different, generic medication first. I tried to discuss this with them directly but to no avail. So I took the different, generic medication, which has neurologically destroyed my tongue (even though I went off of that med after 2... Read More

Joanne S
7/22/2019
So I live in Morrisville Pa. no, I mean no Urgent care in my area, so I go to my Dr. or emergency room where I pay 40%. Omg, this is so awful! And I’m not feeling well! Do your homework when buying health ins. America free healthcare!

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M
7/18/2019
This is the worst insurance company I've ever dealt with that's SCAMMED me out of a month's payment. I moved to a different state, and called to let them know, as they'd have to change my plan slightly to work in the new state. I was told, by their own representative, that there would be a gap month during my move where I would have no health insurance. That was a scary month, I kept praying nothing would happen to me. I had the money to pay, but was told that the month of my move they'd be switching the policy and that I wouldn't have insurance that month. I noticed I couldn't log into my account, so I called to ask them about that, and was told by another representative that everything... Read More

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Ayaz S
7/17/2019
Terrible insurance company I am dealing with. I started with them this year 2019. They do not cover any prescription which is expansive and I have to fight for going in a lengthy appeal process. Even if the approve t, I have to pay a huge portion out of pocket. When call their customer service, they are not friendly. My 2 prescriptions which my doctor prescribed and I was taking for years and previous health insurance company was paying for it. Ambetter denied and asked me to prove that I need it. Is it not a silly question to the member to provide the proof while my doctor has already submitted the proof. To cut the story short I told them that I will not renew my policy with them when... Read More

Amy J
6/27/2019
What is wrong with your prior authorization system. My daughter is Type 1 diabetic. THAT IS AN INCURABLE DISEASE! You are requiring prior authorization on her DME one month after it was prior authorized last time. You usually require every 3 months, which is still ridiculous. WHY SHOULD SOMEONE WITH AN INCURABLE DISEASE HAVE TO PROVE TO YOU THAT THEY STILL HAVE THE DISEASE EVERY 3 MONTHS? This is insanity! I spend so much of my life trying to save my daughters life because you won't approve her DME for long enough for her to get access to her medications and get her insulin levels regulated. Plus I pay $330 a month for you to treat us like her life doesn't matter. YOU ARE A JOKE!

kid.katz
6/24/2019
I have a Gold level plan costing over $13,000 per year with their Ambetter Health by Celtic Insurance. This company is effectively operating a scam. It may not meet the legal definition of fraud, but it certainly meets the moral definition. I have a $1000 deductible policy. They have very limited options for providers and hospitals with the hospitals being among the worst around per Yelp reviews. Even after getting approved for procedures supposedly covered by Ambetter, I have been saddled with the bulk of the bills. For example, I needed medical imaging work done. Only two hospitals with bad reputations are in-network in a city/burbs with a few dozen hospitals. I got the... Read More

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