Ambetter from Sunflower Health Plan
Reviews and Complaints

Ambetter is a total scam. I've been paying more than $400 every month in 2020, and now it's October. I went to the ER and got slapped with a $595 bill. Ambetter only covered a measly $4.25 cents. What about the $4,000 I've been shelling out all year? It's just a complete waste of money. I demand a refund for the entire year.

This insurance is the worst! I canceled it in 8, but I keep getting reminders and bills. I've called them so many times to remind them that I canceled, but now I got a letter in 11 saying they terminated me because I didn't pay. Can you believe it? They can't even communicate properly. They're so incompetent, it's unbelievable.

The Ambetter website said my main doctor and hospital were in network. But turns out, they ain't. They lied to me. I filed a complaint with the *** Commissioner. So, before you get this insurance, make sure to call your providers and don't get tricked like I did.

They won't pay for my Type 2 diabetes medicine. Even though their website says they will. When I called before signing up, they said they cover Tresiba, Trulicity, and Jardiance. But now they're saying I have to try cheaper options first. If that doesn't work... we'll see. They said no to 3 medicines, so now I have no insulin for 10 days.

Not even one star. They take forever, blame the doctor, and do whatever it takes to say no to a claim. My doctor wanted more PT for me after my shoulder surgery, Ambetter blamed the doctor after saying no to the claim, took months to look at my appeal, and only said yes to 4 more PT sessions. Way too late to help. The last time I went for an insurance check, Ambetter said no. Put on your clown outfit if you go with this company.

Oh my gosh! Things can change so fast. I've had Ambetter for 3 years. The first year was great... no problems at all. But in the second year, lots of issues with settling claims came up. Now, at the start of this year, I'm thinking of switching. How can a company go downhill so quickly? Problems are everywhere. If you're a policy-holder and need to talk to Ambetter - I feel sorry for you! Customer Service has been outsourced and the Representatives (not all, but most) don't have enough training to fix claim problems. The worst was when a Representative didn't even understand how deductibles and OOP maximums work! This company is driving me crazy. Thinking about Ambetter should come with a warning!

When I picked Ambetter Sunflower Health for my family's healthcare, I was specifically drawn to their website's claim of covering a certain medication that two of my family members require daily. However, when I went to the pharmacy to get the prescription filled, they denied it, saying it wasn't covered. I reached out to Ambetter Sunflower Health Care multiple times, discussing the medication problem with them. I explained that I chose their healthcare plan based on their website's assurance of coverage for this medication. Every time I contacted Ambetter, they couldn't assist me with this issue. During my last phone call, I requested to speak with management about this medication matter. They put me on hold for a whopping 45 minutes, and unfortunately, the issue remained unresolved. I intend to search for another health insurance company and cease doing business with Ambetter Health Insurance. Ambetter Health Insurance lacks credibility as an insurance provider. I wouldn't recommend doing business with them.

This insurance is the worst ever! I've been dealing with medical problems for years. I just got diagnosed with bilateral occipital nerve neuralgia, the most painful head and neck pain possible. I've been going back and forth to hospitals for years, and the doctors finally realized it wasn't migraines! I've been saying that for years, but the migraine treatments never worked. Then the company put me in a lock-in program, which is a total joke! I'm a good person, a wife, a mother, a daughter, and a daughter-in-law. My family and everyone who knows me says I don't deserve this. If I could, I wouldn't even give it one star. They're making things so hard for me right now, and I think it's because they can't legally fire me! It's already bad enough to be in excruciating pain every day and not be able to function. Now I have to deal with an unsympathetic health insurance company. They say you can appeal things, but don't waste your time! I could keep going, but I think what I've written so far is enough to make people think twice before getting this insurance.

My husband is a firefighter and he has insurance through his department. I'm paying for insurance with Ambetter through the Healthcare Marketplace for my own policy because I'm self-employed and it was cheaper than using my husband's insurance. A few weeks ago, we got member cards and a bill for $728.52 out of nowhere. It seemed really strange, so I contacted Ambetter and the Healthcare Marketplace. They both said it was Ambetter's mistake and that everything was "all good". They said there was no way I could be charged because Ambetter doesn't have an account for us and can't charge us for anything.

But this morning, I woke up to find that $728.52 had been taken out of our ACTUAL CHECKING account. It was real money, not a charge on a credit card that I could dispute. I spent over three hours on the phone this morning with people who didn't apologize at all and didn't believe me. The Healthcare Marketplace even got on the phone as a third party and confirmed that there is NO application or account, and what Ambetter did was wrong. It's actually against the law to take money without authorization, and I never gave them permission to take this money. I don't even know how they got my checking account information. Now, I have to wait for a caseworker to review it before they will give me a refund. And I have to pay overdraft fees because of their illegal actions. I was crying, but they didn't care.

Ambetter is a joke. I have been very sick with post COVID symptoms since last June with multiple ER visits, etc. I lost half of my right kidney, blood clot disorder, asthma, and an autoimmune deficiency. Back in February, my kidney doctor was looking at post COVID *** found one. It is in *** at *** hospital. After my doctor and I talked, I called Ambetter to see the *** to get this considered In Network. I had read in my plan and verified by an Ambetter customer service agent that if the doctor deemed that I couldn't get care in Kansas and my conditions were worsening, the doctor needed to do a Pre Auth. I conveyed all information to my doctor, and he did everything, along with his nurse faxing & refaxing health records with diagnosis, etc. This started in February. I spent a majority of days each week calling Ambetter to check on status. Sometimes hours a day, multiple hang *** put on hold, no one giving me correct information. My nurse and doctor went above and beyond to help as Ambetter kept stringing us along. If my health concerns were not concerning and somewhat life-threatening, my doctor would not be referring me out of state. I feel as if it was my full-time job calling. The referring hospital in *** has a post-COVID clinic and specializes in asthma, immunology, etc. They have had me in their system for over a month & have sent Ambetter the codes of tests they wanted to do. Three weeks ago, me, my doctor's nurse, and 2 reps with Ambetter had a 4-way call. We all discussed concerns & how this should have been given top priority from the beginning. As my nurse wrote urgent, at the end of the call, she asked the Ambetter reps if they needed anything more to expedite this auth. They said NO! As my health continues to decline, last Friday after 9 weeks, I was told over the phone I WAS DENIED! They lied and led me to believe it would go through. I am ready to file a complaint with the insurance commissioner & go public. I see Ambetter has been sued by many states. Horrible.

My son had an account *** He died on October 8, 2022. The payment for his account has been coming out of my checking account. I keep trying to get them to stop it, but they keep telling me they need to talk to him. I keep explaining that he died, but no one seems to be able to help me. I need this removed from my debit card and credited back the charges since October 8.

Because of a problem with Ambetter's system, they took my insurance premium twice from my account. When I realized the mistake, I asked for a refund right away. They said it would take 7-10 business days to process the refund. It's been 15 business days now, and Ambetter still hasn't given me back my money. I've called them multiple times, and every time they just tell me to wait one more day. Ambetter is refusing to refund the money they shouldn't have taken in the first place. This situation has put my family in a tough financial situation.

I filed a claim for Insurance Benefits payment and received a denial. I was told to file a reconsideration and claim dispute because no one could give me an answer as to why it was denied. The department that could help with this "Does not take phone calls." I filed an appeal with the requested documentation that was asked for. I received another denial with no clear explanation in the letter, which told me to call for more information. I got the same run around as the department that makes the decision "Does not take phone calls." I was told to request that Provider Relations check on this, and the only way to contact them is by email because they do not "take phone calls" either. I'm not sure why this company is allowed to sell insurance in the state. I understand that their job is to not pay claims, but they need to when the claim is correct.

I switched to this health insurance provider at the beginning of this year 2022. So far, I've spent over 4 hours on the phone with this company trying to get preauthorizations for my necessary medications. Unfortunately, they haven't resolved any of my medication requests that should be covered. The representatives who answer the phone have heavy accents, which makes communication really hard. I have to repeat myself a lot, and it seems like they don't understand me. One time, I asked to speak to a supervisor and they just hung up on me. This company has been nothing but trouble since I switched to them on Jan 1, 2022. As a diabetic, they won't pay for my testing strips and glucose monitoring sensors that help me control my blood sugar. They also denied my ozempic request without a pre-authorization. I sent them a pre-authorization request, but they won't make a decision until Jan 31 at the earliest. These delays are totally not okay and they need to act on them right away because these medications are really important for a patient's well-being.

On Ambetters web page it clearly states that they will cover Covid 19 testing and treatments at no cost to me, without prior approval. However when I got covid and needed to goto the hospital on October 18 and the 20th of 2021, I also got a bills... multiple bills that added up to over 1300.00 dollors. To make the matter worse I have been hung up on. Given false information from their customer service department (been told that checks were sent out, only to later be told the checks were for zero dollors...), and ignored despite trying to file a dispute via fax. I have been provided emails from agents that I am supposed to share with the hospital to prove that ambetter paid them, however, the email says that I can't share it. I have no clue who is in charge but this has been a horrible experience. At this point I have started making payments to Advent health, and phoenix health to avoid ruining my credit. I have clearly told them that I would reach out to the ComplaintsBoard.com and it was only then that they acknowledged that their was a discrepancy and started a review process but they have informed me that it will take another 30 days before the matter comes to some conclusion. After three months of this back and forth I need someone who can hold them accountable for their false claims and bring this matter to a resolution. I have uploaded the screenshot that I am referencing. It was taken on November 19th. I have attempted to find it again but it seems that Ambetter has removed it from their web age now. Call reference numbers that I was provided.

I got a letter from Ambetter on September 17th saying I was owed a rebate of $4022.87. They said I should get it by September 30, or they would use it to pay my premium due after that date. But I didn't get the rebate check, even though I usually get it on time. So I called Ambetter on October 13. The person I talked to said they would use part of the rebate to pay for my premiums for October, November, and December, which added up to $996.63. That left a balance of $3026.24. The person said they sent a request to the billing department to issue the refund check, but it takes 7-10 days to process. But I still haven't received the check, so I've been calling Ambetter Customer Service every two weeks to find out what's going on. They've given me lots of reasons for the delay, but no solution. On December 18, I spoke to someone who said there seemed to be a problem with Billing not issuing the check like they were supposed to. They said they would escalate the issue and try to speed up the payment. But as of today, December 22, I still haven't received the check. I called Ambetter customer service again and talked to a supervisor, but they didn't confirm that the refund check had been issued.

I am experiencing the same problem as this person. I got a letter from Ambetter on September 17th saying I had a rebate of $4022.87. They said I would get the rebate by September 30, or they would use it to pay my premium due after that date. But I didn't get the rebate check. I called Ambetter on October 13, and the representative said they would use part of the rebate to pay for my premiums in October, November, and December, which totaled $996.63. So, I was supposed to get a rebate of $3026.24. The representative said they sent a request to the billing department to issue the refund check, but I haven't received it yet. I have called Ambetter Customer Service every two weeks to check on the status of the check, but they keep giving me different reasons for the delay and no solution. On December 18, I spoke to a representative who said there was an issue with Billing not issuing the check as they should have. She said she would escalate the issue and expedite the payment. But as of today, December 22, I still haven't received the check. I called Ambetter customer service again and spoke to a supervisor, but they couldn't confirm if the refund check had been issued. On October 3, I called and asked for my rebate. The agent said it would take 7-10 days to process. A month later, I called again, and another agent said they didn't apply it correctly, but they would fix it, and I would receive my rebate in 7-10 days. It's been

I applied for health insurance because I got a new job. The doctor I go to doesn't accept the private insurance provided by my employer. I applied for the insurance in October . I paid for it on 11/19 at 1:13pm. I called my doctor to make an appointment and they said they don't accept Ambetter Sunflower Health insurance. So, I called Ambetter again at 3:33pm and canceled the insurance because I don't want to pay for something I can't use. I spoke to a representative and they said it would take 7 to 10 business days to get a refund. On 12/08, I called to check the status of my refund and they told me I had to cancel through the ***. They transferred me to the *** and they said I have to wait thirty days from the cancellation date to get a refund from Ambetter. I called Ambetter again and they said I was transferred to a supervisor, but I don't have her name. They record all calls, so I asked for transcripts of every call I made to them. The supervisor assured me that I would get my money back in a few more days and that I would get the full amount. She also said I need to call the *** and ask them to change my cancellation date to 11/01. The *** refused. I called Ambetter again on 12/15 and asked for a supervisor. I was put on hold for up to an hour, but no supervisor ever came on the line, so I hung up. I called Ambetter again on 12/17 and asked for a refund. They said the refund request was never processed. Every person at Ambetter has given me wrong or confusing information. I just want my money back. I want the healthcare marketplace and Ambetter to be responsible for taking my money, not being honest about their policies, and giving me the runaround for almost thirty days. *** (Ambetter) and *** (***) said it is going