Ambetter of North Carolina
Reviews and Complaints

Don't bother with Ambetter of North Carolina, Inc. I've been trying to sort out why my payments aren't going through for almost a month now, and I can't even get my meds because of it. I've talked to 20 different people and they all say something different. I even filed a complaint, but nothing's been fixed as of 9/21. I've been dealing with this since 9/2 and as someone with heart problems, this is just not okay. There are other issues too, but this is the biggest one.

This insurance company is a joke! I don't know why the insurance commissioner hasn't looked into them yet. My doctor filled out prior authorization after prior authorization, but Ambetter kept giving me the runaround. I called them eight times and each time they told me to jump through different hoops. And now they're saying they have no record of any prior authorization for me at all! When I asked for a phone number to speak to someone who could help, they told me there was no one else to talk to. Two days ago, they said they would approve my prior authorization and put notes on my file, but surprise surprise, there's no notes today. This company doesn't even do the bare minimum to take care of its customers!

Ambetter has terrible customer service! I applied through the Healthcare Marketplace like I do every year. Ambetter still has no customer service. They transfer you or cut you off, whatever comes first. I've been trying for over a month to tell Ambetter that what I signed up for through the Healthcare Marketplace is not what they are billing me for. Ambetter has the wrong plan. The Healthcare Marketplace placed several three-way calls to them with me five times, and they still can't seem to understand that they don't have me signed up for the correct plan. Where has customer service gone? Are people even working these days? This is health insurance. Why can't someone just talk to us and get something so simple worked out? Ambetter, you have me down for the wrong plan that I signed up for!

This company ain't worth it, at first they cover everything but once the new cycle starts, they don't cover anything. Out-of-pocket costs are through the roof and they control your medicine deadlines. My refill costs over $2000 and no one offered a solution. Even the corporate guy who was supposed to help had a daughter with seizures and he wouldn't pay for it. They're liars, stay away. Go with the big dogs like *** and save yourself the headache.

Ambetter of NC is not good at all! I had health insurance with another company before, but the premiums became too high, so I decided to switch to Ambetter. I called an agent in February and asked if my ob-gyn was in their network. The agent assured me that she was. But now, in June , I'm still fighting for claims to be paid from February and March this year! I was told three different times that this doctor was in network, but on May 25th, I was told that she was never in network! Now, I have to wait 30-45 days for my grievance to be reviewed! This could have been avoided if the agent had been honest with me in February. Now, I have to find another insurance or another ob-gyn that accepts Ambetter of NC. I'm really disappointed, and this company needs to train their agents better. I was given false information that has inconvenienced me greatly during a time when it's important to maintain appointments with my ob-gyn. If I want to continue using this doctor, I will have to pay out of pocket!

My plan for 2023 needs my pcp to refer me to all the specialists. Ambetter won't pay without a referral. My pcp is retiring on March 1 and is no longer in Ambetter's network. I have already scheduled visits with specialists in February and March. I have been waiting for months for these appointments. I chose a new pcp through Ambetter's website and scheduled an appointment. The first available appointment for a new patient is in late September. So, I have canceled the specialist appointments in February and March and am relying on prayer to hold me until I can get referrals in late September for appointments that will undoubtedly be in late 2023. Why didn't anyone at Ambetter think that some of us would face this situation, especially given how many providers are leaving the profession? Customer service was no help at all. I spoke to three people, none of whom spoke much English and none of whom understood my problem. I could hear roosters crowing while on the line with the last person. They all refused to transfer me to their supervisor, and two hung up on me. I filed a complaint with the NC Insurance Commission and am scrambling to find money for my six-month check-up with my cardiologist in March, which I'll be paying for out of pocket. Because I don't have and can't get a referral. I'm absolutely fed up.

Ambetter stopped my insurance coverage because they said I owed a premium for December, but I didn't have to pay anything last year. I called Health Market Place and they said they paid Ambetter and my account is still active. However, Ambetter won't let me speak to a supervisor and only put in for an audit twice without any updates. This is not good service, and I don't know where the money the government paid Ambetter went. I can't get any information on this issue.