Any opinions on AmBetter ACA plans?

[BobsYourUncle]

My first time using ACA and trying to pick an plan for next year. AmBetter plans say that they cover our primary Dr. of last 20 years and the related hospitals, however reading comments online many people say that they were told the same and then claims were denied for out of network. The reviewers say they were told the Dr/Hospital was in the document as in plan but the document was out of date. Lots of negative reviews however I'm sure people who are just "satisfied" don't go online to write reviews. None of the other plans in my area cover this Dr or related hospitals.

Does experience with a company vary widely between states or even counties? Seems like a number of reviews mentioned they might be good in other regions but not theirs.

I do know my Dr. takes AmBetter, but I don't know if that means they take all AmBetter plans. I was not able to find anyone in the Dr.s office that dealt with claims/denials but talked to a couple of administrative staff that did confirm the see patients with AmBetter. I think there may be some confusion because Medicaid in my state is administered by AmBetter

 

[Fermion]

Ambetter is what we use. Balanced Care 4 silver plan, $800 individual $1600 family deductible and max OOP.

Providence is in our network and is our local hospital plus the big one in Spokane. Ambetter has been quite good about paying out some big bills. Poor fellows are not making money off of us and I bet they wish they could drop us.

 

[BobsYourUncle]

@Fermion thanks for your input. Glad to know they are working out for you.

Surprised by the lack of responses, I wonder if AmBetter plans are just not a popular option. I did find 1 thread from back in 2018 that was fairly positive, but not much else out there. Thinking about giving it a try for year one and seeing how it works out.

I'm not that surprised at deductibles and out of pocket max for my ACA choices, but I am amazed at the lack of hospitals covered in my area. AmBetter and United Health Care plans are really the only options for decent hospital coverage in my area. BCBS has one local hospital and it's pretty lowly rated, next closest is 30 miles away and next 60 miles. Only other option was Medica, whom I've never heard of and their cheapest estimated yearly cost plan is almost twice as high as the other 3.

 

[N02L84ER]

We used AmBetter for 3 years, but we are both extremely light users of health care and paid almost nothing except for the monthly premiums.

 

[goodtogo]

This is my 3rd year with AMBetter. I am using the exchange and am counting down the months like many here. Only real use was a colonoscopy (routine preventive) last year. I called them and the hospital billing prior to the procedure in an attempt to verify coverage etc. No promises but told all should be fine and it turned out fine. I was quite relieved about a month afterwords to see the final outcome of the bill and that it was all covered. I had Blue Cross Arkansas for the previous colonoscopy six years earlier. Both my wife and I had them done a week apart. Hers was all covered and mine was rejected leaving a 4K + bill hanging for months. After written appeals being denied with an explanation of "you have a family history", I ended up corresponding with Blue Cross's lead attorney in Little Rock. I had to quote ACA specific language that the claim of "family history" (which was all made up from unknown and totally irrelevant), does not have anything to do with coverage for me. Six months later I get a letter telling me that as a courtesy they will cover the bill but if I appeal any further claim then they will grab back the payment. I called the Hospital billing department to verify the payment and even they seemed shocked, calling this extortion. I still have the letters and will keep them till I die. Needless to say there is not going to be anything with Blue Cross ever in my future. Sorry bout the rant. Yes I would have no problem using AmBetter for health insurance. At least so far. Hope this helps!

 

[RetiredHappy]

NV had Ambetter for a while on ACA but when I checked my doctors against their network list of doctors, most of my doctors were not on their list. But that is the case with ACA plans over here. Most of my doctors don't take ACA exchange plans.

 

[winyaz]

I've had Ambetter for several years in Arizona. They are ok, as health insurance companies go. They have a reasonable number of Dr's that participate, though many more do not. They sometimes deny or delay prior authorizations, causing rescheduling or forcing the Dr to justify tests that are the standard of care and should need no justification. I don't think this is much different than any other health insurance company. The price was good, until this year, but i'm going on medicare soon so decided not to switch.

 

[pb4uski]

I would call AmBetter and ask them and record the conversation and ask them to send you an email confirming it and/or a link that confirms it.

Same thing with your doc and if you can get the specific AmBetter plan and both sides confirm it then I don't know what more you can do.

Document everything thoroughly. It it goes sideways perhaps your documentation can shame them into doing a one-time exception.

 

[meleana]

All I know is I had an Ambetter silver HMO plan through ACA in New Hampshire in 2020 and 2021 and had no problems with it at all.

 

[Texas Proud]

I would call the Drs to see if they take that ACA insurance... I had Molina (from what I read better than Ambetter) and had to find a new GP... called over 20 around me and all said they did not take that insurance... the insurance company will say what is on their site...

We also (like some have said) got rejected for some procedures... or took weeks to get approval..

Finally went with BCBS and things improved... not great as they are a bit slow but much better than Molina..

OHH, also call the hospital... they could have dropped that insurance...

 

[stoic1]

Ambetter GA is good. Provider directory is garbage and not reliable.

 

[ratface]

I had them prior to Medicare and live in the greater Chicago metro area. I had the bare bones Bronze plan, It was the cheapest ACA I could find and I knew the risks. My GP took the plan and I could always find at least one doctor in the specialty I needed. That said it sometimes took some detective work and lots of phone calls to verify coverage and I got a lot of, "WHO" when I mentioned "Ambetter". I had BCBS while employed and it was much better and more widely accepted. Ambetter turned out to be better insurance than I expected for what I considered sub-par coverage, they paid everything that was required and mandated by ACA. I echo what others have said about current listings of doctors and hospitals being somewhat outdated. I think you will get adequate coverage, at lower prices than the big players and it will cost you some aggravation and additional leg work in finding care other than routine basics. Remember it's only for a year at a time.