Ambetter line of insurance plans was offered to Illinois residents as an alternative under the ACA. Ambetter programs are marketed with the essential message that quality healthcare is best delivered locally and it posts an extended list of in-network providers who accept Ambetter insurance and this is one of a subsidiary of Centene, which is one of the largest Health Insurance Marketplace carriers in the United States.
However, many customers in states covered by Ambetter included the state of Illinois and learned only after funding for the insurance that the universe of local physicians and health care providers who accept Ambetter is significantly smaller than represented.
Customers have alleged that Centene lies its list of in-network Ambetter providers, tricking them into thinking that, with Ambetter health insurance, they can maintain seeing their regular doctor when, in fact, they cannot. If you are an Illinois resident who purchased an Ambetter insurance policy and believe you were deceived about the abundance of local healthcare providers.
Ambetter policyholders are stating that they are not able to find, or are having difficulty searching, medical providers that will accept Ambetter insurance. In addition, most policyholders are stating that they purchased the Ambetter product because they thought that their physicians were “in-network” when, in reality, they were not. These policyholders have been vocal with their frustrations online, saying: “None of the people on [the Ambetter website] actually take my insurance.”
“Despite what they claim and what their provider list shows, there are ZERO doctors, offices, or even hospitals that accept this insurance … The closest office was in Atlanta with a 3-month wait for a new patient. The first several doctors on the list were in Minnesota. I’m in the eastern part of Tennessee.”
“This “insurance” is a scam. Nobody in my area accepts their plans and they don’t cover anything, including diagnostic tests.”
“Bought this insurance because I thought one Dr. I liked was on it, surprised he’s not, so now I’m stuck with a Dr. farther away!”
The reason why the investigations open by Attorney’s Bug Simpson for having the potential Lawsuit against Ambetter on behalf of customers with similar complaints.
Wallace is now investigating claims that Illinois citizens were defrauded into purchasing Ambetter Health Insurance plans. Ambetter is based on misconceptions of the number, location, and existence of their in-network providers.
Every state has requirements about the exchange where customers can get individual health insurance policies.
The Affordable Care Act (ACA) also mandates that plans keep a system that is adequate in number and kinds of providers.
A class-action lawsuits file by the organization of the marketplace date january 11 year of 2018 the lawsuit against Centene when consumers enroll in the Ambetter plans, they’re unable to find a doctor who will take their insurance or have to travel long distances to find a doctor who will see them. The plaintiffs maintain that these practices violate the ACA and state law, are a breach of Centene’s insurance contract with its consumers, and lead to higher out-of-pocket costs and deductibles for enrollees through unpaid claims, denied claims, and balance billing.
The lawsuit outlines several instances where Ambetter enrollees have had trouble finding a doctor, have had to travel for health care, have been denied care when they arrived that they believed was covered and in-network, or have relied on information in Ambetter’s provider directory only to find the data to be inaccurate. One of the plaintiffs, for instance, incurred a charge of about $1,500 for emergency room therapy in part because Centene had no in-network emergency room physicians in the Spokane, Washington area.
In the year 2017 and 2018, a hundred and forty complaints from enrollees and this is not the only time that concerns have been asked about Ambetter plans and network adequacy.
