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Ambetter policy from Peach State Health Plan through the Federally Facilitated Marketplace (FFM)The member’s complaint states that she went to the doctor and was advised that she could not be seen because Ambetter stated that a payment had not been madeThe member also stated that her bank verified that a payment was made and the check had been cashedHowever, the member states that her account has not been updated and she is unable to see a provider until this issue has been resolvedAccording to the member’s case records, the member had not contacted the plan related to the issues outlined in this complaintA member advocate reached out to Ms*** on April 21, in reference to her concernsThe member was advised that her account is current and paid through May 31, 2016. The phone line system is a total joke. Sincerely, *** *** Compliance Specialist *** *** ** *** *** *** Atlanta, GA Phone: *** Toll-Free: *** Fax: *** ***@centene.com | PSHP.com, May 8, Revdex.com, IncAttn: Dispute Resolution Department NBroadway, Suite StLouis, MO RE: Case No(***) Attn: Dispute Resolution Department: The member states in her complaint that she made a payment online in This business is in an industry that may require professional licensing, bonding or registration. I still believe they need to have better system in place. I am rejecting this response because: as mentioned, the provider list on the website is blatantly false. How do you possibly have an A+ rating? Customer service. [redacted] never followed up and [redacted] the supervisor, never called as promised. advised that the member purchased the Ambetter policy from Peach State Health Plan through the Federally Facilitated Marketplace (FFM).The member’s complaint states that she has not received her refund that she was advised would be coming to herThe member’s concerns were forwarded to the Ambetter Enrollment Department for review and the following information was providedThe member had an address change request on March 4, to be updated to: *** *** *** *** *** *** *** ** ***The address was not updated in back systemsThe original refund check has been voided and a new check was processed and resent in the amount of $Outreach to the member was conducted on June 20, by a Member AdvocateThe member was advised that a refund check in the amount of $has been processed and mailed to *** *** *** *** *** *** *** ** *** as of June 19, and to allow 5-business days to receive the check. Ambetter of Peach State Health Plan. When considering complaint information, please take into account the company's size and volume of transactions, and understand that the nature of complaints and a firm's responses to them are often more important than the number of complaints. Reviewers write the most about Ambetter From Peach State Health Plan Health Plan and … Sincerely, [redacted] Compliance Specialist [redacted] Phone: [redacted] Toll-Free: [redacted] Fax: [redacted]@centene.com | PSHP.com, Revdex.com: Write Review: Upgrade: Claim: View Reviews (1) Ambetter Of Peach State Inc. is a Georgia Domestic Insurance Company filed on April 13, 2015. We’ll guide you through the process. Also, Ambetter should contact my providers immediately with corrected information regarding the claims listed aboveMoreover, I want to be notified when Ambetter contacts my providers“ Sincerely, [redacted], February 9, Revdex.com, IncAttn: Dispute Resolution Department NBroadway, Suite StLouis, MO RE: Case No( [redacted] ) Attn: Dispute Resolution Department: In response to the complaint filed, please be advised that the member purchased the Ambetter policy from Peach State Health Plan through the Federally Facilitated Marketplace (FFM)Ambetter Enrollment has researched the concerns raised by the complainant and the following information was providedThe payment of $was not applied to the member's account It has been located and is now applied Voluntary withdrawal termination files were received from the Marketplace on January 13, At this time, the members are enrolled from January 1, to February 16, and the account is paid through January 31, The member will need to contact the Federal Marketplace in order to request any changes to the dates of coverage Any claims incurred as of January 1, can be submitted for processing Enrollment is currently set to end on February 16, Please allow hours for systems to update Sincerely, [redacted] Compliance Specialist [redacted] Atlanta, GA Phone: [redacted] Toll-Free: [redacted] Fax [redacted] @centene.com | PSHP.com, Initial Business Response /* (1000, 15, 2016/02/03) */ This should not have to be a whole ordeal. The member’s concerns were forwarded to the claims department for review and the following information was provided. 17 reviews of Peach State Health Plan "When I was trying to choose a plan through the Marketplace, an insurance agent told me to avoid Ambetter/Peach State, but I ignored her because a) it was the only plan I could afford, and b) all the more expensive plans (BCBS, Kaiser, etc) got really awful (like, REALLY awful) reviews too. As the appeal is currently in process, there is no resolution to provide the member at this time. [redacted], July 20, 2017 Revdex.com, Inc. Attn: Dispute Resolution Department 211 N. Broadway, Suite 2060 St. Louis, MO 63102 RE: Case No. I have contacted this company 6 times in the span of a month simply to get a letter stating that my insurance ended with them December 2019. I won't go into another spill, but I've been told many times that I should receive my refund in X amount of days and never receive it. January 3, Revdex.com, IncAttn: Dispute Resolution Department NBroadway, Suite StLouis, MO RE: Case No( [redacted] ) Attn: Dispute Resolution Department: As part of the appeal process, the member’s account will be researched and any claims that require review will be done at that timeAs the appeal is currently in process, there is no resolution to provide the member at this timeOnce the appeal process has been completed, the member will be notified and an update will be provided to all parties Sincerely, [redacted] Compliance Specialist [redacted] Atlanta, GA Phone: [redacted] Toll-Free: [redacted] Fax: [redacted] @centene.com | PSHP.com, Complaint: [redacted] I am rejecting this response because: as mentioned, the provider list on the website is blatantly falseThis is fraudulent and misleadingAdditionally, I did not receive a call from a supervisor as promised, merely a call confirming the same information that I had already found myselfI want to speak with a supervisor [redacted] in Decatur informed me that they no longer accept Ambetter as an in-network provider as of June 2017, hence the day wait periodThis is contrary to the information provided in Ambetter's response to my ComplaintIt seems this information is more readily available to consumers rather than to Ambetter themselvesAgain, ONE provider (***) accepts this insurance- ALL other providers listed on Ambetter's website as "in-network" are no longer accepting this insuranceIf a provider is not in-network, there is a minimum day wait periodBecause of my injuries, my MRI needs to be done much soonerAgain, the only provider who can see me "in-network" (without the waiting period) is ***, who has no available appointmentsNevertheless, I pay premiums because I was under the impression that I could seek an MRI with all other providers listed on the website without the waiting period- which is simply untrueLastly, [redacted] promised that he would be emailing me a list of providers who will cover durable medical equipmentAs with the other promises from [redacted] and others, this was never done [redacted] never followed up and [redacted] the supervisor, never called as promisedThis is not just a complaint about receiving a response, it is a complaint about Ambetter's business practices and customer service as a wholeI want to speak with a supervisor and I want to escalate to the highest levelThis practice can legitimately hurt people who need medical treatment and it must be remediedI have also filed a complaint with the Insurance Commissioner of Georgia in hopes to find relief Sincerely, [redacted], Complaint: [redacted] I am rejecting this response because: The response is not adequate, since I was not offered any resolution, just a promise to look into it within additional monthI have been told by dr.'s office that some of my debt is in Collections alreadyI was absolutely clear on what I expect Ambetter to do for my complaint to be closed which is “I want Ambetter to correct the wrongly processed claims: Claim Number- [redacted] , Claim- Number- [redacted] , Claim Number- [redacted] , Claim Number- [redacted] , and Claim Number- [redacted] (Service Details : ***) (date of service 12/01/2016.)