I have AmBetter insurance through the marketplace, and it feels like a complete scam. Technically, I have coverage, but no one actually accepts my insurance. I’ve called every provider within 50 miles, and none of them take it. The online directory lists doctors who, when I call, tell me they don’t accept AmBetter. When I contact AmBetter, they just give me more names, but those offices also don’t take it.
I called the marketplace and explained the situation, but they told me I don’t qualify for an exception that would allow me to switch plans.
So what do I do? I’m paying for insurance that’s useless, and I’m running out of medication. While not life-threatening, running out would cause serious withdrawal symptoms and drastically affect my quality of life.
How is this even legal? I’m desperate for options.
Try calling AmBetter and asking them to do a three-way call with a provider. Tell them, ‘Let’s call them together, because when I called, they told me they were not in network.’ This forces them to confirm whether the provider actually takes your insurance.
This might be an issue for your state’s Department of Insurance. If AmBetter can’t provide you with an adequate network of providers, they’re supposed to make exceptions or cover out-of-network care. Call your state DOI and file a complaint.
If no one in your area takes your insurance, you might be able to request a ‘single case agreement.’ That would let an out-of-network doctor see you at in-network rates. It’s worth asking AmBetter if they offer this.
What state are you in? I’m in NC, and AmBetter is notorious for this. They have barely any providers, and the ones they list often aren’t accepting new patients.
Shay said:
What state are you in? I’m in NC, and AmBetter is notorious for this. They have barely any providers, and the ones they list often aren’t accepting new patients.
Check if your plan has ‘network deficiency’ coverage. If there’s no in-network provider in your area, they might let you go out-of-network at in-network rates.
If you need meds urgently, try urgent care. It’s not ideal, but many places will see you and prescribe medication even without insurance coverage. Also, check telehealth services like Teledoc.
Have you checked healthcare.gov? It should list providers for your plan. That said, some doctors are listed but don’t actually accept it, so you’ll still need to confirm with their offices.
I’m a doctor, and unfortunately, this is common with AmBetter. Hardly anyone accepts it. Your best bet is to file a complaint with your state’s insurance department and see if you can get an exception to switch plans. In the meantime, an ER visit might be the only way to get care.
This is a total scam, and AmBetter has a history of doing this—listing providers who don’t actually accept their insurance. Unfortunately, since switching isn’t an option right now, try these steps:
Call AmBetter and ask about network deficiency exceptions or out-of-network benefits.
File a complaint with your state’s Department of Insurance.
Look into GoodRx, CostPlus Drugs, or Amazon Pharmacy for your meds.
Try telehealth services if AmBetter offers any.
Consider paying cash for an urgent care visit if nothing else works.
If none of this helps, your best bet might be dropping AmBetter entirely and going cash-pay for care and prescriptions. It might end up costing less than an insurance plan you can’t use.