Ambetter – an ACA MarketPlace Option – Causes Confusion with Members and Providers
(April 21, 2023) – Ambetter released an ACA Marketplace option that required members to utilize a virtual provider. If they preferred to utilize an in-person provider, the member was required to submit paperwork for approval. The plan was very confusing to both members and providers. Many providers were left with a large number of denials and lost charges. After multiple inquiries and meetings, Ambetter acknowledged that the plan was not rolled out appropriately and has left many members and providers confused about the benefit.
Effective immediately, Ambetter will not reject any claims for a lack of a referral to an in-person provider. Ambetter plans to reprocess and accept all previously denied claims with this specific Marketplace product.
Ambetter apologizes for all issues this has caused. If you have other issues you specifically would like to address with Ambetter, they want to hear from you. Please email Mark Hillix, Centene, and Kathy Ripley-Hake, Sunflower Health Plan, as well as carbon copy Shannan Flach on any communication.
If you have any questions, please contact Shannan Flach at (785) 233-7436.
--Shannan Flach