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Ambetter MLR Issues, Unethical Practices, Fraud??? Anyone else???

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I have been a policyholder with Ambetter for several years, initially through Medicaid during my pregnancy, and subsequently through a marketplace plan partially subsidized by a tax credit. My payment history has been consistently punctual, and I value the benefits of their rewards program. However, a recent experience has caused considerable dissatisfaction. In September, I received notification of a Medical Loss Ratio (MLR) rebate totaling $466.61. This amount was automatically applied to my account, and I possess a confirmation number for this transaction. At that time, my monthly premiums were $44.17, and this rebate effectively covered my premiums for the remaining four months of the year. In December, I updated my tax credit application due to changes in my income. This resulted in an approved tax credit of $595, adjusting my monthly premiums to $111. I anticipated that the remaining $289 from the rebate would cover my premiums for January, February, and a portion of March. However, in January, my prescriptions were unexpectedly not covered. Upon contacting Ambetter, I was initially informed that the rebate had not been applied to my account, despite its clear appearance in my transaction history. I was also told that no payments had been received since August and that my plan was suspended. This was perplexing, as my account had a positive balance with no outstanding payments due, and my services were active until January. Furthermore, I received no prior notifications regarding any suspension or payment issues. It is now mid-February, and I still lack access to my insurance. Each representative I speak with provides conflicting information regarding the outstanding balance, the reason for the suspension, and the steps required to resolve the issue. I have dedicated significant time to calls with both Ambetter and the Marketplace. The Marketplace has explicitly stated that Ambetter possesses incorrect information and needs to rectify the situation. This statement was made verbatim during a recent three-way call with a Marketplace agent. I am inquiring if other policyholders have encountered similar circumstances. This is a billing error on Ambetter's part. The government continues to remit payment for my premiums, and once this matter is resolved, I will have incurred two months of out-of-pocket premium expenses garnished from the rebate I was given, all while being denied access to services. I question whether obtaining funds under false pretenses is not illegal. I have taken no action that would warrant the suspension of my account, and I have been unable to fill my prescriptions since December.

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Posted
Feb 12, 2026 at 8:13 PM UTC
LeadScore: 55refill

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