Experience with Centene (Ambetter) with ACA?

[russelltw]

We have Centene coming into NC in 2 of the 100 counties for 2019. I have talked to a couple about what Centene (Ambetter) was like to work with.

Curious if anyone else would offer their review of Centene.

I have just a few clients in those 2 counties. Still wondering if I add them.

 

[YouGotMyMoney]

Prepare for the provider directory to be inaccurate.

 

[kstein]

Agree with Directory comment. An entire hospital system was listed in network until like 12-10-17 and then update after aep ended. Fun stuff

 

[Yagents]

It's your typical Obamacare roller coaster carrier ride, and comes with all of the baggage ACA's created like every other bottom tier ACA HMO carrier.

Don't get on the ride if you're:

• pregnant, or get dizzy easily.
• or expect to actually use your insurance,
• or see a network doctor,
• or if you're allergic to customer service/complaints,
• or don't have cash in the bank (not getting paid for months)

 

[cornelius322]

As a consumer I haven't had an issue with them in metro Atlanta, and my PCP and specialist are in Emory so it's works out fine for me. I was super, extremely apprehensive as I'd been Blue Cross' POS (off-exchange) in 2017 and Humana's POS 2014-16. For that matter I had Celtic (re: also Centene) as a HIPAA conversion policy 2010-12 and had a horrible time with Celtic's HIPAA conversion product. I have Crohn's and my own business, I have no complaints currently, for my drug Humira compared to the speciality pharmacies with Humana and Blue Cross, Ambetter's actually has been the easiest to deal with.

I'll take it over the pre-ACA world hands-down.

 

[MKIndy]

They have been the top carrier on the individual market for 2017-2018 in Indiana (at least among our clients) and likely will be in 2019 as well. We haven't had any major issues and clients were generally pleased during last year's oep. There has been some directory issues as other have mentioned, but it hasn't been a major problem as it arises only infrequently.

They're a little different than other companies in that we have a broker rep that we deal with and until recently they were our contact for everything rather than having different contacts for contracting vs. service issues. They have an elite broker services team that is now available (I believe they were launched recently) and I believe they did have some folks more folks around during open enrollment for service/enrollment issues.

Contracting takes time and has been inconsistent in our experience so you'll want to make sure you get that out of the way ASAP. As far as I know, they don't have GA, MGA or SGA's though they will let you contract other agents under your contract even if they are outside your agency, but there's no official override (up to you to work out the commissions and you're taking a cut from their standard commission). You're better off contracting directly if you can (though, again, this process has been inconsistent and some agents have found that they applied for contracting and never heard back or were denied).