What You Need to Know
Ambetter from Superior HealthPlan is a health insurance plan only available through the Health Insurance Marketplace.
Ambetter from Superior HealthPlan only offers EPO (exclusive provider organization) insurance plans in Texas.
Customer reviews for the insurance plan report poor customer service and poor provider coverage.
Who Is Ambetter from Superior HealthPlan?
Ambetter from Superior HealthPlan, headquartered in Austin, Texas, is a Health Insurance Marketplace product of the Centene Corporation. Based in St. Louis, Mo., Centene is the largest provider of insurance plans under the Affordable Care Act (ACA) with a 3.29% market share.1
Plans from Ambetter from Superior HealthPlan deliver healthcare services to residents of Texas. The Celtic Insurance Company, headquartered in Chicago, Ill., a qualified health plan issuer in the Texas Health Insurance Marketplace, underwrites the plans.
Superior HealthPlan has 1.5 million members across Texas2 and offers nine products. Ambetter from Superior HealthPlan is the company’s Health Insurance Marketplace product, but Superior HealthPlan also offers other health coverage options, such as Medicaid and Medicare Advantage plans.
Ambetter from Superior HealthPlan offers coverage in 138 out of 254 counties in Texas.3 It only offers health maintenance organization (HMO) and exclusive provider organization (EPO) plans on the federal Health Insurance Exchange.
Superior HealthPlan began in El Paso, Texas, in 1999 and expanded to 10 office locations serving Texas. It has a network with more than 90,000 providers across the state, including more than 500 hospitals.4
Extent of Coverage
Ambetter from Superior HealthPlan offers coverage in 138 out of 254 counties in Texas.
What Health Insurance Does Ambetter from Superior HealthPlan Offer?
Ambetter from Superior HealthPlan offers three plan options that reflect the Health Insurance Marketplace metal plan levels: bronze, silver and gold. Both individual and family plans are available.
- Bronze plan. Ambetter Essential Care plans are the company’s bronze level plans. They cover essential health benefits,5 including annual health exams, and come with lower monthly premiums. As a tradeoff, deductibles and out-of-pocket maximums are high, which can result in high out-of-pocket costs if you need a lot of care. These plans are best if you are in good health.
- Silver plan. Ambetter Balanced Care plans are the company’s silver level plans. These plans have lower deductibles and out-of-pocket maximums, but they come with higher monthly premiums. Depending on your income, silver level plans can also offer extra savings.
- Gold plan. Ambetter Secure Care plans are the gold metal tier plans. Expect higher monthly premiums but low deductibles and out-of-pocket maximums. These plans are best if you have high medical costs since the low deductibles allow you to take advantage of coinsurance benefits. These plans are best if you have high health costs and need medical care regularly.
Some Ambetter plans come with vision and/or dental benefits for a higher premium, which cover services such as eye exams and dental cleanings. Some plans may be eligible for a Health Savings Account (HSA).
EPOs and Providers
As an exclusive provider organization in Texas, Ambetter from Superior HealthPlan limits the number of healthcare providers and facilities covered in its plans.
What Are the Member Benefits from Ambetter from Superior HealthPlan?
Ambetter from Superior HealthPlan offers several benefits and tools for members. These include:
- 24/7 Nurse Advice Line.
- Telehealth Services.
- My Health Pays rewards program.
- Mail-order pharmacy.
- Healthcare management programs.
- Gym reimbursement program.
Some plans also come with optional dental and vision coverage, which you choose at time of enrollment.
The My Health Pays rewards program awards points for completing preventive healthy activities, such as eating right and moving more. You can also earn rewards for filling out surveys, getting your flu shot or having a wellness exam. Rewards points can be converted to dollars and used to help pay for various expenses such as:
- Monthly insurance premiums.
- Doctor copays.
Members access the rewards program and other benefits through the Ambetter online patient portal. Use the portal to see your benefits, pay your premiums, order new ID cards and more.
How Do You Enroll in Coverage with Ambetter from Superior HealthPlan?
To enroll in coverage with Ambetter from Superior HealthPlan, you must go through the Health Insurance Marketplace. This occurs during the open enrollment period each year or when qualifying for a special enrollment period. You can use a broker, but only during open enrollment or a qualifying special enrollment period.
How Do You File Claims with Ambetter from Superior HealthPlan?
To file a claim with the company, especially if it is out-of-network, you will need a copy of the detailed claim or itemized receipt from the provider. This is only done for services that the plan has agreed to cover. Providers typically bills Ambetter directly for covered in-network claims.
Your claim to the insurance company must include an explanation of why you paid for covered services, proof of payment for the services in the reimbursement request along with a completed and signed reimbursement claim form.
Send completed paperwork to:
Ambetter from Superior HealthPlan
Claims Department – Member Reimbursement
P.O. Box 5010
Farmington, MO 63640-5010
Within 15 days of submission,6 the plan will let you know about your claim’s acceptance or rejection. If the plan accepts, you can expect payment within five business days.
If rejected, you will receive an explanation about your claim’s rejection. Sometimes, Ambetter will need more time for a determination and will let you know their timeline.
How Is Ambetter from Superior HealthPlan Rated?
Celtic Insurance Company, a Centene Corporation subsidiary, underwrites Ambetter from Superior HealthPlan health insurance plans. Neither A.M. Best nor Standard and Poor’s offer ratings for Centene Corporation or its subsidiaries.
However, the Better Business Bureau (BBB) does list the insurer. While it’s not accredited with the BBB (to be accredited by BBB, a business or organization applies, pays a fee, and affirms that it meets and will abide by certain ethical standards), it has a BBB rating of A+.
BBB does not use customer reviews to calculate its rating, which explains why it’s so high when customer reviews give it a 1.38 out of 5 stars. The company got 12 1-star reviews out of a total of 13 reviews and 27 customer complaints, many of which are resolved. Most of the complaints mentioned poor customer service, not being able to answer questions and poor provider coverage.
What Are Ambetter’s Strengths?
Ambetter from Superior HealthPlan plans are on the lower end of the price spectrum, making them more affordable. Their health insurance plans also have several strengths that add value for members.
The insurer offers a 24/7 nurse hotline for members to ask questions and access medical needs. Features such as telehealth services and mail-order pharmacy make it easier to manage your health from home.
The healthcare management program helps members manage chronic conditions and focus on their health. The gym reimbursement program makes it easier to stay healthy, while the My Health Pays program offers rewards and incentives for activities that contribute to your health.
In addition, Ambetter from Superior HealthPlan offers the option to add vision and dental coverage as part of your plan. Availability and benefits vary based on region, but they should include basic services, such as dental cleanings and eye exams.
What Are Ambetter’s Weaknesses?
In Texas, Ambetter from Superior HealthPlan only offers EPO plans. This limits the number of healthcare providers and facilities covered under your plan. Many online reviews complain about the limited number of doctors and facilities that take the insurance.
Website information on in-network providers and hospitals seem outdated. Finding plan information through the Ambetter website can be difficult. Online reviews mention lack of transparency and poor customer service.
Compare Ambetter from Superior HealthPlan with other marketplace plans and health insurance companies before deciding which one to pick. Weigh the plan’s benefits and drawbacks to determine if it’s the best choice for your situation. If you think Ambetter from Superior HealthPlan is the right plan for you, call your doctors to ensure they take it before signing up.
The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of HealthCareInsider.com or HealthCare, Inc.