CORDOVA, Tenn. - A health insurance provider is causing problems for at least one Mid-South family trying to schedule and visit local specialists.
Jane Iley is new to the public healthcare system.
For years, she and her husband, Dan, had insurance through their respective jobs. Mr. Iley was a firefighter in Memphis; he’s now a contractor for the area.
But life threw some curveballs for the family this past year: a lost job for Jane and the Iley family had to get new insurance through the portal.
“We chose the gold plan, which is supposed to be the best plan they have,” Jane Iley said.
The gold plan with Ambetter is costing the Iley family close to $2,100 per month – or a little under to $25,000 for the entire year.
There was a reason, Jane said, for wanting that plan: lower deductibles and more doctors. Last year, she began having problems in her midsection.
There has been no diagnosis yet; she’s still getting MRIs and seeing specialists.
“If she had something catastrophic wrong with her and we had to pay out of pocket and she had a major surgery, that could affect us financially,” said Dan Iley.
More unforeseen issues for the Ileys
The Ileys signed up for insurance in December.
After signing up for insurance, Jane ran into other unforeseen issues in the new year. She said she found a lack of doctors accepting insurance in Shelby County.
The Cordova woman is currently paying for her insurance – premium and all – and seeing specialists, but paying out of pocket.
Jane said since Jan. 1, she has spent two to three hours on multiple days over the past two weeks on the phone calling doctors listed on the Ambetter website, but to no avail.
“When I started scheduling my doctors’ appointments, nobody accepted the insurance,” Jane Iley said in an interview with FOX13 Investigates on Tuesday. “We paid $2,100 for this insurance and we can’t use it.”
Doctors listed incorrectly; not accepting Ambetter
FOX13 started researching specialists in the area on Ambetter’s website; issues arose immediately.
Our team found Dr. Paul Neblett on a list of OBGYN doctors on Ambetter’s website. The website listed him as working for Baptist Memorial Medical Group, along with a phone number, which is the number for Baptist Memorial Hospital for Women.
But looking further, Dr. Neblett works for Mid-South OBGYN.
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A receptionist answering the phone for this obstetrics and gynecology office said the doctors and the office do not accept Ambetter insurance.
So far, FOX13 found similar issues on Ambetter’s website: at least five OBGYN doctors listed as part of Baptist Memorial that didn’t accept Ambetter’s insurance.
Kim Alexander, a spokesperson for Baptist, said that not all Baptist-affiliated medical groups are employed by the hospital.
“Groups that aren’t employed by Baptist can practice at our hospitals and lease space in our physician’s office buildings,” wrote Alexander in an email. “These groups can choose which insurance plans they accept.”
FOX13 brought a separate doctor to the attention of Baptist during our investigation.
Alexander said the hospital informed Ambetter of its mistake.
“Dr. Laura Bishop works for Ruch Clinic, which is not a Baptist Medical Group physician’s office,” said Alexander. “Her office leases space in a Baptist physician’s office building, but the group is not employed by Baptist, so they can choose which insurance companies they accept.
“It is our understanding that Ambetter mistakenly displayed Dr. Bishop as being a BMG physician in their directory, but that is incorrect. She works with BMG in a training role (she supervises residents) but she does not see clinic patients. We have informed Ambetter of this error and asked them to correct this information.”
As of Tuesday, those gynecologists’ names are still listed incorrectly on Ambetter’s website.
Tennessee goes unlisted on Ambetter Health website
Other issues have come up on the insurance provider’s other webpages, meaning not on the website for Ambetter of Tennessee.
When looking for a contact on Ambetter Health’s website – the main page for the insurance provider – Tennessee is not listed as a state as having its insurance.
The state is not highlighted pink like the other 15 states using its insurance, including Arkansas and Mississippi.
When clicking Tennessee, another page pops up asking you to fill out your name, number and email address to extend your interests in receiving Ambetter coverage in that state.
“Thank you for your interest in Ambetter Healthcare Plans. At this time, we do not offer plans in your area,” the prompt reads. “However, we are continuing to grow and expand our coverage, so please sign up below to receive future updates.”
Ambetter back in the Volunteer State
Ambetter came back to Tennessee this year after a three-year hiatus, according to Kevin Walters, communications director at Tennessee Department of Commerce and Insurance.
The department, per Walters, waived a five-year ban on market reentry for them to return to the state.
Walters wrote in an email to FOX13 that this was done to offer plans “where limited competition exists.”
“Celtic/Ambetter requested to return to the market for the 2019 plan year,” Walters said. “We granted the waiver to provide Tennessee consumers with an additional marketplace option that may provide different price points and networks for consumers to consider.
“The number of carriers operating in Tennessee’s individual marketplace decreased in the first few years after 2014 and a substantial majority of Tennessee counties were being served by only one insurance carrier selling ACA-compliant individual market policies. For example, Celtic/Ambetter provided a second option in 2019 in the Chattanooga area. Blue Cross Blue Shield of Tennessee had previously been the only carrier offering ACA-compliant coverage in and around Chattanooga.”
Why did the insurance provider leave after 2016?
Walters said the company only had one policy at the time. He added that Ambetter’s experience is not unique for the insurance provider or the state.
The insurance provider is owned by Centene Corporation.
The state lists insurance providers’ presentations for coverage this year online.
According to a presentation from Ambetter, the company is certified as a “qualified health plan issuer on the health insurance marketplace.”
Questions sent to Centene and Ambetter over the past week have gone unreturned.
For more information on how to file a complaint with Tennessee’s state government, click here.
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