Ohio Customers Sue Health Insurance Company Ambetter

Dec 4, 2019

The insurance company Ambetter, distributed in Ohio through the Buckeye Health Plan, is facing a lawsuit from four customers. The class-action suit could eventually include hundreds of plaintiffs.

The legal action, filed by the firm Burg Simpson, alleges that Ambetter misled patients by falsely listing doctors as in-network on their website. The Affordable Care Act requires that insurance providers on the exchange must provide a current list of providers.

"Many people found that for a particular specialty, there would be no in-network providers available through Ambetter," says Janet Abaray, managing partner of the firm's Ohio office.

Abaray says in other cases, the only providers listed would be 50 miles away. And the limited enrollment period for exchange health plans in the winter compounded the problem.

"You might find out in March that the providers you thought were included are not on the plan, and you can't do anything about 'til the following January," she says.

Abaray gives the example of Nationwide Children's Hospital. 

"It shows up as being on the provider network. Then if you go to Nationwide Children's Health website, it lists which plans they accept, and it specifically says it doesn't accept Ambetter," says Abaray. "And that's just one example, it's like that throughout the state of Ohio."

Ambetter did not respond to requests for comment.