Centene (Ambetter, Wellcare, Health Net): billing error

Collect

• provider bill
• EOB
• member ID card

Steps

1. Compare the provider bill with the claim in the Ambetter member portal.

   OnlineAmbetter member login (view claims) Sign-in required

2. Call your plan's member services and ask for a correction or reprocessing.

   FormCentene health plan member services directory (Ambetter by state and other Centene plans)

3. If it is not fixed, file a grievance with the state plan.

   FormAmbetter Florida grievance, appeal, concern or recommendation form (PDF)

More contacts for this issue

Facts you can cite

• Contact

  Centene tells members to contact their health plan directly, not corporate headquarters, for questions about benefits, eligibility or authorizations.

  Source: centene.com, verified 2026-10-12

Rules in force

• No Surprises Act (surprise billing protections and good faith estimates)
  45 CFR part 149 (including 149.420 and 149.610)

  Protects patients from out-of-network surprise bills for emergency care, for non-emergency care by out-of-network providers at in-network hospitals and surgery centers, and for air ambulance services. People who are uninsured or not using insurance get a good faith estimate and can dispute a bill that is at least $400 over the estimate.

  Source: cms.gov, verified 2026-10-12

  3 citable points

  • Deadline

    Uninsured or self-pay patients must get a written good faith estimate: not later than 1 business day after scheduling when care is scheduled at least 3 business days ahead; not later than 3 business days after scheduling when scheduled at least 10 business days ahead; and not later than 3 business days after a request.

    Source: law.cornell.edu, verified 2026-10-12

  • Deadline

    Patient-provider dispute resolution is available when the provider charged "$400 or more" than its good faith estimate, for care on or after January 1, 2022, with an initial bill dated within the last 120 calendar days. The patient pays a "$25 non-refundable administrative fee".

    Source: cms.gov, verified 2026-10-12

  • Policy

    While a patient-provider dispute is in progress, the provider or facility may not move the bill to collections or threaten to, and must stop pursuing payment of a bill already in collections until the dispute is resolved.

    Source: cms.gov, verified 2026-10-12

• Restore Online Shoppers' Confidence Act (ROSCA) negative option requirements
  15 U.S.C. 8401-8405

  A seller that charges consumers online through a negative option feature (for example an automatic renewal or a free trial that converts to paid) must clearly disclose all material terms before taking billing information, get the consumer's express informed consent before charging, and provide simple mechanisms to stop recurring charges. The FTC enforces ROSCA.

  Source: law.cornell.edu, verified 2026-10-12

  1 citable point

  • Policy

    The seller must obtain "a consumer's express informed consent before charging the consumer's credit card, debit card, bank account, or other financial account".

    Source: law.cornell.edu, verified 2026-10-12

If that fails, escalate

Go up one step at a time. Keep the reference numbers and dates from each contact.

1. Customer service

   FormCentene health plan member services directory (Ambetter by state and other Centene plans)

   Call the member services number of your own plan (on the back of the member ID card).

2. Written complaint

   MailAmbetter Health (Florida, Sunshine Health) grievances and appeals Ambetter Health Appeal Department, P.O. Box 459087, Fort Lauderdale, FL 33345-9087

   Internal appeal or grievance with the state plan. The Florida address is shown; other states use the address on the denial letter or the state forms page.

3. State agency

   Your state’s insurance department. Find it in the list of state agencies (also as JSON: states/<code>.json, for example states/ny.json).

   External review for marketplace plans; complaint to the state.

4. Federal regulator

   RegulatorU.S. Department of Labor, Employee Benefits Security Administration +1-866-444-3272

   Employer self-funded (ERISA) plans.

5. Federal regulator

   RegulatorCMS No Surprises Help Desk +1-800-985-3059

   Surprise bills under the No Surprises Act.

Watch out

Related

• Billing error at other companies
• Health insurance — how complaints work
• Centene (Ambetter, Wellcare, Health Net): insurance claim denied
• Centene (Ambetter, Wellcare, Health Net): surprise medical bill