{"id":"centene","page":"https://escalate.alexgaoth.com/#/c/centene","html":"https://escalate.alexgaoth.com/c/centene/","generated":"2026-10-15","company":{"id":"centene","name":"Centene (Ambetter, Wellcare, Health Net)","aliases":["centene corporation","ambetter","ambetter health","ambetter from sunshine health","ambetter from superior healthplan","wellcare","wellcare health plans","health net","sunshine health","superior healthplan","peach state health plan","buckeye health plan","meridian"],"sector":"insurance_health","website":"https://www.centene.com","account_url":"https://member.ambetterhealth.com/sso/login","regulators":["dol-ebsa","cms-no-surprises"],"channels":[{"id":"plan-directory","type":"web_form","label":"Centene health plan member services directory (Ambetter by state and other Centene plans)","value":"https://www.centene.com/contact.html","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"access":"open","notes":"Centene corporate does not handle member questions. Members contact their own health plan.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-state-contacts","type":"web_form","label":"Ambetter contact pages by state","value":"https://www.ambetterhealth.com/en/contact-us/","purposes":["claim_denial","claim_delay","billing_error"],"source":"https://www.ambetterhealth.com/en/contact-us/","last_verified":"2026-10-12"},{"id":"ambetter-member-portal","type":"portal","label":"Ambetter member login (view claims)","value":"https://member.ambetterhealth.com/sso/login","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.ambetterhealth.com/en/fl/resources/","last_verified":"2026-10-12"},{"id":"ambetter-fl-appeals-mail","type":"mail","label":"Ambetter Health (Florida, Sunshine Health) grievances and appeals","value":"Ambetter Health Appeal Department, P.O. Box 459087, Fort Lauderdale, FL 33345-9087","purposes":["claim_denial","poor_service"],"notes":"Phone 1-877-687-1169; TTY 1-877-941-9230; fax 1-866-719-5373 (appeals) or 1-866-550-3248 (grievance/complaint). Florida plans only.","source":"https://www.ambetterhealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/FL_MbrGrivanceAppelConcern.pdf","last_verified":"2026-10-12"},{"id":"ambetter-fl-appeal-form","type":"web_form","label":"Ambetter Florida grievance, appeal, concern or recommendation form (PDF)","value":"https://ambetter.sunshinehealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/FL_MbrGrivanceAppelConcern.pdf","purposes":["claim_denial","poor_service"],"source":"https://www.ambetterhealth.com/en/fl/resources/handbooks-forms/","last_verified":"2026-10-12"},{"id":"ambetter-forms-fl","type":"web_form","label":"Ambetter Florida forms (grievance and appeal, member claim reimbursement)","value":"https://www.ambetterhealth.com/en/fl/resources/handbooks-forms/","purposes":["claim_denial","claim_delay"],"notes":"Other states have the same page under their own state path.","source":"https://www.ambetterhealth.com/en/fl/resources/handbooks-forms/","last_verified":"2026-10-12"},{"id":"ambetter-tx-mail","type":"mail","label":"Ambetter from Superior HealthPlan (Texas) general mailing address","value":"Ambetter from Superior HealthPlan, 5900 E. Ben White Blvd., Austin, TX 78741","source":"https://www.ambetterhealth.com/en/tx/contact-us/","last_verified":"2026-10-12"},{"id":"wellcare-phone","type":"phone","label":"Wellcare (Medicare) member services","value":"+1-833-444-9088","purposes":["claim_denial","claim_delay","billing_error"],"notes":"Wellcare also tells members to call the number on the back of the member ID card or pick their state on its contact page.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"wellcare-contact","type":"web_form","label":"Wellcare contact page (state member services numbers)","value":"https://www.wellcare.com/en/contact-us","source":"https://www.wellcare.com/en/contact-us","last_verified":"2026-10-12"},{"id":"wellcare-mail","type":"mail","label":"Wellcare Health Plans general mailing address","value":"Wellcare Health Plans, P.O. Box 31370, Tampa, FL 33631","source":"https://www.wellcare.com/en/contact-us","last_verified":"2026-10-12"},{"id":"health-net-ca-phone","type":"phone","label":"Health Net (California) member services","value":"+1-800-522-0088","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-al-phone","type":"phone","label":"Ambetter member services, Alabama","value":"+1-800-442-1623","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-az-phone","type":"phone","label":"Ambetter member services, Arizona","value":"+1-888-926-5057","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ar-phone","type":"phone","label":"Ambetter member services, Arkansas","value":"+1-877-617-0390","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ca-phone","type":"phone","label":"Ambetter member services, California","value":"+1-844-463-8188","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-fl-phone","type":"phone","label":"Ambetter member services, Florida","value":"+1-877-687-1169","hours":"8am-8pm EST","notes":"Relay Florida 1-800-955-8770.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.ambetterhealth.com/en/fl/contact-us/","last_verified":"2026-10-12"},{"id":"ambetter-ga-phone","type":"phone","label":"Ambetter member services, Georgia","value":"+1-877-687-1180","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-il-phone","type":"phone","label":"Ambetter member services, Illinois","value":"+1-855-745-5507","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-in-phone","type":"phone","label":"Ambetter member services, Indiana","value":"+1-877-687-1182","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ia-phone","type":"phone","label":"Ambetter member services, Iowa","value":"+1-833-919-3213","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ks-phone","type":"phone","label":"Ambetter member services, Kansas","value":"+1-844-518-9505","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ky-phone","type":"phone","label":"Ambetter member services, Kentucky","value":"+1-833-705-2175","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-la-phone","type":"phone","label":"Ambetter member services, Louisiana","value":"+1-833-635-0450","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-mi-phone","type":"phone","label":"Ambetter member services, Michigan","value":"+1-833-993-2426","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ms-phone","type":"phone","label":"Ambetter member services, Mississippi","value":"+1-877-687-1187","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-mo-phone","type":"phone","label":"Ambetter member services, Missouri","value":"+1-855-650-3789","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ne-phone","type":"phone","label":"Ambetter member services, Nebraska","value":"+1-833-890-0329","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nv-phone","type":"phone","label":"Ambetter member services, Nevada","value":"+1-866-263-8134","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nh-phone","type":"phone","label":"Ambetter member services, New Hampshire","value":"+1-844-265-1278","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nj-phone","type":"phone","label":"Ambetter member services, New Jersey","value":"+1-844-606-1926","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nm-phone","type":"phone","label":"Ambetter member services, New Mexico","value":"+1-833-945-2029","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ny-phone","type":"phone","label":"Ambetter member services, New York","value":"+1-888-343-3547","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nc-phone","type":"phone","label":"Ambetter member services, North Carolina","value":"+1-833-863-1310","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-oh-phone","type":"phone","label":"Ambetter member services, Ohio","value":"+1-877-687-1189","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ok-phone","type":"phone","label":"Ambetter member services, Oklahoma","value":"+1-833-492-0679","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-pa-phone","type":"phone","label":"Ambetter member services, Pennsylvania","value":"+1-833-510-4727","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-sc-phone","type":"phone","label":"Ambetter member services, South Carolina","value":"+1-833-270-5443","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-tn-phone","type":"phone","label":"Ambetter member services, Tennessee","value":"+1-833-709-4735","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-tx-phone","type":"phone","label":"Ambetter member services, Texas","value":"+1-877-687-1196","hours":"8am-8pm CST","notes":"Relay Texas/TTY 1-800-735-2989.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.ambetterhealth.com/en/tx/contact-us/","last_verified":"2026-10-12"},{"id":"ambetter-wa-phone","type":"phone","label":"Ambetter member services, Washington","value":"+1-877-687-1197","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"}],"escalation":[{"rung":"frontline","channel":"plan-directory","note":"Call the member services number of your own plan (on the back of the member ID card)."},{"rung":"written_complaint","channel":"ambetter-fl-appeals-mail","note":"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."},{"rung":"state_agency","agency_kind":"insurance_department","note":"External review for marketplace plans; complaint to the state."},{"rung":"regulator","regulator":"dol-ebsa","note":"Employer self-funded (ERISA) plans."},{"rung":"regulator","regulator":"cms-no-surprises","note":"Surprise bills under the No Surprises Act."}],"playbooks":[{"issue":"claim_denial","summary":"Appeal to your Ambetter state plan within 180 days of the denial notice, then ask for external review.","evidence":["denial letter (Notice of Action) with tracking number","member ID card","medical records","provider letter of medical necessity"],"steps":[{"do":"Call your state Ambetter member services number. Ask for the reason and the appeal address for your state.","channel":"plan-directory"},{"do":"Complete the state grievance and appeal form, or write a letter with the same information, including the tracking number from the upper left corner of the denial letter. In Florida, mail or fax it to the Appeal Department.","channel":"ambetter-fl-appeals-mail"},{"do":"After the final internal denial, ask for external review through your state insurance department."},{"do":"Wellcare (Medicare) members can also file a complaint with Medicare after using the plan's process.","channel":"wellcare-contact"}],"facts":[{"kind":"deadline","claim":"For Ambetter Health in Florida, you must file an appeal within 180 calendar days of the date of the Notice of Action letter, and a grievance within 365 calendar days of the date of the event.","issues":["claim_denial"],"source":"https://www.ambetterhealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/FL_MbrGrivanceAppelConcern.pdf","last_verified":"2026-10-12"},{"kind":"process","claim":"Ambetter Florida accepts either its grievance and appeal form or a letter with the same information, mailed to the Appeal Department; it lists separate fax numbers for appeals and for grievances.","issues":["claim_denial"],"source":"https://www.ambetterhealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/FL_MbrGrivanceAppelConcern.pdf","last_verified":"2026-10-12"}]},{"issue":"billing_error","summary":"Check the claim in the member portal, call your plan, then file a grievance.","evidence":["provider bill","EOB","member ID card"],"steps":[{"do":"Compare the provider bill with the claim in the Ambetter member portal.","channel":"ambetter-member-portal"},{"do":"Call your plan's member services and ask for a correction or reprocessing.","channel":"plan-directory"},{"do":"If it is not fixed, file a grievance with the state plan.","channel":"ambetter-fl-appeal-form"}]},{"issue":"surprise_medical_bill","summary":"Compare the bill with the EOB, tell the plan and the provider, then contact the CMS help desk.","evidence":["the bill","EOB","member ID card"],"steps":[{"do":"Compare the bill with the EOB. Note whether it was emergency care or care at an in-network facility.","channel":"ambetter-member-portal"},{"do":"Tell your plan and the provider the bill may be a surprise bill.","channel":"plan-directory"},{"do":"Contact the CMS No Surprises Help Desk.","regulator":"cms-no-surprises"}]}],"facts":[{"kind":"contact","claim":"Centene tells members to contact their health plan directly, not corporate headquarters, for questions about benefits, eligibility or authorizations.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"}],"known_blockers":["Centene runs separate state plans; contact details, forms and appeal addresses differ by state and brand.","Claims view needs a member portal login.","Grievance forms are PDFs that must be mailed or faxed."],"notes":"Centene Corporation (St. Louis) runs marketplace plans under the Ambetter brand in 29 states, Medicare plans under Wellcare, and state Medicaid plans under local names (for example Sunshine Health, Superior HealthPlan, Peach State, Buckeye, Meridian, Health Net in California). Medicare and Medicaid plans have their own appeal rules.","official_domains":["centene.com","ambetterhealth.com","wellcare.com","sunshinehealth.com"],"security":{"never_asks":[{"kind":"policy","claim":"Wellcare will never request a physician's signature when it sends a medical records request.","source":"https://www.wellcare.com/-/media/pdfs/louisiana/provider/bulletins/la_care_prov_fax_scam_notification_2024_r.ashx?la=en&hash=5DDD6B4A0B76C8898A8217B21BA9A5E8","last_verified":"2026-10-12"},{"kind":"policy","claim":"An Ambetter email-scam notice says health insurers and Medicare never ask for your username, password, Social Security number, Medicare number or banking information by email.","source":"https://www.ambetterhealth.com/content/dam/centene/ambetteraz/pdfs/Email_Scams.pdf","last_verified":"2026-10-12"}],"known_scams":[{"kind":"policy","claim":"In 2024 Wellcare warned providers about fraudulent Wellcare-branded faxes that request member medical records and physician signatures. Some of these faxes were followed by harassing phone calls.","source":"https://www.wellcare.com/-/media/pdfs/louisiana/provider/bulletins/la_care_prov_fax_scam_notification_2024_r.ashx?la=en&hash=5DDD6B4A0B76C8898A8217B21BA9A5E8","last_verified":"2026-10-12"},{"kind":"policy","claim":"Criminals pose as Medicare or health insurers by email. The email says there is a problem with your account or asks for updated information, and asks you to click a link to enter it.","source":"https://www.ambetterhealth.com/content/dam/centene/ambetteraz/pdfs/Email_Scams.pdf","last_verified":"2026-10-12"}],"report_phishing":[{"id":"fwa-helpline","type":"phone","label":"Centene Fraud, Waste and Abuse Helpline","value":"+1-866-685-8664","hours":"24/7","notes":"Independently administered. Anonymous reports are accepted. Some Ambetter state plans also list their own fraud hotlines.","source":"https://www.centene.com/who-we-are/ethics-and-integrity.html","last_verified":"2026-10-12"},{"id":"siu-email","type":"email","label":"Centene Special Investigations Unit (report fraud, waste and abuse)","value":"Special_Investigations_Unit@centene.com","source":"https://www.centene.com/why-were-different/healthcare-fraud-waste-abuse-oversight.html","last_verified":"2026-10-12"},{"id":"ethicspoint-online","type":"web_form","label":"Centene online fraud and compliance report (hosted by EthicsPoint)","value":"https://www.centene.ethicspoint.com/","access":"open","source":"https://www.centene.com/why-were-different/healthcare-fraud-waste-abuse-oversight.html","last_verified":"2026-10-12"}]}},"playbooks":{"claim_denial":{"company":{"id":"centene","name":"Centene (Ambetter, Wellcare, Health Net)","sector":"insurance_health","website":"https://www.centene.com","account_url":"https://member.ambetterhealth.com/sso/login"},"issue":{"id":"claim_denial","name":"Insurance claim denied"},"playbook_source":"company","summary":"Appeal to your Ambetter state plan within 180 days of the denial notice, then ask for external review.","evidence":["denial letter (Notice of Action) with tracking number","member ID card","medical records","provider letter of medical necessity"],"steps":[{"do":"Call your state Ambetter member services number. Ask for the reason and the appeal address for your state.","channel":{"id":"plan-directory","type":"web_form","label":"Centene health plan member services directory (Ambetter by state and other Centene plans)","value":"https://www.centene.com/contact.html","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"access":"open","notes":"Centene corporate does not handle member questions. Members contact their own health plan.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"}},{"do":"Complete the state grievance and appeal form, or write a letter with the same information, including the tracking number from the upper left corner of the denial letter. In Florida, mail or fax it to the Appeal Department.","channel":{"id":"ambetter-fl-appeals-mail","type":"mail","label":"Ambetter Health (Florida, Sunshine Health) grievances and appeals","value":"Ambetter Health Appeal Department, P.O. Box 459087, Fort Lauderdale, FL 33345-9087","purposes":["claim_denial","poor_service"],"notes":"Phone 1-877-687-1169; TTY 1-877-941-9230; fax 1-866-719-5373 (appeals) or 1-866-550-3248 (grievance/complaint). Florida plans only.","source":"https://www.ambetterhealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/FL_MbrGrivanceAppelConcern.pdf","last_verified":"2026-10-12"}},{"do":"After the final internal denial, ask for external review through your state insurance department."},{"do":"Wellcare (Medicare) members can also file a complaint with Medicare after using the plan's process.","channel":{"id":"wellcare-contact","type":"web_form","label":"Wellcare contact page (state member services numbers)","value":"https://www.wellcare.com/en/contact-us","source":"https://www.wellcare.com/en/contact-us","last_verified":"2026-10-12"}}],"channels":[{"id":"plan-directory","type":"web_form","label":"Centene health plan member services directory (Ambetter by state and other Centene plans)","value":"https://www.centene.com/contact.html","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"access":"open","notes":"Centene corporate does not handle member questions. Members contact their own health plan.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-state-contacts","type":"web_form","label":"Ambetter contact pages by state","value":"https://www.ambetterhealth.com/en/contact-us/","purposes":["claim_denial","claim_delay","billing_error"],"source":"https://www.ambetterhealth.com/en/contact-us/","last_verified":"2026-10-12"},{"id":"ambetter-member-portal","type":"portal","label":"Ambetter member login (view claims)","value":"https://member.ambetterhealth.com/sso/login","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.ambetterhealth.com/en/fl/resources/","last_verified":"2026-10-12"},{"id":"ambetter-fl-appeals-mail","type":"mail","label":"Ambetter Health (Florida, Sunshine Health) grievances and appeals","value":"Ambetter Health Appeal Department, P.O. Box 459087, Fort Lauderdale, FL 33345-9087","purposes":["claim_denial","poor_service"],"notes":"Phone 1-877-687-1169; TTY 1-877-941-9230; fax 1-866-719-5373 (appeals) or 1-866-550-3248 (grievance/complaint). Florida plans only.","source":"https://www.ambetterhealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/FL_MbrGrivanceAppelConcern.pdf","last_verified":"2026-10-12"},{"id":"ambetter-fl-appeal-form","type":"web_form","label":"Ambetter Florida grievance, appeal, concern or recommendation form (PDF)","value":"https://ambetter.sunshinehealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/FL_MbrGrivanceAppelConcern.pdf","purposes":["claim_denial","poor_service"],"source":"https://www.ambetterhealth.com/en/fl/resources/handbooks-forms/","last_verified":"2026-10-12"},{"id":"ambetter-forms-fl","type":"web_form","label":"Ambetter Florida forms (grievance and appeal, member claim reimbursement)","value":"https://www.ambetterhealth.com/en/fl/resources/handbooks-forms/","purposes":["claim_denial","claim_delay"],"notes":"Other states have the same page under their own state path.","source":"https://www.ambetterhealth.com/en/fl/resources/handbooks-forms/","last_verified":"2026-10-12"},{"id":"ambetter-tx-mail","type":"mail","label":"Ambetter from Superior HealthPlan (Texas) general mailing address","value":"Ambetter from Superior HealthPlan, 5900 E. Ben White Blvd., Austin, TX 78741","source":"https://www.ambetterhealth.com/en/tx/contact-us/","last_verified":"2026-10-12"},{"id":"wellcare-phone","type":"phone","label":"Wellcare (Medicare) member services","value":"+1-833-444-9088","purposes":["claim_denial","claim_delay","billing_error"],"notes":"Wellcare also tells members to call the number on the back of the member ID card or pick their state on its contact page.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"wellcare-contact","type":"web_form","label":"Wellcare contact page (state member services numbers)","value":"https://www.wellcare.com/en/contact-us","source":"https://www.wellcare.com/en/contact-us","last_verified":"2026-10-12"},{"id":"wellcare-mail","type":"mail","label":"Wellcare Health Plans general mailing address","value":"Wellcare Health Plans, P.O. Box 31370, Tampa, FL 33631","source":"https://www.wellcare.com/en/contact-us","last_verified":"2026-10-12"},{"id":"health-net-ca-phone","type":"phone","label":"Health Net (California) member services","value":"+1-800-522-0088","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-al-phone","type":"phone","label":"Ambetter member services, Alabama","value":"+1-800-442-1623","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-az-phone","type":"phone","label":"Ambetter member services, Arizona","value":"+1-888-926-5057","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ar-phone","type":"phone","label":"Ambetter member services, Arkansas","value":"+1-877-617-0390","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ca-phone","type":"phone","label":"Ambetter member services, California","value":"+1-844-463-8188","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-fl-phone","type":"phone","label":"Ambetter member services, Florida","value":"+1-877-687-1169","hours":"8am-8pm EST","notes":"Relay Florida 1-800-955-8770.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.ambetterhealth.com/en/fl/contact-us/","last_verified":"2026-10-12"},{"id":"ambetter-ga-phone","type":"phone","label":"Ambetter member services, Georgia","value":"+1-877-687-1180","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-il-phone","type":"phone","label":"Ambetter member services, Illinois","value":"+1-855-745-5507","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-in-phone","type":"phone","label":"Ambetter member services, Indiana","value":"+1-877-687-1182","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ia-phone","type":"phone","label":"Ambetter member services, Iowa","value":"+1-833-919-3213","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ks-phone","type":"phone","label":"Ambetter member services, Kansas","value":"+1-844-518-9505","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ky-phone","type":"phone","label":"Ambetter member services, Kentucky","value":"+1-833-705-2175","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-la-phone","type":"phone","label":"Ambetter member services, Louisiana","value":"+1-833-635-0450","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-mi-phone","type":"phone","label":"Ambetter member services, Michigan","value":"+1-833-993-2426","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ms-phone","type":"phone","label":"Ambetter member services, Mississippi","value":"+1-877-687-1187","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-mo-phone","type":"phone","label":"Ambetter member services, Missouri","value":"+1-855-650-3789","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ne-phone","type":"phone","label":"Ambetter member services, Nebraska","value":"+1-833-890-0329","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nv-phone","type":"phone","label":"Ambetter member services, Nevada","value":"+1-866-263-8134","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nh-phone","type":"phone","label":"Ambetter member services, New Hampshire","value":"+1-844-265-1278","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nj-phone","type":"phone","label":"Ambetter member services, New Jersey","value":"+1-844-606-1926","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nm-phone","type":"phone","label":"Ambetter member services, New Mexico","value":"+1-833-945-2029","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ny-phone","type":"phone","label":"Ambetter member services, New York","value":"+1-888-343-3547","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nc-phone","type":"phone","label":"Ambetter member services, North Carolina","value":"+1-833-863-1310","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-oh-phone","type":"phone","label":"Ambetter member services, Ohio","value":"+1-877-687-1189","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ok-phone","type":"phone","label":"Ambetter member services, Oklahoma","value":"+1-833-492-0679","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-pa-phone","type":"phone","label":"Ambetter member services, Pennsylvania","value":"+1-833-510-4727","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-sc-phone","type":"phone","label":"Ambetter member services, South Carolina","value":"+1-833-270-5443","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-tn-phone","type":"phone","label":"Ambetter member services, Tennessee","value":"+1-833-709-4735","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-tx-phone","type":"phone","label":"Ambetter member services, Texas","value":"+1-877-687-1196","hours":"8am-8pm CST","notes":"Relay Texas/TTY 1-800-735-2989.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.ambetterhealth.com/en/tx/contact-us/","last_verified":"2026-10-12"},{"id":"ambetter-wa-phone","type":"phone","label":"Ambetter member services, Washington","value":"+1-877-687-1197","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"}],"facts":[{"kind":"deadline","claim":"For Ambetter Health in Florida, you must file an appeal within 180 calendar days of the date of the Notice of Action letter, and a grievance within 365 calendar days of the date of the event.","issues":["claim_denial"],"source":"https://www.ambetterhealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/FL_MbrGrivanceAppelConcern.pdf","last_verified":"2026-10-12"},{"kind":"process","claim":"Ambetter Florida accepts either its grievance and appeal form or a letter with the same information, mailed to the Appeal Department; it lists separate fax numbers for appeals and for grievances.","issues":["claim_denial"],"source":"https://www.ambetterhealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/FL_MbrGrivanceAppelConcern.pdf","last_verified":"2026-10-12"},{"kind":"contact","claim":"Centene tells members to contact their health plan directly, not corporate headquarters, for questions about benefits, eligibility or authorizations.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"}],"rules":{"in_force":[{"id":"aca-appeals-external-review","title":"ACA internal appeals and external review for health coverage","citation":"45 CFR 147.136 (with 29 CFR 2560.503-1 for group health plans)","jurisdiction":"us-federal","status":"in_effect","summary":"After a health plan denies a claim, the patient has 180 days to file an internal appeal. The plan must decide within 30 days (care not yet received), 60 days (care already received) or 72 hours (urgent care). After a final denial, the patient can ask for an independent external review within 4 months; the plan must accept the reviewer's decision.","source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12","points":[{"kind":"deadline","claim":"\"You must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied.\"","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"deadline","claim":"The internal appeal must be completed within 30 days for a service not yet received and within 60 days for a service already received.","issues":["claim_denial","claim_delay"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"deadline","claim":"For urgent care claims, a group health plan must decide an appeal \"not later than 72 hours after receipt of the claimant's request for review\".","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"process","claim":"In urgent situations, \"You may file an internal appeal and an external review request at the same time.\"","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"policy","claim":"Plans must continue coverage pending the outcome of an appeal, and may not reduce or end benefits for an ongoing course of treatment without advance notice and an opportunity for advance review.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"deadline","claim":"An external review must be requested within \"4 months after the date you receive a notice or final determination\" from the insurer. A standard decision is due no later than 45 days after the request is received; an expedited decision no later than 72 hours.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"},{"kind":"policy","claim":"The insurer is required by law to accept the external reviewer's decision. The HHS-administered process is free; a state or insurer-contracted process may charge, but not more than $25 per review.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"},{"kind":"policy","claim":"If the plan fails to strictly follow the internal claims and appeals requirements, the claimant \"is deemed to have exhausted the internal claims and appeals process\", subject to a de minimis exception.","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"limit","claim":"These internal appeal and external review requirements generally do not apply to grandfathered plans.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"contact","claim":"For plans that use the HHS-administered external review process, requests can be filed online with MAXIMUS Federal Services, by calling 1-888-866-6205 for a form, or by email to ferp@maximus.com. For a state process, the contact is in the final denial notice or Explanation of Benefits.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"}]},{"id":"erisa-claims-procedures","title":"ERISA claims procedure timelines for employer benefit plans","citation":"29 CFR 2560.503-1","jurisdiction":"us-federal","status":"in_effect","summary":"Employer-sponsored benefit plans covered by ERISA must decide claims and appeals within set deadlines. Group health plans: 72 hours for urgent care, 15 days for pre-service and 30 days for post-service claims; disability plans: 45 days; other plans: 90 days. Group health and disability claimants get at least 180 days to appeal. If the plan does not follow the procedures, the claimant may sue.","source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12","points":[{"kind":"deadline","claim":"Group health plan initial decisions: urgent care claims \"not later than 72 hours after receipt of the claim by the plan\"; pre-service claims within 15 days, with one extension of up to 15 days; post-service claims \"not later than 30 days after receipt of the claim\", with one extension of up to 15 days.","issues":["claim_delay","claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Disability claims: notice of decision \"not later than 45 days after receipt of the claim by the plan\", with an extension of up to 30 days and a second extension of up to 30 days. Other plans (not group health or disability): not later than 90 days, with one extension of up to 90 days.","issues":["claim_delay","claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Time to appeal a denial: group health plan and disability claimants must have at least 180 days after receiving the adverse benefit determination. Claimants under other plans must have \"at least 60 days following receipt of a notification\" of the adverse determination.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Group health plan appeal decisions (one-level appeal): urgent care within 72 hours, pre-service within 30 days, post-service within 60 days after the plan receives the appeal. With two appeal levels, each level has 15 days (pre-service) or 30 days (post-service).","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Appeal decisions for other plans are due not later than 60 days after the request for review (up to 60 more days in special circumstances); for disability plans the period is 45 days.","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"policy","claim":"On appeal, the plan must provide, \"upon request and free of charge, reasonable access to, and copies of, all documents\" relevant to the claim.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"policy","claim":"If the plan fails to establish or follow these claims procedures, \"a claimant shall be deemed to have exhausted the administrative remedies available under the plan\" and may bring a civil action under ERISA section 502(a).","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Call the member services number of your own plan (on the back of the member ID card).","channel":{"id":"plan-directory","type":"web_form","label":"Centene health plan member services directory (Ambetter by state and other Centene plans)","value":"https://www.centene.com/contact.html","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"access":"open","notes":"Centene corporate does not handle member questions. Members contact their own health plan.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"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.","channel":{"id":"ambetter-fl-appeals-mail","type":"mail","label":"Ambetter Health (Florida, Sunshine Health) grievances and appeals","value":"Ambetter Health Appeal Department, P.O. Box 459087, Fort Lauderdale, FL 33345-9087","purposes":["claim_denial","poor_service"],"notes":"Phone 1-877-687-1169; TTY 1-877-941-9230; fax 1-866-719-5373 (appeals) or 1-866-550-3248 (grievance/complaint). Florida plans only.","source":"https://www.ambetterhealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/FL_MbrGrivanceAppelConcern.pdf","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for marketplace plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["Centene runs separate state plans; contact details, forms and appeal addresses differ by state and brand.","Claims view needs a member portal login.","Grievance forms are PDFs that must be mailed or faxed."],"security":{"official_domains":["centene.com","ambetterhealth.com","wellcare.com","sunshinehealth.com"],"never_asks":[{"kind":"policy","claim":"Wellcare will never request a physician's signature when it sends a medical records request.","source":"https://www.wellcare.com/-/media/pdfs/louisiana/provider/bulletins/la_care_prov_fax_scam_notification_2024_r.ashx?la=en&hash=5DDD6B4A0B76C8898A8217B21BA9A5E8","last_verified":"2026-10-12"},{"kind":"policy","claim":"An Ambetter email-scam notice says health insurers and Medicare never ask for your username, password, Social Security number, Medicare number or banking information by email.","source":"https://www.ambetterhealth.com/content/dam/centene/ambetteraz/pdfs/Email_Scams.pdf","last_verified":"2026-10-12"}],"known_scams":[{"kind":"policy","claim":"In 2024 Wellcare warned providers about fraudulent Wellcare-branded faxes that request member medical records and physician signatures. Some of these faxes were followed by harassing phone calls.","source":"https://www.wellcare.com/-/media/pdfs/louisiana/provider/bulletins/la_care_prov_fax_scam_notification_2024_r.ashx?la=en&hash=5DDD6B4A0B76C8898A8217B21BA9A5E8","last_verified":"2026-10-12"},{"kind":"policy","claim":"Criminals pose as Medicare or health insurers by email. The email says there is a problem with your account or asks for updated information, and asks you to click a link to enter it.","source":"https://www.ambetterhealth.com/content/dam/centene/ambetteraz/pdfs/Email_Scams.pdf","last_verified":"2026-10-12"}],"report_phishing":[{"id":"fwa-helpline","type":"phone","label":"Centene Fraud, Waste and Abuse Helpline","value":"+1-866-685-8664","hours":"24/7","notes":"Independently administered. Anonymous reports are accepted. Some Ambetter state plans also list their own fraud hotlines.","source":"https://www.centene.com/who-we-are/ethics-and-integrity.html","last_verified":"2026-10-12"},{"id":"siu-email","type":"email","label":"Centene Special Investigations Unit (report fraud, waste and abuse)","value":"Special_Investigations_Unit@centene.com","source":"https://www.centene.com/why-were-different/healthcare-fraud-waste-abuse-oversight.html","last_verified":"2026-10-12"},{"id":"ethicspoint-online","type":"web_form","label":"Centene online fraud and compliance report (hosted by EthicsPoint)","value":"https://www.centene.ethicspoint.com/","access":"open","source":"https://www.centene.com/why-were-different/healthcare-fraud-waste-abuse-oversight.html","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":1.0,"sources":{"primary":50},"verified_from":{"page":50},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 100% of 50 sources are the organization's own pages or government sites.","dossier_last_verified":null},"context":{"dossier":false,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Centene Corporation (St. Louis) runs marketplace plans under the Ambetter brand in 29 states, Medicare plans under Wellcare, and state Medicaid plans under local names (for example Sunshine Health, Superior HealthPlan, Peach State, Buckeye, Meridian, Health Net in California). Medicare and Medicaid plans have their own appeal rules.","warnings":[]},"billing_error":{"company":{"id":"centene","name":"Centene (Ambetter, Wellcare, Health Net)","sector":"insurance_health","website":"https://www.centene.com","account_url":"https://member.ambetterhealth.com/sso/login"},"issue":{"id":"billing_error","name":"Billing error"},"playbook_source":"company","summary":"Check the claim in the member portal, call your plan, then file a grievance.","evidence":["provider bill","EOB","member ID card"],"steps":[{"do":"Compare the provider bill with the claim in the Ambetter member portal.","channel":{"id":"ambetter-member-portal","type":"portal","label":"Ambetter member login (view claims)","value":"https://member.ambetterhealth.com/sso/login","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.ambetterhealth.com/en/fl/resources/","last_verified":"2026-10-12"}},{"do":"Call your plan's member services and ask for a correction or reprocessing.","channel":{"id":"plan-directory","type":"web_form","label":"Centene health plan member services directory (Ambetter by state and other Centene plans)","value":"https://www.centene.com/contact.html","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"access":"open","notes":"Centene corporate does not handle member questions. Members contact their own health plan.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"}},{"do":"If it is not fixed, file a grievance with the state plan.","channel":{"id":"ambetter-fl-appeal-form","type":"web_form","label":"Ambetter Florida grievance, appeal, concern or recommendation form (PDF)","value":"https://ambetter.sunshinehealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/FL_MbrGrivanceAppelConcern.pdf","purposes":["claim_denial","poor_service"],"source":"https://www.ambetterhealth.com/en/fl/resources/handbooks-forms/","last_verified":"2026-10-12"}}],"channels":[{"id":"plan-directory","type":"web_form","label":"Centene health plan member services directory (Ambetter by state and other Centene plans)","value":"https://www.centene.com/contact.html","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"access":"open","notes":"Centene corporate does not handle member questions. Members contact their own health plan.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-state-contacts","type":"web_form","label":"Ambetter contact pages by state","value":"https://www.ambetterhealth.com/en/contact-us/","purposes":["claim_denial","claim_delay","billing_error"],"source":"https://www.ambetterhealth.com/en/contact-us/","last_verified":"2026-10-12"},{"id":"ambetter-member-portal","type":"portal","label":"Ambetter member login (view claims)","value":"https://member.ambetterhealth.com/sso/login","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.ambetterhealth.com/en/fl/resources/","last_verified":"2026-10-12"},{"id":"ambetter-tx-mail","type":"mail","label":"Ambetter from Superior HealthPlan (Texas) general mailing address","value":"Ambetter from Superior HealthPlan, 5900 E. Ben White Blvd., Austin, TX 78741","source":"https://www.ambetterhealth.com/en/tx/contact-us/","last_verified":"2026-10-12"},{"id":"wellcare-phone","type":"phone","label":"Wellcare (Medicare) member services","value":"+1-833-444-9088","purposes":["claim_denial","claim_delay","billing_error"],"notes":"Wellcare also tells members to call the number on the back of the member ID card or pick their state on its contact page.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"wellcare-contact","type":"web_form","label":"Wellcare contact page (state member services numbers)","value":"https://www.wellcare.com/en/contact-us","source":"https://www.wellcare.com/en/contact-us","last_verified":"2026-10-12"},{"id":"wellcare-mail","type":"mail","label":"Wellcare Health Plans general mailing address","value":"Wellcare Health Plans, P.O. Box 31370, Tampa, FL 33631","source":"https://www.wellcare.com/en/contact-us","last_verified":"2026-10-12"},{"id":"health-net-ca-phone","type":"phone","label":"Health Net (California) member services","value":"+1-800-522-0088","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-al-phone","type":"phone","label":"Ambetter member services, Alabama","value":"+1-800-442-1623","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-az-phone","type":"phone","label":"Ambetter member services, Arizona","value":"+1-888-926-5057","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ar-phone","type":"phone","label":"Ambetter member services, Arkansas","value":"+1-877-617-0390","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ca-phone","type":"phone","label":"Ambetter member services, California","value":"+1-844-463-8188","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-fl-phone","type":"phone","label":"Ambetter member services, Florida","value":"+1-877-687-1169","hours":"8am-8pm EST","notes":"Relay Florida 1-800-955-8770.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.ambetterhealth.com/en/fl/contact-us/","last_verified":"2026-10-12"},{"id":"ambetter-ga-phone","type":"phone","label":"Ambetter member services, Georgia","value":"+1-877-687-1180","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-il-phone","type":"phone","label":"Ambetter member services, Illinois","value":"+1-855-745-5507","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-in-phone","type":"phone","label":"Ambetter member services, Indiana","value":"+1-877-687-1182","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ia-phone","type":"phone","label":"Ambetter member services, Iowa","value":"+1-833-919-3213","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ks-phone","type":"phone","label":"Ambetter member services, Kansas","value":"+1-844-518-9505","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ky-phone","type":"phone","label":"Ambetter member services, Kentucky","value":"+1-833-705-2175","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-la-phone","type":"phone","label":"Ambetter member services, Louisiana","value":"+1-833-635-0450","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-mi-phone","type":"phone","label":"Ambetter member services, Michigan","value":"+1-833-993-2426","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ms-phone","type":"phone","label":"Ambetter member services, Mississippi","value":"+1-877-687-1187","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-mo-phone","type":"phone","label":"Ambetter member services, Missouri","value":"+1-855-650-3789","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ne-phone","type":"phone","label":"Ambetter member services, Nebraska","value":"+1-833-890-0329","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nv-phone","type":"phone","label":"Ambetter member services, Nevada","value":"+1-866-263-8134","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nh-phone","type":"phone","label":"Ambetter member services, New Hampshire","value":"+1-844-265-1278","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nj-phone","type":"phone","label":"Ambetter member services, New Jersey","value":"+1-844-606-1926","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nm-phone","type":"phone","label":"Ambetter member services, New Mexico","value":"+1-833-945-2029","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ny-phone","type":"phone","label":"Ambetter member services, New York","value":"+1-888-343-3547","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nc-phone","type":"phone","label":"Ambetter member services, North Carolina","value":"+1-833-863-1310","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-oh-phone","type":"phone","label":"Ambetter member services, Ohio","value":"+1-877-687-1189","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ok-phone","type":"phone","label":"Ambetter member services, Oklahoma","value":"+1-833-492-0679","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-pa-phone","type":"phone","label":"Ambetter member services, Pennsylvania","value":"+1-833-510-4727","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-sc-phone","type":"phone","label":"Ambetter member services, South Carolina","value":"+1-833-270-5443","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-tn-phone","type":"phone","label":"Ambetter member services, Tennessee","value":"+1-833-709-4735","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-tx-phone","type":"phone","label":"Ambetter member services, Texas","value":"+1-877-687-1196","hours":"8am-8pm CST","notes":"Relay Texas/TTY 1-800-735-2989.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.ambetterhealth.com/en/tx/contact-us/","last_verified":"2026-10-12"},{"id":"ambetter-wa-phone","type":"phone","label":"Ambetter member services, Washington","value":"+1-877-687-1197","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"}],"facts":[{"kind":"contact","claim":"Centene tells members to contact their health plan directly, not corporate headquarters, for questions about benefits, eligibility or authorizations.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"}],"rules":{"in_force":[{"id":"no-surprises-act","title":"No Surprises Act (surprise billing protections and good faith estimates)","citation":"45 CFR part 149 (including 149.420 and 149.610)","jurisdiction":"us-federal","status":"in_effect","summary":"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":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights","last_verified":"2026-10-12","points_omitted":5,"points":[{"kind":"deadline","claim":"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.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.law.cornell.edu/cfr/text/45/149.610","last_verified":"2026-10-12"},{"kind":"deadline","claim":"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\".","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"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.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}]},{"id":"rosca-negative-option","title":"Restore Online Shoppers' Confidence Act (ROSCA) negative option requirements","citation":"15 U.S.C. 8401-8405","jurisdiction":"us-federal","status":"in_effect","summary":"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":"https://www.law.cornell.edu/uscode/text/15/8403","last_verified":"2026-10-12","points_omitted":4,"points":[{"kind":"policy","claim":"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\".","issues":["unauthorized_charge","billing_error"],"source":"https://www.law.cornell.edu/uscode/text/15/8403","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Call the member services number of your own plan (on the back of the member ID card).","channel":{"id":"plan-directory","type":"web_form","label":"Centene health plan member services directory (Ambetter by state and other Centene plans)","value":"https://www.centene.com/contact.html","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"access":"open","notes":"Centene corporate does not handle member questions. Members contact their own health plan.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"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.","channel":{"id":"ambetter-fl-appeals-mail","type":"mail","label":"Ambetter Health (Florida, Sunshine Health) grievances and appeals","value":"Ambetter Health Appeal Department, P.O. Box 459087, Fort Lauderdale, FL 33345-9087","purposes":["claim_denial","poor_service"],"notes":"Phone 1-877-687-1169; TTY 1-877-941-9230; fax 1-866-719-5373 (appeals) or 1-866-550-3248 (grievance/complaint). Florida plans only.","source":"https://www.ambetterhealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/FL_MbrGrivanceAppelConcern.pdf","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for marketplace plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["Centene runs separate state plans; contact details, forms and appeal addresses differ by state and brand.","Claims view needs a member portal login.","Grievance forms are PDFs that must be mailed or faxed."],"security":{"official_domains":["centene.com","ambetterhealth.com","wellcare.com","sunshinehealth.com"],"never_asks":[{"kind":"policy","claim":"Wellcare will never request a physician's signature when it sends a medical records request.","source":"https://www.wellcare.com/-/media/pdfs/louisiana/provider/bulletins/la_care_prov_fax_scam_notification_2024_r.ashx?la=en&hash=5DDD6B4A0B76C8898A8217B21BA9A5E8","last_verified":"2026-10-12"},{"kind":"policy","claim":"An Ambetter email-scam notice says health insurers and Medicare never ask for your username, password, Social Security number, Medicare number or banking information by email.","source":"https://www.ambetterhealth.com/content/dam/centene/ambetteraz/pdfs/Email_Scams.pdf","last_verified":"2026-10-12"}],"known_scams":[{"kind":"policy","claim":"In 2024 Wellcare warned providers about fraudulent Wellcare-branded faxes that request member medical records and physician signatures. Some of these faxes were followed by harassing phone calls.","source":"https://www.wellcare.com/-/media/pdfs/louisiana/provider/bulletins/la_care_prov_fax_scam_notification_2024_r.ashx?la=en&hash=5DDD6B4A0B76C8898A8217B21BA9A5E8","last_verified":"2026-10-12"},{"kind":"policy","claim":"Criminals pose as Medicare or health insurers by email. The email says there is a problem with your account or asks for updated information, and asks you to click a link to enter it.","source":"https://www.ambetterhealth.com/content/dam/centene/ambetteraz/pdfs/Email_Scams.pdf","last_verified":"2026-10-12"}],"report_phishing":[{"id":"fwa-helpline","type":"phone","label":"Centene Fraud, Waste and Abuse Helpline","value":"+1-866-685-8664","hours":"24/7","notes":"Independently administered. Anonymous reports are accepted. Some Ambetter state plans also list their own fraud hotlines.","source":"https://www.centene.com/who-we-are/ethics-and-integrity.html","last_verified":"2026-10-12"},{"id":"siu-email","type":"email","label":"Centene Special Investigations Unit (report fraud, waste and abuse)","value":"Special_Investigations_Unit@centene.com","source":"https://www.centene.com/why-were-different/healthcare-fraud-waste-abuse-oversight.html","last_verified":"2026-10-12"},{"id":"ethicspoint-online","type":"web_form","label":"Centene online fraud and compliance report (hosted by EthicsPoint)","value":"https://www.centene.ethicspoint.com/","access":"open","source":"https://www.centene.com/why-were-different/healthcare-fraud-waste-abuse-oversight.html","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":1.0,"sources":{"primary":50},"verified_from":{"page":50},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 100% of 50 sources are the organization's own pages or government sites.","dossier_last_verified":null},"context":{"dossier":false,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Centene Corporation (St. Louis) runs marketplace plans under the Ambetter brand in 29 states, Medicare plans under Wellcare, and state Medicaid plans under local names (for example Sunshine Health, Superior HealthPlan, Peach State, Buckeye, Meridian, Health Net in California). Medicare and Medicaid plans have their own appeal rules.","warnings":[]},"surprise_medical_bill":{"company":{"id":"centene","name":"Centene (Ambetter, Wellcare, Health Net)","sector":"insurance_health","website":"https://www.centene.com","account_url":"https://member.ambetterhealth.com/sso/login"},"issue":{"id":"surprise_medical_bill","name":"Surprise medical bill"},"playbook_source":"company","summary":"Compare the bill with the EOB, tell the plan and the provider, then contact the CMS help desk.","evidence":["the bill","EOB","member ID card"],"steps":[{"do":"Compare the bill with the EOB. Note whether it was emergency care or care at an in-network facility.","channel":{"id":"ambetter-member-portal","type":"portal","label":"Ambetter member login (view claims)","value":"https://member.ambetterhealth.com/sso/login","purposes":["claim_delay","claim_denial","billing_error"],"access":"login","source":"https://www.ambetterhealth.com/en/fl/resources/","last_verified":"2026-10-12"}},{"do":"Tell your plan and the provider the bill may be a surprise bill.","channel":{"id":"plan-directory","type":"web_form","label":"Centene health plan member services directory (Ambetter by state and other Centene plans)","value":"https://www.centene.com/contact.html","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"access":"open","notes":"Centene corporate does not handle member questions. Members contact their own health plan.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"}},{"do":"Contact the CMS No Surprises Help Desk.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"channels":[{"id":"plan-directory","type":"web_form","label":"Centene health plan member services directory (Ambetter by state and other Centene plans)","value":"https://www.centene.com/contact.html","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"access":"open","notes":"Centene corporate does not handle member questions. Members contact their own health plan.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-tx-mail","type":"mail","label":"Ambetter from Superior HealthPlan (Texas) general mailing address","value":"Ambetter from Superior HealthPlan, 5900 E. Ben White Blvd., Austin, TX 78741","source":"https://www.ambetterhealth.com/en/tx/contact-us/","last_verified":"2026-10-12"},{"id":"wellcare-contact","type":"web_form","label":"Wellcare contact page (state member services numbers)","value":"https://www.wellcare.com/en/contact-us","source":"https://www.wellcare.com/en/contact-us","last_verified":"2026-10-12"},{"id":"wellcare-mail","type":"mail","label":"Wellcare Health Plans general mailing address","value":"Wellcare Health Plans, P.O. Box 31370, Tampa, FL 33631","source":"https://www.wellcare.com/en/contact-us","last_verified":"2026-10-12"},{"id":"health-net-ca-phone","type":"phone","label":"Health Net (California) member services","value":"+1-800-522-0088","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-al-phone","type":"phone","label":"Ambetter member services, Alabama","value":"+1-800-442-1623","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-az-phone","type":"phone","label":"Ambetter member services, Arizona","value":"+1-888-926-5057","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ar-phone","type":"phone","label":"Ambetter member services, Arkansas","value":"+1-877-617-0390","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ca-phone","type":"phone","label":"Ambetter member services, California","value":"+1-844-463-8188","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-fl-phone","type":"phone","label":"Ambetter member services, Florida","value":"+1-877-687-1169","hours":"8am-8pm EST","notes":"Relay Florida 1-800-955-8770.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.ambetterhealth.com/en/fl/contact-us/","last_verified":"2026-10-12"},{"id":"ambetter-ga-phone","type":"phone","label":"Ambetter member services, Georgia","value":"+1-877-687-1180","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-il-phone","type":"phone","label":"Ambetter member services, Illinois","value":"+1-855-745-5507","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-in-phone","type":"phone","label":"Ambetter member services, Indiana","value":"+1-877-687-1182","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ia-phone","type":"phone","label":"Ambetter member services, Iowa","value":"+1-833-919-3213","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ks-phone","type":"phone","label":"Ambetter member services, Kansas","value":"+1-844-518-9505","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ky-phone","type":"phone","label":"Ambetter member services, Kentucky","value":"+1-833-705-2175","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-la-phone","type":"phone","label":"Ambetter member services, Louisiana","value":"+1-833-635-0450","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-mi-phone","type":"phone","label":"Ambetter member services, Michigan","value":"+1-833-993-2426","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ms-phone","type":"phone","label":"Ambetter member services, Mississippi","value":"+1-877-687-1187","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-mo-phone","type":"phone","label":"Ambetter member services, Missouri","value":"+1-855-650-3789","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ne-phone","type":"phone","label":"Ambetter member services, Nebraska","value":"+1-833-890-0329","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nv-phone","type":"phone","label":"Ambetter member services, Nevada","value":"+1-866-263-8134","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nh-phone","type":"phone","label":"Ambetter member services, New Hampshire","value":"+1-844-265-1278","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nj-phone","type":"phone","label":"Ambetter member services, New Jersey","value":"+1-844-606-1926","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nm-phone","type":"phone","label":"Ambetter member services, New Mexico","value":"+1-833-945-2029","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ny-phone","type":"phone","label":"Ambetter member services, New York","value":"+1-888-343-3547","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-nc-phone","type":"phone","label":"Ambetter member services, North Carolina","value":"+1-833-863-1310","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-oh-phone","type":"phone","label":"Ambetter member services, Ohio","value":"+1-877-687-1189","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-ok-phone","type":"phone","label":"Ambetter member services, Oklahoma","value":"+1-833-492-0679","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-pa-phone","type":"phone","label":"Ambetter member services, Pennsylvania","value":"+1-833-510-4727","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-sc-phone","type":"phone","label":"Ambetter member services, South Carolina","value":"+1-833-270-5443","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-tn-phone","type":"phone","label":"Ambetter member services, Tennessee","value":"+1-833-709-4735","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"},{"id":"ambetter-tx-phone","type":"phone","label":"Ambetter member services, Texas","value":"+1-877-687-1196","hours":"8am-8pm CST","notes":"Relay Texas/TTY 1-800-735-2989.","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.ambetterhealth.com/en/tx/contact-us/","last_verified":"2026-10-12"},{"id":"ambetter-wa-phone","type":"phone","label":"Ambetter member services, Washington","value":"+1-877-687-1197","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill"],"source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"}],"facts":[{"kind":"contact","claim":"Centene tells members to contact their health plan directly, not corporate headquarters, for questions about benefits, eligibility or authorizations.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"}],"rules":{"in_force":[{"id":"no-surprises-act","title":"No Surprises Act (surprise billing protections and good faith estimates)","citation":"45 CFR part 149 (including 149.420 and 149.610)","jurisdiction":"us-federal","status":"in_effect","summary":"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":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights","last_verified":"2026-10-12","points":[{"kind":"limit","claim":"For emergency services, \"you can't be charged any more for emergency medical services than the in-network 'cost-sharing' rate\". This covers the hospital, the providers who treat you there, and air ambulance providers.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights/know-your-rights/insurance","last_verified":"2026-10-12"},{"kind":"policy","claim":"The protections cover non-emergency care related to a visit to an in-network hospital, hospital outpatient department or ambulatory surgical center, and air ambulance services. Ground ambulance services generally are not covered by the No Surprises Act billing protections.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/know-your-rights","last_verified":"2026-10-12"},{"kind":"policy","claim":"A patient gives up the protections for non-emergency care only by signing a notice-and-consent form. Providers of ancillary services cannot use that form: emergency medicine, anesthesiology, pathology, radiology and neonatology; assistant surgeons, hospitalists and intensivists; diagnostic services including radiology and laboratory; and any out-of-network provider when no in-network provider is available at the facility.","issues":["surprise_medical_bill"],"source":"https://www.law.cornell.edu/cfr/text/45/149.420","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A notice-and-consent form for services scheduled at least 72 hours in advance must be given not later than 72 hours before the services. For services scheduled within 72 hours, it must be given on the day of scheduling, and no later than 3 hours before the services if given on the same day.","issues":["surprise_medical_bill"],"source":"https://www.law.cornell.edu/cfr/text/45/149.420","last_verified":"2026-10-12"},{"kind":"deadline","claim":"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.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.law.cornell.edu/cfr/text/45/149.610","last_verified":"2026-10-12"},{"kind":"deadline","claim":"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\".","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"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.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"contact","claim":"No Surprises Help Desk: 1-800-985-3059, weekdays 8:00 am to 8:00 pm ET and weekends 10:00 am to 6:00 pm ET. Complaints can also be filed online through CMS.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Call the member services number of your own plan (on the back of the member ID card).","channel":{"id":"plan-directory","type":"web_form","label":"Centene health plan member services directory (Ambetter by state and other Centene plans)","value":"https://www.centene.com/contact.html","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"access":"open","notes":"Centene corporate does not handle member questions. Members contact their own health plan.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"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.","channel":{"id":"ambetter-fl-appeals-mail","type":"mail","label":"Ambetter Health (Florida, Sunshine Health) grievances and appeals","value":"Ambetter Health Appeal Department, P.O. Box 459087, Fort Lauderdale, FL 33345-9087","purposes":["claim_denial","poor_service"],"notes":"Phone 1-877-687-1169; TTY 1-877-941-9230; fax 1-866-719-5373 (appeals) or 1-866-550-3248 (grievance/complaint). Florida plans only.","source":"https://www.ambetterhealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/FL_MbrGrivanceAppelConcern.pdf","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for marketplace plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["Centene runs separate state plans; contact details, forms and appeal addresses differ by state and brand.","Claims view needs a member portal login.","Grievance forms are PDFs that must be mailed or faxed."],"security":{"official_domains":["centene.com","ambetterhealth.com","wellcare.com","sunshinehealth.com"],"never_asks":[{"kind":"policy","claim":"Wellcare will never request a physician's signature when it sends a medical records request.","source":"https://www.wellcare.com/-/media/pdfs/louisiana/provider/bulletins/la_care_prov_fax_scam_notification_2024_r.ashx?la=en&hash=5DDD6B4A0B76C8898A8217B21BA9A5E8","last_verified":"2026-10-12"},{"kind":"policy","claim":"An Ambetter email-scam notice says health insurers and Medicare never ask for your username, password, Social Security number, Medicare number or banking information by email.","source":"https://www.ambetterhealth.com/content/dam/centene/ambetteraz/pdfs/Email_Scams.pdf","last_verified":"2026-10-12"}],"known_scams":[{"kind":"policy","claim":"In 2024 Wellcare warned providers about fraudulent Wellcare-branded faxes that request member medical records and physician signatures. Some of these faxes were followed by harassing phone calls.","source":"https://www.wellcare.com/-/media/pdfs/louisiana/provider/bulletins/la_care_prov_fax_scam_notification_2024_r.ashx?la=en&hash=5DDD6B4A0B76C8898A8217B21BA9A5E8","last_verified":"2026-10-12"},{"kind":"policy","claim":"Criminals pose as Medicare or health insurers by email. The email says there is a problem with your account or asks for updated information, and asks you to click a link to enter it.","source":"https://www.ambetterhealth.com/content/dam/centene/ambetteraz/pdfs/Email_Scams.pdf","last_verified":"2026-10-12"}],"report_phishing":[{"id":"fwa-helpline","type":"phone","label":"Centene Fraud, Waste and Abuse Helpline","value":"+1-866-685-8664","hours":"24/7","notes":"Independently administered. Anonymous reports are accepted. Some Ambetter state plans also list their own fraud hotlines.","source":"https://www.centene.com/who-we-are/ethics-and-integrity.html","last_verified":"2026-10-12"},{"id":"siu-email","type":"email","label":"Centene Special Investigations Unit (report fraud, waste and abuse)","value":"Special_Investigations_Unit@centene.com","source":"https://www.centene.com/why-were-different/healthcare-fraud-waste-abuse-oversight.html","last_verified":"2026-10-12"},{"id":"ethicspoint-online","type":"web_form","label":"Centene online fraud and compliance report (hosted by EthicsPoint)","value":"https://www.centene.ethicspoint.com/","access":"open","source":"https://www.centene.com/why-were-different/healthcare-fraud-waste-abuse-oversight.html","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":1.0,"sources":{"primary":50},"verified_from":{"page":50},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 100% of 50 sources are the organization's own pages or government sites.","dossier_last_verified":null},"context":{"dossier":false,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"Centene Corporation (St. Louis) runs marketplace plans under the Ambetter brand in 29 states, Medicare plans under Wellcare, and state Medicaid plans under local names (for example Sunshine Health, Superior HealthPlan, Peach State, Buckeye, Meridian, Health Net in California). Medicare and Medicaid plans have their own appeal rules.","warnings":[]}},"escalation":[{"index":0,"rung":"frontline","note":"Call the member services number of your own plan (on the back of the member ID card).","channel":{"id":"plan-directory","type":"web_form","label":"Centene health plan member services directory (Ambetter by state and other Centene plans)","value":"https://www.centene.com/contact.html","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"access":"open","notes":"Centene corporate does not handle member questions. Members contact their own health plan.","source":"https://www.centene.com/contact.html","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"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.","channel":{"id":"ambetter-fl-appeals-mail","type":"mail","label":"Ambetter Health (Florida, Sunshine Health) grievances and appeals","value":"Ambetter Health Appeal Department, P.O. Box 459087, Fort Lauderdale, FL 33345-9087","purposes":["claim_denial","poor_service"],"notes":"Phone 1-877-687-1169; TTY 1-877-941-9230; fax 1-866-719-5373 (appeals) or 1-866-550-3248 (grievance/complaint). Florida plans only.","source":"https://www.ambetterhealth.com/content/dam/centene/Sunshine/Ambetter/PDFs/FL_MbrGrivanceAppelConcern.pdf","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for marketplace plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"security":{"official_domains":["centene.com","ambetterhealth.com","wellcare.com","sunshinehealth.com"],"never_asks":[{"kind":"policy","claim":"Wellcare will never request a physician's signature when it sends a medical records request.","source":"https://www.wellcare.com/-/media/pdfs/louisiana/provider/bulletins/la_care_prov_fax_scam_notification_2024_r.ashx?la=en&hash=5DDD6B4A0B76C8898A8217B21BA9A5E8","last_verified":"2026-10-12"},{"kind":"policy","claim":"An Ambetter email-scam notice says health insurers and Medicare never ask for your username, password, Social Security number, Medicare number or banking information by email.","source":"https://www.ambetterhealth.com/content/dam/centene/ambetteraz/pdfs/Email_Scams.pdf","last_verified":"2026-10-12"}],"known_scams":[{"kind":"policy","claim":"In 2024 Wellcare warned providers about fraudulent Wellcare-branded faxes that request member medical records and physician signatures. Some of these faxes were followed by harassing phone calls.","source":"https://www.wellcare.com/-/media/pdfs/louisiana/provider/bulletins/la_care_prov_fax_scam_notification_2024_r.ashx?la=en&hash=5DDD6B4A0B76C8898A8217B21BA9A5E8","last_verified":"2026-10-12"},{"kind":"policy","claim":"Criminals pose as Medicare or health insurers by email. The email says there is a problem with your account or asks for updated information, and asks you to click a link to enter it.","source":"https://www.ambetterhealth.com/content/dam/centene/ambetteraz/pdfs/Email_Scams.pdf","last_verified":"2026-10-12"}],"report_phishing":[{"id":"fwa-helpline","type":"phone","label":"Centene Fraud, Waste and Abuse Helpline","value":"+1-866-685-8664","hours":"24/7","notes":"Independently administered. Anonymous reports are accepted. Some Ambetter state plans also list their own fraud hotlines.","source":"https://www.centene.com/who-we-are/ethics-and-integrity.html","last_verified":"2026-10-12"},{"id":"siu-email","type":"email","label":"Centene Special Investigations Unit (report fraud, waste and abuse)","value":"Special_Investigations_Unit@centene.com","source":"https://www.centene.com/why-were-different/healthcare-fraud-waste-abuse-oversight.html","last_verified":"2026-10-12"},{"id":"ethicspoint-online","type":"web_form","label":"Centene online fraud and compliance report (hosted by EthicsPoint)","value":"https://www.centene.ethicspoint.com/","access":"open","source":"https://www.centene.com/why-were-different/healthcare-fraud-waste-abuse-oversight.html","last_verified":"2026-10-12"}]},"credibility":{"grade":"A","primary_share":1.0,"sources":{"primary":50},"verified_from":{"page":50},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 100% of 50 sources are the organization's own pages or government sites.","dossier_last_verified":null},"dossier":null,"guide":{"key":"insurance_health","title":"Health insurance — how complaints work","last_verified":"2026-10-12","file":"guides/insurance_health.md","page":"https://escalate.alexgaoth.com/#/guides/insurance_health"}}