Tessa Quinn
Ambetter Health is an affordable health insurance provider that offers access to a range of healthcare practitioners and providers, including hospitals, pharmacies, and medical equipment companies. Ambetter Health contracts with providers who accept their terms, meet their credentialing criteria, and agree to their reimbursement terms. They regularly review their provider network and make decisions about which providers remain in the network. Ambetter Health members can use the 'Find a Provider' tool to search for in-network providers in their area, including hospitals.
| Characteristics | Values |
|---|---|
| Goal | To provide access to a quality healthcare network and providers while keeping premiums affordable |
| Services | All services that the Affordable Care Act describes as Essential Health Benefits, including preventive care, hospitalization coverage, emergency services, and more |
| Providers | A full range of practitioners and providers, including specialty physicians (e.g. cardiologists, neurologists), hospitals, pharmacies, and medical equipment companies |
| Provider Selection Criteria | Providers who accept contract terms, meet credentialing criteria, and agree to reimbursement terms |
| Provider Review | Regular review of the provider network to decide which providers remain and if additional providers are needed |
| Provider Information | Provider specialties, providers accepting new patients, languages spoken, office hours, contact information, and directions |
| Provider Search Tools | Ambetter's "Find a Provider" tool, Virtual 24/7 Care, Teladoc.com/Ambetter |
| Provider Network Design Updates | Beginning in 2024, Amita Health Network Alexian Brothers Holy Cross will join the Ambetter Networks in Illinois |
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What You'll Learn
Ambetter's online 'Find a Provider' tool
Ambetter Health is a health insurance provider that offers affordable health insurance plans. Ambetter contracts with a full range of practitioners and providers, including hospitals, to provide all the services that the Affordable Care Act describes as Essential Health Benefits.
Ambetter's online Find a Provider tool helps members find in-network providers, urgent care clinics, pharmacies, and more. The tool includes details such as provider specialties, providers accepting new patients, languages spoken, office hours, contact information, and directions to the provider's location.
The Find a Provider tool is available through the Ambetter website or the Online Member Portal. Members can also contact Ambetter Member Services by email or phone to request assistance in finding an in-network provider.
In addition to the online tool, Ambetter offers a Virtual 24/7 Care service, which provides convenient, 24-hour access to in-network healthcare providers for non-emergency health issues. Through this service, members can receive medical advice, diagnoses, or prescriptions by phone or video.
Ambetter regularly reviews its provider network and makes decisions about which providers remain in the network based on various factors, including the availability of certain practitioners or hospitals in a specific area, the ability of providers to meet credentialing criteria, and cost-effective healthcare resource use data.
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Ambetter's in-network urgent care centres
Ambetter Health is a brand name used for products and services provided by one or more of the wholly-owned subsidiaries of Centene Corporation. Ambetter strives to provide access to a quality healthcare network and providers while keeping premiums affordable.
Ambetter Health contracts with a full range of practitioners and providers, including hospitals, pharmacies, and medical equipment companies. Ambetter makes sure that practitioners and providers of all types are available within a certain geographic distance or driving time from each of their members' homes.
Ambetter has an online tool called the Ambetter Guide, which helps members find in-network providers, urgent care clinics, pharmacies, and more. This tool can be used to find an in-network urgent care facility in your area.
Ambetter also offers Virtual 24/7 Care, which provides convenient, 24-hour access to in-network healthcare providers for non-emergency health issues. This service can be used to get medical advice, a diagnosis, or a prescription by phone or video. To use Virtual 24/7 Care, members must set up an account at Teladoc.com/Ambetter or AmbetterTelehealthGA.com, depending on their location.
It is important to note that out-of-network doctors, pharmacies, or facilities are not included in the Ambetter network and are not covered by the health plan. Members may have to pay more for these out-of-network services and providers. Therefore, it is recommended to always visit an in-network urgent care center to avoid paying out-of-pocket costs.
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Ambetter's Virtual 24/7 Care
Ambetter Health offers its members access to a quality healthcare network of providers, including hospitals, while keeping premiums affordable. Ambetter Health contracts with providers who accept their contract terms, meet their credentialing criteria, and agree to their reimbursement terms. They regularly review the provider network and make decisions about which providers remain in the network and if additional providers are needed, based on relevant factors.
Ambetter Health provides its members with convenient, 24-hour access to in-network healthcare providers for non-emergency health issues through Virtual 24/7 Care. This service allows members to receive medical advice, a diagnosis, or a prescription by phone or video. Members can use Virtual 24/7 Care anytime, from anywhere, and can also schedule an appointment with a provider as needed.
To find an in-network provider, Ambetter members can use the Find a Provider tool on the Ambetter website. This tool allows members to search for providers based on specialty, location, languages spoken, office hours, and other criteria. It includes information on providers such as hospitals, urgent care clinics, and pharmacies. Ambetter also offers a Virtual 24/7 Care account at Teladoc.com/Ambetter, where members can talk to a registered nurse anytime, day or night, for quick and reliable advice on non-life-threatening medical situations.
It is important to note that Ambetter Health does not provide medical care directly. The medical care is provided by independent contractors who are not agents of Ambetter Health. Ambetter members should always try to use in-network services and providers to avoid paying higher out-of-pocket costs. By utilizing the Find a Provider tool and Virtual 24/7 Care, Ambetter members can easily access the care they need within their network.
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Ambetter's 24/7 Nurse Advice Line
Ambetter Health is a Qualified Health Plan issuer that offers affordable health insurance to its members. Ambetter Health contracts with a full range of practitioners and providers, including hospitals, to deliver all of the services that the Affordable Care Act describes as Essential Health Benefits.
Ambetter Health members can access the 24/7 Nurse Advice Line, a free service that provides quick and reliable advice for non-life-threatening medical situations. This service allows members to speak with a registered nurse at any time of day or night. The 24/7 Nurse Advice Line can be especially useful when members cannot wait for an appointment with their primary care provider (PCP) or need immediate medical attention.
To find an in-network hospital or healthcare provider, members can use Ambetter's online "Find a Provider" tool. This tool provides information on providers' specialties, availability for new patients, languages spoken, office hours, contact information, and directions to the provider's location.
Ambetter Health regularly reviews its provider network and makes decisions about which providers remain in the network based on various factors. These factors include the availability of certain practitioners or hospitals in a member's area, the ability of providers to meet credentialing criteria, cost-effectiveness, and quality metrics.
By offering the 24/7 Nurse Advice Line and access to a network of healthcare providers, Ambetter Health aims to provide its members with timely and affordable healthcare services.
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Ambetter's network goals
One of their primary goals is to ensure that members receive quality care in a timely manner. To achieve this, Ambetter contracts with providers who are located within a reasonable geographic distance or driving time from their members' homes. They also assess hospitals to ensure they are appropriately licensed and accredited, and they monitor the quality of care provided by individual practitioners, taking into account complaints and patient safety concerns.
Ambetter strives to lower costs for members by contracting with providers who accept their contract terms, meet their credentialing criteria, and agree to their reimbursement terms. They regularly review their provider network and make decisions about which providers to include based on various factors, including the availability of certain practitioners or hospitals in specific areas, cost-efficiency, and healthcare outcome history.
To help members find in-network providers, Ambetter offers an online "Find a Provider" tool, which includes information such as provider specialties, languages spoken, office hours, and contact information. They also provide 24/7 virtual care services for non-emergency health issues, allowing members to conveniently access healthcare providers by phone or video.
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Frequently asked questions
In-network means the doctor, pharmacy, or facility is included in the Ambetter network. Ambetter Health contracts with providers who accept their contract terms, meet their credentialing criteria, and agree to their reimbursement terms.
You can find an in-network provider by using Ambetter's online Find a Provider tool, which includes details like provider specialties, providers accepting new patients, languages spoken, office hours, contact information, and directions to the provider's location. You can also request a current non-electronic (paper) listing of all Ambetter in-network providers at no cost.
Beginning in 2024, the following hospitals will join the Ambetter Networks in the Chicagoland area: Amita Health Network Alexian Brothers Holy Cross.
