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Amerigroup Review

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Eric Stauffer is a former insurance agent and banker turned consumer advocate. His priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best...

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UPDATED: Apr 10, 2020

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Serving a scattered group of states in various corners of the country, Amerigroup offers state-sponsored health plans. Their primary markets are seniors, low-income families, and people with disabilities.

About Amerigroup

In 1994 Americaid Community Care was founded to serve the needs of children, mothers, and pregnant women who were enrolled in Medicaid. By 2001 they had become a publicly traded company under the name Amerigroup.

In 2006 Amerigroup began offering Medicare Advantage plans to those who qualified for both Medicare and Medicaid, providing special needs plans. A year later, they moved into the standard Medicare Advantage market, although their primary focus remains on low income and special needs markets.

In 2012, Anthem acquired Amerigroup, and they now operate as a subsidiary. The company’s headquarters is in Virginia Beach, VA. They serve Washington, Nevada, Tennessee, Iowa, Kansas, Texas, Louisiana, Georgia, Florida, New Jersey, New Mexico, and Maryland, and recently moved into Mississippi as well.

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Amerigroup Products

Amerigroup’s primary product is Medicare Advantage, although they also contract with the federal government to provide Medicaid and Medicare/Medicaid combined plans as well. Currently, Advantage plans are only offered in Tennessee, Texas, New Jersey, New Mexico, and Washington.

Medicare Advantage

Amerigroup offers several plans under the Amerivantage name. The available plans vary by state.

In most states, the Classic HMO plan is offered. This plan is a zero premium choice (beyond the regular Medicare Part B premium) and has no deductible. The copay for primary care visits differs by state, by is in the $5-10 range. The plan includes dental, vision, and hearing coverage, and also includes coverage for Part D prescription drugs.

There are a few other plans available to choose from depending on where you live. The Dual Coordination HMO SNP plan is offered in several states and is also a zero premium and zero deductible plan. This plan also has a $0 copay for primary care visits and includes dental, vision, hearing and prescription drugs as well.

We looked at a few of the other plans offered and found them all to be quite similar – $0 additional premium and no deductible. All appear to include dental, vision, and hearing, which is not always the case with Medicare Advantage plans.

Other Products

Currently, Amerigroup only appears to offer the Medicare Medicaid Plan (MMP) in Texas. This combined coverage is designed to help those who qualify for both plans to get the most out of their healthcare.

Government sponsored Medicaid plans are available in most markets. These plans include managed medical assistance and plans for children who qualify for state health coverage.

Amerigroup Rates

Most of the plans we encountered on the Amerigroup website are $0 premium. This means that those who enroll do not pay anything beyond their regular Medicare Part B premium. This is not surprising given the markets at which Amerigroup aims their products.

As a result, it is Amerigroup’s service that is more important for comparison than their rates.

Claims

As a Medicare Advantage and Medicaid plan provider, Amerigroup claims are processed directly through providers. There is no specific claims information provided, however, there is a Member Services line that can be contacted with questions about coverage.

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Ratings and Consumer Reviews

Amerigroup has an A- rating with the Better Business Bureau (BBB). There have been a total of seven complaints registered against the company in the past three years. Two of those were closed in the past 12 months.

We had a hard time finding much in the way of consumer reviews of this company. The official Medicare rating for this company for 2017 is three stars, which is a bit lower than we would like to see. The lack of complaints, however, is generally good news.

The Bottom Line

Amerigroup caters to a fairly specific market, although their plans are available to anyone who qualifies. With little information to go on in terms of their service and reputation, forming a clear opinion of them is difficult. They do offer low-cost options with added value available on their Advantage plans, and will likely be of interest to those on a tight budget.

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Review Information

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About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

16 Comments

  1. I represent a HomeCare Provider who called Amerigroup to get Eligibility Verification of a Member, after being passed from Medicare Provider Services and Medicaid Provider Services and 6 calls later.

    Specialists AARON M. was the most wonderful Customer Services Rep in Amerigroup.

    I told him that I have been transferred 6 times and after he apologized for my frustrating experience, he made sure I get the assistance that I need and went above and beyond to provide me a most pleasant user experience.

    He held on the line WITH me to make sure that he relays the reason for my call and never at any point did I feel hurried or that my call was not important.

    Representatives like him should be commended and moved to a level up or two positions.

    Thank you, AARON M for the exemplary experience ~ MC

    Reply
  2. Amerigroup sucks. I have had lower right side abdominal pain since August of 2019.

    I had two Ultrasounds done and got no answers, so the doctor ordered a CT Scan.

    They repeatedly denied the CT Scan. I ended up going to the ER and getting the CT Scan done.

    The scan found a bone lesion, so I went to an Orthopedic who wants an MRI.

    I highly doubt that I will get this approved. I’m living in pain and apparently they don’t give a crap.

    I feel like suing them for a s#%$ load of money to cover all the pain I have been in for the last six or so months.

    Reply
  3. I recently spent two hours on the phone trying to change my primary care provider.

    Three times I was assigned a provider who the agent claimed was accepting new patients and covered under Amerigroup.

    I called the first one, was denied because they actually were not accepting new patients despite the provider directory saying they were.

    I called Amerigroup and was assigned another PCP who I called only to find out they were not even covered by Amerigroup, despite the directory saying otherwise.

    In total, I wasted almost 2 hours on the phone and made no progress.

    Someone needs to fix the provider search directory and get it up to date.

    Reply
  4. I got the Amerigroup Classic Advantage Plan as of March 1, 2019.

    Each doctor, hospital, and specialist I went to made sure the insurance would cover the visit before they would see me.

    Then every one of them was denied.

    If it WAS paid, I’d get notified they were not in the plan but it was paid anyway.

    I hate this company.

    The only thing good I got out of it was Home Health with a physical therapist, occupational therapist, and nurse…

    even though they would only authorize a fraction of the visits that were requested.

    Reply
  5. Good afternoon and thank you for your reviews.

    Sadly, I’m trying to assist on behalf of a family member.

    She received a denial of benefits letter (eyes) as well and from a low-income family.

    Many of your posts are the exact things she relayed to me.

    I’ve tried calling and waited on hold for several minutes.

    Still haven’t had verbal contact with anyone from Amerigroup.

    At present, I’m hoping someone from Medicaid can assist with this insurance group.

    From what I understand, she was assigned to this company.

    Again, I have to find out the best way to assist her at this point.

    An advocate is really needed these days and new laws enacted.

    I wish everyone the best in dealing with this company.

    Reply
  6. Amerigroup is a joke. Their service is contract out to a third party called “Integra Net” that authorize all their clams or requests. They are not part of Amerigroup. You have to contact “Integra Net” on your own to find out the claim status. They are two separate entities.

    On the paper, Amerigroup advertises a list of wonderful member benefits such as skilled nursing, medical equipment, Managed Long Term Service Support (MLTSS), etc. But, when you actually need it, they. (“INTERGRA Net”) deny almost EVERYTHING.

    My father is 89 years old, he was hospitalized due to a fall. When he was in the hospital, they have to do a cholecystostomy tube procedure on him because of the infection gallbladder. The doctor should perform a Surgery on him to remove the gallbladder. But, my dad was too weak, Doctor decided to postpone the surgery at later date. After the procedure, we were ready to go home.

    HOWEVER, to our surprise, we were told by th hospital that our INSURANCE have DENIED the doctor’s order for the Skill Nursing.

    We called Amerigroup multiple times. Each time, Amerigroup rep told us there was NO ORDER placed for Skill Nursing from the doctor. Each time, we have I a DIFFERENT Amerigroup agent each time we called. It is VERY FRUSTRATING to repeat and start everything all over on each call. When ask Amerigroup for a direct contact number, Amerigroup don’t have one.

    It was a big confusion among hospital, Amerigroup, and our family. On one side, Hospital says Insurance have denied the skilled nursing despite of Doctor’s Request. On the other side, Amerigroup says there was no request for skilled nursing from the doctor. After several days and rounds of tossed back and forth between hospital and Amerigroup, we have track it down to “Integra Net”.

    “Integra Net” is a 3rd path vendor Amerigroup contracted out for their claim approval process. Apparently, “Integra Net” DO NOT SHARE OR PASS the all the claims it received back to Amerigroup because Amerigroup rep couldn’t find the request in their system.

    “Integra Net” DENIED the Skill Nursing request — DESPITE of the DOCTOR’s Order. It says that my father is at his baseline and his health will not benefit or improve with a skill nursing. Since Amerigroup or “Integra Net” DENIED the skilled nursing, hospital have no choice but recommend my dad to be sent to Nursing Home.

    Our family do not like the idea placing my dad in a nursing home, therefore, we requested the In-Home Home Health Care with a hospital bed. AGAIN, “Integra Net” DENIED the hospital bed!! The reason, he is not medically necessary qualified to have a hospital bed.

    Conveniently, all these RESTRICTIONS are NOT detailed or presented on the member benefits summary! And, be aware that many of member KEY Amerigroup benefits are attached with RESTRICTIONS which were not mentioned anywhere on the Amerigroup Memeber Summary.

    It seems Amerigroup is very eager to sent my dad to a NURSING home than to give him a hospital bed at home. And, don’t bother to talk to Amerigroup Rep because they have no authority to act on anything. And, many of the KEY benefits (Skill Nursing, Home Health Care, Medical Equipmenr etc ) are easily DENIED by 3rd party vendor “Integra Net”.

    My experience wth Amerigroup – nightmares, confusions, frustrations, disappointed, and stressful

    Reply
  7. As a provider, I agree with Pam.

    After obtaining PCP referral and contacting Amerigroup Medicare/Medicaid plan to make sure no authorization was needed, a patient received cataract surgery for both eyes and Amerigroup continues to state that we should have sent claim to Medicare.

    This was incorrect and when we pointed this out to Amerigroup they then stated that we sent the claims to the wrong department and gave us a different address and carrier name.

    We are still waiting for an EOB after three months from the 3rd carrier Amerigroup states where the claims need to be forwarded.

    We have gotten the patient involved and Amerigroup is not responding to them either.

    Based on the other comments, it seems that if surgery is involved, Amerigroup will not pay or approve.

    Reply
  8. I was recently denied fluticasone-salmeterol 250-50 by Amerigroup because they claim “it isn’t a covered benefit.” My doctor had been prescribing this medication for the last 6 years and Amerigroup covered the cost. Now all of a sudden they say it is not covered. They also denied a procedure (Splenic Arterial Embolization) to be performed in a doctor’s office that would increase my low platelet level, but that was denied because they claim they only approve that procedure for cancer patients with a tumor. It was either that or have my spleen removed which I refused. Now I wonder if they would deny that too. I appealed their decision, but this process is a joke. They just denied it again. And, they have refused to send me a denial letter so I can take it to the next level. In 2013, they denied physical therapy after I had been intubated for a bad asthma attack and woke up completely paralyzed. Had to thrash around in the bed to regain my strength and learn to walk again on my own. For that, I got a good size hernia which I can’t have repaired because my platelets are low. I do NOT recommend Amerigroup to anyone.

    Reply
  9. Amerigroup systematically creates administrative barriers to psychological services for foster care children. They have the most difficult preauthorization process. Most providers do not accept them because of this. They regularly audit providers as an accost containment strategy. They are unresponsive to feedback.

    Reply
  10. I was approved for my third cervical fusion and was supposed to have it on 12/11/2018. This procedure had been approved and I had already had all my pre-op appointments done, which AmeriGroup would have had to approve. On 12/10/2018 after 4PM, I got a call from my neurosurgeon’s office saying that AmeriGroup had canceled my procedure. Apparently, mine was not the only one canceled. I have waited and dealt with a tremendous amount of pain and was finally going to possibly get some relief when this happened, with no explanation at all. As I have children, schedules had to be changed, transportation arranged, etc. The list goes on. I want to know how and why an insurance company can overrule a Neurosurgeon and just cancel a procedure of this magnitude? Or any procedure that a qualified Medical Professional has deemed necessary? Thank You.

    Reply
    • Hi Sean,

      This sounds like a very difficult and frustrating situation. I hope you are able to find relief very soon.

      Unfortunately, we are living in a weird time in terms of medical care in the United States. There are a lot of people that are falling through the cracks with similar situations as what you describe. Insurance companies are very opaque by nature, and it can often be a “squeaky wheel” situation, meaning I would be calling anyone and everyone until I got a satisfactory result or answer.

      One thing to pay attention to is what happens when your plan rolls into 2019. Deductibles often start over at the beginning of the year, so that would light an extra fire under me if I was in your seat.

      Best of luck,
      Eric Stauffer

      Reply
    • Wow.. sounds all that I’m going through… My surgery has been denied twice. I’ve spent many hours on the phone, as my Dr has also. Peer to peer ..lol never happened… They are even denying my pain meds now.
      Every time I call I get a different response… The first denial letter( and I have proof) was by an OBGYN… I need neck surgery… REALLY???? I’ve even been denied a second opinion.
      I’ve asked to speak to/ with these so-called ( in my opinion, back door Drs) and you guessed it… Not one reply back. I’m so disgusted. They don’t realize the pain I’m having. I’m out on medical leave, my job wants to know why I haven’t had my surgery???
      They only looked at my x-ray, but not my MRI or CT scan.
      This company is not recommended at all by me.

      Reply
  11. Don’t deal with Amerigroup as a provider if you can help it.
    I had a horrible experience with them. There was never a resolution. It is impossible to speak with anyone.
    They deny claims and then tell you time has run out and I was left paying the bill, not the patient.
    My impression is they certainly don’t care about mental health services or their mental health providers.

    Reply
  12. Fired Executive [Redacted] provided federal prosecutors with evidence that Amerigroup was systematically declining services to low-income pregnant women in Illinois from 2001 to 2003. Their contract with the state required that they enroll all eligible clients, but prosecutors submitted emails showing that Amerigroup had a policy of targeting healthy enrollees and specifically excluded pregnant women and others with expensive conditions. In October 2006, a federal jury found Amerigroup liable for $48 million in damages, which was tripled by statute.

    Reply
  13. Horrible service when calling to talk to an MD for Peer to Peer. Feel like a rock rolling off a cliff. Get bounced from one operator to another, and after a hold, *each* asking me to spell name, number, fax number NPI, patient’s ID, and then I got to leave all this info and my number for someone to call me back. And all this for a necessary drug for a patient that is being frivolously denied.

    Reply
  14. Thank you for this information!

    Reply

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