Business Profile

HMOs

WellCare Health Plans, Inc.

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Complaints

This profile includes complaints for WellCare Health Plans, Inc.'s headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

373 total complaints in the last 3 years.
103 complaints closed in the last 12 months.

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The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

Initial Complaint
Date:08/19/2022
Type:Sales and Advertising Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have ****************** and help from S S. On prescription. With Wellcare it's called Dual access. I have a 0 payment for All doctors,. Prescriptions, etc. Back Mar. Of 2022 had cateract surgery. When going to ******************* in *********** ** and was charge what I gathered to be office visit. I told them I'm not to have this charge, informed my insurance WellCare doesn't pay this. I paid $37.75. Call Wellcare and somewhere months later Wellcare paid Southern Eye and not me. Then twice was charged $45.00 for antibiotics eye drops, Southern Eye said Wellcare doesn't pay. I made many phones call to Wellcare,spent hours going from one dept to the other. Get told to this and that. I sent for receipts for refund to Wellcare ***** ** office,told wrong place. I needed to send to Envolved in N.C. still nothing. File "useless appeals" with Wellcare to get off the wall reasons and they'd close the cases. Today I received the last appeal stating I needed to send receipts to ***** Office. I'm like they have had them since May. This started in. Mar 2022 and it's now Aug 2022, some 5 months. Still no refund totaling $127.75. Southern Eye says they are waiting on ******** to pay the 5. and something before they refund my $37.75 that Wellcare paid them, when it should of been since to me. The company needs to get it together. And I'm tired of their kind of c*** I just want to let them know and others that I'm not letting them get by with it .I don't have a copy of receipts because Wellcare in ***** got one and Envolved in Rocky *** N.C. got the ither
Business Response
Date: 08/30/2022
Hello and Good Afternoon, Multiple outreach has been made to ******************** but we have been unable to reach her. We will continue to work complaint until resolution is reached. This case has been escalated to our Vision department for assistance. Thank you.
Customer Answer
Date: 08/30/2022
(The consumer indicated he/she DID NOT accept the response from the business.)
One their response is a lie they have not reached out to me not one time I did and then their response after I did was sending letter saying that they reviewed it and they close the case or I needed to send this or that to this department or that department when I did and still got nothing so they have not done anything and I'm still out my money
Business Response
Date: 09/12/2022
Hello and Good Afternoon, This matter was escalated to our Reimbursement department for assistance. They confirmed the members request for Reimbursement was denied, as not a covered benefit. Contact with ******************* also confirmed they billed incorrectly and would be issuing a refund once the claim is paid by ********* Again we sincerely apologize for any confusion and dissatisfaction experienced. Thank you.
Customer Answer
Date: 09/13/2022

Complaint: 17895049

I am rejecting this response because:
That is the same thing they and ******************* has told me since *****. I just some how can't believe the $5 and something ******** hasn't paid. Not is it true that WellCare says it isn't covered when in fact they connected me to the **** with in their organization and the gentleman asked me the name of the antibiotics and he said oh yes ma'am it's covered also I have assistance with the social security to cover all medicines got the letter as I told WellCare that proves that I was approved for full subsidy and my medicines would be zero plus ******** also will pay for the eye drops someone has not sent this in and Southern I refused to send a bill to him so that's where the receipts came in that I first sent to Florida to the claims department and when I talked to the gentleman at the medicine oh the covers medicine he said no you need to send it to ***************************** gave me the address so I sent receipts there then when I didn't hear nothing after 30 more days I contacted WellCare and they told me no those receipts need to be sent to Florida they are going back and forth back and forth wishy-washy and here it is ***** May June July August September 6 months and nobody has done anything but just drop the ball on it and I'm out a total of $127.27

Sincerely,

*******************************
Initial Complaint
Date:08/18/2022
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have called multiple times to request an "Evidence of Coverage" for their Health insurance plan called Ascension Complete Providence Secure HMO, plan H4343-004 with out any success. Their website does not list the Evidence of Coverage for this plan and the brochure for the plan refers one to their Evidence of Coverage for specific details. Each time I call I get a promise that they will send it to me but since that is not happening, I wonder if this is a scam. I can only imagine what happens to someone who enrolls in this plan and receives this type of customer no-service. I hope that someone will benefit from my eye-opening experience with this firm and avoids the situation that I have experienced at a time of need with their health insurance.
Business Response
Date: 08/30/2022
Multiple call attempts have been made to the complainant and various messages have been left.A letter has been mailed to the address provided with a copy of H4343-004 Evidence of Coverage and steps on viewing the information on the Ascension Website.
Initial Complaint
Date:08/16/2022
Type:Service or Repair Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
In July, I received a determination from wellcare about the approval of a prior authorization on a medication. The mail carrier who delivered the letter said that wellcare did not put enough postage on the letter and I had to pay $.48 postage. I did and called wellcare about this issue because I have never had to do this before. The rep for a grievance, I received a letter saying that they would review my plan. This was not the issue so I filled another grievance explaining that I had to pay postage for a letter that they mailed me. Aug 15th, I received a letter saying that the grievance was resolved because I was responsible for the letter that I sent. Now, I'm frustrated because they are right the sender is responsible for the postage and wellcare is the sender. They want me to mail them a written letter.. how hilarious, they want me to pay postage to get the postage that they owe me back. I do have proof that I paid the 48 cents. The change is not a big deal, it's the principle that disabled are already struggling and we should not have to pay postage for our Medicare prescription company. A multi-million dollar company should be able to pay full postage for the mail they send out. I'm disabled, I should not have to spend a penny on postage that should have been paid by the company. Don't we have enough problems? My goodness just send me a freaking stamp and move on.... It's $.48.... customer's should not have to file multiple complaints to correct an error you made..... FIX IT!
Business Response
Date: 08/26/2022
Business Response /* (1000, 8, 2022/08/23) */
Hello and Good Afternoon, Contact was made with Ms. ***** on 8/18/2022. We sincerely apologize for the inconvenience, we will continue to work on the back end to ensure this does not happen in the future. Thank you.

Consumer Response /* (2000, 10, 2022/08/25) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I accept that they are working to make sure it doesn't happen again but they never offered to give my money back. Sad...
Initial Complaint
Date:08/16/2022
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have been through a rough 4 plus years, due too having diabedies. It started with neuropathy and ulcers on my feet. This led to multiple infections. This led to an amputation and several operations. Following that 2 years of weekly visits to a wound clinic for treatment. Today I finally got the go ahead to get diabetic shoes and stop wearing boots. I called to get diabetic shoes from the local store that does that sort of thing. I was told that they do not take wellcare insurance. I called Wellcare and was told they are ******** advantage and I lose part A and B coverage when I sign with them. I actually knew that but they gave me a convoluted route to goo thru to get a small percentage of the items covered. This would be extremely time consuming when I can't afford the wait.
Business Response
Date: 08/29/2022
good morning, we were not able to reach the complainant after several attempt, we have forwarded the issue to our DME department for assistance. **
Customer Answer
Date: 08/30/2022
(The consumer indicated he/she DID NOT accept the response from the business.)
Wellcare left a message on my phone while I was showering and left a garbled message. This included a number which could not be understood. I calledthe general number which was left on my phone after the call. This led me on a 4 hour Odessa during which I was hung up on at least a dozen times. I was told my case had been escalated already and I would have to talk to the presidential team but they didn't think they were in that day. Since it was 1pm on a weekday I thought this was kind of odd. On the fourth try someone from the presidential team answered. The nice lady told me that my case had been assigned to the gentleman who had left the garbled message. She told me that she would transfer me to that gentleman, on the third ring the phone hung up.Wellcare is a disorganized mess, when they can't justify their position on an issue they just hang up. Please steer clear of them as this will not change. I appreciate this site giving me a voice though it won't help me reach a fair conclusion.
Business Response
Date: 08/31/2022
good mornign, Per DME, they advised they do not see a request in the system for any diabetic shoes. The member's PCP would need to send the order and supporting clinical notes for us to review.
Customer Answer
Date: 09/02/2022

Complaint: 17895347

I am rejecting this response because:

Sincerely,

*******************
Initial Complaint
Date:08/16/2022
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have Wellcare as my ******** Prescription Drug Plan. I'm Disabled and live on a very limited income. I have an infection and the doctor sent a prescription in to the pharmacy. I was allergic the pharmacist caught it before it was filled so the doctor sent in something else. They denied it. We tried every other medication that covers that infection and I'm allergic to all of them except the one that was denied. Myself and the doctor did 2 appeals and had it escalated and they still denied it. It's the only medication that will get rid of the infection I have that I'm not allergic to. They don't care. I'm suffering. I cannot pay cash It's almost 600 dollars for 4 pills. If there was something else that I wasn't allergic to that they would cover I would gladly take it. I'm suffering terribly and they won't cover the medication. This is not fair. There is nothing else I can take for this infection. I would understand if there was something else I could take but there is not due to my allergies. This company doesn't seem to care at all about my situation. I need the medication. I don't want to wind up in the hospital. I barely get enough money monthly to live. There is no other option but this one medication. I'm tired of fighting with them. Please help. Thank you.
Business Response
Date: 08/19/2022
Good Morning,

The below pharmacy appeal was denied please see below for reason of denial.
According to Chapter 6 of the ******** Prescription Drug Benefit ******* ******** law excludes certain drugs from being covered by Part D. BREXAFEMME is one of those excluded drugs because the manufacturer does not participate in the Coverage Gap Discount Program. Therefore, it cannot be paid by ******** Part D.

In order for WellCare to provide coverage for a medication under the Part D plan, a manufacturer must sign an agreement with the Centers for ******** and ******** Services (***) to provide a discount on all of its drugs. The manufacturer and BREXAFEMME, with NDC # *************, is not on the referenced list. This can be viewed on the *** website (https://www.cms.gov/********/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Pharma.html).

Customer Answer
Date: 08/19/2022
(The consumer indicated he/she DID NOT accept the response from the business.)
This response is unexceptable. There is no other medication that will cover this infection. I'm in agony and need this medication. I'm allergic to every other medication that covers this infection.
Initial Complaint
Date:08/15/2022
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Consistently for the past 3 years, around the same time of the year( July or August) I am removed from my Wellcare Plan and switched over to Humana for one month, then returned back to a different Wellcare Plan that I originally enrolled in. This is all done without my authorization. Every year my daughter calls and complains about this obvious fraud. Every year we are promised that it will be investigated and we will receive a return call on the matter. This never happens. The issue here is that I am a 93 year old with a heart condition. I require meds to keep me alive. This frauds causes issues with my obtaining my medicine.

During this last fraud act, I had an appointment with my Cardiologist, which took several months to get. My appointment was canceled because they did not accept the Humana Plan I was fraudulently switched over to. I am handicap and barely able to walk without assistance. How could Wellcare allow this to happen? I am going to die over this act of fraud.
Each year Wellcare wants to pass the issue over to Humana. Humana tells my daughter it is a Wellcare issue. The person who commits this fraud makes the change only for 30 days. Wellcare is not able to trace it. I suspect and a Wellcare representative has confirmed that it is an unscrupulous salesperson who has my personal information along with other victims and commits this fraud in order to make commission.
Why cant WellCare trace this change? Why are they allowing this without my authority? Why cant I freeze my account so changes are not made without my written consent?
My daughter works very hard to choose the right insurance for me every year. This is unacceptable to remove me for 30 days and then bring me back under a different Wellcare plan altogether. I am under a fixed income. The current complaint number opened for this issue with Wellcare is **********.
Business Response
Date: 08/31/2022
Business Response /* (1000, 6, 2022/08/26) */
Hello and Good Afternoon, We sincerely apologize for the dissatisfaction you've experienced. Contact was made with Ms. ***** daughter on 8/23. We escalated this matter for Investigation by our CIU department, and the findings are as follows: The allegation that the beneficiary was recently enrolled without consent is unfounded. Multiple applications were found, however there is no evidence to support the fraudulent allegations. We understand a complaint has been filed with Medicare, and believe that may be the best course of action for another thorough investigation. Thank you.
Initial Complaint
Date:08/11/2022
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have been on the phone with customer service for hours and hours, transferred back and forth countless times trying to get a minor issue resolved. I was informed that I would have a 50 dollar credit for utility assistance with my new insurance plan only to be told later that I had to qualify (which I do). I was told the information application would be sent to my provider ( which it hasnt) and after numerous attempts to talk to someone that can resend it , I get transferred to multiple departments that can't get anything done. Have gone as far as to speak with supervisors and filed 2 grievances with no hope in sight! Thank you for your time and have a great day.
Business Response
Date: 08/29/2022
Business Response /* (1000, 5, 2022/08/15) */
I have made attempts to reach you however, we have been unable to make contact, Please know, the grievance coordinator has completed the investigation of the concerns. The resolution details are as follows: we apologize that your call was transferred multiple times when you called our customer service line. please know that, although we strive to provide resolution to your call upon receipt, we may need to transfer you to another department whose representatives specialize in resolving issues such as pharmacy or billing-related calls. In addition we reached out to our vendor Wex Heaklth and we were informed they received your enrollmeent on July 28,2022 however,an error on their file caused it not to load on their system. The issue has now been corrected and you will receive your utility benefit tomorrow 8/16/2022 with the effective date of 7/1/2022. We apoligize for any inconvenience and we will make another attempt to reach you this evening.
Initial Complaint
Date:08/10/2022
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Wellcare ******** advantage plans are totally lacking in customer service - representatives , supervisors , + grievance administrators are most non professional , poorly trained + nonresponsive of any organization i have ever dealt with - they specialize in lies , broken promises , , + ignorance of their written policies - inconceivable to me that ******** + state insurance commissions allows them to operate - ongoing problems with numerous claim payments - unable to contact phone on hold for extended periods , emails not answered + grievances ignored or closed w/o any response or resolution -
Customer Answer
Date: 08/11/2022
message left on phone to call ************ asap called back + i left a message that has not yet been responded to in over 2 hours , which is standard operating procedure for Wellcare since last November -
Customer Answer
Date: 08/11/2022
received call back after 3pm from **** + she stated that see would research situations -
Business Response
Date: 08/17/2022
According to our conversation on 8/11/2022 you stated a previous agent responded to a prior complaint however, you did not wish to explain your concerns further. After further review it appears that your pervious grievances on file were completed and responded to. In order to investigate further we would need additional information to investigate. We attempted to reach you once again on 8/17/2022 via telephone at 1:06pm EST and we were unable to make contact. You may reach us at ************.
Customer Answer
Date: 08/18/2022
spoke to representative **** 3 hours after she sent message - + she stated she would research all problems going back to 11/2020 + check on multiple grievances that were closed as resolved with no resolution at all - previous agent Desire did absolutely nothing is being done by them to provide accurate + timely customer service at all - the late call back on 8/18 did nothing but provide more unfulfilled promises that has been ongoing standard operating procedure for Wellcare ! -
Customer Answer
Date: 08/19/2022
(The consumer indicated he/she DID NOT accept the response from the business.)
spoke to representative **** 3 hours after she sent message - + she stated she would research all problems going back to 11/2020 + check on multiple grievances that were closed as resolved with no resolution at all - previous agent Desire did absolutely nothing is being done by them to provide accurate + timely customer service at all - the late call back on 8/18 did nothing but provide more unfulfilled promises that has been ongoing standard operating procedure for Wellcare ! -

8/19/22 received message to call **** at ************
in reference to case # prc10948 - called at 1 pm after time phone was answered by ****** who asked me to hold for a moment while she would see if **** was available - on hold for at least 5 minutes = then ****** stated that **** was not available - i formally requested that **** respond to me via email - typical WellCare customer service, put person on hold + hope that they get frustrated + give up -
Customer Answer
Date: 08/26/2022
***Document Attached***
see attached - numerous phone attempts with either no answer or put on hold for extended period when it was answered once -
See Attachment/File: wellcare.jpg
Business Response
Date: 08/30/2022
OB call was made to the member 80/30/2022 @ 1:50pm we advised member once again that Several grievances were filed and phone calls made however member is not willing to provide additional information via telephone of what is specifically needed by the plan or any additional concerns for research. We can not proceeds without additional details.
Customer Answer
Date: 08/30/2022
8/30/22 **** phone call from **** ************ she stated that she had no idea what my concerns were - this after discussing them + at least 4 grievances filed since Nov. 2021 on 8/11/09 with promise of her research will get back to me - she had no knowledge of me attempting to call her on 8/19/22 + being put on hold by ****** for extended period + was told **** was not available - i asked ****** to have **** perform all further contacts via email + she stated she would inform **** - total lack of customer service , lies , + unfullfilled promises -
Customer Answer
Date: 08/30/2022
have over 30 records of phone calls complete w/dates , contact person ,times , reference numbers ,+etc. which i told **** i would forward to her if given an email addresses - frustrated with WellCare - my reason for email documentation is because they can not be trusted to give any accurate ,truthfull , responses + information verbally -
Customer Answer
Date: 11/03/2022

Complaint: 17895961
I am rejecting this response because:
early July checked Wellcare web site + verified that Visionworks was a in network participant - went to Visionworks in ****** + they called Wellcare as was told that prescription would be filled with out of pocket expenses of $150.00 which i paid by check - 11/2 received bill in mail that patient [ myself ] could not be identified - spent 1 hour + on phone w/2 different Wellcare *********** + ****** ] ****** called ************** which is now handling vision claims + was told that Visionworks was not in the Envolve network - all plan documents + member card state to send claims to Wellcare *********************** - having same numerous problems with their dental coverage going back to March being handled by another party - ongoing problems with their customer service , not answering phone , put on hold for extended periods + then hung up on , getting 3 different answers from 3 different reps on the same question , been lied to , promised call backs which never happen , over 4 grievances filed by me + my wife [ also a policy holder ] that were closed as being handled that were NEVER acted upon - their upper management also lies to the BBB to close cases - last BBB case was closed by them stating that i would not supply any documentation , which in actuality i offered on 33 occasions to emeil them numerous pages of documentation to prove my veracity in numerous multiple interactions with them + they blatantly ignored my requests completely - i know that this will get no truthdull response from them , but consumers should be made aware of their total unprofessional incompetence -

Sincerely,

*********************************
Business Response
Date: 11/11/2022
Member expressed dissatisfaction with overall plan experience and stated that he will no longer be enrolled with Wellcare. We apologized for any inconvenience he may have experienced. .
Customer Answer
Date: 11/11/2022

Complaint: 17895961

I am rejecting this response because:absolutely was attempted or performed by anyone at Wellcare to alleviate the horrendous performance of any of their actions since i enrolled in Nov. 2021 - all their responses to BBB + other consumer agencies were total + complete lies - also i did not at anytime voluntarily disenroll in wellcare at any time - they disenrolled me - see letter i received from them on 10/6/22 - they are definitely not an honorable enterprise + the numerous complaints filed with BBB ***** + other state + federal consumer agencies fully attest to this fact -
Sincerely,

*********************************

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WellCare Health Plans, Inc. is NOT a BBB Accredited Business.