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

378 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:03/29/2024
Type:Billing 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 am unable to access my account through the ********************** website. I had an account for several years and it worked satisfactorily. However, I recently created an account for my husband using the same email address as my account. This caused an issue. After spending a lot of time on the phone with them, they were able to get my husband's account up and running. However, my account is still not working. The representative on the phone tried to login on her end and access my account, but could not get it to work. The representative said she would "escalate" this issue and someone would call me the next day. That never happened. No one has called me to fix this issue.
Business Response
Date: 04/04/2024
Good afternoon, the member was assisted by our web support team, and has access to the member portal. Thank you.
Initial Complaint
Date:03/27/2024
Type:Customer Service 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 received a payment booklet in the mail on 3/26/24 from Wellcare. I DID NOT enroll or contact them in any way, shape or form. They have sent mail time and time again, which I have ignored. I will not be paying something I never enrolled in.
Business Response
Date: 03/27/2024
Hello ******,
My name is *******, we received your review regarding the health plan. To further research your case, we need more information. Please contact me at ************ and reference case number PRC-*****. I am looking forward to speaking with you.

Thank you,
*******,
Initial Complaint
Date:03/26/2024
Type:Customer Service 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.
When I get a prescription filled the reciept from the pharmacy identifies the insurance company as ******** Health Care. My Part D plan is with Wellcare Value Script. When I contacted Wellcare to get an understanding of why this is happening all I got was to be passed around and then told to call ********. I spent over 3 hours on the phone with two different representatives on 03/22/24 and finally asked to talk with a manager. I was told that I would get a call back within 24 hours. Received a call on 03/25 from Wellcare, not a manager, wanting to make sure my issue had been resolved. I told him it had not and that I was waiting on a call from a manager. He then tried to get me to again go into detail of the issue which I declined to do and again told him I want to talk with a manger. After being placed on hold for 5 minutes I was told no manager was available. He then wanted me a spend time to file a complaint internal to Wellcare at which point I told him that since I can't even get a cll back from a manager, why should I beleve that filing an internal complaint would go anywhere. That has lead to filing this complaint with BBB.
Business Response
Date: 04/04/2024
Hello and Good Afternoon, Contact has been made with **********************, he was informed review of medication claims confirms we are paying for his medications, not ********. We also made outreach to **** Pharmacy and they confirmed they have the correct insurance information in their system and claims are paid by Wellcare. Thank you.
Customer Answer
Date: 04/05/2024

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.

Sincerely,

***********************************
Initial Complaint
Date:03/25/2024
Type:Product 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.
Enrolled separately in Wellcare Value Script (PDP) and for an HMO plan, for which Wellcare says materials are coming by mail. But in the meantime, Wellcare keeps texting and calling me to "see if I have questions". Since I have not received my materials including an Explanation of Benefits, it is too soon for me to have questions. Therefore, I believe these are sales contacts, not customer service. I have repeatedly told Wellcare I am not interested, and please just start me in the HMO. I don't want to cancel my enrollment, I just want Wellcare to stop calling me and texting me. Leave me alone!!!
Business Response
Date: 04/08/2024
Good morning,
Upon contacting the member, they confirmed that the issue has been resolved as they have received their welcome materials and no longer require any further assistance. The member has also stated that they do not need escalation and that all necessary mailings are being sent to them as an active member. As per the member's confirmation, this complaint can be closed out, and no further action is required. Closed out the complaint as per the member's request. Member confirmed receipt of welcome material. Member no longer receiving unwanted communications. Member's request for no further action or escalation noted and respected.

Thank you
Customer Answer
Date: 04/08/2024

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
As you requested, I am letting you know that Wellcare did contact me regarding my complaint about them contacting me. I explained that my complaint had to do with solicitations disguised as customer service.

Since then, I have not received any further contacts. My own Wellcare account has moved on to the point that I do not anticipate there will be any others.

Sincerely,

******* * *******
Initial Complaint
Date:03/20/2024
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 is not processing my disenrollment form within the 9-10 time frame as I was told. They are now telling me it won't be processed until 3/31/2024.They have made themselves my primary prescription provider. However they do not cover many of my prescriptions at a reasonable cost. So I was told by a representative how to file a disenrollment claim, which I have done on March 11, 2024. I was told that it would take 10 days to get me disenrolled. I called today and now they are saying it will be March 31st. My concern is that they will continue to lie to me and I will be stuck with them after the enrollment time (that runs from 1/1/2024 to 3/31/2024) because they will continue to cheat me and not take care of my disenrollment.I did finally talk to an English speaking representative here in the states that has escalated my issue to their enrollment department and told me the issue should be settled within 72 hours. I will be checking back with them to make sure this is the case.
Business Response
Date: 04/03/2024
Dear April ***** ,
Thank you for bringing this matter to our attention. We are sorry for any inconvenience that you have experienced. As per our conversation, your coverage with WellCare has been terminated. If you have any further questions or concerns, please do not hesitate to contact us.
Sincerely,

**** D
Initial Complaint
Date:03/15/2024
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.
Well care will not fill my prescriptions. I have eight of them now. That they have denied coverage on. One's a heart medication ventolin for my lungs migraine medicines. Everything is denied. Well. Care was chosen by our government as I supplementary prescription plan. they are lousy. You might as well not have anything at all. They tried to get $1,360 for a co-pay for one that they did approve but it had to be sent from their pharmacy. And they would not bill my secondary insurance for the co-pay. So I had to call My pharmacy here in town and see if they would cover the copay. Yes they did so I was able to get my medicine. But I don't know for how long they give it to me and they take it away. They have promised to call me back and they never do. You can't understand them. They cannot pronounce the medicines. I never had to do so much work to get a prescription filled as I have with this company. Humana was my last company. They would contact my doctor. They would contact the pharmacy. These people want me to do it and I'm not a pharmacist. I don't know what to tell him to fill. Plus they're not going to do it for me. I'm not a doctor. And I told her that. If you have a choice and getting a prescription plan and can pay for it out of your pocket, do not go with these people.
Business Response
Date: 04/11/2024
Good afternoon, Pharmacy advised Member Name: ************************* Member DOB: 05/14/1953 RITM06282617- Repatha 140 inj. - Rejects for PA required, no request on file. Omeprazole 40mg, - No claims for this medication at all. Emagality 120mg. - Last paid claim was on 02/27 for a zero copay Folic acid 1mg.- rejects for A5: NOT COVERED UNDER PART D LAW Ventolin HFA, - paid at pharmacy under medication name ALBUTEROL SULFATE HFA 90 MCG on 03/08 with a zero copay. Diclofenace Sodium 1%- No claims for this medication Nurtec ODT, 75 mg.- last paid claim on 02/05 for a zero copay. future mock claims pay. Duloxtine HCL 40 - last paid claim on 03/09 with a zero copay. There is currently an approved PA on file. I do not find any rejections other than too soon or the PA required for Repatha. The member was advised on 03/26/2024. ty
Initial Complaint
Date:03/12/2024
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.
Refusing to follow ******** fee schedule, guidelines and requesting providers to fraudulently auth CPT codes so they do not get paid. Will not allow Providers to make CEO complaints.CPT ***** is the valid CPT for the posterior approach, but the *** rep is advising providers to use another code and or whichever is closest since WellCare does not have that loaded yet. They were advised to use the 0775T code which is the 2023 CPT which is now retired or the ***** which is the lateral approach. The issue is the physician will dictate the notes based on procedure and the coder will code off dictation and the authorization will be no good and the provider will not be paid. The *** reps will not allow anyone to make a complaint or look into this. They said just pick a code to get authorized. That is not ethical nor help the provider. ***** is the valid CPT for 2024 for the posterior approach and needs to be added to your system and *** needs to be educated on how providers can't just pick CPT's. Lets all just do the right thing and follow ******** guidelines so patients can have their surgery.
Business Response
Date: 04/03/2024
Good morning,
We have contacted the vendor regarding the *** code in question and have received details from them. Our team is currently reviewing the case, and once a resolution has been reached, we will provide further feedback accordingly.

Thank you for your patience and understanding.
Initial Complaint
Date:03/11/2024
Type:Billing 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 had before ******** and Husky. I never paid for nothing. The insurance company called me with all promises of better coverage. I believed and accept Welcare. The result my doctor send me a bill of ****** plus ****** that I paid but credit card. I spoke with Welcare a couple of the time and nothing was resolved. I am handicap person and I don't work.Wellcare Dual Access Open Client ID ******** .
Business Response
Date: 03/25/2024
Dear *****,
Thank you for bringing this matter to our attention. We are sorry for any inconvenience that you have experienced. We researched your plan and it does not cover Providers that are out of network for the services rendered. If you have any further questions or concerns, please do not hesitate to contact us.
Sincerely,
**** D
Customer Answer
Date: 03/25/2024

Complaint: 21414875

I am rejecting this response because:
They didn't notice me about no payment of doctors out of network or no noticed about they will suspend my ********* I am disabled person and I have a bill to pay, because they never notice me about it. They are a fraud and scam company, that take advantage of people with health problems.
Sincerely,

***********************
Business Response
Date: 04/16/2024
Dear ***********************,
We apologize that you are not pleased with the outcome of your complaint. Please contact your Providers and request that your bills are submitted to your secondary insurance , also please be advised the Providers are aware that they are out of network with insurance companies.

Thank you,

**** D
Initial Complaint
Date:03/11/2024
Type:Product 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 received a letter from WELLCARE CLASSIC PDP S4802087 thanking me for enrolling in this plan.Which begins 5/01/2024 I did not enroll in this plan and have no intention in enrolling in this plan.this feels and looks like a scam.
Business Response
Date: 03/12/2024
Hello, I have tried to contact you regarding your complaint to discuss. I will attempt reaching out by phone and/or email to discuss. I have researched the issue and would like to provid details.
Initial Complaint
Date:03/11/2024
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.
Member ID ******** I enrolled over the phone in February for the free plan to start in March. (Im told I spoke with *********************.). When I spoke with the WellCare rep, she told me there were four free plans. I asked her more than once: youre sure youre not confused because I thought there was only one free plan. But she persisted and confidently told me that all 4 were free. So I took value plus or whatever the best was of the 4. Then I receive a bill of ***** per month. I called to speak to a rep and he told me Id have to pay. I recorded the original enrollment phone call and can go back and find the spot where she told me the plan was free. That is fraudulent and she enrolled me into a plan I did not consent to. I want the bill erased. I want to be enrolled in the appropriate plan I specified I consented to, the free one, asap.
Business Response
Date: 03/26/2024
Good afternoon,
As of now, the case remains open and is actively under investigation. We have collaborated with our CIU department, which specializes in such matters, to thoroughly review and assess any potential misrepresentation that *** have occurred during the enrollment call. Please rest assured that we are dedicated to ensuring a fair and comprehensive review of the allegations. We understand the importance of timely updates and wish to assure you that this case will not be closed without informing you of the final determination or resolution reached. We apologize for any delays in this process and appreciate your patience and understanding. We are committed to providing you with a transparent and accountable resolution.
Thank you for your cooperation and understanding.
Customer Answer
Date: 03/26/2024

Complaint: 21408988

I am rejecting this response because:
I gave them a recording of me saying I consented to only the free plan and only that. Their rep ****** me up for a ***** plan. No deep investigation is appropriate. They are deliberately dragging this out. This way they are saving money on me not getting prescriptions regardless of whether or not it puts me in the hospital.
criminals

Sincerely,

*****************************
Business Response
Date: 04/12/2024
Hello,
This case is currently under review. It has been confirmed that the member was indeed misinformed about the monthly premium amount for the plan. The member was enrolled via telephonic enrollment on February 7, 2024, into the Wellcare ******** Rx Value Plus (PDP) S4802-207 Plan, with an effective date of March 1, 2024. Our billing and enrollment teams are now working together to establish a final resolution for the member. Once the final determination is reached, we will provide feedback accordingly.
Thank you
Customer Answer
Date: 04/12/2024

Complaint: 21408988

I am rejecting this response because: no resolution offered. Even though they knew I was misinformed for a long time theyre delaying delaying delaying.
I cant accept a resolution if there is nothing to accept

Sincerely,

*****************************
Business Response
Date: 05/13/2024
Hello,
The member's claim of being misled during enrollment was substantiated after review. The Enrollment team was promptly informed and rectified the member's plan accordingly, receiving confirmation via email from the member to switch to a plan with a $0.00 premium. The plan transition was successfully executed, and our Enrollment team has confirmed that the member will not be held accountable for any outstanding premiums. Since the member did not make any payments toward their monthly premiums, no reimbursement is owed. The updated member card has been emailed, and the member can expect to receive further documents by mail within the next 10 days. All concerns have been resolved satisfactorily. Additionally, the member has requested communication exclusively via email and not by phone.
Thank you.
Customer Answer
Date: 05/14/2024

Complaint: 21408988

I am rejecting this response because:
To use the word prompt is beyond a lie, months went by when I provided a recording of it happening day 1. Then as soon as they switched me to the new plan, they started denying one of the medications every day. I inquired why via the email preference stated in his response and it has gone ignored
Also this case was closed, suddenly its open again?

Sincerely,

*****************************
Business Response
Date: 05/16/2024
Good afternoon,
The member has brought up another complaint subsequent to being informed about the final resolution regarding enrollment in the incorrect plan and the expectation of a $0.00 premium after being misinformed. We have reached out to our pharmacy for a thorough review and will subsequently contact the member to communicate the findings pertaining to their medications. Upon review, it appears that the member's transactions were denied due to the drug not being covered. I have requested the pharmacy to ascertain if this is linked to any recent changes in the plan as the medication did process previously three times. Despite our attempts, the member has declined to provide any additional information over the phone and is only responding via email. We will send over the findings of the review once completed.
Thank you
Customer Answer
Date: 05/16/2024

Complaint: 21408988

I am rejecting this response because:theres no resolution offered other looking into it. Im on the autism spectrum and I process information better when I read it. Id appreciate if youd stop the phone shaming.

Sincerely,

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

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