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

376 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:02/26/2024
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.
For a long time, I had uncontrollable high blood pressure. My cardiologist unsuccessfully tried different drugs and their combination until she gave me in 2021 samples of Edarbyclor and *********. Unfortunately, these medications are very expensive. To make them more affordable WellCare requested from my doctor to fill Tier exception documentation to explain the necessity of these drugs. Doctor explained that she tried different generic alternative, but it didnt help and therefor I should take these medications for lifetime. In 2022 WellCare accepted this explanation and put these medications to Tier 1 and I received them from pharmacy with 0 copay but only for one year. In 2023 my doctor filled Tier exception documentation again and I again was given my medication with 0 copayment for one year. In the beginning of 2024 when I came to CVS pharmacy to receive refills for Edarbyclor and Nebivolol the price was very high again. 02/08/24 I called WellCare customer service and spoke with *******. He promised to Fax Tier exception documentation to my doctor. In 02/09/2024 the doctor still didnt get fax from WellCare. On 02/12/24 I called WellCare customer service again and representative told me that fax was sent to a wrong number. He sent fax to correct number. In the same day I called Centene (the owner of WellCare) and opened emergency complaint with Representative ****************** (phone # ************).On 02/15/24 received a phone call from WellCare that request for ********* was approved. On 02/16/24 I received a phone call from WellCare that request for Edarbyclor was approved. In the same day I came to CVS and received Nebivolol for 0 copay but for Edarbyclor I was asked to pay $550.00 for 3 months. I didnt take it. I called WellCare and was told that Edarbyclor was moved from tier 4 to tier 3. In the same day I called ****************** from Expedite department and he promised to call me back. I didnt Received any call from him and on 02/20/24 I called ************ ***, Executive Response Specialist II Operations Complaint Resolution Presidential/CEO Complaints (Ph: ************). He told me that he sent all documents to Pharmacy ***** and I should call them. I called pharmacy **** and spoke with Representative *****. For 45 mins he could not tell me why Edarbyclor was moved to tier 3 not tier 1. He transferred me to supervisor *****. I gave her CVS phone number and she put me on hold and called CVS. She returned back and told me that there was some mistake and told me that she would put me on hold and fix this issue. She put me on hold and after several minutes system transferred me to customer service. I spoke with another supervisor of Pharmacy ****. Alli. She checks my case and tells that they cannot put Edarbyclor to tier 1 because its tier 5 and they could put this medication only to tier 3. It was incorrect because in WellCare 2024 Comprehensive Formulary list of cover drugs on pg. 37 Edarbyclor *****mg is Tier 4. The same was in 2022 and 2023 years when WellCare moved this medication to tier 1. I stop calling WellCare from this time. I am without pills and my blood pressure is up. I hope you can help me. I dont know where else I can complain.
Business Response
Date: 02/27/2024
Good monring, per the Pharmacy department Brand name medications can only be lowered to tier 3 for brands.. Thank you.
Customer Answer
Date: 02/27/2024

Complaint: ********

I am rejecting this response because: WellCare for 2 years moved this medication from tier 4 to tier 1. What does happen now? There is no explanation about new rules in WellCare Annual Notice for Changes for 2024. If you need to look my record for previous years and current year my WellCare member ID: ********
Sincerely,

*****************************
Business Response
Date: 02/28/2024
Good afternoon, this issue has already been addressed in previous case, PRC *****, the pharmacy department reviewed and advised the tier 4 brand medication, can only be lowered to a tier 3. The member had been advised on several occasions. thank you.
Initial Complaint
Date:02/26/2024
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 are continues to contact me on behalf of another person and will not acknowledge that this individual may be using my phone number on their account. They have not offered to correct the issue, thus, I continue to get correspondence in behalf of another person. I just want them to contact the correct person that is using my phone number or delete my phone number from the associated account and they refuse to do so!
Business Response
Date: 02/27/2024
Dear *******************************,
Thank you for bringing this matter to our attention. We are sorry for any inconvenience that you have experienced. We have removed your contact information from our system. If you have any further questions or concerns, please do not hesitate to contact us.
Sincerely,
************
Customer Answer
Date: 02/27/2024

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,

*******************************
Customer Answer
Date: 08/06/2024

Complaint: 21336940

I am rejecting this response because: I have been getting calls from WellCare regarding another member that has been using my phone number for the past 2 years. I have reported this issue with WellCare and they have not fixed it. I have reported the issue to the BBB and the calls momentarily stopped. Now I have started to receive correspondence again from WellCare for the same member which proves to me WellCare did not fix the issue with this member. I do not know if he is using my information or not and WellCare refuses to assist me.

*******************************
Business Response
Date: 08/06/2024
Thank you for bringing this matter to our attention. Your issue was addressed in Feb 2024 in which your contact number was removed from an account. If you are now stating your information is connected to someone else account, we are unaware of that issue. When it comes to member information, we are provided information from either the member or CMS ********* We are sorry for any inconvenience that you have experienced. We will do everything we can to resolve the issue as quickly as possible. If you have any further questions or concerns, please do not hesitate to contact us.
Sincerely,
**** D
Customer Answer
Date: 08/12/2024

Complaint: 21336940

I am rejecting this response because:
WellCare has failed to rectify the issue by not only disassociated my personal phone number with this account, but also confirm with the individual they are calling about the correct phone number. This issue has been going on for almost a year or more, and I have continuously been told that my phone number will not be called anymore. However, I feel WellCare is failing to correct the issue with the individual by confirming their correct information as I continue over the course of months to get correspondence from them, sometimes on a daily basis. I want my number permanently disassociated with this individual and no more correspondence from WellCare.

Sincerely,

*******************************
Initial Complaint
Date:02/21/2024
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.
I've been with well care prescriptions plan for over 10 years and the start of 2024 well care change my RXPCN from MEDDADV to RXPCN to MEDDPRIME which doesn't not cover my same medication I've taken for 10 plus years and wants me to change my plan to what they want it to be ,mine you all this was done with out my permission or knowledge, I'm 63 years old with bladder cancer and well care and ******** is doing this now , well care treats clients wrong , in what's supposed to be your golden years has turn to rust, I've paid for well care to have big offices and drive fancy cars while they will not cover medication
Business Response
Date: 09/03/2024
Dear *****************************,
Thank you for bringing this matter to our attention. We are sorry for any inconvenience that you have experienced. We made numerous outreach to the number porivded and was unable to speak with you concerning your concerns. If you have any further questions or concerns, please do not hesitate to contact us.
Sincerely,
**** D
Initial Complaint
Date:02/21/2024
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.
I called Well Care Nov 4 For a dental Referral in their Network & was given a *************************** *********** at Village Walk101 *************** *************, ** ***** Went to this dentist-**************** November 6 I had them pre call WellCare to pre Certify my benefits so I did not have a repeat of the out of pocket expenses I had last Feb They gave his office a hard time but after I called several times and pointed out that they referred me, they gave his office approval.Now they are balking about paying?They have asked his office for more billing And when I called on this yesterday they had no idea what I was talking about!!!I had this claim number CHMNC2305111C00000201 That was on the denial ************* had NO IDEA what I was talking about After 45 min I hung up when the Asian rep asked me for the 3rd time So was this a crownCan you just look into itThey paid the same dentist $91.78 on 10/4/23- so he was "IN network" then????BAL OWED is $1558
Customer Answer
Date: 03/05/2024
This matter has been resolved & is considered complete

Thank you for your immediate assistance

***********************
Initial Complaint
Date:02/16/2024
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 had some dental work at ASPEN DENTAL done in October 2023 and tried to use my Flex Card which was denied. I had never used it before. Wellcare said the funds were never loaded onto the card and had me send a lot of info to them and ASPEN sent a lot too. I have sent numerous emails to them, spent numerous hours on the phone with them and sent all the info they have requested. They never respond to my emails. My coverage with them ended November 1, 2023. I am requesting a reimbursement of $728.05 from them for my out of pocket expenses . My ID number is ********. I will appreciate any help you can give me.
Business Response
Date: 02/28/2024
Hello and Good Afternoon, Contact has been made with ************** and she was informed we will be reprocessing Claims from Aspen Dental. Once they obtain payment, they will reimburse member minus her patient responsibility for the uncovered services. ************** has also been given my call back information if she requires further assistance. Thank you.
Customer Answer
Date: 06/11/2024

Complaint: 21301808

I am rejecting this response because:
I need to reopen this complaint because Wellcare has not resolved the issue.

Sincerely,

***************************
Business Response
Date: 06/17/2024
Hello and Good Afternooon,
Outreach has been made to ************** with no success, messages have been left with direct call back number. The claim for DOS 10/26/2023 was reprocessed to pay the allowed amount to the provider on 2/29/2024. ************** was informed she would be responsible for a 40% coinsurance and for non-covered services. ************** was advised of the signed treatment plan received from Aspen Dental reflecting she was quoted a member responsibility in the amount of $614.05 after her insurance benefit which was financed through CareCredit. We apologize for any confusion or dissatisfaction, my direct telephone number was left should she need additional assistance.

Thank you
Customer Answer
Date: 06/17/2024
I
Complaint: 21301808

I am rejecting this response because:
The Flex card I had which I had never used before, was supposed to pay the part that the insurance didn't cover. ***** from Aspen DENTAL tried to use it, but it was rejected. I contacted Wellcare and was told the funds had not been loaded onto the card. I have been told several times that a reimbursement check had been mailed to Aspen Dental, who would forward it to me. The Flex Card should have covered what I charged to Care CREDIT and the $60 Cash I paid.
Sincerely,

***************************
Initial Complaint
Date:02/15/2024
Type:Order 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 ******** I signed up. I gave them a list of my prescriptions. I was told there would be no cost. I tried to use the card at the pharmacy and learned there was a $500 deductible on the card. I was told I could pay $36 without the card. I don't spend $500 on drugs in a year. I called to cancel, but they would not cancel without my wife's permission, but they signed me up for the policy without her permission. I want them to cancel this policy, with no fees or penalties.
Business Response
Date: 02/28/2024
I established contact with the member and discussed the issue. The member did not have a deductible for the found medications, that deductible was for Tier 3-6 medications. The member has since canceled the policy. We apologize for any inconvenience this may have caused.

Thank you
Initial Complaint
Date:02/15/2024
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.
I have enrolled in Wellcare's ******** Prescription Drug coverage plan in December of 2023. I was billed for the enrollment premium and I paid it before the payment due date which was Jan 20 2024. I saved the receipt. I also have a statement showing the amount was drawn from my bank. After I made the payment, for almost a month, I continued to receive repeated emails and phone calls from the company, stating that my payment was still due and threatening to cancel my coverage. Each time I presented the evidence and was told that the issue would be taken care of, but it was not. Finally I gave up and paid the amount again, because it was not worth the time and effort of fighting it. THIS REPEAT PAYMENT THAT I MADE HAS NOT BEEN REFLECTED IN MY PAYMENT HISTORY AND MY ACCOUNT STATUS IS STILL SHOWN AS DELINQUENT. I am just one small step away from being convinced that this is a fraudulent enterprise that siphons off payments described as "premiums" and does not provide any service in return.
Business Response
Date: 02/20/2024
The plan has made contact with Complainant: *************** where he was informed, his payment proof displays him making payment under the wrong member ID. In speaking with him, he verified the member ID and confirmed and understood, he incorrectly paid under the wrong member number. We were able to receive resolution that the member will be refunded the amount paid and he is responsible for the balance monthly or for the remainder of the year.The plan has attempted to reach out to Mr. **** on 3 occasions to the contact provided as scheduled and have been unsuccessful with reaching out or for him following up for resolution. No further actions are necessary on our end as this issue is resolved.
Initial Complaint
Date:02/15/2024
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.
On January 31, 2024. I switched my Wellcare Classic part D plan to Wellcare Advantage. February 6, 2024. I called in to see my orthopedic doctor. I was informed that, my was not apart of Wellcare network. When Wellcare told and ensured me that my provider was affiliated with wellcare providers. On the day of my next scheduled appointment I was told that my doctor was not a provider in the wellcare network when Wellcare again reassured me that my provider was in the network. From February 6th, 2024, to present day I have spent hours on the phone being constantly transferred and and place on hold for very long periods of time. With no resolution made to the correction, Saturday February 10,2024, I was in a car accident while out of town and now I am home I called Wellcare to get a referral for a physical therapist and was given the run-around for hours at a time while on the phone with Wellcare, I was given three phone numbers that did not work they were numbers to senior assisted living homes instead of physical therapy offices. With this fiasco of Wellcare negligence and poor customer service I was not able to get anything resolved or physical therapist or a doctor. February 14, Wellcare had a Physical Therapist call me to find out from the Physical **************** that they are no longer in - network. I need assistance because Wellcare is not providing the services I need.
Business Response
Date: 02/26/2024
I made contact with the member and began investigating the complaint. After substantial research I was able to locate her a satisfactory physical therapist in her area.
Initial Complaint
Date:02/13/2024
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.
Since my membership Everytime I am told of new benefits like utility assistance and I request to use the benefit I am told my plan does not cover the benefit. In particular my **** card with 25 dollar benefits per month. I have a card that they keep saying is not activated when I go to use the benefit but member services also says the benefit is available on the card. Also I am supposed to get help with my utility bill because of medical necessity...today I was told yes you have that benefit by one representative and later transferred to someone who said I did not have that benefit. I should have had access to this benefit since 2020 is one of the reasons I chose wellcare and my current plan. In ******************************************************************** network psychiatrist until July 2023 and they didn't use my insurance to make me a patient. This was after about 6 months of trying from may 2020...when I gave up looking. Also the over the counter benefit store has changed from CVS to ********* or so a representative told me in December 2023...yet CVS told me they are still my over the counter provider. My request for hard copy benefits in the mail have gone unresponded to...my address has been questioned. My *********************** **** card have not been received to date either. My premium of 174 dollars is being sent to wellcare every month and I am not getting any service needed or told that I am entitled to under my understanding of the ******** advantage plan I signed up for...these benefits were selling points of the plan and don't exist for me as agreed.
Business Response
Date: 02/22/2024
We have contacted the member and successfully addressed all issues. We worked within the different departments to reach a satisfactory resolution. We apologize for any inconvenience this may have caused.

Thank you.
Customer Answer
Date: 03/06/2024

Complaint: 21286712

I am rejecting this response because:
The issues have been discussed with ******* of the Executive Escalation Team on but not limited to 2.28.2024, 3.1.2024, and finally in a last attempt for resolution on 3.5.2024 with me losing benefits and still not receiving cards for access to current benefits to this day. I have received mail from them since incident date as they may allege this is the issue. I have not had full access to my full benefits as outlined by this plan since about May of 2020. I continue to pay my own utility bill and this is a hardship on a fixed income. Thank you for your assistance with this frustrating matter. CR
Sincerely,

*******************************
Business Response
Date: 04/05/2024
I have spoken with the customer and reached a solution with collaboration with our other departments. We aim to satisfy any and all issues and we apologize for the inconvenience.
Initial Complaint
Date:02/12/2024
Type:Billing 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.
1. I and my mother both received mailings in the mail this fall from a *** called Wellcare. I had never heard of them. We both received repeated mailings that;a. Presumed that we had enrolled in their ******** Part D prescription drug plan.b. Attempted to bully me into paying the first month's premium of $60.30.c. Threatened to charge me an additional $18.70 in late fees if I didn't meet their payment deadline.d. My mother's actual dollar amounts were even higher; a first month's premium of $114.80, an additional $73.20 in late fees. Since neither my mother or I had ever enrolled with this company, I threw all the mailings out.2. On January 14, ****, I picked up a refill on some existing prescriptions. I was informed by the pharmacist that another ins. ***, Medco ********, was appearing on my insurance records as my primary ******** prescription insurance company. It turns out it was a front for Wellcare.a. I contacted PACE, the primary ******** insurance company I had chosen for my drug coverage. They reported that their records showed I had enrolled with Wellcare as my primary insurance, reducing PACE to my secondary ins. *** This is untrue. b. I got PACE to remove Wellcare from their records, effective 2/1/24. 3. I filed an official complaint with the PA ********************* on their web site on 1/19/24. My complaint ID is ******. I also sent some of Wellcare's recent mailings in postal mail as evidence.4. Since then, Wellcare has continued to attempt to interfere with my prescription refills. I did receive a call from ******** and had them remove Wellcare from both my insurance record and my mother's.5. Finally, my mother and I have both received disenrollment acknowledgements in postal mail from Wellcare, effective date is 1/1/****.It is obvious that this company is illegally enrolling people in their ******** program. They need to be prosecuted to the full extent of the law and dealt the maximum sentences.
Business Response
Date: 02/20/2024
Hello and Good Afternoon! Contact was made with ************ in efforts of assisting with his concerns, however he declined assistance from WellCare. Our research confirmed his enrollment into the plan was via SPAP ********************* Assistance Program) and there was no sales agent involved. Thank you.
Customer Answer
Date: 02/24/2024

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ******** and find that this resolution is partially satisfactory to me as far as what they can or will provide at this point.
I will follow up with the ******************** Assistance Program to see if this is indeed true and why it happened without my consent. If not accurate, I will file another complaint.
Sincerely,

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

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