Business Profile

HMOs

WellCare Health Plans, Inc.

This business is NOT BBB Accredited.

Find BBB Accredited Businesses in HMOs.

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

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

If you've experienced an issue

Submit a Complaint

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:01/16/2024
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 have been on monjaro since august for insulin resistance. they are refusing to ***** me the prescription. Only reason why I use ********* They have put limitations in my patient rights. I am the sole decision maker in my health. I want immediate resolution or paid money for the medication.
Business Response
Date: 01/26/2024
Hello. We apologize for the dissatisfaction that you experienced. The plan has made contact with the member/complainant regarding their concern and have educated them on their prescription issue. The member has also been mailed notification of the prescription issue. No further action necessary.
Initial Complaint
Date:01/12/2024
Type:Order 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 signed up for Wellcare ************ I signed up, they represented the Oakland Pharmacy in Oakland, IA as being part of their network. Since the first of January, they have said that the pharmacy is not in network and declined to cover prescriptions there. When I call them, they try to refer me back to the pharmacy, but the pharmacy has already done all they can do to rectify the problem. The action needs to be taken by Wellcare. But Wellcare won't admit their mistake.
Customer Answer
Date: 01/26/2024
To Whom It May ************************* BBB Complaint #******** against Wellcare Health Plans, Inc.

This complaint was fielded by a member of *******'s Executive Team. She was prompt and very helpful. The Oakland Pharmacy is now in their network thanks to her efforts.

The problem which generated the complaint is now resolved. I am entirely satisfied and grateful to the Wellcare ******************* for their successful efforts.

Sincerely
****************************
Initial Complaint
Date:01/12/2024
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.
Today I went to pick up my meds and was told that because of the new year, I could only get a 7-day supply instead of the 120 that the doctor had ordered I called Wellcare and was told the same thing so I asked to speak to a supervisor and was told because it is a opioid I could only get a 7 day supply I then asked the supervisor to send me in writing what he was telling me and was told he couldn't do that so I asked for a web page address or anywhere that I could go to read in writing what he was telling me and again there isn't anywhere. What kind of business has RULES but it's not written anywhere? same doctor, patient, meds for the last 5 years only thing different is a new insurance and that is Wellcare
Business Response
Date: 01/26/2024
Good afternoon, we were unable to reach the member after 3 separate attempt to ************ to confirm the medication in question. thank you .
Customer Answer
Date: 01/26/2024

Complaint: 21127951

I am rejecting this response because: No one called o left a message

Sincerely,

*************************
Business Response
Date: 01/30/2024
Good morning, we made 3 separate attempts to the member, on 01/16/2024, 01/17/2024, and 01/23/2024. The number called is ************. . Our pharmacy advised: Centers for ******** and ******** (CMS) has a safety edit for all Opioid medications. Our plan *** not have an opioid claims history for new enrollees, especially at the beginning of a new contract year. Consequently, existing members *** experience a claim rejection due to the opioid **** edit when processing their initial opioid prescription for the new year, particularly if it exceeds a seven-day supply. Now that the initial 7 day supply has been filled, the member *** fill the medication for a higher day supply. The pharmacy processed a paid claim for a 23 day supply on 01/18/24 and I was able to process a future paid test claim for a 30 day supply ."
Customer Answer
Date: 01/30/2024

Complaint: 21127951

I am rejecting this response because: Last Sunday(01/28/2024) I received a phone call from WellCare and the very same question I keep asking and no one can answer is when an agent tells you on phone that number #1 I can only get a 7 day supply because it is a new year and yes that what I was told and number #2 because it is a new medicine(and it was not) I can only get a 7 day supply my answer was to please show me a WellCare web page where I can go to see this in writing or to send me a letter and was told that there is no web page and they can NOT send me anything in writing. I also asked for someone to listen to the recording of the phone call I had with WellCare and as of today no one as called me back even though I was told someone would call me within ***** hours. once more time same meds same doctor thing only thing different is the insurance company.

Sincerely,

*************************
Initial Complaint
Date:01/11/2024
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.
I have a Prescription Drug Plan with Wellcare. Member ID ******************************* plan has no copay charge ($0) for generic medications (tier 1) at the preferred pharmacy as was detailed on the ******** PDP plan website and Wellcare website.I priced two generic medications on Wellcare website under my login - there was no copay charge.When I went to my preferred pharmacy to pick up medication, there was a charge for each generic medication (?). My wife has the same Wellcare PDP plan and the same problem.It means that Wellcare is collecting money starting from the start of 2024.I have spent 5 hours today on phone calls with Wellcare and talked to 3 representatives and one supervisor. They all agreed that their plan should not charge for generics at preferred pharmacies.Also, all incorrectly blamed the pharmacy for charging co-pays - absolutely not true and shady.The issue was not resolved on the phone.I have contacted ******** and was told to file a complaint with Wellcare which I did - complaint #**********. ******* told me to continue to pay for my meds because it will take 30 days to get a reply to my complaint. I find Wellcare practices to inflate their profits by charging improperly for generics to members (all are senior citizens) which should have $0 copay, very shady.
Business Response
Date: 01/24/2024
Good afternoon,
The plan reached out member and spoke with his wife and provided Pharmacy findings: After looking at the member's claims, the claim for ****** on 01/03/24 pushed the member from deductible through their initial coverage stage and into the coverage gap. While in the gap stage, the member is responsible for 25% of the drug cost. ****** is disputing the findings, and this has been sent back to the pharmacy team for further review. Once an update is provided, I will follow back up with the member and his wife and the BBB.
Customer Answer
Date: 01/29/2024

Complaint: 21123986

I am rejecting this response because:
The representative did not possess any knowledge on the subject to be able to handle my complaint: she could not answer nor explain anything; did not provide her contact - everything was on the phone - no emails.
The last phone call was quite unpleasant to the point of being hostile.

Sincerely,

*****************************
Business Response
Date: 02/12/2024
Good afternoon,

After looking at the member's claims, the claim for Humira on 01/03/24 pushed the member from deductible through their initial coverage stage and into the coverage gap. While in the gap stage, the member is responsible for 25% of the drug cost.
Initial Complaint
Date:01/08/2024
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.
Urgent need for Wellcare account access. But not able despite two hour long customer care calls.I've had ********************** for several years and it worked well...until late December 2023. Now, with a high and urgent need to log in and compare prices on drugs because of serious issues, I have not been able to access my account. Two phone calls to Wellcare customer care have produced NO HELP. First on Dec. 26 was about an hour. Problem of account access not solved. I was told IT help would call me. Never received a call. Next call was on Jan. 3 and was 55 minutes. Problem still not solved. And I continue to wait despite telling Wellcare customer rep that this is urgent.
Business Response
Date: 01/30/2024
Good afternoon,
We recently contacted the member regarding the issue they reported. According to their feedback, the problem has been successfully resolved by a member of our IT team a few days prior. The member confirmed that they can now log in without any issues and have regained access to the Rx transactions they were initially seeking.
Thank you
Customer Answer
Date: 01/31/2024

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution restored my access which is what I needed, THOUGH it did so in a very delayed timeframe, restoring my access on January 10 for an initial call made on December 26 to WellCare and a follow-up call on January 3, for an important matter, access to ******** Part D drug plan information. That type of inadequate response is unsatisfactory to anyone with a Part D drug plan from WellCare and I rate this company F for customer service..

Sincerely,

*********************
Initial Complaint
Date:01/05/2024
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.
January 4, **** I signed up for ******** D drug program with WellCare in November 2023. I have called twice in December to ask if I would receive my medical card by January 2. I was told the medical card was in the mail. It is almost January 5 and I do not have my ******** D drug card. I have purchasemy medicines by next week which cost over $300 if I do not have my presciption card. I have attached the letter that was sent to me on November 20, 2023. It is January 5 and I do not have my card.
Business Response
Date: 01/12/2024
Dear ***************************,
Thank you for bringing this matter to our attention. We are sorry for any inconvenience that you have experienced. We were able resend you another member ID card to address that we have on file. I also sent you and email containing your member id cards. If you have any further questions or concerns, please do not hesitate to contact us.

Sincerely,
**** D
Customer Answer
Date: 01/12/2024

Complaint: 21100347

I am rejecting this response because: It is January 12 and i have not receive my member ID. This should have been mailed log before January 1, I will not be satisfied until I have an ID card in my hand.

Sincerely,

***************************
Initial Complaint
Date:01/04/2024
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.
My Wellcare member ID: *********** **************************** account #: *************** March 8th of 2022 I saw my obgyn for the first time since being raped. The next day I called Wellcare to confirm that they would cover my Nexplanon birth control implant. I called Wellcare on 03/09/22 @ ~****. All of their phone calls are recorded. I was told that the Nexplanon would require an authorization form which could be expedited. Then I called the doctor's ****** and spoke to **** in the billing department and told him such. **** later told me that he spoke to **** at Wellcare and she told him he didn't need to file anything, the Wellcare reference # is **********. **** called me back to schedule the appointment. The date of service for the Nexplanon implant is 03/16/2022. The doctor's ****** lied to Wellcare and told them that I was notified on the date of service that it would not be covered and agreed to go ahead. I was not notified. I had already gottten a second estimate from *********************************** which was around $770. Had they told me it would cost $1340, I would have done the sensible thing. I have been in contact with both companies trying to get this resolved with very little cooperation from either side. The bill which i finally received from PWCSWFL was dated 10/02/2022. My obgyn discovered I had *** and decided to treat it with the 3 dose, full cycle of the *** vaccine. I called Wellcare, I spoke to ******, Wellcare ticket #: **********, I was told the vaccine Guardasil would be covered at no additional charge to me and there was no need for prior authorization. The dates of service for the 2 shots are 05/27/2022 & 07/27/2022 respectively. I was surprised to find these on the bill as well, charge status denied. The Explanation of Benefits from Wellcare simply stated 'denied, provider billing error'. I have been in touch with Wellcare several times, I have names and numbers as needed. Finally in November of 2023 my case was escalated to ***** of the escalation team, my Wellcare case #: PRC12267. Today January 3rd ***** called to inform me the *** vaccines will be paid but the birth control would not be.
Business Response
Date: 01/23/2024
Hello,

I have reached out to the member in attempts to resolve this issue which presented itself previously. The cause of the issue stemmed from Provider Error, causing an issue for her. The denied portion of the claim is something that Wellcare unfortunately does not cover, therefore is an expense that is not payable. I offered to research further however the member has new insurance with a new doctor and stated she has moved on from the issue.

Thank you.
Initial Complaint
Date:01/03/2024
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.
My WellCare Id is : ********. I received a check for $702 from welcare covering 60% of services dated from February 2023 to May 2023.I deposited the check into my account and then it bounced we called welcare, and they transferred us to the executive response team ticket number ***********, woman named ****** we were told someone would call us back. I just finished calling them. They do not seem to know anything about the balance check and it asked for an additional three days.*** had numerous problems with welcare for the past two years and we just appreciate help with this, so I dont have to keep going in circles with them again Thank you so much God bless you
Business Response
Date: 01/18/2024
Good morning,

On 2/16/24 and 2/17/24, the plan was made outreach to update ************** and updated a manual Check dated 01/12/24 for $702.00 was mailed to the member. If you have any questions, please reach out to plan.

Thank you,
Customer Answer
Date: 01/21/2024

Complaint: 21085878

I am rejecting this response because: I have still not received the check

Sincerely,

***********************
Customer Answer
Date: 02/05/2024

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:01/03/2024
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 have finished 2023 and am transitioning to **** with Wellcare. They were to transfer my mail order meds from CVS to Express Scripts. The web site has missing meds and the Wellcare staff does not know how to resolve these. The phones are answered by computers that begin by wasting much time. There are problems with expiring prescriptions and the staff at Wellcare do not know how to handle these. There is a refusal by Wellcare management to listen to customer regarding the re-authorization of expiring meds. Wellcare insists they will contact the doctors to renew scripts. Thus happens over and over in spit of the customer telling ********************** that the doctors will NOT refill scripts based on the Wellcare staff who call my doctor. MY doctor REQUIRES that I CONTACT him for REFILLS. Wellcare has been told this over and over and they keep doing it wrong anyway. The Wellcare leadership fails to TRAIN the staff to do anything but read prepared responses that are IRRELEVANT. All of this wastes major time.
Business Response
Date: 01/12/2024
Thank you Mr. **************;for bringing the issue to your attention. We apologize for any inconvenience or frustration caused by the problem. Our Pharmacy department made outreach to you to address your concerns and resolution was made. If you have any further questions , please feel free to contact WellCare.

**** D
Customer Answer
Date: 01/12/2024

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.
Actually, Wellcare did NOTHING to resolve the matter BUT other parties have resolved it for Wellcare. This matter is settled, BUT Wellcare still does NOT answer their phones or attend to their customers in appropriate time frames.

Sincerely,

*****************************
Initial Complaint
Date:01/03/2024
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.
My complaint with well care is that on October 11 I was married to a retired military person and needed to stop well care because I was going to be enrolled in Tricare due to the distance of driving to get enrolled in Tricare for life and the ***** military system, I was enrolled in the dears military enrollment system and authorized Tricare on December 6. We had contacted well care and well care said until I was enrolled in Tricare for life and dears. They couldnt disenroll us. We requested it on December 6 and it took several hours on the phone. We got nothing in the mail, I went to their website and it has a disenrollment Feature and then ask you at the very end before you submit it to initiate a disenrollment password that you have to get from well care. I called well care they said theres no such thing as that on the website and I cant believe the inept customer service people, so I elevated it to a supervisor , and they said no you have to change plans and it will be effective **** the disenrollment. I said this is a life-changing event its a marriage, and I spoke to a British supervisor. She had a British accent, and she swore that we would be disenrolled on ****, I cant get care because my attached to ********* well care and as of October 11 I married a retired military person and as of December 6 I am enrolled in Tricare for life and the dears defense enrollment program. I have a military ID that authorized me Tricare. Well care is dragging their feet. I called them today and they said they will send me a form or I have to request a form. Ive done all that I spent hours on the phone. My husband has been hours on the phone with these app people I need to get some help disenroll From well care I have lodged a complaint with ******** also.This company has done nothing but run me in circles and Im so over it. Thank you for your help,*********************.
Business Response
Date: 01/17/2024
Good morning, all,

Per review, member has been disenrolled from plan H5199 PBP 012 effective 1/31/2024. The plan does not disenroll during the middle of month only last day of the month. If ***** has any questions, she can follow back with me at ************ reference number PRC-**** Outreach to member has been made and provided to member spouse per her authorization over the phone,

Thank you,

BBB Business Profiles may not be reproduced for sales or promotional purposes.

BBB Business Profiles are provided solely to assist you in exercising your own best judgment. BBB asks third parties who publish complaints, reviews and/or responses on this website to affirm that the information provided is accurate. However, BBB does not verify the accuracy of information provided by third parties, and does not guarantee the accuracy of any information in Business Profiles.

When considering complaint information, please take into account the company's size and volume of transactions, and understand that the nature of complaints and a firm's responses to them are often more important than the number of complaints.

BBB Business Profiles generally cover a three-year reporting period, except for customer reviews. Customer reviews posted prior to July 5, 2024, will no longer be published when they reach three years from their submission date. Customer reviews posted on/after July 5, 2024, will be published indefinitely unless otherwise voluntarily retracted by the user who submitted the content, or BBB no longer believes the review is authentic. BBB Business Profiles are subject to change at any time. If you choose to do business with this company, please let them know that you checked their record with BBB.

As a matter of policy, BBB does not endorse any product, service or business. Businesses are under no obligation to seek BBB accreditation, and some businesses are not accredited because they have not sought BBB accreditation. BBB charges a fee for BBB Accreditation. This fee supports BBB's efforts to fulfill its mission of advancing marketplace trust.

Cookies on BBB.org

Complaints

Customer Complaints Summary

If you've experienced an issue

Filter and sort by

Sort by

Complaint status

Complaint type

Complaint statuses

Business Response

Complaint statuses

Customer Answer

Complaint statuses

Business Response

Customer Answer

Business Response

Customer Answer

Complaint statuses

Business Response

Customer Answer

Business Response

Complaint statuses

Business Response

Customer Answer

Complaint statuses

Business Response

Customer Answer

Complaint statuses

Business Response

Complaint statuses

Business Response

Customer Answer

Customer Answer

Complaint statuses

Business Response

Customer Answer

Complaint statuses

Business Response

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