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

377 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:01/03/2024
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.
i have contacted wellcare since 8/2023 complaining that i cannot access my online account. i have talked to customer services numerous times, web support numerous times, and yet they say a supervisor will have to fix the problem and no one contacts me. so i call again, and again and again. this is ridiculous, i cannot access my account for billing, to order a id card, to retrieve messages, etc. this is annoying and i am at my **** end with wellcare. please help
Business Response
Date: 01/05/2024
Hello, outreach was made by our Executive team and Web Support team, in light of the complaint the issue at hand has been resolved successfully and satisfactory. We apologize about the inconvenience this may have caused.

Thank you!

- ******************
Customer Answer
Date: 01/05/2024

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:12/28/2023
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.
WellCare signed me up against my will and refuses to stop billing me or change status.
Business Response
Date: 01/17/2024
Hello. We apologize for the dissatisfaction that you experienced. The member has been disenrolled. No further actions necessary.
Initial Complaint
Date:12/27/2023
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.
After I applied for ********* I began to receive correspondence from wellcare indicating that I have a drug plan from them and asking for monthly payments. The correspondence said to call to cancel the plan and I did that last week. Today, I received my third and fourth or fourth and fifth correspondence from wellcare including a member ID card. I never applied for this and I dont want it. I find this kind of marketing very aggressive and very offensive, especially to super seniors. I almost paid it but my daughter told me not to pay it Thank you for your help.
Business Response
Date: 01/12/2024
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 enrollment and termination effective date. The member has also been mailed proof of termination. No further action necessary.
Customer Answer
Date: 01/12/2024

Complaint: 21057420

I am rejecting this response because:
I spoke with ***** from well care and he claimed ******** enrolled us in his drug plan Its a very strange way of doing business. I just wanted to let you know that. I never had a drug plan so I have no idea why they would just automatically enroll me in a drug plan But Im going to call them to find out. Well Care seem to find this a completely normal way of doing business.

Sincerely,

*****************************
Initial Complaint
Date:12/14/2023
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.
Wellcare Member I. D. # ********. For the past year of coverage they provide dental insurance by Envolve dental Insurance. After months of phone calls I finally filled with BBB. All the dentist listings they provided didnt accept their insurance. Wellcare FINALLY found a dentist to provide me with dentures. I had bottom denture done and was very happy with dentist. As new year approached, I called Wellcare to verify I would have the same Envolve dental insurance. For new year( I kept my same plan). After inquiring multiple times I was assured dental would remain the same. I received my new card for **** and of course, it has a different dental insurance. The dentist I spent some much time and effort to find doesn't take this ins. After going on Liberty dental insurance sight and looking at providers, it has not been updated for a while. I started inquiring and many don't accept this insurance anymore. I spent months making phone calls between Wellcare, Envolve, and supposed providers this past year and forced Wellcare to provide a provider that could do my dentures and actually accepted the ins. I am 69 disabled and have a bad heart. I don't have it in me to go thru this nightmare again. I want Well care to provide a dentist who I can trust to do my top denture after January ****. I was VERY happy with the dentist and had made plans to go back in January but due to Wellcare incompetence now that won't happen.
Business Response
Date: 01/02/2024
Hello and good afternoon. We have directed this complaint to the dental vendor Liberty Dental. The member has also been informed that if he needs assistance in locating a contracted provider or assistance with dental benefits, he can contact ************** Services at **************.
Thank you.
Customer Answer
Date: 01/03/2024

Complaint: 21007307

I am rejecting this response because:

Sincerely,

***************************
Initial Complaint
Date:12/08/2023
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.
Wellcare healthy rewards gives you gift cards for getting preventative health care done. I had a colonoscopy done in October 2023. I earned a $40 ******* gift card. Wellcare says they mailed me two $20 ******* gift cards on 10/16/23. I never received. I called October ******************************************************** I had to wait 30 business days to report. I waited 30 business days, and called back on 11/27/23. I was told I would receive call back in 72 hours. I never received call, after waiting a entire week. I then called back, told to wait another 72 hours. I waited 72 hours and called back. They are still saying ....please call back in 72 hours. This is a ridiculous way to run a company. I think I may be being SCAMMED. Wellcare HAS NOT DELIVERED on a promise made. I would like Wellcare to send me out new gift cards. Absolutely the worst customer service I have ever experienced with a company. This is NOT my 1st time complaining about Wellcare with the BBB. BBB HAS HELPED me in past, can you please help me now? Thank you. I know gift cards is a Non medical complaint, But I still feel the company should stand by stand by their promises.
Business Response
Date: 12/21/2023
Good afternoon,
The plan contacted ******************** 12/21/23 and supplied details from vendor Healthmind as of 12/12/23 this member gift card is being tracked and if balance is still on card as of 1/12/24 a new card will be sent. ******************** has been recommended to follow up with the plan if Healthmind does not follow back up by 1/12/24.

Thank you,
Business Response
Date: 12/21/2023
Good afternoon,
The plan contacted ******************** 12/21/23 and supplied details from vendor Healthmind as of 12/12/23 this member gift card is being tracked and if balance is still on card as of 1/12/24 a new card will be sent. ******************** has been recommended to follow up with the plan if Healthmind does not follow back up by 1/12/24.

Thank you,
Customer Answer
Date: 12/21/2023

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:12/06/2023
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.
I have a Wellcare Part * ******** Prescription *rug Plan (I* # *********. ********************** owes me a $175 reimbursement. Since August, I have spent over 6 hours dealing with Wellcare's ineffective customer service to no avail. According to Wellcare's own website, my "*rug Coverage Exception Request" for Havrix Suspension was approved by Wellcare on 9/20/23. I was told I would receive a check within 30 days. It has now been 75 days and I have not received my check. Today I spent an hour with two different customer service reps who said they could not find anything in their system about my Approval. They could not tell me if my check had been mailed. I am beginning to wonder if this type of treatment is part of Wellcare's business model knowing that most people will just give up.
Business Response
Date: 01/04/2024
Good afternoon,
This case has been reviewed, we have partnered with our pharmacy team who has confirmed the member is to receive a check for $175.00, check was processed on 9/30/2023 and sent on 10/2/2023 but was lost in transit per pharmacy review. Address listed did not have the city appropriately spelled, address was updated and resent. The member can expect the check to arrive 14 days from 12/14/2023.
Customer Answer
Date: 01/04/2024

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:11/29/2023
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 previously dealth with this company before with constant sending of unsolicited mail after requesting in writing and over the phone to remove my address from their marketing mailing list. My mistake was moving to a new residence, and now they have caught up with me again. Calls & letters are ignored, so here I am again asking BBB to please assist to be removed from their marketing before by accident I somehow find myself signed up for an account I never wanted. That is my fear.
Business Response
Date: 12/04/2023
Hello ********,
My name is *******, we received your review regarding the health plan. To further research your case, we need more information. Please contact ******* at ************ and reference case number PRC-12310.
Thank you,
*******

Customer Answer
Date: 12/05/2023

Complaint: 20929510

I am rejecting this response because: We have yet to communicate. I have called several times to return the two calls and messages I received. I think this would be easily resolved by hearing back from Wellcare that they will simply remove my name and address from all marketing communications. I left another voice mail earlier reiterating this, but have yet to hear back from them today. Perhaps they will call me later, but it appears at least at this time this is not resolved.

Sincerely,

***************************
Business Response
Date: 12/08/2023
Good morning,
The plan contacted ************** on 12/06/23 @ 12:24 pm ************** that she has been placed on the Marketing Do not mail and call list. No further action is needed. ************** was satisfied.
Customer Answer
Date: 12/08/2023

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:11/27/2023
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.
************************************ My Wellcare Assist(HMO) member ID ********, card effective date 09/01/2023. On or about this date I received a new ID card from *********************** unfortunately I did not examine the card closely and did not discover the change in my PCP until I attempted to acquire a prescription on 11/22/2023 from what I thought was my PCP. It was then that the change in my PCP was discovered. This change was done and completed TOTALLY WITHOUT my consent, authorization or conversation or knowledge. I had and have NO thought, reason or desire to change, or have ever expressed any desire to WellCare to make such a change. This change was preformed without authorization or consent from or by me, without the knowledge of ********* or my actual PCP (***************************). The change or transfer to this new PCP turned out to be a clinic Dr ******************** employed by *** Street Health- ********, ** , when in actuality Dr ******************* is attached to the ********** ** ****** of *** Street Health, 35plus miles from my home- this is significant because Iam a Small Cell extensive,- cancer patient at this time and no longer drive( not since May of 2023). I have NEVER been to any *** Street Health clinic-EVER. Both WellCare and *** Street Health have refused to provide me with any information about how, when , why or who facilitated this change process. *** Street Health did inform me that I was in fact, in their computers as a patient from WellCare, stating that I would have had to have made an IN person appearance in order to be in their computers but could NOT provide me with the date of this appearance or even which clinic I appeared in or the date this Dr ******************* spoke with me and had this originally examination. I have tried on several occasions to work with both of these organizations to get to the bottom of this issue, but to absolutely no avail.
Business Response
Date: 12/11/2023
The member was assisted and placed back with the *** he requested, thank you
Customer Answer
Date: 12/18/2023

Complaint: 20916417

I am rejecting this response because:

Sincerely,

*****************************
Initial Complaint
Date:11/22/2023
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 September 12,2022 Wellcare Dual Access authorized the procedure for dental extractions, bone grafts, and 6 titanium dental implant bodies. Due to having several complications from the oral surgery that included being hospitalized multiple times as well as one implant having to be removed, the oral surgeon did not feel it was in my best interest to move forward in the second and third stage of the procedure which includes placing the abutments on the implant bodies and fabricating the removable fixed denture until the significant swelling went down and I was completely healed. Even though, I am still numb on my lower right mandible, the dentist decided that we can go forward with the procedure that requires placing the abutments and removable fixed denture because without these next steps it is causing further health complications by hindering my ability to eat and also causing constant pain from gingiva growing over three of the implants. Wellcare has denied needed services claiming that their plans have changed from 2022 to 2023. I have made complaints and appeals through ********* Maximus, and Wellcare. Even while phone recordings will prove that I was told by Ms. **** and ******************** at Wellcare that it should not be considered an appeal but rather as a continuum of care, but no one will help me get that process started. I've documented everything including agent names, dates, times, summary of discussions, promises, and supposed resolutions that have still not been met. I was also told by a couple of sales agents that I am not the only one having this issue with Wellcare, and that they are having difficulties holding up to their financial obligations. ******** advised me to ask for evidence of coverage for 2022 and 2023 and to highlight specific plan changes.Ms. **** has promised to get these to me three times and has failed to do so, also refusing to return calls as promised. Not only have I filed an appeal, provider has also deemed it medical necessity.
Business Response
Date: 11/30/2023
Good afternoon, Contact has been made with ********************* on 11/30/23 to verify complaint, and once research and review has been completed the plan will follow back up with resolution to **************** and the BBB.
Customer Answer
Date: 12/01/2023

Complaint: 20900212

I am rejecting this response because: Ms. ******* from Wellcare did contact me. However, multiple agents from Wellcare has previously contacted me promising a resolution but a resolution has yet to be made as it's been over a year and still trying to get the procedure completed. Even in previous and current complaints through ********* Wellcare promises a resolution but again, no resolution is ever made. Literally nothing has been accomplished after my procedure started on September 12, 2023. Now, I was told they authorize it to begin with so it isn't considered a contuuim of care that isn't true because I have the document from the dental office saying they did authorize it and cover it. After that I was told I was only with Wellcare for the month of December, which is also untrue because again I have the document showing otherwise. I'm not satisfied with this response because it's been over a year of promised resolutions and absolutely nothing has been done

Sincerely,

*********************
Business Response
Date: 12/20/2023
Good afternoon
Per review of member issue, Appeal AP-********** was received on 09/12/2023 and denied due the plan does not cover services this file was sent to Maximus for an independent review on 10/09/2023, and on 12/12/2023 is the scheduled date for a hearing. **************** requested Evidence of coverage sent: Friday, December 15, 2023, 5:08 PM To: ***********************'.
Customer Answer
Date: 12/20/2023

Complaint: 20900212

I am rejecting this response because: As I stated before, it was covered on September 12, 2022 when procedure began. Due to complications the procedure was not able to be completed by the end of 2022 when the plan apparently changed and I was not notified. Yes, I did have a ALJ hearing on December 12, 2023 for this issue, at which Wellcare did not even attend. However, a decision was made after medical records and testimony was submitted, and the judge found it fully favorable on my part after reviewing everything. Everything this far has been documented with proof thus far by myself, ********* and OMHA. Therefore, Wellcare needs to stop putting people's lives in jeopardy with deception, lack of representation, and lack of responsibility. Also note, Wellcares response to the complaint to ******** on November 21, 2023 says " Spoke with member and all complaints were resolved, and the member had no other concerns". This was a down right lie.

Sincerely,

*********************
Initial Complaint
Date:11/20/2023
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 May 9, 2023 a provider I saw for the first time submitted request for payment. However, they submitted Wellcare ******** Advantage as secondary and my RETIREMENT supplemental insurance Cigna as primary. At this pont Wellcare changed coordination of benefits to Cigna as primary. I have made at least 10 calls with no results. Wellcare insists Cigna is primary. I have spoken with ***** and a rep from ********. Both have assured me Wellcare is primary. Since May 9 Wellcare has denied all claims. One provider has refused to see me until payment is made. I take medications that will not be refilled until this is settled. I am a cancer survivor and still see my oncologist. These claims also have not been paid. I was told on Sept 8 it would take 10 days for the coordination of benefits to be corrected and all claims would be refiled with Wellcare as primary within 30 days. Today after 1.5 hours on the phone I was told again ***** was primary. I was also informed my start date with Wellcare was 7-5-23. Not so. My first day of coverage was 1-1-22, as I turned 65 on 12-31-21. O have a ref #**********. When I reference that my calls I am shuffled between claims/escalation team/excellence center. Nothing has changed. I want this resolved so I can see my providers and resume my medications. I also have been threatened with collections. My Wellcare member ID is ********. We have also emailed Wellcare with no response. When I ask Wellcare why they think Cigna is primary they will not answer or say they do not have access to view or insist that commercial insurance is always primary, even though Cigna is a retirement benefit, not commercial. This has gone on for 7 months and I am at the end of my rope. Please help!
Business Response
Date: 12/04/2023
Hello and Good Afternoon, Contact was made with ************************** today and she has been informed we have updated our systems to reflect WellCare as primary. We apologize for the dissatisfaction you've experienced. Thank you.
Customer Answer
Date: 12/05/2023

Complaint: 20887467

I am rejecting this response because: although I have spoken with the *************** I was informed that it will take some time for the claims to be paid. I will be satisfied once this has happened and I see the results, In the meantime I have paid one claim myself to the provider to avoid collections.

Sincerely,

*********************************
Business Response
Date: 12/06/2023
Hello and Good Morning,
We absolutely understand the reasoning for your rejection and thank you for your patience and communication with us. We again apologize for the dissatisfaction you've experienced.
Thank you,
****************
Customer Answer
Date: 12/06/2023

Complaint: 20887467

I am rejecting this response because: I wish for this case to be kept open until I have confirmation all claims have been paid. I appreciate the response from Wellcare, but I want to be sure all claims are processed and paid before this case is closed.

Sincerely,

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

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