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Business Profile

HMOs

WellCare Health Plans, Inc.

This business is NOT BBB Accredited.

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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

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WellCare Health Plans, Inc. has 26 locations, listed below.

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    Customer Complaints Summary

    • 378 total complaints in the last 3 years.
    • 104 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.

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    Complaint status

    Complaint type

    • Initial Complaint

      Date:11/20/2023

      Type:Service or Repair Issues
      Status:
      Answered
      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,

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

    • Initial Complaint

      Date:11/20/2023

      Type:Service or Repair Issues
      Status:
      Answered
      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.
      May 2023 I signed up with Wellcare, had to replace UHC, because they weren't paying my doctor's ******* most seniors I have only whatever I'm told over the phone. I stressed the plan mimic UHC's and representative assured me it, Wellcare, had the same benefits.Guess what, not even close. My doctor's ****** has submitted all necessary statements they're required!They're claiming they have NOTHING?If they don't have the benefits I need, I need to change while I'm in the open period!Noone has been able to help me. I've spent weeks playing phone tag, just to get shuffled off to ANOTHER REPRESENTATIVE AGAIN!

      Business Response

      Date: 12/05/2023

      Hello,

      Wellcare has completed it's due diligence regarding this complaint. We have researched the concern and tried to come to a complete resolution; however, we have made multiple attempts to reach this member, to no avail, therefore we were unsuccessful in relaying the information the member needed to come to a conclusion on their end. 

      Thank you,

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

    • Initial Complaint

      Date:11/15/2023

      Type:Customer Service Issues
      Status:
      Answered
      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 refuses to accept that I have full PoA for my mother so I am authorized to cancel her Plan D.

      Customer Answer

      Date: 11/16/2023

      Please explain why you need a copy of the PoA I have for my mother. Your request makes no sense.

      Customer Answer

      Date: 11/16/2023

      Again, this makes no sense. If you had read my complaint, you would understand that I offered to email the PoA immediately to Wellcare, but they refused to let me do that. Also, as Wellcare is well aware, I set this plan up for my mother using the PoA, so they did have a record of it then and have apparently misplaced it. The PoA does not expire until my mother dies. At this point, my authority as a trustee of her estate and executor of her will kicks in. You are making no sense with your requirements. Why would I bother filing this complaint if I did not have the authority to make these decisions for my mother? I do have other things to do with my time.

      Business Response

      Date: 11/30/2023

      Good morning,

          We received your review regarding the health plan. To further research your case, we need more information. Please contact us at ************ and reference case number PRC-*****. We have been unsuccessful locating the member with the information provided. 

      Thank you, 

    • Initial Complaint

      Date:11/13/2023

      Type:Service or Repair Issues
      Status:
      Answered
      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.
      Was given a prescription for medication for sudden, painful back spasms. Recently had lumbar spine surgery.Prescription was for Valium 2 mg. Previously had been on baclofen and also methyl carbon mall. The baclofen apparently is the preferred medicine as dictated by the health plan I was on that for several months and it was number one completely in effective unless I took at least six tablets has a fairly high incidence of dependence probably because you have to take so much. Methyl carbon mall was a good medication but the charge was prohibitive. I could get the medicine for my dogs from the vet for a quarter of the price. Thats ridiculous the volume for this incident only I am in severe pain and they sent the prescription back to the doctors office because theres a prior off needed. This is well care catering to big Pharma . I am still in a lot of pain I still havent gotten the medication Im not going to take a medication that is ineffective. The medical plan does not constitute more authority than the prescribing physician as far as I am concerned I think this practice needs to be stopped

      Business Response

      Date: 11/27/2023

      Good morning, the member was unable to contact regarding the issue, we sent the information provided to our Pharmacy team, they advised , we are not entirely sure what the issue is but regarding the Valium 2 mg (DIAZEPAM) this medication is formulary tier 2 however it does require a ** if 65 years and older. It also has a quantity limit of 120 EA per 30 day(s). As for the METHOCARBAMOL, this medication is formulary and the member's copay has never been more than $16.84.    

    • Initial Complaint

      Date:11/07/2023

      Type:Product Issues
      Status:
      Answered
      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 only wanted information and they said we applied for well care now they are refusing to disenroll me and my wife and are taking money from our SSI check started at $11 and went up to $50 they said because we didn't have previous health care.This has been illegal since 01 01 2019 they owe everyone they charged this fine to since 1 1 2019 their money back.now they are refusing to disenroll us .We have aetna ins and don't want anything to do with well care they are nasty and refuse to work with us we need help .I will contact an attorney if necessary.We just want them to go away and stop harassing us! Any Information on how to handle this will be greatly appreciated! Thank you *********************.

      Business Response

      Date: 11/09/2023

      ********************************  
      My name is *******, we received your review about the health plan. To further research your case, we need more information.  I tried reaching you but was not able to leave a message on voice mail saying it is full. Please contact Desiree at ************ and reference case number PRC-*****.  
      Thank you,  
      *******  

    • Initial Complaint

      Date:11/07/2023

      Type:Product Issues
      Status:
      Answered
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      In May 2023 my pharmacy notified me that Wellcare had cancelled its prescription coverage for my area. They covered my prescriptions (less deductible) through June 2023. I have not received a monthly report from them since July 2023 yet they continue to draft premiums from my bank account. I called them to request reimbursement for the monthly premiums but the request was not responded to perhaps because the person I spoke with was obviously from another country and did not understand. When I asked to cancel my policy for **** she said, "call back next year."!! I would like a refund of the premiums for July through December 2023 and cancel my policy for ****.

      Business Response

      Date: 11/21/2023

      Good afternoon,

         This complaint is still under review, the member was advised at the pharmacy of a rejection and was under the impression her prescription coverage was cancelled. Pharmacy team has determined the pharmacy is no longer contracted and has not processed a paid claim since July. The member will need to use a different pharmacy that is contracted. I was able to find a nearby CVS PHARMACY at *************************************** **********, **. ***** Phone #-************ and was able to process a payable test claim. Pharmacy team was also able to verify EOB's for the month of June that was printed 07/05/2023 and for the month of July that was printed 08/08/23. If member did not receive either of those or would like them, a request can be made for a reprint.

       Thank you 

      Customer Answer

      Date: 11/22/2023

       
      Complaint: 20835934

      I am rejecting this response because:  Wellcare covered my prescriptions for the first 6 months then withdrew all coverage yet continued to deduct premiums from my account.

      Sincerely,

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

      Business Response

      Date: 11/29/2023

      Good morning, 

        This case is currently under review, we have been unable to establish contact with the member a total of 6 attempts have been made via phone call. The member research has concluded, revealing their drug prescription plan remains active; however, it's important to note that the pharmacy the member is using is currently no longer under contract. The pharmacy is not receiving approved transactions under the members WellCare plan and is processing transactions via another party which is why copays' have changed and he has not received any EOB for the months in question. Please feel free to contact us back via phone call regarding your open case to further explain details regarding your **** disenrollment request. 

      Thank you,

      Customer Answer

      Date: 12/07/2023

       
      Complaint: 20835934

      I am rejecting this response because:  Wellcare claims they have tried to contact me 6 times by phone yet my phone does not support  that statement. Perhaps U.S. Mail may be be a better choice.  My pharmacy is no longer submitting claims to Wellcare because Wellcare pulled their contract with them. Reason unknown.  Perhaps it is to force me to transfer my prescriptions to a pharmacy Welcare has an interest in. Additionally, my prescription claims were NOT submitted to another source, I have had to absorb the full cost of all my prescriptions.  I have not receive a monthly statement yet Wellcare continues to deduct funds from my bank account.   

      Sincerely,

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

    • Initial Complaint

      Date:11/07/2023

      Type:Product Issues
      Status:
      Answered
      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 became a Wellcare Prescription Drug Plan client in August 2023. On 09/25/23 I contacted customer service to report I'm unable to log into my account. After going through the IT troubleshooting, the issue was not resolved. I was told this issue would be escalated - reference #**********. 09/27/23 I called after hearing nothing back. On 10/04/23 I called again - reference #**********. I received a generic email from web support instructing me to take steps that had already been taken to attempt to resolve the issue. 10/21/23 I filed an online inquiry to attempt to resolve the issue - never received a response. It is now 11/07/23 and this issue has not been resolved and I can't reach anyone who can provide a solution to this. So I'm reaching out here hoping someone will respond and act.

      Business Response

      Date: 11/21/2023

      Good afternoon,

         This case is currently under review, Websupport team has been added to to the case and currently attempting to make outreach to the member to advise troubleshooting attempts. 

       

      Thank you 

      Customer Answer

      Date: 11/22/2023

       
      Complaint: 20835566

      I am rejecting this response because: this issue has not yet been resolved. I am now receiving error messages when attempting to log in. While I've been contacted by the business, no one has resolved this issue. Tech support is still stating to try the original troubleshooting methods that did not work before. I can log in to my husband's account using the same computer and browser with no problem, so this issue is on Wellcare's side.

      Sincerely,

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

      Business Response

      Date: 11/29/2023

      Good morning, 

         This case is currently under review, this issue was escalated to our web support team who has reached out to the member and despite three attempts they have been unable to establish contact. I was able to make contact with the member yesterday on 11/28/2023 and in response to the members request, web support will attempt to make contact again today at 12:30PM. 

      Thank you 

      Customer Answer

      Date: 11/29/2023

       
      Complaint: 20835566

      I am rejecting this response because: although an appointment was made for a call on 11/29/23 at 12:30 pm, no one did in fact contact me. I called tech support at 1:00 pm to attempt to reach the technician and could not be put in touch with them.

      Sincerely,

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

      Business Response

      Date: 12/18/2023

      Good morning,

         This case is still currently under review, contact has been made with the member with both myself and our web support team. The members issue is still being addressed and her ticket remains open until final resolution. Complainant has been updated and is awaiting for web support investigation to be concluded regarding her issue logging into the website portal. 

       

      Thank you 

      Customer Answer

      Date: 12/18/2023

       
      Complaint: 20835566

      I am rejecting this response because: While contact has been made, the issue remains unresolved after nearly 3 months.

      Sincerely,

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

    • Initial Complaint

      Date:11/07/2023

      Type:Service or Repair Issues
      Status:
      Resolved
      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.
      Trying to login into WellCare's website. Can get the initial login but cannot get past the Add New Account window. My attached documentation includes this info. I have tried for almost 2 months and no success.

      Business Response

      Date: 11/29/2023

      The member was contacted by our web support team and assisted. thank you.   

      Customer Answer

      Date: 11/29/2023

       
      Complaint: 20830430

       

      I am rejecting this response because:

      You may have the 11/17/2023 conversation already.


      11/17/2023 10:50 am ticket ********** ********* (web support person also)
      She said they identified the problem as the dwnafzigere-mail was associted with my wife ****** login.  I explained what I had intially doen and would agree that is probably the problem. ********* will let IT know they can delete Wandas account and then we should be able to enter both as new logins.

      Since I had not received a call in 10 days, I called Wellcare.  See notes below

      11/27/2023 9:00 am ticket ********** - **********
      Took info and used the above ticket (**********). Confirmed our two e-mail addresses, and contact phone number. She is requesting someone call me today and delete the two accounts.

      So, in summary, regardless of what Wellcare has told you, the login problem is NOT resolved, and I am still waiting.

      Thanks for your assistance!

      Sincerely,


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

      Customer Answer

      Date: 01/30/2024

      The problem with login to wellcare has been resolved.

       

      Thanks

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

    • Initial Complaint

      Date:11/01/2023

      Type:Delivery Issues
      Status:
      Answered
      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 get ******** Advantage Plan from Wellcare. I ordered Vitamin B-complex according to OTC. They included items manufactured by CVS only. Unfortunately, they provide B-Complex with Vitamin only. I don't need a Vitamin C but they Wellcare reject to to give a permission for alternative item by competitive manufacturer.

      Business Response

      Date: 11/13/2023

      Good afternoon,  

       

      As reviewing members account there are only two orders placed at our CVS stores for OTC items. 

      1. January 14, 2023, member placed an order for item P126 (aspirin 81mg tablets 200ct) for $10.00.  2. June 23, 2023, member placed an order for item P152 (aspirin 81 tablets 500ct) for $14.00.  

      Only Item V72 and V86 for the Super B complex with vitamin C caplets is in the members OTC plan catalog.

      Member expressed that he simply wanted the Super B complex by itself unfortunately, we don't carry this item, however the catalog for the current year is prepared in advance and reviewed by the health plan before sent for distribution. Though the catalog changes yearly, we are happy to obtain product recommendations from the members to review when creating the product offering for the following year. Member file has been fully documented.     

       

      Thank you,  

      Customer Answer

      Date: 11/13/2023

       
      Complaint: 20810746

      I am rejecting this response because:

      I understand that this item (B-Complex WITHOUT Vitamin C) is not in the catalog.  I understand that Wellcare selected CVS as a OTC provider.  Wellcare doesn't include this item into the catalog because CVS doesn't manufacture this product. 

      I can not take B-Complex WITH Vitamin C by medical reasons.

      Taking into account Vitamins are provided on OTC base and can not be prescribed as a regular medicine if selected manufacturer is not able to provide a required product Wellcare is responsible to select an alternative manufacturer.  By the way all of major pharma gamers provide this product.   Therefore if Wellcare doesn't want to provide a product manufactured by competitors it participate in monopoly scheme and discriminate other medicines' providers.  

      That's it

      Sincerely,

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

    • Initial Complaint

      Date:10/30/2023

      Type:Service or Repair Issues
      Status:
      Resolved
      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 no online access to my health account. ********************** started using entry key id to sign in, but it doesn't work. I have zero access to my health information. I have called and spoken with various wellcare people. No answers whatsoever. They say "oh well" and pass me off to another person, who says same thing. No access for about 3 months now!! I'm fed up. Please help. This is a major health care company and members can't access their own info is not acceptable.

      Business Response

      Date: 11/13/2023

      The member was contacted yesterday by web support(11/06/2023) and able to log into their account with no issue and was assist in resetting the password. Member requires no further assistance.  

      Customer Answer

      Date: 11/13/2023

       
      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,

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

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

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