Business Profile

HMOs

WellCare Health Plans, Inc.

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Complaints

This profile includes complaints for WellCare Health Plans, Inc.'s headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

378 total complaints in the last 3 years.
104 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:10/30/2023
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.
For a 6-27-23 home visit from Wellcare was promised a $100 **** gift card in "about a month." When I still hadn't received it 8-16-23 I called & talked to ***************************, she said it was "no doubt on its way." When still had not received 9-6-23 I called & talked to Crystal **** #I *********), who said I should call back if it still hadn't come in a couple weeks. On 9-27-23 It still hadn't come - I called and talked to April who said she'd have her boss (something like "*******") call me. She never did. Around Oct. 7 I received a letter saying a $100 **** gift card was enclosed, except it was a ******* card which won't pay for the things I'd budgeted for. and which has no value to me. I have tried nine times to call their ************ # but it always disconnects right after saying to leave my name and phone #. I am pursuing this with the BBB because something similar happened last year and I ended up never getting anything. They have led me on a time-consuming wild goose chase and it is aggravating enough that I am going to continue to pursue this until I get some kind of satisfaction.
Business Response
Date: 09/04/2024
We have thoroughly reviewed the complaint and escalated the matter to our vendor contact, *************************. After careful consideration, it was determined that we are unable to provide a **** gift card due to CMS guidelines, which prohibit us from offering monetary value gift cards as incentives to our members.
The plan has also confirmed that we have communicated with the vendor to ensure that any future correspondence accompanying gift cards will no longer mention **** to prevent any confusion.
To resolve this issue, we have provided the member with a $100 ******* gift card as an alternative. We trust this addresses the concern and appreciate your assistance in facilitating this resolution.
Initial Complaint
Date:10/25/2023
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.
This company is the absolute worst I have ever dealt with!! No one seems to know what they are talking about and I never get anything resolved !! Every time I call I get a a different answer! This is my ******** prescription as part D and it's useless.
Business Response
Date: 11/03/2023
Hello *******,
We received your review regarding the health plan. To further research your case, we need more information. Please contact my department at ************ and reference case number PRC-12229.
Thank you,
Initial Complaint
Date:10/24/2023
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.
WellCare issued us a reimbursement check and made it payable to my father's estate. My father didnt have a living trust bec he didnt have any assets when he passed. My mother is the sole heir. I am the daughter and also my mother's POA. I had called/emailed/wrote letters multiple times to get the check reissued to my mother's name to no avail. I had asked the insurance agent to help us but it is also not getting anywhere. The check was dated Aug 2022 and it is now Oct 2023 and WellCare hasnt reissued the check. I had provided all documents multiple times and those had fallen onto deaf ears. Per CA Law, if decedent's estate is less than $184,500, the affidavit signed by the heir is sufficient doc so the asset can be released. I am attaching the signed/notarized POA, the signed/notarized small estate affidavit, as well as self-help packet re ********** small estate affidavit. I actually just got off the phone w WellCare and customer service wont transfer me to billing without getting supervisor approval. I had made two phone calls and transferred 4 times and spent a total of 1 1/2 hours with WellCare just right now and I wasnt able to get to billing because by the time i finished telling them my issue and they eventually transferred me to billing - billing is already closed for the day. I need the check reissued to my mothers name.
Business Response
Date: 11/07/2023
Hello and Good Morning, Contact has been made with ****** and she has been informed the check was reissued. We will keep her case open until check is received, she has my contact information for follow up. Thank you!
Customer Answer
Date: 11/07/2023

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. ****** was very helpful and prompt. I didn't have to submit any additional information.
Thank you very much BBB for your assistance in this matter. After about 1 1/2 years of back and forth with various WellCare reps, my case has finally been resolved.

Sincerely,

*******************************
Initial Complaint
Date:10/23/2023
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.
My insurance plan has a healthy rewards program that issues gift cards for completed activities. In September of 2023 I completed an activity, but it showed as 50% completed so I called to find out why and was told I had to wait on insurance to verify it. I tried logging back in and it showed an error. I then called to have it corrected but was told I no longer qualified for healthy rewards and to call my agent. On October 20,2023 I spoke with customer service and was put on hold several times finally to be transferred back to healthy rewards to be told once again I was terminated on September 29. I dont care if I dont get any rewards but I was never notified that they no longer have the program. Also why did it come up online when I logged in if it was no longer available. No one can tell me why they just keep transferring me. I also have to try several times to get logged into the website because it just runs on a gray screen for several days before it allows you to login.Im not happy with it Wellcare anymore an plan to find another provider for the upcoming year. Im very dissatisfied with their service. My member Id ********
Business Response
Date: 10/25/2023
Hello and Good Afternoon, We have made multiple outreach in efforts of assisting but have been unsuccessful and left messages. Please return my call as additional details are needed to reach resolution. Thank you.
Initial Complaint
Date:10/12/2023
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 husband paid a year of premiums to Wellcare for his ********** He passed away March 29, 2023 of Covid. I have tried over and over to get a refund from Wellcare for the balance of his premiums from April - Dec. and they refuse to refund me. They keep putting me off.They say they never received the documents, I have sent them numerous times everything they required. Death cert. birth cert. marriage cert. etc. I even went to an Attorney for an Affidavit to get them to pay me -proving to them I am his wife and they need to refund me. (I cannot find our Will). The Attorney has a copy, but we cannot file the copy, They send my attorney a letter stating "it was resolved"I still have not received a refund from them to this day.They have caused me such anxiety and stress- I can no longer talk to them, All they do is lie.I know it is not a lot of money, but it is the right thing to do. What if they do this to all the elderly that purchase this insurance? Can you image how much money they are keeping from us?It just saddens me to think that all I am going through and then I have to deal with this.I don't know if you can help me. But I know the BBB can look into these companies and maybe make them take care of this. Thank you *********************** ************ Wellcare; PO BOX ***** ***** ** 33161-3370 His ID#********
Business Response
Date: 10/26/2023
Good afternoon,
This case has been reviewed, Previous note on file indicated that refund for $72.90 was processed on 4/19/2023 to the members account. Outreach was made to the complainant who contacted her bank while on the phone with me and confirmed payment was received and all issues have been addressed.

Thank you
Initial Complaint
Date:10/12/2023
Type:Sales and Advertising Issues
Status:
UnresolvedMore 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 (tel. **************) entices Seniors to join their Med Advantage Plan claiming that they will be rewarded with gift cards for completing various annual health activities. I have completed the Annual Physical Exam as well as the Annual Colon Cancer Screening (FIT TEST) on 3/9/23 and they and their Healthy Rewards Vendor, Healthmine (tel. **************) take down my numerous complaints and Grievances but either never answer my inquiries or disconnect my calls. I believe they are cheating Seniors and would like them to discontinue their False Claims!Sincerely *********************** Member ID *********
Business Response
Date: 10/26/2023
The issue has been forwarded to the vendor manager for review. thank you
Customer Answer
Date: 10/26/2023

Complaint: 20725395

I am rejecting this response because: This matter involves my wife (*******************, dob 4/8/53) and myself. We have completed 2 of the Healthy Rewards activities 7 mos. ago and still haven't received our "Healthy Rewards" gift cards.

Sincerely,

*********************
*******************
Business Response
Date: 10/27/2023
The member was updated this morning, thank you
Customer Answer
Date: 10/27/2023

Complaint: 20725395

I am rejecting this response because:
I still have not received earned gift cards.

Sincerely,

*************************, PhD
Business Response
Date: 11/01/2023
the member advised he hasnt tried to redeem the gift cards as of today, he will let me know via email when they do.
Customer Answer
Date: 11/01/2023

Complaint: 20725395

I am rejecting this response because: Healthmine's web site continues to show erroneous information about claims for me and my wife. They fail to notify Wellcare, their principal, about why the site isn't functioning properly nor do they answer the numerous complaints which I have sent to them. The e-mail with the supposed links to download the gift cards doesn't work properly and is extremely difficult to navigate. Wellcare informed me that they are trying to correct these problems but so far, they remain unresolved.
Much thanks to the BBB for trying to help me resolve these issues!

Sincerely,

*************************, PhD
Initial Complaint
Date:10/10/2023
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.
In 07/2023, WellCare stop providing transportation for medical appointments. My appointments are crucial to my recovery because I couldnt drive and family members used their available time to take me. Ive escalated through WellCare with no success and no return calls. Then I filed a complaints with ******** that trigger a call from WellCare just to say they contacted me. In the meantime, *** missed over a dozen appointments and physical therapy sessions. Due to WellCare non action, my health and quality of life suffers with limited mobility. WellCare uses enrollment time to lure ******** recipients to their plan. Once the recipient enrolls, theyll have to wait until the next year to change. Therefore, if they evaluate their members needs during plan year, additional transportation service should be provided. Its now October 10, 2023 without a resolution and missing life-threatening appointments.
Business Response
Date: 10/23/2023
Hello and Good Afternoon, This matter was escalated to our Care Management team for assistance. ************************ has been educated in her health plan benefit and encouraged to review **** health plan options during open enrollment to see if she may be able to select a different Wellcare plan for next year that offers additional or unlimited rides. Thank you.
Initial Complaint
Date:09/28/2023
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.
My 91 year old mom, with dementia, was released from the hospital on 8/11/23. It is now 9/28/23, and we have been trying for 6 weeks now to get her a home health aide. This Wellcare Giveback Open plan clearly states they will provide an in-network home health aide for up to 35 hours per week. This is FRAUD. First you need an authorization which they claim to have faxed to the doctors office. Once they receive the authorization back, it will take 2 weeks to process. On 9/11/23, we change her Primary doctor to an in-network doctor listed on their portal. Call the new doctors office to make an appointment and they tell me they do not accept Wellcare. WHAT??? On 9/14/23, a Wellcare representative gives me the name of 2 agencies where we can get a home health aide. We call both agencies, and they DO NOT provide home health aides. On 9/15/23, a Wellcare representative tells us we need an in home supportive care agency. We print the names of 5 agencies from their portal. 4 of the 5 agencies never heard of and/or do not accept Wellcare. We could not reach the 5th agency. If this isnt FRAUD, then we do not know what FRAUD is. Wellcare is the WORST insurance company we have ever dealt with. I finally tell them that I will file a complaint and now they are going to escalate this to an even higher ESCALATION TEAM. Really?? Two hours later I have a voicemail from ***** from the Research and Resolution Team about my reference #**********. She does not leave a call back number, and when I call the number that she called from, the number you are trying to call is NOT IN SERVICE. Again, WHAT ?? I call their HQ in ***** ************ listed on their website, the phone does not ring and I am automatically disconnected. Every complaint posted about Wellcare is valid. They should be banned as an insurance company. Only saving ***** is Open Enrollment where we can get rid of Wellcare FOREVER.
Customer Answer
Date: 09/28/2023
Attached is HIPAA and other information requested
Business Response
Date: 10/12/2023
Good afternoon,
We apologize for your dissatisfaction with the plan, this case has been reviewed. Case management has confirmed the member does not qualify for skilled needs for home health aide, the member needs are custodial. Home health agencies do not provide daily aide service, nor do they provide several hours a day. Agency on aging would provide in home aide services for personal care, housekeeping, respite, supplies, waiver program etc. and can provide the services the daughter is looking for. Reps have explained this to the daughter and provided the daughter the phone number to call *********** on aging.

Thank you
Customer Answer
Date: 10/13/2023

Complaint: 20667872

I am rejecting this response because:
1. Then your plan should not specifically state that you provide this service because you DO NOT.
2. Why dont I qualify for skilled nursing services??

Sincerely,

*************************
Business Response
Date: 10/16/2023
Good Morning,
This case has been reviewed and escalated to case management who determined the members needs are custodial and not skilled. Also for skilled services the member must have a physician's order sent to a home health agency for services and the physician must agree to sign all orders from the home health agency which include all the services provided. Most home health agencies do not follow a patient for more than 2-4 weeks and then the services would be discontinued. The member is in need of long term aide services that is provided by the agency on aging. Most home health agencies do not provide an aide more than 1-2 days a week and only for 1 hour each time. The home health agency does not have aide available and member will probably be discharged from the agency soon if not already as dementia is not a skilled need but custodial.
Thank you
Customer Answer
Date: 10/16/2023

Complaint: 20667872

I am rejecting this response because:
I will repeat again that your plan should not specifically state that you provide up to 35 hours per week of a home health aide. Your plan provides no such services.
And secondly, I did submit a doctors authorization that a home health aide would be required. So after all we have been through, for the response to be that there was no doctors authorization, is just another slap in the face that WellCare obviously has not taken the time to thoroughly review my case.

Sincerely,

*************************
Initial Complaint
Date:09/27/2023
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 been trying to create an online account since September 4, 2023. The system cannot match my credentials to my member ID even though I have a Wellcare account. I called several times and they created multiple "tickets" for escalation to a supervisor. No one has contacted me to correct what they claim is a "known" error in their new system. It is very frustrating because every time I call, they make me go through the same series of questions to no avail. Then they tell me that I just have to wait for some indeterminate period of time for a supervisor to contact me. That never happens. I would not use this prescription drug provider again due to exceptionally poor customer service. All I want is to have online access made available to me and they refuse to open it up.
Business Response
Date: 10/11/2023
Good morning,

The plan contacted ********************** member and was unable to log him in. When we get to the last page of the Entry key registration it gives an error stating The information you have entered does not match our records We had also sent a ticket for the issue as well.
We were able to get him into the *** Caremark portal so he would have some access to his Prescriptions. Member is now active in the background system in the WellCare system. The web support team will be reaching out to ********************** to try to gain access to the plan's portal.
Thank you,

Customer Answer
Date: 10/11/2023

Complaint: 20664978

I am rejecting this response because, although they gave me an alternative link to another website (not the plans website), it took about a month for them to give me that alternative AND they still are giving me a run-around about providing me access to the plan. I would be satisfied if they would simply acknowledge that their website technology is failed and they have no idea how to fix it or if they would actually have someone fix it. Instead, I get a message that they are aware of the problem and some unidentified supervisor who no one is allowed to talk to will get back to me in ***** days. As I write this, it is October 11. I started this on September 4. That seems to be more than 14 days by my calendar.

Sincerely,

***************************
Business Response
Date: 10/19/2023
Good afternoon, The Web Support team has contacted the member, and his issue has been resolved. He was able to register and log in yesterday. The member stated he was pleased and no longer required assistance. Thank you.
Customer Answer
Date: 10/24/2023

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.
Thank you for your help as it was instrumental to getting a resolution.
Sincerely,

***************************
Initial Complaint
Date:09/22/2023
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.
Re: In ********* ************************************************************* ID #******** I am appointed representative for my mom. On May 5, 2023, we requested a prepaid hospital bill reimbursement with WellCare Health Plan in *****, Florida. As of today, there has been no resolution other than excuses. I've included an overview below. I have attached a timeline of the events.The last page (9) is not legible; a legible copy was requested and not received, so I need to resubmit.Documents were sent to the wrong department, and I should have filed an appeal and resubmitted the documents to the Appeal Department.Theres no record of me filing an appeal.Lastly, theres no record of the appointment of representatives on file.This is after multiple conversations I had with WellCare; suddenly, they have no record of the appointment.
Business Response
Date: 10/03/2023
Good afternoon,
The plan contacted the complaint **** on 10/03/23 and supplied resolution Member's reimbursement request has been processed. Manual Check dated 9.27.23 was issued to the member. The member should receive their check in ***** business days. If any questions, please contact back the plan and use reference number PRC-12153.
Customer Answer
Date: 10/03/2023

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,

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

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