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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

    • 375 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:08/04/2023

      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.
      This company is harassing not only me but other people by calling all the time and non stop. I feel bad for the others and myself having to deal with calls about you need to do this we said so.This company has been told by myself to stop the harassment on calling. I signed a piece of paper by them stating not to contact me by phone because of their behavior on harassment. If they are to contact me it will be by mail only. I have also contacted Social security about this and my Governor

      Business Response

      Date: 08/16/2023

      ****************** desired resolution is no further contact by the business - We will not be making outreach to prevent further abrasion. Thank you.
    • Initial Complaint

      Date:08/04/2023

      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 been diagnosed with Osteoarthritis and have been receiving medical treatment from an Orthopedic specialist for years. Recently the orthopedist I was seeing left the practice at OSF *************** of **** Hospital. I have aggressively attempted to find another doctor who would accept WellCare insurance to no avail. I have made numerous requests to **************** for other referrals. This has been going on for almost 2 months and still nothing. I receive calls from them almost daily with apologies for the inconvenience but no credible referrals. The referrals that have provided during this time have been useless. Either the doctor does not accept the insurance or the information is outdated. I am 73 years old, retired and receiving Social Security. I am in pain and cannot afford to pay a doctor out of pocket. While I definitely plan to change insurance providers at the next enrollment period, I will still not be able to attempt to secure another doctor until January.

      Business Response

      Date: 08/18/2023

      Good afternoon, 

        This case is currently under review, We have partnered with our case management team. The member has been contacted and currently working on assisting the member locate a provider to fit their medical needs. Once we have received full resolution I will be sure to submit feedback. 

      Thank you

      Customer Answer

      Date: 08/22/2023

       
      Complaint: 20421471

      I am rejecting this response because:
      I have received a letter by mail dated August 8, 2023. The letter erroneously states that  requested that the grievance be withdrawn which is an out and out lie. It goes on to say I refused to talk about the grievance since it was nonsense (also a lie) and that for this reason the grievance would be closed. However on Tuesday morning I received a call informing me the case was been turned over to Case Management. This is the third time I have been told this with no results. I reminded the caller that we are going into week 9 and I am still on pain with no orthopedic doctor. Clearly there is no communication between persons or departments. 
      The issue is not resolved and I am not closing my complaint. 
      Sincerely,

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

      Business Response

      Date: 08/22/2023

      Good afternoon,

         This case has been reviewed and escalated, the member has been contacted by a case manager who has provided four offices and phone numbers. and also provided her with mileage with distance, all offices are under 30 minutes from her home.

       

      Thank you 

      Customer Answer

      Date: 08/24/2023

       
      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.

      Sincerely,

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

       

      Thank you !

    • Initial Complaint

      Date:08/03/2023

      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.
      I have had Wellcare Now for prescription coverage for several months. I HATE IT. My member id# is ******** and the issuer # is 80840.Today - 8/2/23 - I planned on going to ******* to pick up several prescriptions but this morning their pharmacy called. They said I can't use my drug coverage because ******** thinks that I have ********* which I do not. The pharmacy told me to call ********, which I did. ******** told me to call Wellcare Now. Wellcare Now told me that my doctor - who I'm getting ready to fire because of negligence - has to sign a certain form before this can be fixed. This means I will not get my medicine at all because she's been known to keep me waiting in the past for months on end.i was forced to cancel the bus I reserved and never got my prescriptions. I have multiple health problems, some of which are quite serious, and it is unfair of Wellcare Now to give me such a hard time over this. I could scream! They're using red tape to stop me from using insurance that I'm legally entitled to have!I MUST have those prescriptions in my hands by Friday, which gives Wellcare Now a little less than two days to sort this out . I NEED MY MEDICINE NOW.

      Business Response

      Date: 08/16/2023

      Good afternoon, 

        This case has been reviewed, Our pharmacy team has determined the denial was correct due to medication being used in a nebulizer. A nebulizer is a piece of durable medical equipment (DME). Drugs used with DME in the home are covered under ******** Part ** Our records show that the member does not live in a long-term care (LTC) facility. We cannot pay for drugs under ******** Part D if they are covered under ******** Part A or ** The Member has not cooperated with further information and several outreach attempts were made,the member disconnected during introduction. The review was conducted with the information provided in the complaint.

       

      Thank you 

    • Initial Complaint

      Date:08/02/2023

      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.
      As a small business owner and mental healthcare provider, I received a letter in the mail from Wellcare to my office indicating that I had been enrolled in their insurance system. I called to inform them that I had not applied to be a provider under their insurance, and that I would like to be removed from their database. They informed me that in order to be removed, I would need to provide a call back phone number that my "local contact" could call me back on. I asked for the local representative's name and phone number instead and they would not provide it to me. I heard people laughing loudly in the background of the customer service call which made me suspicious that this company was a scam. At very least, I would like them to remove me from all of their databases.

      Business Response

      Date: 08/21/2023

      Hello,
      The plan has terminated the provider ID: ******* in our systems. The provider signed a contract in May for all ******** Product Types and that includes DSNP, MAPD,PPO, and Wellcare. Since the provider received the contract and returned it signed, the plan was not aware the provider was not wanting to participate in Wellcare. The plan has taken the necessary steps to term the MA portion of the contract per the providers request and remove her from the MA find a provider website.
    • Initial Complaint

      Date:07/14/2023

      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 called WellCare about a issue of mines but WellCare hasnt been able to solve my issue about my medication and I need help in getting my issue resolved with WellCare.

      Business Response

      Date: 07/20/2023

      We have assisted ************** in switching to mail order. After contacting CVS, and his current Pharmacy ******** ******* Pharmacy stated that his particular prescription was on back order for the remaining box however two boxes were already dispensed. Once the back order is available ************** will be contacted by the ******* Pharmacy. ************** agreed that it mail orders would be beneficial. We have assisted ************** with the process of mail order.  

      Customer Answer

      Date: 08/14/2023

      Complaint:

      Hello, I been have a ongoing issue with WellCare I file a complaint . I was contacted by a representative name **** and I was given her number to call her with any questions and concerns. I reached out to **** several times because my issues has not been resolved and i havent gotten not one returned phone call from ****. I need someone that will resolve my issue and concerns and not just make one call to me and stop responding and assume the issue is resolved. Im

       

      Desired Resolution:

      Contact by the business

      Business Response

      Date: 08/14/2023

      Hello, Wellcare has fulfilled the issue as discussed on 7/18/23: ************** confirmed that he has the medication needed which is ******* however he was prescribed 3 boxes for a 90day supply and was only dispensed two (2) boxes as ******* Pharmacy stated the remaining is in back order due to shortage. We conferenced call ******* Pharmacy at ************ spoke with **** who confirmed that ************** does have one more box remaining, she confirmed that there is a shortage for this specific medication and once received they will contact him for the remaining box. ************** inquired about mail order and he was advised if he wishes to have mail order we can contact CVS and he agreed. We conferenced CVS mail order,confirmed they are able to set up mail order if he wishes, then explained how mail order works prior to ************** advising it would be beneficial to him. They shared, they will fax the request to his provider to obtain the next prescription for ******* and mail order will be started. ************** agreed, was thankful, and had no further concerns at the time.

      This concern has been resolved and closed based on this interaction on 7/18/23.

      Customer Answer

      Date: 08/14/2023

       
      Complaint: 20321840

      I am rejecting this response because:

      Sincerely,

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

      This was not fulfilled **** didnt at all complete what she was supposed to do I see now that wellcare doesnt appreciate my business or me as a customer so I need to explore my options this is a pitiful excuse for a company.

      Customer Answer

      Date: 08/18/2023

      I have contacted WellCare a few times because Im unable to get my meds. I need someone from the **************** to contact me and not that **** lady because she lied like she complete what she was supposed to do and she didnt. Im having issues getting my meds that I need and no one from Corporate seems to care aslong as they are getting their monthly premium from me. I need someone to call me ASAP so I can get this matter taken care of if not I need to go further and contact the insurance commissioner because this is ridiculous that my issue hasnt yet been resolved.

      Customer Answer

      Date: 08/28/2023

      I called to check the status of my order and the recording said I would have my meds from August *****, 2023. I checked the app today and saw something different August 25 it will be shipped. I informed CVS Caremark that my meds need to be in my hand no later than next Friday because I will be moving and asked could I pick it up and I was given the runaround. I need someone from Corp to call me ASAP so we can come up with a solution so I can have my meds in time.

      Business Response

      Date: 08/29/2023

      Hello,
      The plan has spoken with ************** where he shared his concern and frustration with the previous agent: ****. He shared his need for his medication and was informed the medication wasnt available until the appropriate fill date of 8/25/23. Due to the shortage at ******* pharmacy, there was only 1 box available, but was on a first-come-first-serve basis. He was informed, contact had been made with CVS Caremark who was willing to complete the mail-order of the medication with the understanding the processing time is 1-2 days, then the medication is sent out the following business day. We specifically spoke with the agent: DG who confirmed the medication should be received some time this week, possibly Tuesday or Wednesday. It was recommended to ************** to reach back out via this BBB complaint if he runs into any issues related to this. If the medication isnt there by Wednesday, he should follow-up initially with CVS Caremark to check the status and if there are issues, rebuttal his BBB complaint.

      I hope this time around, we were able to fulfill his request.

      Customer Answer

      Date: 08/29/2023

       
      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:07/12/2023

      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.
      ******** member id ********************** provided dental insurance cannot find provider. Multiple attempts contacted supervisor and not getting help. I would like wellcare to provide thru their dental policy a dentist who will provide denture service and accept the insurance they provide

      Business Response

      Date: 07/20/2023

      Today we were able to obtain resolution for ******************** concerns, we assisted *** ****** in locating a participating provider near his area that can service his needs. The provider has been confirmed that accepts his plan and new patients. Call investigations are being conducted to ensure quality service. At this time **************** did not have further concerns. It was my pleasure assisting ****************.

      Customer Answer

      Date: 07/20/2023

       
      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:07/11/2023

      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.
      This complaint is in regard to my ******** ******** prescription drug plan with Wellcare and trying to receive a refund for unused premium due to is death. In a letter we received dated April 20, 2023 Wellcare of *****, ** expressed their condolences for the passing of our father, who passed on 4/11/23. Their letter stated that his plan ended as of 4/30/23 and if any premiums were paid for any month after 4/30/23, they would issue a refund to the estate within 30 days from the date of their letter. Our father paid a year's premium on January 19, 2023 in the amount of $855.60. That is $71.30/month. We believe the reimbursement should be for ****December - approx 8 months x $71.30 = $570.40. Between my wife and I, we have made approximately 10 phone calls (and many many prompts before you can get to a person who can begin to help) and all we got is no one resolving the issue. Calls are directed to a foreign country. We now ask for a supervisor in ***************** and those calls are better but even after speaking with 4 of those supervisors on 5/25, 6/29, 6/30, 7/10 and 7/11 we have had no results. We've been given two different ticket numbers but all they do is indicate the file is in review. This is an absolutely horrible way of doing business especially when we're dealing with the sadness of a death in the family. We have not had any difficulty being reimbursed by any of my ******** other companies who owe money. Only Wellcare doesn't seem to care. I am attaching a copy of Wellcare's letter and proof of our payment on our *********** credit card. We even provided Wellcare with a copy of our Father's Will showing I am the Executor of the estate. Please help us get our money back. Thank you. *********************

      Business Response

      Date: 07/25/2023

      Good afternoon,

        This case has been revived and our Billing team has confirmed reimbursement was issued on 5/1/23. We have been in contact with the complainant and was able to confirm this via the member's Credit Card statement and states issues have been resolved.

       

       

      Thank you

      Customer Answer

      Date: 07/25/2023

       
      Better Business Bureau:

      We have heard from Wellcare and our issue has been resolved to our satisfaction.  Thank you for your help. 

      *********************
    • Initial Complaint

      Date:07/10/2023

      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, *************************, am PofA for my dad's healthcare needs.Nov '22 - initiated chronic meal delivery for my dad (Chei-Long Tsai) thru Mom's Meals. The benefit is paid for by Wellcare insurance. Since it was the end of the year he only received a fraction of the 252 meals allowed per year. Jan '23 - Wellcare insurance/Mom's meals granted an extension for the remainder of '22s meal benefit. My dad received a few deliveries in Jan '23 as part of the '22 extension (all meals from the 2022 benefit). It became too much for my parents because my mom was receiving Mom's meals deliveries at this time to their shared household. I called and put my dads account on hold in mid Jan, '23. My plan was to exhaust my mom's meal benefit, which was to happen July 31, '23, and then begin my dad's deliveries. Mom's meals account notes confirm the deliveries in Jan '22 were from '22 benefit and do not affect '23 eligibility.July 5, '23 - I call Wellcare to request an authorization to begin my dad's meal delivery, and am told an authorization was sent in February (I did not request this authorization for '23 meals). Mom's meals claims they systems shows meals sent between 2/23 and 5/4. NO Meals were delivered to my dad's during those dates nor did I receive a single phone call from Mom's meals or Wellcare regarding the alleged authorization, or to ask me what meals we would like, or to confirm any delivery times/dates. Yet, ***'s meals insists they happened. This must be a computer glitch on their end. July 8, 2023 - ********************************* at Mom's meals confirms my dad's account was on hold, and should have gone into inactive status after 3 months, at which time a new authorization would be required. Seems they may have gotten another authorization from Wellcare somehow, but it was not requested by me.My dad is still owed 252 meals for his chronic meal benefit for '23. Please work with them to correct this error & send a new authorization for his 2023 benefit.

      Business Response

      Date: 07/19/2023

      The members meals have been set appropriately: CHEI-LONG TSAI meal deliveries are to begin 8/15/23 and end on 12/19/23 totaling 10 deliveries/ FU *************** meal deliveries will end on 7/31/23 exhausting her plan benefits for the year. The *** and members have been made aware and made whole.

      Customer Answer

      Date: 07/26/2023


      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,

      Chei-long Tsai
    • Initial Complaint

      Date:07/03/2023

      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.
      On 06/22/2023 I called Wellcare because I have a lawsuit with the **** company that caused my deceased husband's Kidney Cancer. I needed claims and the name of the company that provided Wellcare used as their **** provider at the time. This would have been between Oct 2013- June 2015. ******* who answered the call tried to take me around the mulberry **** and then refused to assist me. I am a licensed agent which I also stated to ******* which means I could have taken my complaint straight to the department of insurance which could cause a lot of problems.

      Business Response

      Date: 07/06/2023

      Today we spoke with **************** and provided her with the contact information for the DME provider. The DME provider in question is not contracted with the plan as they are non-participating providers. **************** will contact them directly to request invoices. No further actions to be taken at this time.

      Customer Answer

      Date: 07/06/2023

       
      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:06/29/2023

      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.
      Member ID: ******** I paid the year in full and ended up canceling in March. I had called to get the difference refunded. WellCare stated that they had sent me out a check on 3/16/23, which I have never received. I asked if they can check what date the check was cashed and they said You shouldve received it by 4/19/2023. That doesnt answer my question. I have since then called 6 times and each time their account supervisor says that the amount will be deposited into the checking account from which it was initially taken out of. None of my statements have shown a credit from them. They tell you that you have to wait 1-2 business days for the billing **** to contact you and that theres no way to call them yourself. I am not always able to get to my phone and I asked what happens when I miss the call, to which they replied try not to miss the call. Well that doesnt help. I am tired of constantly having to call only for them to tell me the same thing. At this point, it is as if theyll do anything to not give me my refund back.

      Business Response

      Date: 07/03/2023

      Member Made a payment of $141.60 on 1/21/2023. The member was sent a refund check # ********** dated 03/24/2023 in the amount of $118.00. Refund check was cashed on 4/17/2023. In addition, Member had a monthly late enrollment penalty (LEP) of .70 cents. Member account was updated on 5/09/2023 showing the member no longer has a monthly LEP. Updated on the account can take up to 1 -02 billing cycles to reflect the updates. After updates the member had a credit of $1.40. This has been refunded back to his checking ending in 5662.

      Customer Answer

      Date: 07/05/2023

       
      Complaint: 20252256

      I am rejecting this response because:

      I never received the check. I have asked multiple times for them to tell me the name of the bank that it was deposited in  and all they tell me is that billing will get back to me, which they never did. I do not see the check deposited into any of my accounts. Unless they can provide me proof that the check was sent out and can tell me which bank it was cashed at, I do not believe they sent me the check in the first place.


      Sincerely,

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

      Business Response

      Date: 07/10/2023

      We have attached the copies of the cashed check in the amount of $118.00 for your review.

      Customer Answer

      Date: 07/10/2023

       
      Complaint: 20252256

      I am rejecting this response because:

      I have never had an account at this bank. This bank does not have a location where I live.  I also do not see my signature on the back of the check. I do not believe that this is the check that was sent to me. May I see the front of it? 

       


      Sincerely,

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

      Business Response

      Date: 07/11/2023

      Hello, I have attached the front of the check. I will reach back out to that department to verify the next step.

       

      Customer Answer

      Date: 07/11/2023

       
      Complaint: 20252256

      I am rejecting this response because:
      Thank you for your assistance. Unfortunately I have never seen this check. I also did not receive a deposit of $1.40 to the account ending in **** as of July 7. 2023. I would greatly appreciate it if I could get the $118.00 back into my **** account, as Ive been trying to resolve this issue since March. Please and thank you.

      Sincerely,

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

      Business Response

      Date: 07/12/2023

      We have forwarded the payment information to our Special Investigation Unit for review. I will provide further information once a resolution is reached. Thank you for your patience.

       

      Business Response

      Date: 07/25/2023

      According to our conversation with ********** on July 24, 2023 we advised, per the review of our Special Investigation Unit (SIU) we were informed that you would need to file a police report with your local Police Department or the **** to handle the theft of the check. our records show that check# ********** dated 03/24/2023 in the amount of $118.00 was cashed. We confirmed that the address we have on file is the correct address. Thank you.

      Customer Answer

      Date: 07/25/2023

       
      Complaint: 20252256

      I am rejecting this response because:

      I do not feel that it should be my responsibility to file a police report. It should be the responsibility of the company to communicate with the banks to get the money back. I have been trying to communicate with someone about this issue for around 3 months and WellCare has kept insisting that they would send another check or deposit the $118.00 back into my checking account, which was obviously a lie. I will escalate this higher if need be and take legal action. 

       

       


      Sincerely,

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

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