HMOs
WellCare Health Plans, Inc.This business is NOT BBB Accredited.
Find BBB Accredited Businesses in HMOs.
Complaints
This profile includes complaints for WellCare Health Plans, Inc.'s headquarters and its corporate-owned locations. To view all corporate locations, see
Customer Complaints Summary
- 376 total complaints in the last 3 years.
- 103 complaints closed in the last 12 months.
If you've experienced an issue
Submit a ComplaintThe 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:02/14/2023
Type:Service or Repair IssuesStatus: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 am a member of this ******** drug plan. I am trying to get 2 prescriptions from 2 separate providers covered* 1 I have been trying for almost a year. The first* Lidocaine ointment was denied* the dr tried a preauthorization and it was denied and so I spoke with my pharmacies and the doctor and they said they were told by wellcare that I had to start the process myself* the second is for progesterone* ( I'm not sure they spoke to the dr.) I called Wellcare and the lady said she'd fax the forms to each one. That was on Friday 2/10/23. The same rep * ***** called me on Monday* 2/13/23 at 9:15 pm. I am not even sure why she called but went over the info again then placed me on hold and I was put into a 3 way call with the afterhours emergency staff at the local hospital...which neither of my doctors even belong to. I apologized to the emergency doctor and told the rep from wellcare that it was after 9 on a Monday here and that she would need to wait a few days for them to fill out the forms and return them and that these things should be done during business hours and she should find out if she needs to call me. Due to the language barrier and her confusion about the day and time* I'm thinking she may be out of the U.S. She said when there was no answer at the Dr's office* so she called this hospital. I'm not only confused but trying to find out if steps have even been started to get these prescriptions covered* I deserve an chance to appeal* even if they don't end up getting covered. But I really need them. One is for nerve pain and we have exhausted other avenues* so I'm just in pain for a couple of months now. The other is a hormone for menopause taken with another one* which is covered but doesn't do me any good if I can't get the first hormone covered. Please help* wellcare is a mess* website is a mess* and I need an advocate or something to help me. ** so much! please email me* I am often bedridden so its hard to phone me.Business Response
Date: 02/28/2023
Hello and Good Afternoon, ************** has been in contact with me via email as she is unreachable by phone. Our appeals department made outreach in order to validate the oral appeal but were unsuccessful. We have proceeded with creating a written appeal to prevent any further delays. Please allow time for processing and review. Thank you.Customer Answer
Date: 02/28/2023
Complaint: 19399893
I am rejecting this response because:
The matter is still in process. They are aware of the appeal my doctor started through their online service. They rejected it within hours after it was submitted, not the 3 to 4.5 business days they said the appeal process takes. I will wait for their oral appeal and I hope *************** are given the opportunity to submitt evidence.
Sincerely,
**************
Jenovesia *****Business Response
Date: 03/06/2023
Hello and Good Afternoon,
Pharmacy Appeals received an appeal for both coverage determination and tier exemption for the Lidocaine Ointment under RD cases *********** and ***********. Both cases denials have been upheld on 03/02/2023. Denial for the coverage of Lidocaine Ointment was denied due to the diagnosis. The Progesterone Capsules have been upheld due to the quantity that was being requested being above the Quantity limit for the plan.
Thank you
Customer Answer
Date: 03/08/2023
Complaint: 19399893
I am rejecting this response because:1. I received a letter, (which I believe I've already submitted, but will again if requested), plus a few emails, saying the progesterone was not approved. I have received a refund of previous copay and have already had it filled again. So they are in error, which I have brought this up to them several times but they still say its been denied.
2. Secondly, the lidocaine 5% ointment was denied a second time in error. Once again, my doctor submitted the necessary documentation but this time for lidocaine CREAM 5% which is very different and more likely to be approved by insurance companies. I saw my physician on the 1st of March, WellCare's rejection letters were dated the 2nd of March. Once again giving little attention to the request, and it shows since they got the prescription wrong. Today they sent me 2 letters about the ointment. They sent me an additional letter about lidocaine cream 4%, which is an otc drug. Which they disapproved for that reason. Again, they were in error, my dr requested lidocaine cream 5% not 4%.
I will be emailing Wellcare asking for a new agent to be assigned, I also requested twice, copies of all documentation and online forms sent by my physicians. I want to be sure there is no errors on anyone's part. I also believe I have a right to them. They have not complied. My doctor said they did not word the diagnosis in the manner Wellcare said they did, specifically using the words "polyneuropathy unspecified". As for their lengthy reasoning of denials, I will have to write ******** to verify them. I am confused as to why they sent 2 letters received today, which I will try to upload to you, concerning the ointment each citing different reasons why it was denied. (That was the one we originally asked for and was denied the first time). Since we changed the the prescription to a cream, does this count toward a second appeal? I only have 3 chances to appeal. So I'm going to need help before going through with this last one.
I will be sending them an email also telling them that I am considering contacting the **** here in ******* and the **** of Health and ***** Services. I don't believe my appeals have been handled professionally or given the attention their policies allow and I deserve.
Sincerely,
Jenovesia *****Initial Complaint
Date:02/13/2023
Type:Service or Repair IssuesStatus:ResolvedMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
My primary complaint is that on three different occasions in January, 2023 my prescriptions for three different medications were sent to my old address (11 ************************** in ***** **) instead of my new address at *********************** in *****, **. Ironically my bill was sent to my new address.On Feb. *****, 2023 I contacted WellCare and CVS multiple times in an attempt to resolve this issue without luck given that I am out of medication. While WellCare acknowledged their mistake, they have refused to send these medications to my correct address and are requiring me to wait 90 days for additional medication.Business Response
Date: 02/28/2023
Hello, Contact has been made with ************ to have all matters addressed. We apologize for the inconvenience and are diligently working with our Pharmacy department to reach resolution. Thank you.Customer Answer
Date: 02/28/2023
Complaint: 19388033
I am rejecting this response because the business reply only indicates that they are looking into the matter. They have yet to commit to any specific resolution.
Sincerely,
*******************Business Response
Date: 03/08/2023
Hello, Our research indicates mail order shipments were delivered to the correct address. We have been in communication with Pharmacy to have the proper overrides put in place so we may generate reshipments of her medication. We are currently awaiting tracking information but packages will be shipped expedited. Thank you.Customer Answer
Date: 03/08/2023
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 if WellCare follows through. ( if not we will renew our complaint.)Despite having provided our new address to WellCare on multiple occasions, our address is *****************************************. We look forward to receiving our medications.
Sincerely,
*******************Initial Complaint
Date:02/09/2023
Type:Order IssuesStatus: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 praise on the older generation to give them misguided information regarding their insurance coverage. In the month of December, I signed up for WellCare as a supplemental package which I believe to be working with ******** and not have any issues. Three days later I realized that this was going to impact ******** plan and tried to cancel at which time I sent 17 faxes since then and completed multiple disenrollment forms. I have been hung up on repeatedly as well as lied to about callbacks and when I would have my disenrollment occurring. A plan that took me 10 minutes to sign up for has now taken three weeks for me to try and the disenroll and this plan is currently still ongoing. I feel taken advantage of and lied to and misguided in regards to something as important as my health. They have removed $130 from my account.Business Response
Date: 02/23/2023
after review: MEMBER REQ TO DISENROLL FROM WELLCARE.AS PER REVIEW MEMBER REQUESTED AFTER THE *** DATE AND OBV DATE HENCE MEMBER NEED TO SUBMIT THE WRITTEN DISENROLLMENT LETTER WITH VALID ELECTION PERIOD. PER REVIEW IN OMNI, WE HAVENT RECIEVED ANY DISENROLLMENT LETTER FOR THE MEMBERInitial Complaint
Date:02/07/2023
Type:Service or Repair IssuesStatus:ResolvedMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
My husband passed away 11/20/2022. On 2/7/2023 I get a letter of denial for the ambulance service that took him to the hospital. The letter states and if I don't agree with it I need to file an appeal within 60 days. I called to file the appeal and had to tell my story to 4 different people. The last one told me I could not get any information on this account. I need to find out that the bill was corrected by the provider and was paid by the insurance. I then told her I wanted to speak with her supervisor and she hung up on me. This is a ****** bill and I need to know it was taken care of.Business Response
Date: 02/16/2023
The plan has reached out to member on 2/08/22 @ 11:48, 2/08/22 @ 3:37 pm and 2/08/22 @ 4:07 pm and left detail message advising reaching out in reference to BBB complaint. An unable to contact letter was sent out to ******* on 2/108/23. The plan has not been able to reach member and will close case due to no repones back from complaint. ************** can contact back the plan and discuses this issue ************.Customer Answer
Date: 02/17/2023
Complaint: 19348970
I am rejecting this response because: No one from WellCare has called or left a message. Also thdey did send letter with paperwork for my husband to fill out. How is thaty gonna happen when he passed 11/20/22 and they know that.
Sincerely,
*************************Business Response
Date: 02/20/2023
The plan has a final resolution for complainant: Reviewed claims see the amount state in complaint $905.00 claim #********** showing paid date 12/12/2022 to ****************** EMS when reviewing more there was duplicate claim denial due it was sent twice. No further action needed.Customer Answer
Date: 02/24/2023
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. This is all I wanted. Don't know why I had to involve you. Thank you for your help in this matter.
Sincerely,
*************************Initial Complaint
Date:02/07/2023
Type:Product IssuesStatus: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.
Social Security Check Deductions for 2022 and 2023 Wellcare confirms that I had Value Script Account since ******* 1,2022. SSA deduction was not set up since 2022.Wellcare ValueScript plan paid for in Full on ******* 14, 2022, amounting to $127.20 for the entire year, since my monthly payments in 2022 was $10.60 month.Social Security took out $68.90 per month, total of $826.80 for the year, deducted each month named ******** Prescription Drug Plan (Wellcare ******** RX Value Plus (PDP)Request Refund for $826.80 for 2022.I was told you cant be paying for two plans at once.This year, 2023, it started same thing.Paid for my Wellcare ValuePlus Plan in Full in ******* 12,2023 Total $90.00 yr/$7.50 month Social Securtiy took $71.40 month out of my check in ******* and continuing thru 2023.This Charge is the amount for the Wellcare ******** RX Value Plus Plan for 2023, same plan I was charged for all of 2022. Want to stop this deduction from coming out all this year.I check with Wellcare and ******** and both said that Social Security is not authorized to take out any amount for either 2022 or 2023. They both sent me to Social Security and they said that the amount was being sent to Wellcare for the ******** RX Value Plus Plan, which I have never had or signed up for.Social Security also said that no **** was taken out in 2022 or 2023.I think, I know, I am being billed for two accounts at Wellcare. Wellcare only has me having one account, ********, Wellcare Value Script (PDP) Plan for both 2022 and 2023.I have been faithfully paying my account in FULL at the beginning of every year since I signed up with Wellcare .I would like Wellcare to REFUND amount taken out of my check in 2022, $826.80.I would also like Wellcare to stop the deductions of $71.40 month from my check this year, 2023.Please help me so I dont get another $71.40 month, $856.80 year taken out of my check for the rest of this year.I think this is a case of FRAUD by Wellcare.Business Response
Date: 02/21/2023
On 2-21-2023 we conferenced call SSA who advised that we would need to reach out to ********* We made an outreach to ******** and explained the concerns and were advised that the issue would be escalated internally, and they would be in contact with the member to obtain resolution. Upon our research we found that not additional payments have been received besides member's direct payments for part D premiums. Member should expect resolution from ******** directly.Initial Complaint
Date:02/06/2023
Type:Service or Repair IssuesStatus: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.
Tried to get help about a premium payment. I mailed two separate checks for one monthly payment. First was told they had received it then when questioned further was told that they had not received it. Informed them that i would have to stop payment on lost checks. The day after the stop payment they tried to cash one. **************** is terrible, they cannot understand English. Problem still unresolved.Business Response
Date: 02/15/2023
Billing advised we received both checks. Member has been advised as well, however, there was a stop payment requested by the member for these checks, as of this date, we have not received the request from the bankInitial Complaint
Date:02/06/2023
Type:Product IssuesStatus: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 received a letter dated 01/24/2023 stating that a medication that I am taking would no longer be covered by Wellcare insurance. I contacted Wellcare on 02/03/2023. I was advised by the wellcare representive that they would fax my physicians office the same day to request a prior authorization for this tier 3 medication. I received a message over the weekend, that was a automated message with no information other than it was wellcare calling. 02/06/2023 I called wellcare to ask what the reason was for the automated no information voicemail message. I was advised that on 02/05/2023 Sunday that my request made on 02/03/2023 Friday was denied. After spending 45 minutes on the phone being transftered from a outsourced call center 3 times I was advised mutliple times that wellcare had not received a responce from my physicans office over the 2 day weekend so wellcare decided to deny my request, and did not even allow 1 full business day for my physicians office to respond to the fax sent on 02/03/2023.I was then advised by wellcare that I would need to fill out an appeal letter that would arrive in the mail **** buisness days.My medication is due to be filled on 02/16/2023.I need this to be resolved by someone that is not an outsourced company that will allow my physicians office more than 24 hours to respond to a fax communication.Business Response
Date: 02/09/2023
We reached out to CVS and confirmed that the authorization for medication in question was in place however, it was too soon to fill at this time. The Pharmacy has set up the auto fill for 2/13/2023 and we confirmed that the medication will be ready for pick up on 2/13/2023.
Initial Complaint
Date:02/06/2023
Type:Product IssuesStatus: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.
Ordered a new flex card for new hearing aids and glasses in early January; now 2/6 still did not receive drlespite almost dail calls; finally one employee suggested paying the 1000$, the amount of the flex card benefit, and submit the receipts for reimbursement. Sent me a form, I filled out and returned and submitted receipts electronically and the kept emailing me that they were not received, so resubmitted about 4 times. Finally today per call said they were received but the funds went back into the plan???? Still waiting for resolution I submitted the flex card amount from My meager ssd funds awaitiing reimbursement still havent t received worst company I have ever encountered, everything is like pulling teeth; my WellCare member id: ******** *****************************Business Response
Date: 02/15/2023
Made contact with member was able to confirm complain 02/07/23. Member spoke with vendor and agent processed request for request on 2/07/23. The plan made contact with member on 2/15/23 per member he received refund check on 2/14/23. No further action is needed issue is resolved.Initial Complaint
Date:02/02/2023
Type:Order IssuesStatus: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.
I filled out a Wellcare prescription drug reimbursement form in July 2022. I was told by Wellcare it was approved 8/3 and a check would be mailed to me for $336.39. We have talked to numerous people and given several task numbers they assigned to correct this problem with no results to date. I called again on December 19 and was told (Wellcare - ******** task#********) a new check was issued to me and it would arrived within 45days. She confirmed my mailing address. It never arrived. Called Wellcare 1/25/23 talked to Hope task#********** and her typical canned answer "someone will call you in 3 days". They never do. Probably talked to 15 or 16 people from August '22 thru Jan '23. This issue has never been resolved.Business Response
Date: 02/02/2023
Hello and Good Afternoon, We sincerely apologize for the inconvenience. We will be escalating this matter for review and in touch with resolution as soon as possible. Thank you.Customer Answer
Date: 02/04/2023
Complaint: 18969644
I am rejecting this response because:
Sincerely,
**********************;This is a typical canned answer I have received numerous time from many people. Nothing ever gets done!. I have told them this and have requested another approach from their end since this doesn't work. They won't comply.
Business Response
Date: 02/07/2023
Hello and Good Afternoon, We can assure this is not a canned response as we are diligently working towards resolution. We are pending response per call review as well as escalation to our Pharmacy department regarding the reimbursement. Thank you.Customer Answer
Date: 02/09/2023
Complaint: 18969644
I am rejecting this response because: Same response we have received over the past six months with the same results - no check. We were told the check was sent to us twice since August 3, 2022. I have never filed a complaint with the BBB probably because I never dealt with a company like this one.
Sincerely,
***********************Initial Complaint
Date:01/31/2023
Type:Customer Service IssuesStatus: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 called customer service to get some information on a reimbursement request I sent in April 2022. I was on the phone for over an hour, was transferred five times, and was finally hung up on. Not a single person had any idea what I was talking about, much less was able to find this simple information for me. The experience was incredibly frustrating and insulting to me as a customer.Im hoping this form will be more useful in helping me with this situation.In December 2021, I broke my arm and needed a home health aide to help me. Hartford Health Care was the only assistance available, and they do not accept my insurance. So I paid $1065.00 out of pocket with the very limited funds I have. In the spring of 2022, Wellcare reached out to me and said some or all of this expense could be reimbursable as it was a medical emergency. I sent a receipt of my payment and the bill, with the hopes that I would receive some assistance. I have yet to hear back in regard to this matter, and calling is of no use because no one appears to be able to help me.If you could please let me know the status of the reimbursement, I would very much appreciate it.Thank you,*******Business Response
Date: 02/16/2023
Hello we have been unable to reach you to obtain some additional information from you and provide assistance as needed. Please contact the Executive Response Team at Wellcare at ************ , please reference the case number PRC-11517.
Thank you.
Customer Answer
Date: 02/23/2023
Complaint: 18960294
I am rejecting this response because:I spoke to someone last week but since then have not received any more information. I've called twice and left a message this week and no one has called me back. The situation is still not resolved.
Sincerely,
*************************Business Response
Date: 03/01/2023
According to our research, member was reimbursed on check # ********** dated 8/12/2022 in the amount of $ ****** ********* fee schedule). Check was signed and cashed on 9/15/2022. Please see attached.Customer Answer
Date: 03/02/2023
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.
To become accredited, a business must agree to BBB Standards for Trust and pass BBB's vetting process.
Why choose a BBB Accredited Business?BBB Business Profiles may not be reproduced for sales or promotional purposes.
BBB Business Profiles are provided solely to assist you in exercising your own best judgment. BBB asks third parties who publish complaints, reviews and/or responses on this website to affirm that the information provided is accurate. However, BBB does not verify the accuracy of information provided by third parties, and does not guarantee the accuracy of any information in Business Profiles.
When considering complaint information, please take into account the company's size and volume of transactions, and understand that the nature of complaints and a firm's responses to them are often more important than the number of complaints.
BBB Business Profiles generally cover a three-year reporting period, except for customer reviews. Customer reviews posted prior to July 5, 2024, will no longer be published when they reach three years from their submission date. Customer reviews posted on/after July 5, 2024, will be published indefinitely unless otherwise voluntarily retracted by the user who submitted the content, or BBB no longer believes the review is authentic. BBB Business Profiles are subject to change at any time. If you choose to do business with this company, please let them know that you checked their record with BBB.
As a matter of policy, BBB does not endorse any product, service or business. Businesses are under no obligation to seek BBB accreditation, and some businesses are not accredited because they have not sought BBB accreditation. BBB charges a fee for BBB Accreditation. This fee supports BBB's efforts to fulfill its mission of advancing marketplace trust.