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

Customer Complaints Summary

378 total complaints in the last 3 years.
103 complaints closed in the last 12 months.

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The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

Initial Complaint
Date:12/28/2022
Type:Billing 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.
On Jan 24, 2022, I paid Wellcare $154.80 for Part D coverage for the whole year. I paid it on their portal and got a confirmation number. I got a call in May from someone at Wellcare saying my account was delinquent, which is when I knew this company didn't keep great records. I explained it was paid, it was on a credit card and I had proof. Finally, we figured out they refunded me $120 in March for no reason at all. I was able to give the rep my confirmation number as they lost my payment. None of this made sense to me. I told her I would just give them back the $120 that they randomly refunded me. So I again went on the payment portal, under my account number and made the payment. Recently, I started getting letters and phone calls saying I will be disenrolled if I don't make a payment by December 20th or 30th.. I called and again explained I paid $154.80 in Jan and I have a credit card statement..do they not have the notes from May? No, they don't. I have just buried my mom, and they are harassing me over $12.80. This is why I pay the year in advance. I talked to numerous people. Not one had an email that I could send part of my credit card statement to as proof of payment. I spoke to one "supervisor" who couldn't look at proof I paid it, just kept saying, I only see $120. I have once again found my payment booklet from January which I didn't think I needed to keep. I don't know which one is the confirmation number..****** or 9NB1C9 but I also included the part of credit card statements that lists MedicalRX with Wellcare's phone number after it on Jan 24, and the one on may 24th. I just want these people to apply my money and leave me alone. I don't know how I will make a payment with them again? Do I have to keep it forever? I realize customer service is in *****, but I assume the computer system is sophisticated enough and the parent company in MO has enough money to get this worked out. I assume they will disenroll me any day.
Business Response
Date: 01/06/2023
Hello and Good Afternoon, This matter was escalated to our Billing department for thorough review. It was confirmed the member has an outstanding unpaid balance, which resulted in her coverage being terminated. There was no plan error found. Thank you.
Customer Answer
Date: 01/09/2023

Complaint: ********

I am rejecting this response because:
I paid $154.80 on my credit card in January for the whole year. Here is the statement. Paid in full. Randomly, wellcare refunded me $120 so I gave back $120. Still paid in full. Would not waste my time on $12 a month. Just to verify, on my credit card, it says, "MedicalRX Ins" 877 389-9457FL after it. Just for the fun of it, I called the number tonite, Wellcare answered and it was the same group of people that I have been talking to all year. The reason I pay the whole amount in January is so I don't have to speak to anyone on the phone. The number of times I've been on the phone this year for something that was resolved 6 months ago is outrageous.
Andrea, you said the payment was applied to the wrong account. So you admit i paid it. I gather you don't want to deal with this anymore...neither do I. Wellcare may have applied my payment to the wrong account, no idea. But if you're listening to the recorded calls, you would also hear the the conversation I had with girl who also "found" my payment, she advised me of the refund, I advised her I would pay the same amount...at the end of the day, it didn't need to be this way. You see I paid this in full in January.
$154.80 and $120 to Wellcare pd on visa..I will gladly send paper copies.
I will be making a formal complaint to Medicare.

Sincerely,

****** ********
Initial Complaint
Date:12/20/2022
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.
Wellcare is refusing to pay a claim for a covered procedure at an in network facility. The claim is from 8/12/22. After many phone calls and getting the run around I have been unable to resolve this.
Business Response
Date: 01/09/2023
Good day,
Message has been left on complainant voice mail with our contact information given.
Our findings: Claim # ********** was billed with codes 77061-BREAST TOMOSYNTHESIS UNI and ***** -DX MAMMO INCL CAD UNI that paid $18.05

Per review code77061 is a covered code and no authorization is required but should be processed and possibly bundled
We send back to claims for reprocessing. Provider will be notified.
Case PRC-***** phone ************
Customer Answer
Date: 01/11/2023

Complaint: 18617618

I am rejecting this response because: The claim was resubmitted and rejected again and so still not paid since 8/12/22.

Sincerely,

*****************************
Business Response
Date: 01/12/2023
Good day,
Claim #********** date of service 08/12/2022 has been adjusted 01/05/2023 to pay allowable less any patient responsilbilty to Provider ********************************* phone ************.
Complainant can contact provider directly to confirm receipt.
thank you
Customer Answer
Date: 01/12/2023

Complaint: 18617618

I am rejecting this response because:

Sincerely,

*****************************
Initial Complaint
Date:12/20/2022
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.
I sent a financial and ***** care *** to Wellcare Health Plans, Inc. Attn: Enrollment Department ***************************************** on October 24, 2022. Wellcare has still not recognized the *** and the customer service number ************, after an hour an a half on Monday, December 19 at 5pm informed me that they couldn't help me, the could not give me a higher level supervisor or a number for anyone in the company. They indicated that the ** above is correct and that there was no one that can answer my questions about *** or the fluctuation in charges on the account. they tell me the member can call. The member is unable to call, hence the ***.
Business Response
Date: 12/22/2022
We have made several attempts to reach you via telephone however, we've been unsuccessful. Member information is needed for investigation, please contact Executive Response Team at ************ and please reference PRC-*****. Thank you.
Initial Complaint
Date:12/16/2022
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.
Hi All, I have an issue with wellcare provided the flex card, as attached the pic showed based on my plan that I signed up on August,2022, and when I got my flex card I checked my balance is $****, but now its 0 balance, and I did contacted wellcare support dep. Immediately, they transfer me to here and there, I was spending whole day and no one could help to locate where is my ****, they just said your plan have been changed from 12/01/2022, Im older retired, my ******** never changed why my wellcare health plan changed and without notice, from the wellcare agent told me that you still have **** in dental and hearing, but vision only have 250, but like they said I checked my balance still $0. Im so tired to call them and without resolve. This wellcare company is lied to people, if you cant honor whats on your plan benefits, dont open your business, and I think need government to pay attention on them
Business Response
Date: 12/22/2022
Reviewing the member's account, we can confirm the member has $6.39 available for Dental expenses which caused the debit card declines. I have included the transaction history below. We are showing the member called on 12/12 and 12/14. On both calls, the balance was provided. 2022 Available Balance Dental and Hearing $1,250.00 Vision Balance $6.39.
Initial Complaint
Date:12/08/2022
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.
Joining Part D thru Wellcare on 1/1/23. They want to charge my wife and me a penalty every month forever due to a break in insurance in 2018. We sent them proof of insurance that there was no break. They said they got info from someone and we have to contact them. I said who so we can contact them. They don't know, they just say we get a penalty and will not help. Spent 90 minutes on the phone today, went through 3 reps, and finally got someone in ******* who was going to call me right back and she did not. We got a letter that said all was fine and five days later we get one that says it was not. If they will not help you you have no recourse and their reps totally cannot communicate or understand you are stuck..
Business Response
Date: 12/19/2022
Hello and Good Afternoon. This matter was escalated to our Enrollment department for review, where it was confirmed Mr. and ******************* in fact did not have any lapses in coverage. Therefore, Late Enrollment Penalties have been removed from both of their accounts. We sincerely apologize for the frustration this has caused. Thank you.
Customer Answer
Date: 12/19/2022

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. They have told me it was corrected but as yet have no proof, hopefully it is true. They have also apologized for the misinformation provided by the representtives.

Sincerely,

*************************
Initial Complaint
Date:12/07/2022
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.
My brother (*******************) who resides at ******************** who is 65yr old .He can't talk ,hear, or read due to his disability that stems from a child. He has been getting SSD all his life . He is only allowed to be in the community with supervision because of poor insight and decision making. I have been put in charge since my mother died two years ago due to the pandemic.He is now living in the community with supervision and services ( ********** .I have power of attorney and is his proxy too.My problem is that he passes the table where the representative who represent different health insurance seek out consumers and encourage them to complete an application. They know he can't talk or comprehend. His disability is clear and not hidden. This time they switched him to well care but he is enrolled in united healthcare. His doctors know how to communicate with him .I called both insurance to stop this change but well care will not let me fax over my power of attorney so they can speak to me. I informed them of the problem and they still insist he has to talk on the phone but he can't (he can't speak because he can't hear . This change will be detrimental to his process and health. This keeps happening and they know he doesn't understand because his disability isn't hinder. It is obvious because the way he responds. It is getting hard to keep him safe especially from people who are trying to earn points. The people at well care kept hanging up on me or transferring me . I asked what can I do and they say put him on the phone.????? At a lost
Business Response
Date: 12/15/2022
Hello, we have completed your request for disenrollment effective 1/1/2023 the enrollment will be terminated. According to our investigation, a sales broker was not involved with the enrollment process. We will be contacting you to provide further details and provide further assistance if needed. Thank you.
Customer Answer
Date: 12/15/2022

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,

***** Day
Initial Complaint
Date:12/02/2022
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.
i am on a wellcare giveback insurance i have never gotten back my giveback that was supposed to be added to my social security i keep calling they tell me its has been submitted to ******** yet when i call ******** they have nothing in there file that i belong to a wellcare part c giveback i signed up on august of 2021 yet nothing
Business Response
Date: 12/15/2022
Education has been provided to inform that ******** has opened a ticket to correct the issue and provide the update to SSA as credit/refund will not be issue by the plan itself. Member agreed to follow-up with ******** directly for status and resolution.
Customer Answer
Date: 12/17/2022

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.

Sincerely,

*******************
Initial Complaint
Date:12/01/2022
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.
They are known for being the worst bunch of cons in the industry. They advertise all over the tv for plans and are known for denying claims and having the member be responsible. I am to the point of filing a complaint with ******** as everyone on here should do and he insurance commissioner because this c*** wont stop. They have been closed and fined by *** before and every year they increase the CEO's salary with our fixed income money. They don't have anyone in my doctors list local and all they can say I am sure, he doesn't have a plan with us. they are cons take ur money and continue to increase salarys and bonueses but dont afford local members access to healthcare services they ought to be ashamed of themselves. if you call them u get run around or sent over to ***** call centers where they dont know a badger from a wolverine.... i will contact ****** and any other local state official because if it wont stop we need to put people in that will bring balance to corrupt businesses
Business Response
Date: 12/05/2022
Please provide your member ID# so that we may further investigate your concerns, You may reach us at ************ case# PRC-*****, thank you.
Initial Complaint
Date:11/30/2022
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.
We received another unwanted mail from this company on November 29. This is even after they said they would remove my late mother's name and our address from their mailing list. THEY LIED. I have already called them and now they are wanting her PERSONAL INFORMATION AND PER OUR ATTONEY I DO NOT HAVE TO GIVE IT OUT. THEY ARE GOING AGAINST HIPPA. I WILL BE UPLOADING DOCUMENTS SHOWING PART OF HER INFORMATION ON THEM AND WHAT THEY RESPONSED BACK TO US THROUGH BBB EARLIER. I WAS ALSO TOLD THIS WAS OPEN ENROLLMENT, BUT HOW CAN SOMEONE WHO IS DEAD APPLY FOR ********* UNLESS THEY WANT ME TO GO TO HER GRAVE SITE AND ASK HER.I AM IN THE POSSES OF FILING LEGAL ACTIONS AGAINST THIS COMPANY. THIS SHOULD NOT TAKE THIS LONG TO RESOLVE. EVEN AFTER I HAVE THEM BEFORE ************** COMPLAINT AND SPOKE WITH SOMEONE IN THEIR COMPANY. EVEN ******** AND SS KNOW SHE DIED OVER 4 YEARS AGO AND ******** HAS TOLD ME THAT THIS IS FRAUD AND A SCAM.
Business Response
Date: 11/30/2022
Good day, we apologize for any inconvenience you experienced when WellCare contacted you recently about additional plan offers. Please provide us with additional information such as your mothers name, member ID#, and address and will investigate further. Thank you.
Customer Answer
Date: 11/30/2022

Complaint: 18479062

I am rejecting this response because: This information was provided before when I was told the contacts would stop. This company should follow through on the existing do not contact requests and that will solve the problem. They can also stop initiating unwanted contacts with random people under the guise of "servicing customers" and that would solve the problem. SHE NEVER HAD AN ACCOUNT WITH YOUR COMPANY. I WILL NOT GIVE OUT HER PERSONAL INFORMATION AGAIN PER OUR ATTORNEY.

Sincerely,

*********************
Initial Complaint
Date:11/18/2022
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 am an authorization specialist who works for an out patient rehab facility and have been trying to get authorization for patient since the end of October and early November. I constantly get the run arround and no one knows what they are doing. Their customer service ********************** is a disaster. This patient is in need of PT, OT, ST services and they are not being seen because this company can not get it together. We are an OON provider but specialize in the therapy this patient needs. I submit auth to the health plan directly but then they bounce the auth to their third party, and then back to the health plan. The only reason I know this is becuase I called them back to follow up. I constantly call and get hung up on and no one ever calls back (why take a call back number). The authorization I did receive today is completely wrong. It says it's for Physical Therapy but the *** codes are for Speech Therapy. Without these services the patient is losing out on regaining function, mobility, her independence and quality of life.
Business Response
Date: 11/29/2022
Hello and Good Afternoon, Outreach has been made to this provider to assist, however they are out of office. Callback information has been left, we are waiting to hear back and happy to assist. Thank you.

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