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:11/17/2022
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 have well care for my insurance and that was a big mistake, I have multiple sclerosis and I have a number of Doctors so I have to have test done every month they are denying my claims that my Doctors put in for me even denying paying some of my Doctors so I have to call them up which stresses me so bad and fight with them. I ask for a manager or supervisor to call me no one ever does! This is the worse insurance ever. I have never had this problem with my other insurance!!!
Business Response
Date: 12/06/2022
Claims billed by ************ and **************** have either denied for a coding edit or auth denials. Unfortunately, the provider will need to dispute these denials with supporting documentation. CCT does not review member disputes for coding errors made. If the member is being billed, The plan will be reaching out to the provider relations for review. The plan will provide an update once these providers have been contacted and claims have been reviewed at this time issue is pending.
Customer Answer
Date: 12/07/2022

Complaint: 18416917

I am rejecting this response because: they reject evey claim not only MY Dr ***** also my test my shots everything I need help with regarding my MS

Sincerely,

*********************************
Business Response
Date: 12/08/2022
Contacted member on 12/8/22 @9:49 am advised responding to rejection from BBB. Tried to advise this issue is pending but call was lost not sure if member is hanging up on call 2nd call to member and call is lost. The plan will update BBB when complaint when provider relations has reached out to claims billed by ************, ***************** and **************** they all have either denied for a coding edit or auth denials to assist in resubmitting the claims correctly.
Customer Answer
Date: 12/08/2022

Complaint: 18416917

I am rejecting this response because:

Sincerely,

*******************************; I will not recommend well care to Noone, they denied my claim to have a MRI ( which I need because of my MS) every test my doctors ordered for me I have to fight with them every time and it stress me out. I will tell anyone if we'll care reach put to the to RUN!!!
Initial Complaint
Date:11/17/2022
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 have Wellcare Insurance. I have had 4 1/2 years of 11 operations on a hip and femur. I have been trying to get authorization for some visits because ***** is out of network. I have been waiting for an answer for over 2 weeks. I have had several people lie to me about the status of my appeal, but no one will give me an answer. I'm in Terrible pain and need PT. My complaint is there stalling and UNPROFESSIONAL BEHAVIOR. I was promised a call back on Monday, 11/14/22 @ 10:30 that never came. They are not following throu5and I'm stuck. I'm at their mercy.
Business Response
Date: 12/05/2022
We have obtained resolution regarding the expedited request for Physical Therapy authorization. The denial for authorization was appealed and approved after proper information was received from the provider. The provider has confirmed that the information will be updated to reflect the number of visits approved and member will be contacted by a therapist to establish the services.
Initial Complaint
Date:11/16/2022
Type:Billing 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 received a credit card 11-04-2022 that I did not apply for and never used, I received a bill with a balance due on 11-06-2022, however the due date was 10-24-2022...so it was already late. Balance due stated as $152.90 for monthly service fees. I phoned to inquire about this and learned it is an Rx supplemental plan that goes with my ******** Advantage plan, (I do not have any perscriptions and I don't yet have ******** Advantage) I only have ******** A & B. I requested they close this account (which I did not apply for) and that they remove the so called owed balance. After at least an hour of phone time, (45 min with rep, 15 with a supervisor) I was finally impolitely informed (by the supervisor) that my request was "never gonna happen". The card # is **** **** *********. My phone call to them was **** or 11-10-2022 at about 10:am. Their customer service phone # ****************. The billing address is Wellcare, ******************************************. They are operated by ************** which contact info I could not find.
Business Response
Date: 12/07/2022
Good day,
We apologize for the delay in responding. The Plan has been updating ******************************* on the investigation status, most recently on 12/02/2022 we spoke to her. Our findings:Credit card received is not affiliated neither issued by WellCare. CareCredit, from Synchrony, customer service ************** The Centers for ******** & ******** Services (CMS) auto-enrollment notice is sent to people who automatically qualify for Extra Help because they qualify for ******** and full ******** benefits and currently get their coverage through Original ********. The notice lets people know that theyll be enrolled in a ******** Prescription Drug Plan if they havent joined a plan on their own. The notice tells people which plan ******** will enroll them in, and outlines their costs in that plan . Our records show member was enrolled the WellCare Classic (PDP) G23-014 coverage effective date 12/1/2021 with term date 12/31/2022 due to ******************** enrolled in other insurance for effective date 01/01/2023. We in the process of reviewing premium records, and will provide member finale outcome shortly.
Thank you ********* PRC-11271
Initial Complaint
Date:11/15/2022
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.
I went to use my flex card to get glasses, and my flex card was declined, my insurance was being taken out of my soc sec check automatically, my flex card was cancelled, on the well care flex card insurance end, I was told to send them a copy of what I paid. I keep sending the information, and can not get any refund or an answer.
Business Response
Date: 11/17/2022
Good afternoon, we have not been able to reach the member after several attempt, but have emailed the resolution, after review, We have submitted a ticket to our claims team to have this form processed so the member can be reimbursed. Please note the member will be reimbursed $250 as that is the max ****** for their vision benefit. Please allow 2-3 business days for processing and then **** days for the check to reach the member. We are showing the member's account is active and the debit card is ready for use. Please note, the claim we submitted yesterday is now approved and pending payment for $250.00. The check will be issued tomorrow and will be mailed to the member.
Initial Complaint
Date:11/09/2022
Type:Order 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.
Re Ascension Complete Providence Secure plan #H4343, specifically the "Flex Card", access to customer service has been refused to my *** ***************************** who has emailed the *** to Wellcare account services on 11/4/22 as requested and confirmation of receipt of *** on 11/4/22 and 11/7/22. Additional phone calls to the Flex Card were made today indicating that they can't allow my *** to access my info. Also filled complaints with Ascension *************** services, Case I88530525. Ascension Complete Providence Secure Plan describes benefits in the *** that require the use of their "Flex Card' which have not been accessible, which were a deciding factor when I signed a contract for their health plan.
Business Response
Date: 11/09/2022
The complainant has advised they are under plan: Ascension Complete Providence Secure Plan #H4343. This is not a plan accessible to this team. Please redirect this complaint to the appropriate company. We are closing this complaint as inaccessible and invalid.
Initial Complaint
Date:11/07/2022
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 have weekly outpatient individual psychotherapy from an out-of-network provider (since 11/21). My Summary of Benefits lists this as a covered service with no limits listed. Prior claims were paid but as of 8/02/2022 every claim (7) has been denied, The *** statesThe benefit limits for this service/procedure has been reached with no further information. I thoroughly searched and could not find mention of a limit either online or in information I had from WellCare. On 11/2/22 I called WellCare **************** about this (husband acts as representative). The representative couldn't find limits either and suggested I appeal. This seemed to be WellCares error so I asked if they could correct the mistake instead of making us appeal. She did not know and transferred me to someone who then told me; Yes I have a limit, No she didnt know or couldnt tell me the limit, My Provider knows the limit and I am not entitled to know what the limit is. She said that my out of network provider has a contract that states the limits. I dont know who this contract is with. I contacted my provider then and there and he had no knowledge of limits or contracts. Even after telling her this she persisted. She said WellCare sent a letter to my provider about this. I asked her to read me the letter and she refused and said that I had no right to this information or to any information in correspondence between WellCare and my Provider. She could not transfer me and claimed she had no supervisor and no further avenues were available to me. She said I could file a grievance, which I did. I was on the phone for over 3 hrs. Today I heard from ***************************, Coordinator Region I, regarding the grievance. She said this is a **************** issue not a grievance issue and wanted to transfer me back to ****************. I asked not to be transferred. She said shed look into this and hung up before I could say anything else. Im not sure where to go from here.
Business Response
Date: 11/21/2022
this issue is still in review, ty
Customer Answer
Date: 11/21/2022

Complaint: 18360023

This issue in this complaint has not been resolved.
I understand and appreciate that it is being reviewed by WellCare. I do not wish to withdraw my complaint until the issue is resolved and I am contacted with the date I can expect the claims in question will be paid. I am also waiting to be contacted by WellCare regarding the significant misinformation I received from ***************** I, along with ********************** recorded parts of this conversation with *****************
Sincerely,

***************************
Business Response
Date: 11/28/2022
member has been advised of her Psychotherapy benefits and claims have all been sent to reprocess.
Customer Answer
Date: 11/28/2022

Complaint: 18360023

I am rejecting this response because:This complaint is two fold.
Firstly the denied claim issue will not be resolved until payment is made or an actual time frame for the payment is provided to me. I am waiting for **** from the executive response team to give me that info. I have not heard from him in over a week.
The second aspect of this complaint is about ***************** I simply asked Do I have a limit on the number of covered psychotherapy sessions. This issue has not been addressed or resolved. After 3 + hours on the phone the bottom line was
I have a session limit but I am not allowed to know what the limit is.
The claim was denied because I reached this limit
WellCare doesnt know what this limit is

Only my (Out-of-Network) provider knows this limit. (He doesnt)
My provider was contacted by WellCare (My provider wasnt )
I am not allowed to know what WellCare communicates to my provider.
The ******** Service Supervisor I was speaking to had no supervisor in all of WellCare.
The only resource available to me was to file a grievance (which I did)
This all sounded really wrong so I started recording the conversation. Ideally I would like to see documentation of concrete steps taken regarding this specific incident. *********** is not resolution. I assume I was given incorrect information. Was I? No one has told me as much.
Sincerely,

***************************
Business Response
Date: 11/30/2022
good morning, i spoke to the member on 11/16/2022 at 410pm, advised her Psychotherapy visits are unlimited, at that time claims were in review, as of today, all claims (7) have been sent back to reprocess* ty * **************** leadership has also been advised of the issue*
Customer Answer
Date: 11/30/2022

Complaint: 18360023

I am rejecting this response because:

Just received this message from WellCare: good morning, i spoke to the member on 11/16/2022 at 410pm, advised her Psychotherapy visits are unlimited, at that time claims were in review, as of today, all claims (7) have been sent back to reprocess. ty **************** leadership has also been advised of the issue.

On 11/16 Wellcare advised me of nothing. Wellcare called me by mistake and I informed them of the status of this complaint. **** from the executive response team contacted me on 11/16/202 in error as she was unaware that **** from her team had already established a PRC#. I told her I had no limits on my benefits. I restated my **************** complaint. I told her **** had advised customer service supervisors about this complaint. When I last spoke with **** he realized he had likely sent this information to the wrong supervisor but told me it was all he could do.??
On 11/28, just 2 days ago, WellCare messaged the BBB with a similar resolution. I wrote a lengthy response explaining why I was rejecting their response. Please re-read.
Im assuming the claims will get paid sooner or later which feels like the most anyone can expect from WellCare. I know WellCare believes that forwarding a complaint to **************** Leadership is a resolution. I suspect I am asking for a resolution that is likely unavailable to me. Until I change Health Insurance I feel obligated to request better service.
Sincerely,

***************************
Initial Complaint
Date:11/03/2022
Type:Delivery 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.
Well care insurance keep denying my health treatment it happens every time i have to have the *** or a Catscan they even denying my prescription as of today i have to go for a Catscan in order to have a surgery on my lumbar spine they denyed dr. ******* twice in 4 days for that Catscan im in a lot of pain and i must have that surgery ASAP but i cant without a catscan at this point i dont know what to do.
Business Response
Date: 11/14/2022
Hello and Good Afternoon, We sincerely apologize for the dissatisfaction you've experienced. Outreach was made to **************, and he verbalized not wanting to speak with us. We will be moving forward with Appealing the denied authorization in hopes of resolving this matter. Thank you.
Initial Complaint
Date:11/03/2022
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.
On 10/5/22 I went online and attempted to delete two medication from my prescription list. Those Medications were Basaglar and Tresiba. Note: these medications had been prescribed 4/13/22 by Endocrinologist Dr. ******** ** ******* (I never filled this prescription at all.)

At the same time on 10/5 I did order from CVS Caremark Mail two other prescriptions Azithromyacin RX# ********* and Lansoprazole RX# *********.

Well On 10/11/22 at 11:15 AM, UPS delivers to me Basaglar RX ********* (of which I get this medication from a PATIENT Assistance Foundation) and Tresiba RX# ********* (Which I do NOT TAKE at ALL). Now this ORDER # ********** did include the two medications, that I did order.

So, 10/11/22 I contacted CVS Caremark Mail Order and explained that I received Basaglar and Tresiba in ERROR. Spoke with Senior Represemtative ****** at CVS Caremark; who stated she would send an EMAIL to Wellcare (My Insurance Company) Member Name Nancy ** ****** and ID # ******** and have them issue a MAIL TAG (so I could send the medications back)

On 10/16/22, CVS Caremark Mail attempted to DEBIT my Checking account in the AMOUNT of $684.73. They did not get these funds, as I was watching and had placed stop payment. Plus, I'm on disability and those funds weren't available anyways. STILL in meantime, I was waiting to hear back from ****** Senior Representative with Mail Tag Info.

On 10/30/22, CVS Caremark Mail Attempted a CHARGE to my Credit Card of $743.90 (Of which I didn't notice until 10/31) That charge was not paid either, as the funds weren't available.

On 10/31/22, I contacted Wellcare my Insurance Company, who transferred me to CVS Caremark Mail. I inquired on the outcome of the MAIL TAG...spoke with another Senior Representative Ed F. who transferred me to CVS Caremark Case Cordinator ****. **** advised me that ****** who I originally spoke with on 10/11/22 wasn't available and she would send her an

SEE ATTACHED DOCUMENT PLS
Business Response
Date: 11/09/2022
The status of this mail tag is denied, due to no cvs error.

Communication history shows member received a confirmation
email with the details of each mediation ordered and could’ve canceled same day
or the next.

Member then ordered other medications a few days later and
still did not try and cancel. Our policy for mail tag approval would be a CVS
error, or doctor sent in and filled.
Customer Answer
Date: 11/11/2022

Complaint: ********

I am rejecting this response because:

Sincerely,

***** ******
Customer Answer
Date: 11/14/2022
I did not receive email from CVS regarding mailing of prescriptions.
some emails seem to not be received...see my first screenshot describing other situations i've experienced. Internet doesn't appear to be accurate all the time.
Business Response
Date: 11/28/2022
good morning, response sent to BBB on 11/09/2022..Action was taken and your message was sent. Thank you., member was also advised of the resolution : The status of this mail tag is denied, due to no cvs error. Communication history shows member received a confirmation email with the details of each mediation ordered and could’ve canceled same day or the next. Member then ordered other medications a few days later and still did not try and cancel. Our policy for mail tag approval would be a CVS error, or doctor sent in and filled
Customer Answer
Date: 11/28/2022

Complaint: ********

I am rejecting this response because: I did not order more medications after this issue. In fact I refused a shipment from CVS CAREMARK just today. I dropped off at USPS. I told CVS CAREMARK to close my account. As I NO LONGER choose to deal with them period. Now they send notices via text that this med or that med is due to be filled. I am ignoring their texts.. I have now started getting meds through Sam's Club Pharmacy.

Sincerely,

***** ******
Business Response
Date: 11/29/2022
Good afternoon, the Vendor advised: This still stands as a denial, we cannot order a member’s
medication via WEB, only members can. If these were filled by CVS Reps the
yellow highlight would say CSR. I am showing no error on our end. See attached, case is closed from the plans perspective, thank you
Customer Answer
Date: 11/29/2022

Complaint: ********

I am rejecting this response because: Once Again... I was deleting those medications Basaglar and Tresiba...Maybe they have a system Problem... I DID NOT and Would NOT order those medications. I am also filling out complaint in RI BBB complaint against CVS Caremark Case No. 18477479. Will never accept that I ordered these medications...just would not make 1 ounce of sense. When I haven't taken Tresiba long before April 2022... Doctor sent prescription in error...and Basaglar I get from Lily Foundation since April 2022...under the patient assistance...

Sincerely,

***** ******
Initial Complaint
Date:11/02/2022
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.
On May 27, 2022 I relocated from ****** to Californian. The first thing I did was find a supplement to my ********* My policy with Wellcare went into effect on June 1st, 2022. Today is November 1st, 2022, and I have not been able to see a doctor due to mistakes that have been made by employees at Wellcare. I have spent numerous hours on the phone speaking with several employees at Wellcare. I was issued a Wellcare insurance card with a primary physician listed on the card that is not contracted with Wellcare. I waited three months to see another doctor who is contracted with Wellcare, but they were unable to see me because the doctor's name on the card is not correct. I was assured by Wellcare this would be corrected and a new card would be issued. It has been over a month, and this has not been done. I've tried to see another dr. and pay cash, but I can't do that either because I have insurance. I am stuck. I have heart disease with a stent. I have been diagnosed with kidney failure. I have had Melanoma several times. I need to take medications which I'm going to run out of. It is very important for me to receive medical care. I have paid for insurance every month. There does not seem to be even one person at Wellcare who knows how to help. My daughter has called. The receptionists at two physicians' offices have called. I'm hoping that you can get their attention and get this resolved. Thank you, ***********************
Business Response
Date: 11/02/2022
good afternoon, after review, due to the complainant not being a member of ours, we are unable to research or assist the member with the complaint as we do not have them in our system. Thank you

Customer Answer
Date: 11/02/2022

Complaint: 18346289

I am rejecting this response because I have WellCare ****************** This is exactly what Im talking about. Nobody has any idea of how to help. If Im not covered by WellCare, then I would a refund for the four months I have been paying. I paid $170.10 for the months of June through October makes no the total I have paid $850.50.

Sincerely,
***********************
***********************
Business Response
Date: 11/07/2022
Hello and Good Afternoon, We were intially unable to locate **************** in our system as she is a member of WellCare by HealthNet. We are working diligently to coordinate with the appropriate departments that can assist **************** with her concerns. We appreciate your understanding and patience in this matter. Thank you
Customer Answer
Date: 11/13/2022

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:10/26/2022
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.
I would like to disenroll from Wellcare Prescription plan. However, each representative, including supervisors give me the run around or wrong information. I have called everyday since Oct. 15th of this year but no one resolves the issue. I was told to write a letter so that I can be disenrolled. The representative gave me the details in which the letter needs to include. I did exactly that. I mailed the letter on Oct. 15th and also faxed it on Oct. 25th. No one helps me to disenroll. All I want to do is disenroll. Wellcare is quick to accept members that wish to enroll and take their premiums but make it virtually impossible to disenroll.
Business Response
Date: 11/08/2022
The plan has contacted the ***** and advised the disenrollent request was processed on 10/25/2022 with an effective termination date of 12/31/2022 in accordance with CMS regulations. The member was also advised her concerns with customer service have been forwarded to **************** ********************** for appropriate actions to be taken.
Customer Answer
Date: 11/08/2022

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,

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

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