Business Profile

HMOs

WellCare Health Plans, Inc.

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Complaints

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

Customer Complaints Summary

378 total complaints in the last 3 years.
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:10/25/2022
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 signed up for a new ******** advantage plan, that included dental, with Wellcare, that started in January 2022. I called Wellcare for names of dentist in January. They gave me 3 names and phone numbers (paper I wrote them on is included). I went to see one of the dentists on the list, but they never got back to me with a treatment plan. After not hearing back from that dentist, I decided to go see a different one. I called Wellcare again, I believe in May. This time they gave me addresses and phone numbers (paper that I wrote them on is included.) I looked up the name of the practice on the internet because I wasn't given that information. I noticed that the first 2 names that they gave me matched what they gave me before, so I decided to call the first one. I go to see him, had my x-rays sent from the other dentist. They came back with a treatment plan. The first things on the list were the most expensive costs so it quickly hit my *** of $1,500. I had $1,406.99 remaining after I seen the last dentist. This tells me that they talked to the insurance company. So after talking to them they gave me a treatment plan. First charge was supposed to pay 80% of the amount. I have to assume that they talked to the insurance company because it showed my balance. Second charge on the treatment plan only showed that they would pay the remainder of the $1,406.99, okay. I chose to do work on what the insurance would cover. After having the work done, I get a statement saying "the patient can't be identified from the identification number reported above." The a week later I get a statement saying that they paid 50%, when I called about that, they said it was because this dentist was out of network. This is information from them, twice. I believe the issue is that that practice is owned by a dentist on their list, but the dentist that is in that office isn't on their list.This makes no sense to me. The place I went-same phone number, same address, billing name! The dentist isn't
Business Response
Date: 11/08/2022
Dental vendor advised: Internal call records shows that the member contacted Envolve ***************************** (CS) ********************** on 1/3 and 5/9/2022 where she was provided with a list of INN providers (********************* at ****** and ****** IV DDS PLLC and ***************************** at ******************************* DDS PA II). The member reached out again to ENVD CS on 2/4, 3/24, 8/2, 8/29, **/**, and **/**/2022 to obtain additional assistance (please see attached call details). Envolve Dental (ENVD) has the following three claims on file from ****** and Moldin IV DDS where the member was seen by ******************************* (please see attached claims detail): DOS 5/**/2022 D2331 - Resin-Based Composite - Two Surfaces, Anterior on tooth # 7 (Surface F, M) D2331 - Resin-Based Composite - Two Surfaces, Anterior on tooth # 8 (Surface F, M) D2335 - Resin-Based Composite - Four or More Surfaces or Involving Incisal Angle on tooth # 9 (Surface F, I, L, M) D2331 - Resin-Based Composite - Two Surfaces, Anterior on tooth # ** ( Surface F, M) D0**0 - Limited Oral Evaluation - Problem Focused DOS 5/25/2022 D7**0 - Extraction, Erupted Tooth or Exposed Root on tooth # 6 D72** - Surgical Removal of Erupted Tooth on tooth # ** D7**0 - Extraction, Erupted Tooth or Exposed Root on tooth # ** DOS 7/**/2022 D5213 - Maxillary Partial Denture - Cast Metal Framework with Resin Denture Bases on tooth, Outreach was conducted to the ****** of ****** and ****** IV DDS PLLC at ************** where I spoke with *******, to whom I provided member demographics and grievance details. ******* advised: Outreach was made the attempt to verify coverage on 5/9/2022, and they were advised the members **-WellCare follows the same fee schedule as United Concordia Member was provided with a treatment plan, estimate, and was presented with her out-of-pocket cost that she would be responsible for, member decided to proceed with treatment Member currently has a balance in the amount of $276.76 ******************** is credentialed with United Concordia, however, he is not an INN provider with **-WellCare, the members plan allows her to see INN and OON providers ENVD has Envolve Dental also has claims from ********************* where the member received the following services on DOS 2/8/2022 (please see attached claims detail): DOS 2/8/2022 with ********************************* D0272 - Bitewings - Two Radiographic Images D0330 - Panoramic Radiographic Image DOS 2/8/2022 with *********************** D0150 - Comprehensive Oral Evaluation - New or Established Patient Outreach was placed to ********************* at **************, where I spoke with ******, to whom I provided member demographics and grievance details. ****** advised the following: Member was seen as a new patient on 2/8/2022 by Dr. ********************* Confirmation could not be provided in reference to if the member was advised of any out-of-pocket cost or if the member was presented with and signed a treatment consent form Confirmed the ****** policy is to inform all patients that the providers do not accept nor do they participate with any insurance programs Member currently has not paid for any services rendered, the ****** received a payment of $31.66 from ENVD and the member has a balance of $275.99 On **/2/2022 at 9:20 am an outbound call was placed to ****************** at *************, where voicemail was reached without an option to leave a message.
Initial Complaint
Date:10/25/2022
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.
I, have had WellCare ******** RX value plus, prescription drug plan, since 2019. ALWAYS, paid for a flu shot . . . however, to my complete horror and surprise, yesterday I was denied a flu shot at our local ********* According, to Wellcare the flu vaccine is not on my formulary!! Why, the change??
Business Response
Date: 10/28/2022
We have attempted to contact the complainant for additional information needed for research such as member ID# however, we have not made contact.
Initial Complaint
Date:10/25/2022
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.
Wellcare is sending unwanted soliciting mail to the deceased. I tried called this company 1st time and got hanged up on, then called them again and the first person I spoke with who speech who had a speech problem and I tried to explain to him fist but he had to transferred me to another rep who asked me for my name which I would not give out but gave her my late mother's name and then I tried to explain to her that my late mother passed away over 4 years ago and she started asking me for her ******** # which I informed her that after we settled my mother's estate, all that documents were shredded and that we no longer have any of her personal information. I also tried to tell her that all my late mother's mail was forwarded to my address listed on their mailing list, but she kept asking for my mother's ******** #. She did not even want to here what I had to tell her. Even ******** knows she has passed away. This company is trying to fraud the deceased and their families. If we continue to receive unwanted soliciting mail from this company, we will report them for ******** Fraud.
Business Response
Date: 11/03/2022
Hello and Good Afternoon, We sincerely apologize for the dissatisfaction and frustration you've experienced. We have added your address to our Do Not Mail list as your mother was never a member of the plan. Again, we sincerely apologize. Thank you.
Customer Answer
Date: 11/03/2022

Better Business Bureau:
If they continue to send anything else, we will take legal actions against their company.

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

Sincerely,

J ********
Initial Complaint
Date:10/20/2022
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 was disenrolled from the wellcare ******** rx value plus plan starting January 02,2022. I canceled the plan on December 07,2021,but it took me till July for them to send me a cancellation letter. I do not have a computer just a mobile device so I can't upload letter. In September, 2022,I received a payment booklet showing that I was to begin paying on the account that I was disenrolled from. Having difficulty hearing, I gave my wife permission to speak for me after I told them I was disenrolled and did not want to continue the plan. My wife told them the same thing. We were asked if we wanted to file a grievance and my wife did so. She was told that the account was still active and someone would call the following day to complete setting it up, at which time my wife expressed that we did not want to continue the plan. She did so again the next day when the representative called. ******* wants to continue to be disenrolled from the plan. If you need for him to get a copy of the disenrollment letter made, we can mail it to you. ******* feels harrassed and just wants it to end. Please help.
Business Response
Date: 10/24/2022
Upon further research, we are unable to locate member on our data database. Voicemail was left at the phone # provided, however, it seems to be a law firm and not a residence.
Customer Answer
Date: 10/28/2022

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********. I believe their response was dishonest, however if it means that I will not have any further communication from them, I will accept it.

Sincerely,

*******************************
Initial Complaint
Date:10/19/2022
Type:Order 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.
I sign up for WellCare. Found a primary in network. My first visit with my primary. She told me to take these requests to the hospital get x-ray and blood work. Which I did. WellCare refused to pay the bill. Now Im stuck with $1000 bloodwork bill.. just did what I was told?
Business Response
Date: 10/21/2022
We have conducted research and we are unable to locate your information on our database. Member ID# ************** does not exist on Wellcare's database. We apologize for any inconvenience. Please contact your current insurance for further assistance. Thank you.
Customer Answer
Date: 10/21/2022

Complaint: 18241389

I am rejecting this response because:

Sincerely,

***********************
Customer Answer
Date: 10/21/2022
Here is copy of my card. Maybe that will help.
Initial Complaint
Date:10/18/2022
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.
A wellcare customer has apparently given them an incorrect number. ************. I sometimes get 3-4 calls a day asking for me to complete a survey. the automated message says the name of the wellcare customer but I can not make out the name. In the past I have called wellcare at least 15 times in the past to get the calls stopped. Every time the customer goes to the doctor etc the calls start back. If I call wellcare it recognizes my number and tells me it sees the account associated with the number and asks for the last 4 digits. This number belongs to a nuclear site. It has been my office number for 15 years. It is not a residence. Sometimes I get 3-4 automated calls a day. It is getting to to the point of harassment. When I call wellcare the customer service people say they can't help me. The number that calls me constantly is ************. This is a last attempt before I get the company involved.
Business Response
Date: 10/20/2022
good afternoon, the complainant has been added to the Do Not call/mail list. ty
Customer Answer
Date: 12/12/2022

Complaint: ********

I am rejecting this response because:
Below is a copy of complaint #******** that was closed on October. The issue was resolved but has now started again. I contacted BBB to ask if the complaint could be reopened but never heard back, Hearing nothing I started a new complaint. A wellcare customer has apparently given them an incorrect number. ************. I sometimes get 2-3 calls a day asking for me to complete a survey. the automated message says the name of the wellcare customer but I can not make out the name. I have called wellcare at least 15 times in the past to get the calls stopped. Every time the customer goes to the doctor etc the calls start back. If I call wellcare it recognizes my number and tells me it sees the account associated with the number and asks for the last 4 digits. This number belongs to a nuclear site. It has been my office number for 15 years. It is not a residence. My voicemail is getting automated messages constantly. It is getting to to the point of harassment. When I call wellcare the customer service people say they can't help me. The number that calls me constantly is ************, and ************.

Sincerely,

***************************
Business Response
Date: 01/09/2023
Based on the original request, we have ***************************** with the phone number ************ included on the suppression list. thank you
Customer Answer
Date: 04/26/2023

Complaint: 18233416

I am rejecting this response because: Wellcare has continued to harass me by constantly calling my office. I have called Wellcare multiple times, I have filed a BB complaint, reported them to donotcall.gov. Each time the calls will stop for a month or so then start back. The number they are calling in my office at a nuclear site. It is not a residential number. I have never been a wellcare customer, Nor will I ever be after this. This is a last attempt to get them to stop. I guess my next step is to turn this into the *** site the number they are harassing belongs to a site that is controlled by the federal governments nuclear regulatory commission.

Sincerely,

***************************
Business Response
Date: 05/02/2023
added *************************** once again to the Suppression List, as well as flagged the complaint up to see if there is any other action to take to ensure he is not contacted again. Please note, there have been discrepancies in the provided address and name (reference bolded text). The entry I just added is below: Please let me know if this is incorrect and I will modify. *************************** *************************************************************************************************** Daytime Phone: **************
Customer Answer
Date: 05/10/2023

Complaint: 18233416

I am rejecting this response because: Nothing has stopped. I have received 4 more calls already in the last 3 days. This has gone on for over a year. I tried to call your corp office just now with the number you left me. No answer so I left a message. Please stop your robo call service from calling my office and leaving voicemails constantly.

Sincerely,

***************************
Business Response
Date: 05/12/2023
Good afternoon, we located the complainants phone number in a members account, this has since been corrected, thank you
Initial Complaint
Date:10/11/2022
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 made a material reprentation that they would pay all my doctors when i signed up for insurance.. they asked me who i was seeing and i told them all of my doctors and now i find out that i relied on the material representation to my detriment. Because now i cant see my therapist and its very dangerous to my health and well-being.
Business Response
Date: 10/20/2022
On 10/11/22 the plan made contact with member and advise will submit for review and research. As of 10/2022 it is still under review the plan will reach out to member as well provider Dr. *********************;to advise status update of still pending.
Customer Answer
Date: 10/20/2022

Complaint: 18193193

I am rejecting this response because:
i need my therapy and its been cut off. WellCare is not providing the service i was told Id have. This is detrimental to my health and well being.

Sincerely,

***********************************
Business Response
Date: 10/31/2022
On 10/11/22 @3:20 pm member said enrolled advised agent that provided he wanted to keep and was advised therapist was in network. Member said he was advised from provider the plan had denied all 9 claims due to tele visits. Advised after to second denied the provider continue. On 10/14/22 @1:25 pm ************* confirm 9 visit that have been denied that the plan does not cover tele visits states that cannot stop see member as well trying to be placed in network to continue to see member. DOS 8/2/22, 8/9/22, 8/15/22, 8/29/22, 9/7/22, 9/12/22, 9/19/22, 9/26/22 and 10/4/22. On 10/31/22 @ 2:42 pm to ************ left detail messages advised wanted to ask few questions 1.What services are being paid and what services are not being paid? 2.What is the amount that is due? 3.Typically, while we are reviewing a member's account, the account is placed on hold, is there a way for you all to do this AND still see them as well? Member was contacted 10/31/22 to advised of message left for provider waiting for a return call back to plan from provider.
Initial Complaint
Date:10/10/2022
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.
Procedure on 5/13/2022. Wellcare is attached to ******** is reason they did pay anything. Wellcare sent letter stating that it was not a necessary procedure conurdicting my doctors orders.
Business Response
Date: 10/31/2022
Upon speaking with the member is was determined the member is enrolled with ALLWELL and is not a direct Wellcare member; therefore, the member's complaint has been redirected to ALLWELL as we do not have access to the members benefits.
Initial Complaint
Date:10/04/2022
Type:Service or Repair 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.
I bought a ******** advantage plan from this company for the year 2022. I based the decision on the fact that it included $2,000 worth of (not in network dental coverage). I expected to need dental procedures in ********************************************************* network. I asked and was reassured repeatedly that this particular benifit was in place. Every dental claim submitted since was denied because my dentist is not in network. I called numerous times and had conversations where they immediately told me I had no such coverage, and the, upon further investigation told me that I did. After 9 months of claims, denials, probalbly over 20 hours of phone time nothing has been resolved. Promised return phone calls were never received. I feel I have either been mis-informed at the time of purchase, or I am being mislead now. It is very upsetting to purchase a health policy based on what they tell you and find out after the fact that it was not the case.
Business Response
Date: 10/25/2022
Good Afternoon,
The Plan has been in direct contact with member to address her concern. Update-call review is in process and an additional update will be provided once completed.
Thank you PRC-11094
Customer Answer
Date: 10/26/2022

Complaint: 18153738

I am rejecting this response because: They communicated with me shortly after your contact with them. Since then they have not provided me with any updates or responded to any of my phone calls. There has been more than ample time to research and conclude this matter.. I have been asking for assistance since the beginning of the year.

***************************
Initial Complaint
Date:09/28/2022
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 called to cancel this wellcare flex card because they are charging me money and it's holding me back from a lot of my treatment and they are charging me $30 for every doctors appointment. And when I called wellcare they said that they can not cancel this card by any means, and that's why I contacted your office.
Business Response
Date: 10/06/2022
On 10/5/22 @10:56 am ************ HIPPA verifier advised member of BBB complaint and want to confirm the request of canceling the Flex Card. Member stated correct does want to remain to stay on his prescription drug plan. Member states he just feels that he is not able to use this benefit like he feels like it should be used for. I advised member not sure if this can be done but will reach out to vendor management for review and research on this issue and I will follow back up.
Customer Answer
Date: 10/07/2022

Complaint: 18139567

I am rejecting this response because: i just want the one for my prescriptions only.

Sincerely,

***********************
Business Response
Date: 10/12/2022
Member plan MAL termed on 9/30/22 member new plan MA-PDP active 10/01/22 please see screen shots of termed plan ******** and active plan ********. Member rolled into Plan PDG02-G02-076 10/01/22. Member currently on Prescription drug plan

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