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:01/21/2025
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 enrolled in a ******** pharmacy benefits plan advertised as 0$ per month, during ******** open enrollment. Around Jan 17 I opened a letter from Wellcare telling me that their premium was now $28.70 per month because I had no previous pharmacy plan and I was being penalized. I spent 1 hour and 7 minutes on the phone with them this morning***************). I told them I did not want this coverage and it was not what I signed up for. This is a bait and switch type scam in my opinion. I was told I could not cancel the plan and if I didn't pay the premiums they would report me. I asked them to file a dispute.
Business Response
Date: 01/30/2025
Hello,
Thank you for reaching out regarding your concerns. We understand your frustration and appreciate the opportunity to address your complaint.
Upon review, we confirmed the member enrolled into a ******** pharmacy benefits plan effective January 1, 2025. A late enrollment penalty was applied due to uncovered months without prior creditable prescription drug coverage, per ******** guidelines. This information was outlined in the notification letter sent to the member.
After speaking with the member on January 28, 2025, He requested to disenroll from the plan to facilitate this request, we promptly emailed him the necessary disenrollment form on the same day. We also provided instructions on how to return the form for processing. The members request has been escalated to our enrollment team for review and processing.
If you have any additional questions or require further assistance, please contact us directly. We are committed to resolving this matter as efficiently as possible.
Thank you,
Customer Answer
Date: 01/30/2025

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,

******* ********
Customer Answer
Date: 02/04/2025

Complaint: 22834012

I am rejecting this response because: I submitted a form to discontinue this insurance policy and it was denied multiple days later. I am definitely not satisfied with this resolution.

Sincerely,

******* ********
Business Response
Date: 03/07/2025
The member was informed that disenrollment requires a valid election period. The disenrollment form was sent to the member on January 28, 2025 via email, and later submitted to the enrollment team for processing. The case has been escalated, and final determination was made no plan error occurred, the *** (late enrollment penalty) posted on the members account is valid and the member did not disagree. The member believes he should have been advised sooner during the application, once application was submitted and completed, documents were sent to the member on on December 6, 2024, and December 19, 2024 informing him of the ***.
Customer Answer
Date: 03/07/2025

Complaint: 22834012

I am rejecting this response because: They state:The member believes he should have been advised sooner during the
application, once application was submitted and completed, documents
were sent to the member on on December 6, 2024, and December 19, 2024
informing him of the **** I was notified by a letter dated Jan 1 2025 and received about 10 days later. There was no opportunity to decline enrollment.

Sincerely,

******* ********
Initial Complaint
Date:01/17/2025
Type:Billing 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 enrolled me in a healthcare plan I never requested. I am a veteran I get all of my prescriptions delivered right to my door all for free. They either just hijacked me or it was deception. All of these healthcare plans I throw in the garbage I don't need them again I'm a veteran I get my Healthcare through the *********************** healthcare. I tried calling their customer support and the wait time estimated wait time was 626 minutes. Over 10 hours. I will try again tomorrow morning when they open. This is unacceptable to me they hijacked me they deceived me whatever it was I throw all those things away. I want off of their plan completely forever off. Now they have made it pretty much to discourage people from calling them over 10 hours wait I have to leave my phone open to them for over 10 hours for something I never enrolled in help. Have them cancel me forever please.
Business Response
Date: 01/24/2025
Hello,
Thank you for reaching out regarding the complaint filed concerning an enrollment with Wellcare. We appreciate the opportunity to address the concerns raised
Upon review, the member in question was enrolled in a Wellcare plan through a process known as Facilitated Enrollment by CMS. This occurs when CMS identifies individuals who qualify for Extra Help and ensures they are enrolled in a plan with a premium below the ***************** average. This process is designed to prevent a lapse in drug coverage and avoid potential late enrollment penalties.
When the member contacted Wellcare on 01/18/2025, our representative explained that they were not required to pay a premium due to their eligibility for Extra Help. Despite this, the member opted to cancel the enrollment, citing that their medications were already covered through other means. A disenrollment request was submitted at that time. Following the request, Wellcare received confirmation from CMS on 01/21/2025 that the enrollment had been cancelled. As a result, the plan, which was originally set to begin on 03/01/2025, will no longer take effect. A disenrollment letter was sent to the member on 01/20/2025, confirming the request and providing guidance on potential next steps regarding previous coverage.
Wellcare also made multiple attempts to reach the member via outbound calls on 01/21/2025, 01/22/2025, and 01/23/2025 to ensure resolution, leaving voicemail messages with the appropriate contact details.
If any further clarification is needed, we are happy to assist.
Customer Answer
Date: 01/28/2025

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:01/16/2025
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 July 10th, 2024 I was prescheduled to get a ride to my foot doctor. ****************** from my insurance uses Lyft and the Lyft was late in picking me up. Then when I was to go home {which is 19 miles away} I tried for about 3 hours calling *** for a ride home. They couldn&#**;t find a driver, so I had to call a taxi to go home and it cost $84.24. After reviewing the situation for 30 days they made their decision to reimburse me the full amount of $83 dollars and some cents. When I made a grievance with them on July 10th I thought the taxi fare was 83 something, but when I got the taxi receipt it was $84.24. So, I got an approval letter in August of 2024 and have been calling the *** since and there is no progress to get my refund is what I believe. It is taking too long. I sent the the proper papers they wanted, such as the taxi receipt and I had to send the papers twice, because the first time I sent them they gave me the wrong address and never got them. Everything was prescheduled for my medical appointment and they took me there {although they were 30 minutes late in going to} and didn&#**;t take me back home. I have 12 free rides under my H32**33303735323536**H insurance. I&#**;d like my refund.
Business Response
Date: 01/21/2025
Good morning,
I spoke to the complainant on 01.21.2025. The complainant will be getting a full refund via check to his PO BOX address. The complainant is satisfied with the outcome.
Customer Answer
Date: 01/22/2025

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 I get my check, otherwise I want the case to remain open. Thank you

Sincerely,

**** ***********
Initial Complaint
Date:01/16/2025
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 calling about the WellCare insurance plan out of ******************************** they have a very big issue with forcing people to take their insurance they told me and separately they told my boyfriend's uncle that Humana had left our area and we had no choice but to take the well care insurance would that being done my boyfriend's uncle his name is ***** *********** He lives in ****** ******** He wasn't able to afford his diabetes medication or his heart medication so he has not taken it since January 1st due to the price of the medication now this is appalling It's disgusting and it's ridiculous and it's not Right that he cannot afford it they should be reprimanded for this something should be done and I can't imagine how many other people they forced to take this insurance and how many people will have to skip on their medications every month because they cannot afford them so all I can say is I need you to do something with h These people I was lucky enough to get a phone call from a ****** **** phone number is **************************** he called me tonight and asked me if I wanted to go back to Humana cuz he sees everything on the insurance end I obviously signed back up with Humana but how many other people are going to miss this phone call please do something!!! ????
Business Response
Date: 01/17/2025
Hello ******* ******,
My name is *******, we received your review regarding the health plan. To further research your case, we need more information. Please contact me at ************ and reference case number PRC-16557.

Thank you,
Desiree
Initial Complaint
Date:01/16/2025
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.
WellCare has been sending me correspondence implying that I have an account with them and owe them premiums for the coverage they are providing. I have never and will not opt to have additional ******** coverage through WellCare. Their payment booklet telling me what payments I owe them misrepresents a financial obligation and is predatory. They do not have customer service that is reachable by phone, and calling just gets you a series of special offers rather than a way to clear anything up.
Business Response
Date: 01/21/2025
We have been in contact with the individual regarding their concerns. Upon outreach on January 21, 2025, we spoke with them and confirmed their enrollment status. It was explained that they had been auto-enrolled in the plan, and the only change was their LIS level, which resulted in a balance. The individual stated they did not want WellCare coverage and requested a disenrollment form.
The requested form has been sent via email, and once it is returned, it will be forwarded to the enrollment team for processing. Prior to this conversation, multiple outreach attempts were made on January 16 and January 17, 2025, but we were unable to reach them. Voicemails were left with callback details.
At this time, we are awaiting the return of the disenrollment form to proceed with resolution. Please let us know if any further details are required.
Initial Complaint
Date:01/14/2025
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 retired in 10/2024, my health coverage ended 10/31/2024. I was in SEP from 11/01/2024 - 01/02/2025 (Special election period). I have contacted Wellcare on 12/27/2024 to enroll in their Value Script plan. My application was denied with the reason "You attempted to enroll outside of an enrollment period". However, according to ***, my enrollment period was 11/01/2024 - 01/02/2025. I have contacted Wellcare multiple times and literally spent hours either waiting to speak with somebody or explaining the issue again and again to different agents to no avail.Their customer service **** are absolutely incompetent, they just read from the same script.
Business Response
Date: 01/23/2025
Hello. We apologize for the dissatisfaction that you experienced. The member has been enrolled with the plan and the issue has been resolved during our contact. The member expressed satisfaction. No further actions necessary.
Customer Answer
Date: 01/24/2025

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:01/13/2025
Type:Billing 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've been a Wellcare Value Script customer for 2 years. I cancelled the coverage effective 1/1/2025 around August, 2024. I changed my mind, but couldn't reenroll over the phone. In November, 2024 I applied for continued Value Script Part D ******** Coverage in 2025. On November 28, 2024 Wellcare Value Script issued a Value Script membership card to me with the same Plan#, RxBin, RxPCN and RxGRp numbers. Wellcare fraudulently claims I applied for the Wellcare CLASSIC Plan. There is no premium for the Value Script Plan I applied for, and the coverage is available at any pharmacy. The Classic Plan charges about $5 a month and limits use to certain pharmacies. I am now being billed for the Classic Plan that I NEVER applied for. I don't plan to pay the premiums but can't help but wonder what this will do to my credit score. I spoke to 2 Wellcare agents and finally a Wellcare preenrollment agent (their term, not mine). Wellcare claims to be unable to access my application to verify that I didn't ask to change my policy, and correct their mistake. As this is outside the ******** enrollment period, and I don't qualify for a special exception, Wellcare refuses to do anything to correct their mistake. I was told I must contact ******** and try to get a special exception before Wellcare will correct their mistake. As far as Wellcare is concerned I'm just out of luck. I called and spoke with ******** and ******** said it won't help me.
Business Response
Date: 01/14/2025
our enrollment department confirmed the member is enrolled in the value script plan, effective 01/01/2025
Customer Answer
Date: 01/14/2025

Complaint: 22800508

I am rejecting this response because: This response is the only evidence of coverage I have. Also, according to the attachment that came from the Wellcare website, I am not financially responsible for paying any amount for this coverage. However, Wellcare sent me payment coupons. I don't understand this. Wellcare needs to tell me whether they expect me to pay for this coverage.

Sincerely,

********* **********
Business Response
Date: 01/15/2025
good afternoon, the plan you are in is a no premium plan. WellCare value Script. thank you.
Customer Answer
Date: 01/16/2025

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:01/13/2025
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.
Hello. I have Wellcare for my ******** part D coverage. They recently raised their monthly prices significantly, so I called to cancel my coverage. They told me to send a letter to cancel, which I did. They are refusing to cancel my coverage. Please cancel my Wellcare ******** part D coverage as I am already enrolled with a different company for this.
Business Response
Date: 01/21/2025
We have been actively attempting to contact the member regarding their concerns but have not received a response to our outreach efforts. Multiple calls have been placed, and voicemails were left with the appropriate contact information, but we have not heard back from the member.
Our records indicate that the member was disenrolled from coverage as of January 1, 2025. A disenrollment confirmation letter was sent to the member via mail on January 9, 2025. Based on this information, we are preparing to close the case.
If the member still requires assistance, we encourage them to reach out to us directly. Please let us know if any further action is needed from our end.
Initial Complaint
Date:01/10/2025
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 2024 Wellcare ID #********. My *************************** ID #********. I am a quadriplegic and use a power wheelchair. This allows me some independence. It also helps me protect myself from certain medical conditions that occur from immobility (pressure ulcers, blood clots, pneumonia, etc). On approximately 11-18-24 National ****************** (my wheelchair provider) sent a repair authorization request to Wellcare. I received a denial letter dated 11-27-24 from Wellcare. NS&M submitted an appeal on 12-9-24. Wellcare informed me on 12-10-24 that they had received the appeal and would take 30 days for a decision. The decision would be available on 1-8-25. On 1-8-25 I called Wellcare for their decision. I was told my appeal was null and void because we had crossed over to a new year. I was also told my appeal was null and void because Wellcare changed my health plan. **** would now have to submit a new authorization request. Wellcare told me they did not have the correct form for submttial in **********. It could take 24 hours to resolve that.I feel that I have been lied to and this is a delay and dismiss tactic. They put my appeal into a 30 day review, knowing it would be voided in 21 days. They changed my policy knowing that would void any reviews at the end of the year.Throughout the process I was continually told the appeal was still pending and a decision would be available by 1-8-25.Without my power wheelchair, the risks to my health increase dramatically. That chair is not only extremely important for medical check *** and examinations, it's much more difficult to get to them without it.
Business Response
Date: 01/21/2025
Hello.We apologize for the dissatisfaction that you experienced. The plan has made contact with the member/complainant regarding their concerns, and we are currently working on getting this matter resolved.
Customer Answer
Date: 01/23/2025

Complaint: 22795541

I am rejecting this response because:
On January 21st, 2025 my provider (National Seating & Mobility) resubmitted an 'authorization request' to Wellcare. Even though Wellcare has been informed that this situation is detrimental to my health, they put the 'authorization request' into a 'standard 14 day review' process instead of an 'urgent 72 hour review' process.

Sincerely,

**** ******
Business Response
Date: 01/27/2025
Hello.We apologize for the dissatisfaction that you experienced. The plan has made contact with the member/complainant regarding their concerns, and we are currently working on getting this matter resolved.
Customer Answer
Date: 01/28/2025

Complaint: 22795541

I am rejecting this response because:
At the time of this notice, the matter has not yet been resolved. Wellcare has been in contact with me, but so far they've only connected me to other people in their organization. Nothing concrete has been said or done.

Sincerely,

**** ******
Business Response
Date: 03/04/2025
Hello, contact has been made with the member and information below has been shared.
Final Resolution:
3/04/2025: Spoke with the member, who confirmed all issues have been addressed and no further action is required. The member expressed appreciation and agreed to case closure.
3/04/2025: Provider contact (****** ******) confirmed the order has been placed with an estimated arrival time of two weeks. The provider will contact the member once all parts arrive to schedule the repair. The provider confirmed no further action is needed from the plan.
The member has been provided with attachments showing proof of approval.

Please let me know if any additional information is required.
Thank you,
Customer Answer
Date: 03/06/2025

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and agree that resolution has been made. I only hope Wellcare will not put anyone else through the turmoil and suffering that I had to endure. I am lucky that the medical conditions that arose during this conflict were not permanent. The next person may not be so lucky.

Sincerely,

**** ******
Initial Complaint
Date:01/10/2025
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 filed a complaint and i was called and there was an attempt to resolve the issue but Im still without a card and I have left messages but still have not gotten a returned call. Because of the new year and wellcares policy the balance on my card was lost Dec 31. I still do not have a card ! So i find it really crappy that they cant send me a relacement card but they sure had no problem mailing me a letter refusing to pay my er bill.
Business Response
Date: 02/04/2025
Good afternoon,
The plan is pending on how the card was sent to Ms. ******** and an update was provided on 2/04/25 an update was provided.

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