We use cookies to give users the best content and online experience. By clicking “Accept All Cookies”, you agree to allow us to use all cookies. Visit our Privacy Policy to learn more.

Manage Cookies
Resources for Businesses My BBB
Share
Business Profile

HMOs

WellCare Health Plans, Inc.

This business is NOT BBB Accredited.

Find BBB Accredited Businesses in HMOs.

Complaints

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

Find a Location

WellCare Health Plans, Inc. has 26 locations, listed below.

*This company may be headquartered in or have additional locations in another country. Please click on the country abbreviation in the search box below to change to a different country location.

    Please enter a valid location.

    Customer Complaints Summary

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

    If you've experienced an issue

    Submit a Complaint

    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.

    Sort by

    Complaint status

    Complaint type

    • Initial Complaint

      Date:01/10/2025

      Type:Customer Service Issues
      Status:
      Resolved
      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 January 8, 2025, Wellcare denied prior authorization for my prescription of Sevelamar Carbonate, for which they covered for years. They lied to my doctors and pharmacy by saying they never covered this drug in the past and said that I didn't have ******** Part B, which is also a lie. Now, I can't get the medication, and I need it in order to live. Their customer service **** are all from ***** and have heavy accents that I can't understand. They are rude, and don't understand English as well. I have to constantly repeat myself when talking to these incompetent customer service ****. ** they don't cover this medication, I will have to change providers. Their company is trash and an embarrassment, and I wouldn't recommend this company to an enemy!

      Business Response

      Date: 01/21/2025

      Thank you for reaching out regarding this matter. We have been actively attempting to contact the member to discuss their concerns and provide further assistance. However, our outreach efforts thus far have been unsuccessful, as our calls have gone unanswered, and the members voicemail is full, preventing us from leaving messages on some occasions. 

      Our records indicate that the medication in question was previously covered under the members 2024 benefit plan but is no longer included in their 2025 formulary. The pharmacy claims have been appropriately rejecting due to the need for ******** Part B coverage. The member has been advised via denial letter that if their ******** records are inaccurate, they should contact ******** directly to update their information. Additionally, their provider has the option to submit an independent review request.

      We remain available and ready to assist the member should they reach out for further guidance. Please let us know if there are any additional steps required on our end.

      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.

      Sincerely,

      Demezz ********

    • Initial Complaint

      Date:01/07/2025

      Type:Service or Repair Issues
      Status:
      Answered
      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 tried to get into my on line account with ******************** for the past week. and have spent countless hours on phone just trying to get someone to send me a wellcare prescription claim form. I spoke to six different people in 3 days. The last being a supervisor. All living in the ***********. Not one knew what a vaccine was or what Shingrex is or that it was covered. I was sent to sites that were for doctors and pharmacies. I finally got into my account and found form myself! But asked them to mail it because they have no way of submitting online in the 21 st century. I have to pay $200 for the shingles vaccine and it will take 2 months to be reimbursed from time of submission. I don't even know if the form will be sent. So really the vaccine is not free! And who are these people ? Do they really do business here in the **? Do they have an office here, or just a PO Box. The whole customer service ********************** is in the ***********! Again, THE VACCINE IS NOT FREE! I'm out $200 for 4 months(possibly longer) and a good 2 days of work.

      Business Response

      Date: 01/21/2025

      the member advised she was able to access her account and received the reimbursement forms.  

    • Initial Complaint

      Date:01/06/2025

      Type:Billing Issues
      Status:
      Answered
      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,The spendable card reduced the amount in 2025 without any notice or explanation from $100 .00 to $49.00 , although my income is below poverty line. Wellcare did not send me any letter prior of this change , and this is a violation and shows the level of chaos and lack of professionalism of this company and continue misleading of the members.

      Business Response

      Date: 01/06/2025

      contacted the member on 01/06/2025 to advise the annual notice of change was mailed to his address on 09/22/2024 to advise of the spendable change for 2025. He advised he didn not receive, and i confirmed the address sent as correct. I also advised we could send another, he declined. 

      Customer Answer

      Date: 01/07/2025

       
      Complaint: 22771003

      I am rejecting this response because:


      Wellcare deliberately not sending the notice of change to prevent the member from the Open Enrollment Period (AEP) each year ( ******** Annual Enrollment Period ).
      Wellcare is deliberately not sending me the "Notice of Change" , preventing me from participating in the ******** Annual Enrollment Period (AEP), this could be considered a serious violation of federal regulations and could potentially be considered insurance fraud, as it deprives the member of the opportunity to review and potentially change their plan during the designated open enrollment period , 
      ( From Oct 15th through Dec 7th every year ).
      my address remain the same never change for many decades and never had any issues with postal mail .
      Wellcare usually send me regular postal mail and emails to me and i do receive them regularly without any issues , but they did not send me any letter or email regarding this matter notice of change .

      Sincerely,

      ***** Alkhalisi

      Business Response

      Date: 01/07/2025

      good afternoon, the annual notice of change was mailed to the members address, we confirmed the address with the member, Mailed on 09/22/2024. see attached, thank you 

      Customer Answer

      Date: 01/15/2025

       
      Complaint: 22771003

      I am rejecting this response because:


      WellCare did not send me any letter prior of this change , and this is a violation and shows the level of chaos and lack of professionalism of this company and continue misleading of the members.
      my address remain the same never change for many decades and never had any issues with postal mail .
      Wellcare usually send me regular postal mail and emails to me and i do receive them regularly without any issues , but they did not send me any letter or email regarding this matter notice of change .

      Sincerely,

      ***** Alkhalisi

    • Initial Complaint

      Date:01/06/2025

      Type:Billing Issues
      Status:
      Answered
      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.
      deny payment insurance for the use of **** for *****************************. **** has been approved by ******** and ***** has been paying for this since 10/03/2023. I would like this to be appoved for my pdp insurance Wellcare my member # ********

      Business Response

      Date: 01/21/2025

      Thank you for reaching out regarding the members complaint. Below is the resolution to their concern:

      Confirmed the prior authorization approval for the medication, effective January 4, 2025.
      Advised the member to inform their pharmacy to submit the claim under the approved prior authorization.
      Informed the member to contact WellCare for further assistance if any issues arise after the pharmacy submits the claim.

      At this time, the member has acknowledged the resolution and is working with their pharmacy to complete the claim submission. Please let us know if any further action is needed.

    • Initial Complaint

      Date:12/27/2024

      Type:Product Issues
      Status:
      Answered
      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.
      10/15/24 - After speaking with 8 WellCare agents (3:40min.) I spoke with Supervisor ***** who said, We are all set for the policy change to be effective on 1/1/25, but who failed to assign a confirmation number to the agreed upon change in insurance plan. I was not made aware of this until 12/20/24 when I received payment Bo let with former plan, which was after the deadline of 12/7/24 to make policy changes.Between 12/23/24 and 12/27/24 I spent 7:31 min. on the phone speaking with 17 agents and 4 supervisors and 6 departments with no resolution.

      Business Response

      Date: 01/07/2025

      Good afternoon, 

      We have escalated this issue to enrollment team and call review was performed for previous calls to the plan. This case is currently pending as we have not yet fully resolved this issue, we are awaiting findings from the enrollment team to fully confirm if a plan change can take place. We have spoken with the member and we will follow up once we have fully resolution. 

      Thank you 

      Customer Answer

      Date: 01/17/2025

       
      Complaint: 22737254

      I am rejecting this response because:
          Welfare executive response team indicated that on December 30 they were reaching out to the enrollment team for a solution. I have had conversations on January 6th, 7th, 8th and 10th, with always a response that they would call back. But that does not happen. I believe that they are not taking responsibility for the mistake agent **** made on October 15.
      Sincerely,

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

      Business Response

      Date: 01/24/2025

      Hello, 

      This case remains open and is still under review, WellCare leadership has conducted an extensive internal review and engaged with our Enrollment and Compliance teams to explore potential solutions. Unfortunately, per CMS regulations, an application must be submitted during *** or under a valid Special Enrollment Period (SEP) to process plan changes outside of the *** timeframe. As no application was submitted, Ms. ****** remains enrolled in her original plan for 2025 and we are working on a proper resolution for the member. 

      Outreach has been made to the member numerous times and four voicemails have been left informing them the issue is still being addressed and the case remains open. Once we have proper resolution we will be sure to contact the member. Once again we do apologize for any inconvenience this has caused and we will be sure to have this issues resolved once further review is conducted. 

      Thank you

    • Initial Complaint

      Date:12/23/2024

      Type:Service or Repair Issues
      Status:
      Answered
      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 2023 I went to ************ clinic for a regular cleaning after the cleaning they referred me to an dental specialist because needed an implant. So I went to **** dental clinic. Sage ************* accepted to proceed the service for implant of two molars that they found in need for molars replacement.The Sage ************* after ordered the Elite ************* the extraction of the damaged molars started the regular procedure for the implant then a SAGE agent approached me at the room during the dental procedure I was in the dental chair bleeding, with anesthesia and pain with a mechanical instrument inside my mouth and without saying as word she told me that Well Care refused to pay the most important part of the procedure which is covered, according to their own evidence of coverage book in Spanish and English. I have been trying to solve this situation for more than a year with numerous calls and 9 bogusness escalations.I hope in the future, patients in need of this type of dental services do not believe in such manipulation or illegal scams and take a lot carefully information about this criminal acts. Although Well Care did not include in 2024 this false benefit again.

      Business Response

      Date: 01/03/2025

      good morning, this issue is currently under review with the dental vendor, thank you 

    • Initial Complaint

      Date:12/23/2024

      Type:Billing Issues
      Status:
      Resolved
      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.
      Have been promised a Refund of nearly $300.00 since the beginning of November. After multiple calls and emails, no Refund?? Promised a call back last week, and no call. What can be done to receive my Refund?

      Business Response

      Date: 12/27/2024

      Dear Mr. ****************** you for bringing this matter to our attention. We are sorry for any inconvenience that you have experienced. A check dated 12/2424 has been reissue and mailed to the mailing address that we have on file. Please allow 8-10 business days not including weekends and holidays for the funds to arrive at the members mailing address on file.
      If you have any further questions or concerns, please do not hesitate to contact us.
      Sincerely,

      **** D

      Customer Answer

      Date: 12/28/2024

       
      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:12/23/2024

      Type:Product Issues
      Status:
      Answered
      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'm a member of wellcare health at this time . My member ID# is ************** . On 12/9/2024 I had a home visit assessment visit with (signify healthcare ) with the promise that I would receive a $100.00 gift card for ******* after completing the home visit assessment . To this date I have not received this alleged gift card and both wellcare and signifyhealth have received there payment from ******************* under false pretences. Both companies have scammed ******** and mediacade for insurance claims and used me to accomplish this rongful act .

      Business Response

      Date: 01/08/2025

      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.

    • Initial Complaint

      Date:12/23/2024

      Type:Product Issues
      Status:
      Answered
      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.
      12/18/2024 a person change my police with their Company from a low cost another Low Cost that does not take` of my health needs I told him I did want these things but he did anyway I call there help Line But I did not understand them HelpMe I do not understand

      Business Response

      Date: 01/07/2025

      the member was changed to the original PDP plan. thank you 

    • Initial Complaint

      Date:12/20/2024

      Type:Customer Service Issues
      Status:
      Resolved
      Resolved:
      The complainant verified the issue was resolved to their satisfaction.
      Unresolved:
      The business responded to the dispute but failed to make a good faith effort to resolve it.
      Answered:
      The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
      Unanswered:
      The business failed to respond to the dispute.
      Unpursuable:
      BBB is unable to locate the business.
      I received a letter that looked very official, stating the I had to sign up for Wellcare for 2025. I did. Now I discover it is only an option not a requirement for ********. The letter was made to look like it was from ********, that is why I signed up. I have Unitedhealthcare and want to keep it. I am 75 and don't like getting taken advantage of by unscrupulous businesses. Thank you.

      Business Response

      Date: 12/30/2024

      Hello. We apologize for the dissatisfaction that you experienced. The member has been disenrolled and the issue has been resolved. No further actions necessary. 

      Customer Answer

      Date: 12/30/2024

       
      Better Business Bureau:

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

      Sincerely,

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

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

    To become accredited, a business must agree to BBB Standards for Trust and pass BBB's vetting process.

    Why choose a BBB Accredited Business?

    BBB Business Profiles may not be reproduced for sales or promotional purposes.

    BBB Business Profiles are provided solely to assist you in exercising your own best judgment. BBB asks third parties who publish complaints, reviews and/or responses on this website to affirm that the information provided is accurate. However, BBB does not verify the accuracy of information provided by third parties, and does not guarantee the accuracy of any information in Business Profiles.

    When considering complaint information, please take into account the company's size and volume of transactions, and understand that the nature of complaints and a firm's responses to them are often more important than the number of complaints.

    BBB Business Profiles generally cover a three-year reporting period, except for customer reviews. Customer reviews posted prior to July 5, 2024, will no longer be published when they reach three years from their submission date. Customer reviews posted on/after July 5, 2024, will be published indefinitely unless otherwise voluntarily retracted by the user who submitted the content, or BBB no longer believes the review is authentic. BBB Business Profiles are subject to change at any time. If you choose to do business with this company, please let them know that you checked their record with BBB.

    As a matter of policy, BBB does not endorse any product, service or business. Businesses are under no obligation to seek BBB accreditation, and some businesses are not accredited because they have not sought BBB accreditation. BBB charges a fee for BBB Accreditation. This fee supports BBB's efforts to fulfill its mission of advancing marketplace trust.