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.
104 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:11/25/2024
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 HAD INROLLED IN WELLCARE DRUG PLAND 11-12-2024 I HAVE CALLED SINCE TO CANCEL MY ENROLLMENT I HAVE SPENT MANY HOURS ON THE PHONE WITH THEM SINCE 11-12-24 I AM TOLD ITS CANCELD EVERYTIME THEY WILL NOT CANCEL IT I TALKED TO ******** THEY SAID THEY HAVE NOT DISENROLLED ME AS OF TODAY 11-21-24 I HAVE SPENT 6 HOURS CALLING WELLCARE TOLD SAME THING ASK FOR SUPERVISOR TOLD SAME THING EVERY PHONE NUMBER I TRY GOES SAME PLACE I DO NOT WANT TO BE ENROLLED WITH WELLCARE I WANT TO STAY WITH MY CURRENT PLAN WITH SILVER SCRIPT BUT THEY CAN NOT CHANGE ANYTHING UNTIL IM DISENROLLED WITH WELLCARE ******** ALSO SAYS I MUST BE UNENROLLED FROM WELLCARE. WELLCARE WILL NOT CANCEL MY ENROLLMENT I CANT AFFORD TO NOT HAVE A PRESCRIPTION DRUG PLAN AS I HAVE MEDICATIONS THAT I NEED TO TAKE. I DO NOT HAVE ANY MATERIALS OR ID CARD FROM ********************** ONLY ******** ID, *************
Business Response
Date: 11/26/2024
Hello and Good Afternoon,

We sincerely apologize for any inconvenience caused to you. Our records indicate this plan has been cancelled and a letter confirming has been issued.

Thank you!
Customer Answer
Date: 11/26/2024

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:11/25/2024
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 disenrolled from Wellcare on September 25, 2025,and received a letter from WellCare dated 0926/24; it was not sent First Class Mail and I did not receive the letter until October 11, 2025.Wellcare told me ******** had called them and told Wellcare not to disenroll me. ******** denies making any such ******* took weeks, and many hours for me to straighten this out, and get into the ******** Advantage Plan that I wanted, which I now have (confirmed today 11/22/24 by ******** on the telephone), which is Devoted Choice Plus Oregon PPO ******** Advantage Plan.Yesterday, 11/21/24 I received a letter from Wellcare that says: "******** has enrolled you back in Wellcare No Premium Open (PPO) with no break in coverage as of 10/01/24. We will be sending you a new membership card, etc etc etc.I request that the ******** strike Wellcare off as an authorized provider of ******** Advantage Plans. I also request that Wellcare STOP AND DESIST FROM ALL CONTACT WITH ME IN ANY FORM OR FORMAT.
Business Response
Date: 11/26/2024
Good afternoon, Complainant requested not to be contacted by the plan in any format. As per my research the complainant was disenrolled from the plan in 2018. The complainant last letter from the plan was 12.31.2018. There is no other communication from WellCare since 2018. Complaint was added to our ******** Suppression List as of 11.26.2024 as do not contact at all.
Customer Answer
Date: 11/26/2024

Complaint: 22593703

I am rejecting this response because, I have had correspondence and a case with Wellcare in 2024. They state that they had no record of me since 2018. This is false.

Sincerely,

****** *****
Business Response
Date: 11/27/2024
Good afternoon,
I am asking for the complainant to send the correspondence to WellCare so that we can review and *****. Also, as per my original response to the BBB on 11.26.2024, the member was added to ******** Suppression list as of 11.26.2024. Thank you for your time and attention.
Customer Answer
Date: 12/02/2024

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:11/20/2024
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.
I ***resent a Medical DME supplier, our Wellcare provider ID is **********: 05/03/2024 Billed Amount $30,693.25.On 6/4/2024, Wellcare processed most of the items on our purchase claim #********** to purchase allowable per purchase prior authorization #********* that was obtained prior to dispensing items to patient. Wellcare also denied some items on the claim due to missing modifier codes.On 6/10/2024, I submitted a corrected claim with the needed modifiers and Wellcare ***rocessed our corrected claim on 7/17/2024 under claim #**********. This claim ***rocessed ALL previously paid as purchase codes at a rental allowable rate in error instead of the prior authorized purchase allowable rate and Wellcare recouped their previous payment from us on claim **********.On 7/24/2024, I submitted a claim dispute online to Wellcare for claim #********** informing them they ***rocessed the claim to rental allowables in error. Wellcare's website said to allow 30 days for a response.On 8/26/2024 I statused the disputed ********** claim and it was "in process" per Wellcare's website.On 9/23/2024, due to no response from Wellcare, I reached out to an online chat *** and they informed me the appeal was denied because they wanted the dispute mailed. The dispute along with supporting documentation and proof of purchase prior authorization was mailed that same day to ******************************On 10/14/2024, Wellcare updated the claim number to **********A on their website and since that date, it has had a status of "In process". When trying to view more details, the website returns a status of "Claim Unavailable, Details are currently not available. Please try again later" Details continue to be unavailable as of today, 11/19/2024.We would like this matter to be finalized and be paid the full purchase allowable per our prior authorization. We would also appreciate a ticket number for our Dispute / Appeal so it can be investigated via your website.
Business Response
Date: 11/26/2024
Hello and Good Morning,

We sincerely apologize for the dissatisfaction you've experienced. We have made multiple outreach to acknowledge complaint, but there was no answer and messages were left. We have escalated this to our Claims team for review and will reach back out once resolution has been reached.
Thank you!
Customer Answer
Date: 11/26/2024

Complaint: 22578722

I am rejecting this response because:
I did receive Wellcare's voicemail and called back on 11/22/2024 at 11:37am and after 15 minutes on hold, was forced to leave a voicemail for rep ****** via the **** I gave further informaiton on the patients Wellcare ID and DOB in the voicemail. I appreciate the escalation of this issue to the claims team but I am leaving this complaint open until the claims processing team has completed the reprocessing of claim to purchase allowable. Please also know that Wellcare can communicate any updates or questions via my email that was included in this complaint as the email is secure and a preferred method of communication for better tracking of status. If verbal communication is required and I am unavailable to take your call, my voicemail is also secured and detailed information can be communicated in the voicemail message.

Sincerely,

***** ****
Business Response
Date: 12/05/2024
Hello and Good Afternoon!
I apologize we were unable to reach each other via phone, I have reached out via email and will be sure to relay complete resolution from Claims once review is completed.
Thank you
Customer Answer
Date: 12/05/2024

Complaint: 22578722

****** reached out via email and I replied telling her to let me know if she needs any additional information in order to get this claim to reprocess to the prior authorized purchase allowable. I am leaving complaint open until the claim has been reprocessed and a resolution has been reached.

Sincerely,

***** ****
Business Response
Date: 12/11/2024
Hello and Good Afternoon,
Thank you for your patience and communication! We have reprocessed Claim and payment has been issued. Please let us know if you have any questions.
Sincerely,
****** *.
Customer Answer
Date: 12/11/2024

Better Business Bureau:

Thank you ****** for your quick response and communication in this matter. 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:11/13/2024
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.
Company falsely advertises coverages and formularies. In spite of federal guidance authorizing the prescription coverage of Monjuaro for heart and weight related matters - they deny patients with disability the right to be covered, to be well, and to thrive. To live a HEALTHY life. They falsely advertise the availability to attract coverage - then they deny the advertised coverage.
Business Response
Date: 11/14/2024
Good afternoon, Mr. ******

I am following up on our conversation on 11/13/24. Per that conversation I advised per review this medication Monjuara is not on the formulary and due to guidelines, this drug is used for weight loss purposes, which is one of the classes not covered under Part D coverage. I advised as well, I will do some research about the enrollment process to verify if there was any error on the plans side and follow back up. Your issue is currently still pending. If you have any questions or concerns, please feel free to contact me back. My call back number is ************* your reference number is PRC-*****. I am looking forward to speaking with you again soon.

Thank you,
*******
Initial Complaint
Date:11/11/2024
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.
It is preposterous in this day and age that I should have to file a complaint with the BBB to get technical support from this company. I have spent hours on the phone with their representatives trying to get help setting up online access to my account. They have no IT support, and their representatives are clueless when it comes to providing technical support. ******** requires me to get a prescription plan within 3 months of my 65th birthday, or pay a penalty in the future. I signed up with Wellcare, but have no way of creating an online account to pay the bill. I can log on to my account, but when I fill out the information to get online access to my health plan, I get a message saying "we cannot process your request." I have no other recourse to resolve this issue. Please help!
Business Response
Date: 11/26/2024
Hello and Good Afternoon,

We sincerely apologize for the dissatisfaction you've experienced. We are actively working with Ms. ****** and our Web Support team in efforts of having this matter resolved.

Thank you
Customer Answer
Date: 11/26/2024

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:11/11/2024
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.
I signed up with Wellcare insurance in January 2024 and i paid my premium in full for the whole year in check , the amount i sent out was $247.20 , back in September 1 2024 i had to switch to a different insurance because Wellcare did not want to pay for my procedure . Wellcare owes me my refund of $82.40 for canceling them ,they owe me for Sept, Oct,Nov,and December ,four months my premium was $20.60 a month . I have been calling them almost every week waiting to talk to them for 40 minutes and still no refund , it,s been two months and they are still giving me the running around .
Customer Answer
Date: 11/12/2024
Hello I filed a complaint on WellCare health insurance about my refund and today they have resolved my issue, I would like to withdraw my complaint thank you kindly.
Initial Complaint
Date:11/05/2024
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 received a letter from WellCare stating that I would need to find a new policy for 2025. I proceeded to do so and found a policy with United Healthcare. The problem is *** said the policy I wanted was no longer available in 2025. They then without my authorization put me in a plan beginning 11-1-2024. I would be stupid if I changed plans in November and had to incur all of the deductibles and co-pays again. I have doctors appointments scheduled that I have waited months for and I have prescriptions that I need such as insulin and insulin pump supplies. I cannot afford these items without insurance. I am demanding that WellCare immediately reinstate my insurance retroactive to the date of cancellation
Business Response
Date: 11/07/2024
Hello and Good Morning,
We sincerely apologize for the dissatisfaction *** Sunday experienced. We were able to make contact with her to acknowledge complaint and relay resolution. Once *** cancels her enrollment, she will return to her original plan.
Thank you
Customer Answer
Date: 11/08/2024

Complaint: 22515149

I am rejecting this response because:
The policy needs to be reinstated now. Once they reinstate UHC will drop off.
Sincerely,

**** Sunday
Business Response
Date: 11/08/2024
Hello and Good Afternoon,
We apologize for any confusion. Review of eligibility today 11/8/2024, shows *** Sunday is still enrolled with ***. She cannot be reinstated into her original plan until that coverage is cancelled.
Thank you
Customer Answer
Date: 11/09/2024

Complaint: 22515149

I am rejecting this response because: the United Healthcare Plan has been cancelled as is evident in the attached letter

Sincerely,

**** Sunday
Business Response
Date: 11/15/2024
Hello and Good Morning,
We have escalated the attached letter provided by *** Sunday to our Enrollment department for review.
Thank you!
Initial Complaint
Date:10/22/2024
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.
It has just been a lot of wrongness and trickery with Wellcare employees fraud waste abuse and refusal to tell the truth and release the premium refund that they been promising me over five years. They told me it goes back to 2005 and 1000 times they told me it is in the mail. Also told me it was identity theft fraud and put in a fraud claim and then started playing dumb about that. Now that everyone across the board are confirming this is fraud by ******* *************** a State employee in ******** stole my ******** card for almost ******************************* over the phone the last five days I'm gonna get it. They need to stop playing games and release the checks they got sitting there.******** 8dw3 kg2 cd08 ********
Business Response
Date: 10/24/2024
Dear ****** *****,
Thank you for bringing this matter to our attention. We are sorry for any inconvenience that you have experienced. We have made 3 outreach attempts to your contact number and left messages. We also made 2 outreach attempts to your email address that you provided with your complaint. We have not been able to speak with you to discuss your complaint. If you have any further questions or concerns, please do not hesitate to contact us.
Sincerely,
**** D
Customer Answer
Date: 11/11/2024

Complaint: 22455759

I am rejecting this response because: I called wellcare yesterday at 5:20pm and upon my call ************ requested an appeal number unknown to me because I never file an appeal with wellcare or any other healthcare agency and we're baffled. Then the customer service lady said her name is KS is all she provided two letter. I said what appeal numbers are this and she immediately said I must see can I give it to you "hold on" I said you must give it to me because it is about me and so next call I make I can provide the requested number. She came back refusing to give me the number and said it is about identity theft you reported 9/19/24 and I requested a manager several times to file a complaint against her for not having good giving me the appeal number and she would just go silent without answering and simply ignore me until she speaks PLAYING DUMB a foreign lady. Then she says I will give you these numbers to credit bureaus ***************** 525-6085 888 397-3742 and ************ the first number requested an appeal number that I couldn't proceed. I reported her on centene wellcare fraud hotline ************ and given report key 878953946301.

Sincerely,

****** *****
Business Response
Date: 11/12/2024
Dear ****** *****
After investigation, it was determined member had coverage from 4/1-4/30/21 and there were never any payments made by the member or anyone on his 30-day plan. During the member coverage with us, WellCare paid out one claim under claim number ********** for $92.69. Please contact CMS ******** in reference to payments you might have made to CMS ********* as there were no payments made to WellCare by you or anyone else under your name, date of birth and ID#. ********************** does not govern Michigan State Employees as you stated in your original complaint as the person employed who committed fraud on your name. There are no open appeals within WellCare for you as there is no overpayments due to you, you filed a complaint, and your complaint was investigated and resolved.

Sincerely,
Myra
Customer Answer
Date: 11/15/2024

Complaint: 22455759

I am rejecting this response because:

Wellcare employees and **** are lying as it was wellcare employees told me over 5 years you owe it to me and that I will get it. 1000 times you said the check was in the mail and I sign up in 2005 and that I will get it in 5-7 business days. It were wellcare whom told me that it was identity theft and provided me with a claim number to which you lie. I will check my records and find that claim record because as you are aware a ******* *************** is the name a State employee that stole my ******** over 20 years I could use my card now you choose to lie about knowing that wrong name was there until recently ***** provided notice that ******** finally removed the name off the record. Also. I sign up with ****** in 2003 when I couldn't use my ******** card they confessed the owe me the premium refund just review LT23032994653 and Jardin ***** in there executive office called it fraud and told me that I will get it and customer service told me last week I will get it in 14 business days. Wellcare are lying and never informed me about ***** dollar and told me my premium owe are from 2005. They are barefaced liar and the truth will come out because they are trying to hide behind ******** fraud and my effective date is 12/1/2002. These are criminals.

Sincerely,

****** *****
Initial Complaint
Date:10/22/2024
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.
My secondary insurance has yet to re enroll me . My husband paid in my behalf I am in need of an ultra sound due to complications with a surgery I just had. Also I on a specialty medication I cant receive because of this Well care insurance. My husband and I have repeatedly called and they talk in circles . They cashed my husbands check and I still dont have insurance. I need shots every two weeks I am due next week .
Business Response
Date: 10/24/2024
I placed a successful outbound call to the complainant on 10.23.2024. We spoke regarding this complaint, where the member was informed her account is currently active as of 10.01.2024 with no gap in coverage. The compliment was made aware due to no payment slip sent in; the check was cashed only to the husband's account. The complainant understood the error that was made and acknowledge that the account is currently active, and complainant can now pick up her medication and also get her ultrasound completed. Complainant was given a resolution on that call.
Initial Complaint
Date:10/21/2024
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 do not have nor do I want wellcare, and I have disenrolled twice, but they won't leave me alone. They are constantly sending me mail and saying that I'm still a member.
Business Response
Date: 10/23/2024
Dear CHERYL ****
Thank you for bringing this matter to our attention. We are sorry for any inconvenience that you have experienced. We investigated your account and determined that the application was created directly from the *** website. We sent out the disenrollment form via mail and email for to complete and return.
If you have any further questions or concerns, please do not hesitate to contact us.

Sincerely,
**** D

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