Complaints

This profile includes complaints for WellDyneRx, LLC.'s headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  WellDyneRx, LLC.

  500 Eagles Landing Dr Lakeland, FL 33810-2899

• 

  WellDyneRx

  7472 S Tucson Way STE 100 Centennial, CO 80112-3964

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:03/28/2024

  Type:Delivery Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  My ************************ contracts with ******** for mail order pharmacy. My doctor sent my prescription electronically to ******** on 2/29/24. I tried logging into the ******** website 3/18/24 to find out why I had not received my ** and could no longer log in. I called and spoke to 3 different people on 3/18/24 at ******** and they said they tried to fill the ** on 3/1/24 and it wouldnt go thru. I told them my insurance changed on 3/1/24 and that is why my doctor sent it to them on 2/29/24 as I had health partners insurance then. The ******** rep accused me of trying to get them to commit fraud by filling the ** after 2/29/24! I just want my ** my doctor prescribed for me and sent to ******** on 2/29/24 to be filled when my insurance was active at the time the order was sent and I had met my insurance deductible! I contacted *************** who contacted ******** and they passed it off as Welldynes error. ******** said they cannot go back and fill the ** as of the date my doctor sent it to them 2/29/24. They got the order that day and it should have been filled that day- I dont care if it didnt SHIP that day- its the insurance part that matters!

  Business Response

  Date: 04/10/2024

  ******** received the prescription from the patients doctor on 2/29/24 at 2:54 pm. Our standard order process takes ***** hours to complete.

  On 3/1/24 at 5:13 am, a member of our team began processing the order and the claim failed due to the patient no longer covered by her insurance. Our team attempted to run the claim for the medication two more times before sending to perform outreach to alert the member that the claim rejected due to non-coverage and the order would be cancelled. We attempted to reprocess the claim again on 3/11/24 and 3/18/24.Both attempts resulted in a failure due to non-coverage and the order was cancelled.
  

  The patient called our customer care team on 3/18/24 and was advised that the order was cancelled and to contact *************** directly with additional concerns. The patient called again the same day requesting that we backdate the order. The representative explained that we are unable to do so as it would be classified as fraud.
  

  The patient contacted *************** and they reached out to our customer care team on 3/20/********* this call we explained that the order was received on 2/29/24 and that processing can take up to 72 hours. The claim was processed within 24 hours of receiving but rejected since the patients insurance was no longer active.
  

  On 3/26/24, another *************** rep called our customer care team to verify the order. We advised of our process timelines and detailed that when the order was processed, the patient had been set to inactive in our system due to no longer having coverage through ***************.

  Customer Answer

  Date: 04/10/2024

   
  Complaint: 21501551
  
  I am rejecting this response because:
  Patients do not want to know why the business did not process a prescription the day their doctor sent it to The pharmacy. Patients know they had the proper health insurance when the prescription was sent to the pharmacy and the prescription would have been paid for and covered by the patients insurance. I paid thousands of dollar in health insurance and had met my deductible for the **** on Feb 29, 2024 and as a consumer do not accept that my prescription could not be processed the day they received and. Also to suggest the consumer is trying to get the pharmacy to commit fraud is insulting. Pointing fingers at the consumer is wrong. The pharmacy is trying to place blame where it does not belong. This is poor business practice. I do not accept this response and want other consumers to be aware of this standard practice. As consumers we know our mail order RX wont be shipped right away may but I do expect my active insurance to be billed promptly on the day I had insurance.
  Sincerely,
  
  ***********************

  Business Response

  Date: 04/19/2024

  ******** understands the frustration the patient is experiencing with her order not being fulfilled. An order does not begin until the prescription has been reviewed and validated by the pharmacy team. The review process can take ***** hours from the time a prescription is received. Once the prescription clears review, an order can be placed for the medication and processed through the patients insurance. If the patients insurance expires during this time, the claim will be denied by insurance since it must be active at the time of ordering (point of sale). If the patient or doctor had notified ******** that the prescription was urgent, we *** have been able to process the order the same day. As a pharmacy, ******** cannot backdate any claims as it can be classified as fraud against the pharmacy. ******* was not insinuating that the patient was asking us to commit fraud, but explaining how it can be classified as fraud if a pharmacy backdates a claim. ** apologize for any confusion or misunderstanding that *** have occurred during the call.
  Our ***************** team is further reviewing the call between the patient and rep. ** will be providing additional training to reps on how to best explain these complex situations. In addition, we are updating our patient FAQs on how to obtain a prescription prior to insurance expiring.** recognize the dissatisfaction and frustration from the patient, but we must adhere to standard pharmacy practices and laws.

• Initial Complaint

  Date:03/22/2024

  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.

  I have been requesting a reimbursement for three out-of-pocket expenses made in June, July, Sept. 2023. I have spent multiple hours, calling multiple times for several months now and have not received any reimbursement to date. I have spoken with supervisors and the process has been restarted by the company more than once, still without resolution.

  Business Response

  Date: 04/04/2024

  ******** apologizes for the delay in the reimbursement of the patients claims. The three claims in question were previously denied in our system and required manual overrides before processing could occur. These claims were completed and payment refunded on 3/22/24. Please allow 7-10 days to receive your refund check in the mail.

  Customer Answer

  Date: 04/04/2024

   
  Complaint: 21472318
  
  I have only received one check as of today. Ill wait another week for the other two before reiterate my complain.
  
  Sincerely,
  
  ************************************

  Business Response

  Date: 04/17/2024

  WellDyne sent one check with the total amount the patient submitted claims for on 6/9/23 and 7/12/23.On 6/9/23, the patient paid $160.59 and the copay would be $32.12 equaling $128.47 for this claim. The claim on 7/12/23 was for $133.35 with a copay of $18 equaling $115.35 for payment. In total after combining the two claims, the patient should have received a check in the amount of $243.82.

  Customer Answer

  Date: 04/17/2024

   
  Complaint: 21472318
  
  I am rejecting this response because:

  I still have not received the check for $243.82 as stated by Welldyne. I received a voicemail from them that a check had been mailed at the end of March, but I have not received the check as of today.
  
  Sincerely,
  
  ************************************

  Business Response

  Date: 04/23/2024

  As of today, our records indicate the check in the amount of $243.82 was delivered to the patient and cashed yesterday April 22, 2024. 

• Initial Complaint

  Date:03/18/2024

  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.

  I was recently prescribed Skyrizi by my specialist and completed my first three initial infusions, then was instructed to begin maintenance. I called in my first maintenance refill Thurs Mar 14, and was told my prescription was cancelled by the pharmacy and needed to be resubmitted by my doctor. After this was done, I asked the phone clerk to put a note on my file to please stop cancelling my prescriptions (Welldyne had done this several times with a previous medication). The clerk told me they would expedite my refill, and I should receive it as soon as possible. I did not receive my refill the following day, Fri Mar 15, so I called them to check the status, and they told me it was still in the queue. I called back today Mon Mar 18 and learned it was not expedited, and in fact Welldyne lost my copay card information (I had already given it to them for the initial infusions). Welldyne neglected to tell me this. I gave them the information they needed, and the payment went through, but they said I wouldn't receive my refill until Fri Mar 22, which is possibly too late for a maintenance injection for this sort of medication. I need my refill as soon as possible, and it is through Welldyne's negligence that I do not have it already. This is outrageous practice, and given the sheer amount of similar complaints, I'm surprised Welldyne is still allowed to be in business.

  Business Response

  Date: 03/28/2024

  On 3/11/24, WellDyne Specialty Pharmacy received a request from the patients provider to discontinue the prescription for the medication mentioned. Three days after this request, the patient called our patient care team to fill the medication previously discontinued. Due to this, our pharmacy would need to obtain a new prescription.
  

  The patient followed up with WellDyne Specialty multiple times that same day on 3/14/24 to check status of the medication. The first time, our patient care advocate informed the patient we had not yet received the prescription. The second time, we informed him that the prescription was received, we were working on fulfillment and they would let him know when the medication was ready. At the request of the patient, we added a note to not cancel the order.
  

  On 3/18/24, WellDyne Specialty received a call from the patient to capture their copay assistance information. As this was the first time the medication was being filled through our pharmacy, we needed to capture it from the patient. During this call, we informed him that this medication is ordered directly from the manufacturer and could take longer. The patient explained it was urgent he receive as soon as possible.
  

  Unfortunately, we were unable to expedite the order and set up delivery for 3/21/24. The medication was delivered on the set date.

  We apologize for the delay in care that the patient experienced during his attempt to fill his medication.  

• Initial Complaint

  Date:03/12/2024

  Type:Delivery 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 taking 10mg Dayvago for years. For some unknown reason these people decided to wait until I requested my refill to review the medical necessity of my medication. I requested a refill on 2/25 my doctor submitted the requested records the next day, ever since I've been waiting for a determination. Mind you these are sleeping pills (l cannot sleep without them) everytime I call, I either get hung up on or get told that someone will call me and I never hear anything from them or the useless representative tells me its pending review. At this point Im feeling the effects of not being able to sleep for over a week today is 3/12. I need help getting my medication authorized by this company. I have a child that is mentally ill, I'm am her stability however, dealing with this company we are about to be in the same boat. The sad thing is that my daughter is also insured with this company and everytime her mental medication is up for refills I am experiencing the same issue. It's so bad her doctor ****** samples because she knows Welldyne will s**** up her prescription everytime.

  Business Response

  Date: 03/25/2024

  ******** received the prior authorization (PA) for the patients medication mentioned on 2/29/24. On 3/1/24, the patient called for a status check and was advised by our member services team that it was in review and could take up to seven business days for coverage determination.
  The patient called for another status update on 3/11/24. At this time the PA request was still in review. Due to a large volume of PA requests received, review was taking longer than normal. The review was completed and approved for 12 months on 3/13/24. The patient was notified and our system shows that there has been a paid claim for the medication.
  No calls received or made during this time indicate that the call ended prematurely. 
  For the patients daughter, our records indicate that she currently has one medication with a PA that does not expire until 10/20/24 and the date of last refill for a 90-day supply was 2/27/24. ******** also received a PA request for another medication on 1/10/24, but that was denied due to lack of information submitted on 1/18/24. The patient was notified and provided reasoning for the denial. 

  Customer Answer

  Date: 03/25/2024

   
  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 even if they lied on the response. If the person releases the call or if notes are not made of course there will be no notes in their system.  It's a known issue with this company. 
  
  Sincerely,
  
  *****************************

• Initial Complaint

  Date:03/01/2024

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I have been trying for months to get an rx for ******** to help manage my pre-diabetes, bmi, weight, cholesterol, insulin resistance, A1C which is 6.4, and to help with my glucose which is consistently high despite taking metformin. Every single prescription that weve tried to get. Prior authorization on has come back denied because I dont have type 2 diabetes, despite having all of the other qualifying factors for these medications. Type two diabetes has an a1C of 6.5, Im at 6.4. It has been so frustrating, discouraging, and has been taking a huge toll on my mental health trying to find something and having it denied again and again and again. The only reason I go through ********, is because the insurance provided through my work forces is to go through them. *** tried taking to people, and instead of telling me what Im qualified for, they just tell me to tell them what I want and theyll say yes or no. I keep getting a run around, and can never get in touch with somebody. My health is not your toy to flip a coin and play with.

  Business Response

  Date: 03/14/2024

  On 2/21/2024, ******** received a prior authorization (PA) request for the medication mentioned by the patient. This request was denied because the patient did not meet the criteria nor medical diagnosis that is required to qualify for coverage of the drug. ******** is currently working with the plan for final determination. A member of the patients plan will outreach to the patient once a decision has been made. 

• Initial Complaint

  Date:02/29/2024

  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 have a prescription filled through ******************. When I submitted for refill of my medication over a week before it was due i was told it would ship on this past Monday (2/26/24). I never received the medication. When calling in the last 3 days I was unable to get a hold of ****************** due to long hold time (over 35 minutes each). I finally spoke to a rep today (2/29/24) and was told that they could not process my order until I paid a >$2800 copay. I have a discount card to help with this but was told I can not use it due to "IRS" laws until my full deductible is met? I am being denied my medication. until I can cover the cost on my own. The discount card is from the manufacturer and I have used it for years as I have been on this medication for years. This medication has a 98% compliance rate so missing a single dose could affect my treatment. I did pay the $2800 in January out of pocket. No communication form them, poor customer service when calling in to speak with someone, and now denying me my medication until I pay up!!

  Business Response

  Date: 03/13/2024

  On 2/23/24, *************************** received a request to refill the patients medication for delivery on 2/27/24. The order was placed on hold as the patient needed to pay $2,893.29 before processing. Per plan set-up and IRS guidelines, the patients deductible must be met before the coupon card could be applied.
  The patient called on 2/29/24 to check status and our patient care advocate apologized for the delay and explained that the coupon card could not be applied until his deductible was met. After speaking with his plan, he called our patient care team and was connected to a supervisor who assisted with the payment and scheduled delivery on 3/1/24.  
  As of 3/1, the patients plan made a change to allow the use of copay cards prior to deductibles being met. Once we can process the copay card delayed due to the nationwide Change Healthcare outage we will refund the patient. Outreach was made to the patient on 3/2/24 regarding this change.    

  Customer Answer

  Date: 03/13/2024

   
  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:02/28/2024

  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've been calling every day for three days, per their request because to quote whoever I talked to "we won't call you back."Currently waiting on hold, at this point it's been over 3 hours today alone. Genuinely feels like they're trying to not give me my medication. I've been transferred from person to person, without staff giving information to whoever they're transferring to me to so I have to start over from scratch with each new person. The last person I talked to said "there's very little notes on your account"--this is after days and countless hours. Today alone I've been told that my medication was being sent, that my card was declined, that my card was accepted, that I still needed prior auth, that everything was fine and I would get my meds tomorrow, that there were several holds on my account. All by different people. I'm so disappointed that my insurance is requiring me to use this pharmacy. My time sensitive medication is late because of errors on their part and I just need my medication. My doctor is frustrated because they've done everything they're supposed do.

  Business Response

  Date: 03/12/2024

  On 2/26/24 the patient called *************************** to add a copay card.However, due to a nationwide system outage we were unable to process it at the time. The patient called back the next day for assistance with ordering and wanted to expedite the process since they had missed a dose. Our patient care advocate worked internally to escalate since the system outage was still ongoing.
  The patient called on 2/28/24 to process the order. Since he had missed a dose of medication, he was transferred to a pharmacist for counseling. The patient was advised that he had a high deductible that needed to be paid before we could schedule the medication and transferred to a patient care advocate for assistance. The patient care advocate ran a trial claim and it rejected for prior authorization. Our Prior Authorization agent advised that the medication had been approved and that the claim process with a patient responsibility of $5,424.07. The patient care advocate explained that per his high deductible health plans (****) setup as of 1/1/24 it would not allow a copay card to be added to a medication until the deductible is met.
  On 2/29/24, a patient care advocate attempted outreach with no answer and left a voicemail. The patient contacted our pharmacy to advise that his plan placed an override on the medication so a copay card could be used. A supervisor spoke with the patient about the **** and plan requirements. The patient disconnected the call and our supervisor attempted to contact him but had to leave a voicemail. Later that day, the patient contacted *********************************** and was informed that his case would be reviewed in the morning and someone would contact him back to complete the order. 
  On 3/1/24, pharmacy leadership attempted outreach twice and a voicemail was left.A pharmacy manager was able to reach the patient and schedule the order to be delivered on 3/2/24. 

  Customer Answer

  Date: 03/20/2024

   
  Complaint: 21361790
  
  I am rejecting this response because:

  It fails to acknowledge the length and efforts I had to put in to obtain my medication. This was not a one call back and forth problem. 
  

  I was told by my insurance that my copay card would cover the medication without having to pay the $5000 amount and ******** having a cyber issue on their part shouldn't delay my medication by a full week. 

  Had I not called back multiple times a day everyday then my medication would not have been processed and delivered. On the third day I called I was told my meds would be sent out. When I called back to confirm I was told they would not. This back and forth was constant throughout the process. 

   

  
  Sincerely,
  
  *****************************

  Business Response

  Date: 03/28/2024

  ******** acknowledges and apologizes for our longer than normal wait times, and back and forth that led to the patients frustrations of calling multiple times while trying to obtain his medication. Our goal is to ensure that we provide the highest quality care every time we assist a patient.  
  

  At the time of this request, the patients plan did not allow for the use of copay assistance until the patient reached their deductible. This slowed the process as the patient had to pay the full amount out of pocket before fulfillment of the medication could occur. The patients plan has since changed their policy and moving forward he will be able to use the copay card until the funds are exhausted. Once exhausted, he will be responsible for the remainder of his deductible. 

• Initial Complaint

  Date:02/26/2024

  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 have been trying to make contact with this company for over two weeks to get an update on my specialty medicine. My physician and myself have been on hold for HOURS with this company with no response. I have tried calling, waiting on hold, and placing a call back. They have literally called me back 6+hours later only to be told the specialty department is closed and they cant help. Ive been told twice someone will call me back and no one does. If I was not forced to use this company through my insurance I would have switched to a different pharmacy, but I am left with no choice. This company should be shut down. There is no way anything they do is professional or timely. Some medications can not be put off for weeks and months before being filled or waiting around to find out theyre rejected. Its criminal how they handle patient care. They should be held accountable for lack of communication and lack of fulfillment of continued patient care.

  Business Response

  Date: 03/11/2024

  On 2/12/24, the patient called *************************** to fill a prescription.The pharmacist team contacted the ***************** and requested a transfer.The prescription was received by *************************** and placed in the wrong queue leading to delays in the patient receiving their medication.
  On 2/23/24, the patient requested a call back and received one in the evening by a member services representative who was unable to assist. ******* created a request for a patient care advocate to call the patient to schedule their order.
  We attempted to contact the patient on 2/27, 2/29 and 3/2, but had to leave a voicemail each time. The patient contacted the pharmacy on 3/2 and the order was successfully placed. It shipped on 3/6/24 and delivered 3/7/24.

  Customer Answer

  Date: 03/11/2024

   
  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. 
  

  However, I also made calls to ******** on 2/26 was unable to get ahold of the company. I DID answer/call back on 2/29 and 3/2 with continued poor solutions to having my prescription filled. It took almost 4 weeks to have a prescription filled and sent to me.
  

  Sincerely,
  
  *********************************

• Initial Complaint

  Date:02/22/2024

  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 cannot get any help or answers regarding my prescriptions. I need it to breathe, I have talked to so many representatives and that have all te me different things .. my dose is due and I have no med. twice they disconnected the call no call back.

  Business Response

  Date: 03/04/2024

  On Friday 2/2/24, ******** requested a refill from the members provider. A second attempt was made a week later on Friday 2/9/24.
  The prescriber submitted a new prescription for the medication to ******** on Monday 2/12/24.
  On Tuesday 2/20/24, prior authorization review was completed and approved for the medication. At this time, outreach was made to the member to update them that the order had been placed.
  The medication shipped on Friday 2/23/24 and was delivered to the member on 2/24/24.

• Initial Complaint

  Date:02/22/2024

  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.

  WellDyne has paid for one medication since we have had them, our flu shots only. I am a type 2 diabetic, and they have denied my mounjaro. Aetna paid for it previously. My doctors office sent them a PA, which ******** took more than 7 business days to review. Then it was denied of course, because they dont want to cover it. My doctor sent them chart notes twice, and they kept telling me that is what they were waiting on to make a decision. Lies. THEN, my doctors office filed an appeal BECAUSE THIS IS WHAT IS LOWERING MY A1C. My doctor wants me to take this for my diabetes. They also paid zero on my Metformin (for diabetes). My birth control was denied and I would have had to pay $192 for a month of it. So, my doctor changed my medication to a HIGHER DOSE medication that she didnt really want me on so that I could afford birth control. My portal with WellDyne shows that have paid zero on my thyroid medication and my blood pressure medication. I do not have a thyroid in my body..it was removed, but oh well..i will pay out of pocket so that I can survive. Just a scam of an insurance company. I pay into the top tier of coverage so that my husband and I will be covered and yet, they have covered nothing for us. They are also denying his Nexium-type medication for his ulcer and his Vitamin D that the doctor prescribed. Dont buy WellDyne coverage!

  Business Response

  Date: 03/08/2024

  ******** received a prior authorization (PA) request for the medication mentioned by the patient on 2/6/24. This request was denied because the patient did not meet the criteria nor medical diagnosis that is required to qualify for coverage of the drug. An appeal for this decision was submitted on 2/20/24 and was denied due to the patient still not meeting criteria.  
  Both the patient and their spouse received letters in early January 2024. One notified the patients spouse that their medication would require prior authorization, but ******** does not have record of a PA or claim for that medication. The other letter notified the patient that one of her mentioned medications was excluded from coverage and provided covered alternative medication. Our records indicate a paid claim for a generic alternative with a $0 copay.
  Vitamins and other nutritional supplements are not covered under the patients plan *************** and would be denied if a claim was processed. 

  Customer Answer

  Date: 03/08/2024

   
  Complaint: 21330131
  
  I am rejecting this response because:

  WellDyne is incorrect.  Their non-coverage of Mounjaro is based on the fact that they say I am not diabetic; they say I am pre-diabetic.  This is incorrect, as my doctors office has informed them with a Prior Authorization and an Urgent Appeal.  ******** denied both.  My medical records are teeming with a diagnosis of Type 2 Diabetes.  I have been a diabetic for YEARS NOW.  Their denial of coverage according to ******** was because they believe I was taking ******** for weight loss only.  This is based on my doctors notes that I was calorie counting, and trying to stay in a calorie deficit and exercising.  This was true.  I do calorie deficit, low carb diet, and exercise for weight loss and TO LOWER MY A1C!!!  Because Im a TYPE 2 DIABETIC.  

  I have also been informed by ******** that a prior authorization can be sent in by my doctor, but to quote their employee, it wont do any good.  It still wont be approved.  There hopefully is a recorded call of this conversation.  On another phone call to WellDynes Prior ******************** I was asking why it had been past the 7 business days they are allowed to approve or deny the prior authorization, and I was told there was still no decision and there was nothing I could do about it.  When I asked for the employees name to put in my notes, he would not give me his full name.  He told me his last name was B.  

  My gynecologists nurse said she was having to switch the birth control they prefer for me to be on due to my hypertension, because ******** refused to cover the type they had me on.  To pick up my Lo Loestrin, it would have cost me $193.00 per month.  The nurse said when they do a peer-to-peer call with WellDyne to try to get something approved, they put a PODIATRIST on the phone instead of a gynecologist or OBGYN.  

  But rest assured, while my health is being harmed due to bogus non-approvals from WellDyne, attorneys for our company are looking into a class action lawsuit over all of the denials.  

  
  Sincerely,
  
  *******************

  Business Response

  Date: 03/19/2024

  As mentioned previously, the patients prior authorization request and appeal were denied as the patient did not meet the clinical criteria and guidelines published for the medication. Due to ongoing concerns, ******** will send the request and provided medical information for external review and final determination. During this process, an Endocrinologist will review the information and determine if the medication is medically necessary for the patient.Once their determination is made, ******** will notify the patient.
  

  Regarding the birth control medication, ******** alerted the member that the original medication she was taking would no longer be covered by her plan and provided alternatives. If her doctor determines that she should remain on the original medication, they may file for medical necessity to provide coverage at no cost. To complete this exception process, have your doctor complete the *** Contraceptive Coverage exception Form on *****************************************;

  Customer Answer

  Date: 03/20/2024

   
  Complaint: 21330131
  
  I am rejecting this response because:

  I was NOT given alternatives for the birth control medication. The ******** employee simply told me that a "prior authorization could be sent by my gynecologist, but it wouldn't help anyway". When I asked to speak to a supervisor,  she said, "you can, but my supervisor will tell you the same thing anyway". So, my gynecologist is now prescribing me a different medication. 

  I would ask before this endocrinologist reviews my records for my need for ********, please have my complete records available .... the ones that show i AM diabetic and have been diagnosed as such for years now.  Thank you.
  
  Sincerely,
  
  *******************

  Business Response

  Date: 03/28/2024

  ******** understands that the patient is frustrated with the level of service they received while discussing the prior authorization process (PA) for her medication. We take pride in providing exceptional service to all our patients and this includes mailing letters informing them of any upcoming disruptions to their medications. The attached letter details the patients medication was excluded from their formulary and listed preferred alternatives. We have redacted the medication name for the patients privacy. If the patient would prefer to take the previous medication that is excluded, her doctor can complete the *** Contraceptive Coverage exception form on ***********************************.
  Regarding the external review for the patients other medication. All information shared with ******** during the PA process will be sent to the Endocrinologist for their review and assessment of necessity to care. 

  Customer Answer

  Date: 04/02/2024

   
  Complaint: 21330131
  
  I am rejecting this response because:

  They are not reviewing records of my diabetes diagnosis, which I do have, and they do not apologize for bad customer service. They are endangering my health. I have been experiencing blood sugar drops again, light headedness, dizziness and heart palpitations. I will seek ************** to deal with this horrible company. My husband has been informed what to do in the event something happens to me since I can no longer get my diabetic medication. The company is also looking into getting counsel. So, I will gather all of my medical records and prepare for the next steps. 
  
  Sincerely,
  
  *******************