ComplaintsforWellCare Health Plans, Inc.

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Initial Complaint
07/01/2024
Complaint Type:
Customer Service Issues
Status:
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.
Im trying to disenroll from WellCare so I can get ******** plan and I cant if Im enrolled in WellCare. I have called them and they have refused to disenroll me over the phone. I have no printer so I cant print the form to disenroll. They are preventing me from getting insured.
Business response
07/08/2024
good morning, we were unable to reach the complainant by telephone, email sent as well, our enrollment department advised: MEMBER ACCOUNT ACTIVE FROM EFF DATE 03/01/2024. AS PER TICKET MEMBER REQUESTED STATUS OF DISENROLLMENT. AS PER REVIEW THERE IS NO WRITTEN DISENROLLMENT LETTER RECEIVED IN OMNI. REQUEST RECEIVED AFTER EFF DATE AND OBV DATE. FOR THIS MEMBER NEED TO SUBMIT WRITTEN DISENROLLMENT LETTER WITH VALID ELECTION PERIOD IN ORDER TO DISENROLL FROM WELLCARE. DISENROLLMENT FORM SENT... thank you
Initial Complaint
06/19/2024
Complaint Type:
Service or Repair Issues
Status:
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.
I went to my doctor on 6-14-2024 to have two prescriptions filled. My doctor called in both prescriptions to Express Scripts which is WellCare's mail in pharmacy. One for Baclofen RX1315537 and one for Sumatriptan RX2416651099717. When I went to fill the Baclofen, it was $394.42. I knew it shouldn't be more than $20. I cancelled that immediately and went to ********* to get it filled. It was $16.61. I've tried to fill the Sumatriptan. As of this time, they have put a hold on it and are refusing to fill it for unknow reasons. It's migraine medicine. I talked to a person at WellCare at 645pm on 6/18. He was pretty hateful. He said he wasn't going to do anything to help me with my problem. That was shocking. I asked him the second time if he was refusing to help me. Again, he replied that's right. I've called Express Scripts twice and have gotten basically the same thing, no help. It would be nice if companies dealing in American medications would have people who are their representatives have a working knowledge of the English language. If they don't release my prescription for Sumatriptan by the end of the week, I'm going to have to go to my doctor and get another prescription written for ********** In a nutshell I have two problems. One, Express Scripts refusing to fill my migraine medicine for no reason. Two, Express Scripts trying to charge over $400 for a $16 prescription. I would think that's against the law. Whoever I talked to at WellCare should be fired, period. My member ID # for ********************** is ******** and Plan # is S4802-086. I've had WellCare and Express Scripts before and never had any problems. My healthcare options come due for changes at the end of the year. I'm getting rid of both of these places. I'll use ********* until I can make those changes.
Business response
07/02/2024
Hello,
We have educated the member regarding the two transactions in question and advised that WellCare is unable to assist in transferring the prescription from one pharmacy to another. The member needs to contact the desired pharmacy to arrange the transfer or inquire about obtaining a new prescription from their provider. The member understood and confirmed that all issues have been addressed.
Thank you

Customer response
07/02/2024

Complaint: 21869479

I am rejecting this response because:

I talked to WellCare. They said they were going to do anything about my complaint. They said to get another Rx from my doctor and go to ********** In a nutshell, I talked to six people on the phone and wasted about three hours of my time for nothing. Most of them couldn't half speak English or understand it. I'll be getting another RX insurance at the end of the year. Thank you so much for your time. You have helped me countless times through the years. I'm one of your biggest fans. Please warn people of this ghetto insurance.

Thanks again
*************************
Initial Complaint
06/14/2024
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I keep getting notices that I may have moved, and every time, I return the address information AND call you. It has happened again. This time I learn it's due to the mailing address on Social Security. Note that my account info with ********************** is correct, in that my permanent address is in ******* (a nursing home without mail access) AND all my Rx's are being filled by one pharmacy in ***** and shipped to me in *****. You can see it online with the claims.As I am in a nursing home, my mail all goes to my daughter in *******, and this is where my social sec. end of year statement is sent. Social security does not allow two addresses on accounts (I called to verify), but I have a screenshot of my SS account showing my mailing address and the section underneath saying this is not my permanent residence. Thank you for confirming. By the way, I finally got through to someone today, was on hold half an hour, person tried to help but then forwarded me to a supervisor who then also put me on hold to "investigate" for another half hour. One hour total without resolution, as I've had this call with you every 6 months or so and nothing changes. As I write this, I have been on hold with a so-called supervisor (who sounded like I woke her up from sleep), said she will research this, and ONE HOUR later I am still on hold, without anyone checking back on me. They are a bunch of lazy people who say they'll correct something, then don't. And their online contact us form doesn't work, I have screenshots of the page saying "not able to submit form". It's a sham. And no email communication allowed to them. All very inefficient.
Business response
06/17/2024
Dear ******************************* ,
Thank you for bringing this matter to our attention. We are sorry for any inconvenience that you have experienced. We will do everything we can to resolve the issue as quickly as possible.
If you have any further questions or concerns, please do not hesitate to contact us.

Sincerely,
**** D
Customer response
06/19/2024

Complaint: 21851983

The company escalation department did reach out to speak with me yesterday but I told the agent I was unable to chat then and can we speak next day (today, June 19). Imagine my surprise when I called the number given to me, I got an automated message saying they are closed for the Federal holiday. The agent could've told me that yesterday. In addition, the automated message had me click a button to leave a message for a callback in 24 hours, next open day. And, that number went dead, saying it's not a valid number. This is just one of several examples of trying to communicate with this company. I don't have the time to keep calling a toll free number and being routed to different departments that don't work or cannot get through to a live person. Why not simply offer email communications.......

Sincerely,

*******************************
Business response
06/21/2024
Dear ******************,
Thank you for bringing this matter to our attention. We are sorry for any inconvenience that you have experienced. We have been in contact via email and your issues have been addressed and resolved.
Sincerely,
**** D
Customer response
06/21/2024

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, what appears online is not updated as of June 21. WellCare emailed me on June 20 and I think we have resolved the issue, but it may happen again. I am replying resolved now to close the case, but again, your BBB site is not showing the latest communication from the provider to me. All I see is the original generic apology of a week ago.

Sincerely,

*******************************
Initial Complaint
06/14/2024
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I am attaching 3 PDF documents about a claim for 6.55 that Wellcare simply ignores. I have emailed corporate officers of parent company Centene 2 times (*********************** and *******************) and 1 time to Wellcare CEO (***************************) without a response
Business response
06/28/2024
Hello,
This case is still under review. We have contacted the member and received the necessary documents for the *** review. The *** is currently being processed, and once we receive the final determination, we will promptly share it with you.
Thank you
Customer response
06/28/2024

Complaint: 21849774

I am rejecting this response because:I have yet to receive the final determination alluded to in their message - when that is received I will be in a better position to properly address that

Sincerely,

*****************************
Customer response
07/02/2024

Better Business Bureau:

We'll have a check soon!

Thanks!

Sincerely,

*****************************
Initial Complaint
06/04/2024
Complaint Type:
Customer Service Issues
Status:
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.
I am a member of Wellcares ******** D ************ drug plan. I am having issues of not being allowed to speak with someone in the ************* to help with me getting access to my online account with Wellcare.In addition I am trying to get a resolution to being denied twice by Wellcare a basic tier medication that my Cardiologist wants me to take.I am also being called / spammed multiple times per month by people claiming to represent Wellcare, (possibly a 3rd party contractor) who has all of my personal information, and is wanting to come to my home and review medication. I have asked multiple times to be taken off this call list but still get calls.
Business response
06/17/2024
Hello,I have contacted the member and assisted him with his issues. There was an issue with his prescriptions which currently is being fixed as we speak. An alternative has been found. The web support team assisted in getting him online, and he has been placed on a suppression list for marketing.

Thank you.
Customer response
06/20/2024

Complaint: 21799154

I am rejecting this response because:
I received an automated message that I answered on 06/19 from wellcare stating I needed to give them a call back. I called the Escalations team 4 times this morning 06/20 and could not reach anyone, the line went to a unknown voicemail twice and was hung up on by the automated system twice.
I checked my online portal and it stated that the medication was denied and I checked with my pharmacy and they are still unable to fill the medication.
Please have someone contact me as this is not resolved.
Sincerely,

***********************
Business response
06/20/2024
I attempted to reach out, I'm not sure what was wrong with our lines earlier. I spoke with the provider's ******, who confirmed the Prior Authorization was denied however an appeal was put in and it was approved from 6/19/2024 until further notice. Provider's ****** stated they were in the process of contacting you with this information.
Initial Complaint
06/03/2024
Complaint Type:
Service or Repair Issues
Status:
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.
I'm a member of Wellcare No Premium Open PPP (Member #********)I received an explanation of benefits from Wellcare on 2/10/2024 & there were 4 FRAUDULENT CHARGES from FAST LAB TECHNOLOGIES LLC FOR COVID TESTS TOTALING $1300.00.DATES OF SERVICE 12/26/2023, 12/27/2023, 1/9/2024 & 1/11/2024.I received an explanation of benefits from Wellcare on 5/9/2024 & I THERE WERE (7) FRAUDULENT from ("PANAM HOLDING ***** for Orthotics totaling $7700.00 FOR DATE OF SERVICE 3/18/204.1) I called Welllcare back in February to advise them of the fraudulent charges from FAST LAB TECHNOLOGIES, ******* was transferred to several people & spent over 2 hours on the ************ were supposed to report it to their FRAUD ****************** WAS SUPPOSED TO GET BACK TO ****** NEVER RECEIVED A CALL BACK. 2) Today, 6/3/2024, I called Wellcare again to report the fraudulent charges from PANAM HOLDING **** Once again I was transferred to at least 5 different people who did not have a clue as to what needed to been done. Once again I was on the phone for at least 2 hours. **** gave me a ticket #********** & her Id #******* .**** then transferred me to a 3rd party claim ********** spoke with ************ supposedly was going to file a claim with Wellcare, which made absolutely no sense since I was on the phone with Wellcare for 2 hours. She gave me a case #************.I am totally appalled at the way Wellcare is handling this FRAUDULENT situation. There isn't a person there who knows what to do & they just keep passing the buck!!!! There are not protecting their members. Obviously, someone as my Health Insurance Information & perhaps someone on the inside of Wellcare is responsible. I don't know what to think at this point. All I know is that FRAUDULENT claims are being submitted under my name. I want these FRAUDULENT CLAIMS ADDRESSED & HANDLED ACCORDINGLY.Thank you for your ************************************************
Business response
06/05/2024
Dear *************************** ,
Thank you for bringing this matter to our attention. We are sorry for any inconvenience that you have experienced. We will do everything we can to resolve the issue as quickly as possible.
If you have any further questions or concerns, please do not hesitate to contact us.
Sincerely,
************
Initial Complaint
05/30/2024
Complaint Type:
Product Issues
Status:
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.
5/22/24 doc prescribed medicine for painful and HIGHLY CONTAGIOUS bumps, and WellCare is refusing to fill the prescription. Im on ******** snd ******** and cannot afford the medicine on my own. $40 vs $1.85 and they are refusing to approve it. This is disgusting. 8 days later, they are denying the medicine?!? Asking same questions over and over. Attempting to blame my doc, making excuses. Disgusting. Highly contagious?!? They need to be shut down. Outsourced from the ***********.
Business response
06/10/2024
Good afternoon, the pharmacy department advised Per denial letter sent out to member/provider ********* law states prescription drugs are covered by Part D if used for a "medically accepted indication." This means it is approved by the Food and ******************* ***** or the indication is supported by a ******** approved drug compendia. TRETINOIN Cream for ILLNESS UNSPECIFIED is not approved by the *** or supported by a ******** approved drug compendia. Therefore, it cannot be paid by your ******** *********** member/provider disagrees with decision they are able to ask for an independent review (appeal) of the decision. Information on where to send was also provided in the decision letter. Standard Mail: C2C Innovative Solutions, *** P.O. ****************************************** Fax ********************* Appeals: (833 710-0580, For Expedited Appeals: ************** Phone: ************** Thank you., They also advised Per Compass initial PA was received 05/28/2024 which was marked completed and denied on the same day. The appeal was then received on 05/29/2024 and was completed and denied on 05/31/2024. The denial letter I have attached dated 05/31/2024 was for the appeal submitted on 05/29/2024. At this time there is no additional requests submitted for the member.
Customer response
06/19/2024

Complaint: 21774913

I am rejecting this response because:
They were dishonest on several
Occasions, stating they only worked M-F, yet called me on Saturday and Sunday. They were unprofessional, and switched me to several different people, several times. Each one stating they would: call me tomorrow, we will follow up with xyz amount of time, you will be speaking with this person. Yet, their integrity and follow through was inconsistent, and untrue.

The main reason for my rejection is WellCare stating my doctor:
A. provided no diagnosis code.
B. And also provided a diagnosis code of unspecified.
C. They never actually called my doctor

I called my doctors office and they told me the diagnosis code they submitted for insurance and prescription was B07.8

The last interaction I had with WellCare was this morning with ****** at 8:40am. She said she would expedite the info to the prior-authorization **** and would let ******** know, and he would call me back.

Thank you again for your time. I hope this info is helpful.

Sincerely,

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

As I reflected, and went through my notes, additional information came to mind (as is the way of my brain injury, info is in my brain, but not always accessible at the time needed, or in any sort of order). I am thinking that the files I attempted to upload yesterday, also did not get to you. Again, my apologies.

In addition:

I spoke with *********************, Tier 2 agent, with ******** on Friday 6/6/24.
She informed me that the cream is supposed to be covered and I should have only needed to pay approximately $1.55 for the cream. I have attached the printed out copy from the ******** Website of that conversation. She guided me step by step on the phone, i informing me that if, WellCare changed what is in their formulary, they have not communicated that information to ********.

I have attached all info that will hopefully be helpful to you. Also my reciept of payment to Rite Aid is attached. My doc office sent the Pharmacy a one time coupon to help offset the cost, but, with my financial situation, being in ******** and ********* finances are tight to say the least. ****** looking to inform and hopefully be refunded for what I paid out of pocket, when I should not have had to do so.

Again, appreciate all your help, thank you.

Be well,
*************************
Business response
06/20/2024
The appeals sent were denied, the member has been advised as well as the provider. We consider this matter closed. thank you
Customer response
06/21/2024

Complaint: 21774913

I am rejecting this response because:
Per ********* this prescription IS covered. The information can be found on the Medicare.Gov website. The necessary information and medical diagnosis code, B07.8, was provided by the Physician who wrote the prescription. Therefore, this prescription IS covered under my prescription plan. Kindly reimburse me for the unnecessary out of pocket expense that I have incurred as a result of this mistake.
See attached files.

Thank you and have a nice day.

Sincerely,

*************************
Business response
06/24/2024
There are 2 DERs (Drug Evaluation Review) on file. One was denied on 05/28/2024 for missing DX (Diagnosis). There was an appeal that upheld the denial on 05/31/2024 also for a non-*** approved DX. Tretinoin 0.05% is not *** approve to treat sores on the hand as the member is stating it is being used for. **
Customer response
06/24/2024

Complaint: 21774913

I am rejecting this response because:
This company has not done their due diligence in regards to the uploaded information from ********* and they are not doing their job. Closing a medical case, lying about the facts, and then refusing to uphold their end of the Prescription drug agreement is despicable, fraudulent, and I will make sure that ********* the company that pays you and partners with you, knows every detail of your dishonesty, laziness, and gaslighting tactics. You should be ashamed of yourselves.

Sincerely,

*************************
Initial Complaint
05/29/2024
Complaint Type:
Billing Issues
Status:
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.
i payed 450 dollars for a box of trulicity and ***** dollars for a box of ******** that was for a deductble i don't have to pay because I have special help from social that's pays that they way over charge me they double charge me and **************
Business response
06/06/2024
Good afternoon,
We have made several attempts to contact the member by phone and email but have not received a response as further information is needed. The ticket number and our department's phone number were provided in the email and voicemail messages left for the complainant. Unfortunately, we could not conduct any research as the information provided by the complainant does not match any records of members in our plan.
Thank you.
Initial Complaint
05/28/2024
Complaint Type:
Service or Repair Issues
Status:
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.
My previous provider (Aetna) did not interfere in any way with any of my prescriptions. Well care interfered with my refilling of my Ozempic 2mg prescription, which posed a risk to my health if not continued. They require my doctor's ******** for each refill. My doctor found Wellfare hard to deal with and uncooperative, requiring an expended phone conversation. As a result of this difficulty my doctor terminated me as a patient, leaving me without a primary care physician. I suffer from Bipolar II disorder, and directly the result of Wellcare's unjustified delay and interference with my needed medication I experienced a relapse of symptoms including severe anxiety and depression. The delay in this medication as a result of what Wellcare did placed my health at risk.
Business response
05/28/2024
Dear _Gregory Field,
Thank you for bringing this matter to our attention. We are sorry for any inconvenience that you have experienced. We will do everything we can to resolve the issue as quickly as possible.
If you have any further questions or concerns, please do not hesitate to contact us.
Sincerely,
**** D
Initial Complaint
05/22/2024
Complaint Type:
Service or Repair Issues
Status:
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.
As a healthcare provider (Provider ID# ********, CAP ************* who provides services to Wellcare recipients, it's incredibly frustrating to have no follow through on trying to obtain in-network status. As our patients have PPO plans we are not required to have network status, however as an out of network provider we are not allowed to have provider portal access and therefore are unable to determine benefits, check on claim status, etc. In order to do this we have to call in, face long hold times, and representatives who are off shore, don't always speak poor english, often have babies and dogs crying in the back ground or poor phone connection resulting in disconnect and needing to start the process over again. I would not recommend Wellcare to any of my patients as an Advantage Plans for these reasons.
Business response
05/24/2024
Hello ******************,

BBB CASE COMPLAINT ID ********/*********

My name is *******, I would like to address your concerns. Please reach out to me at ************ with reference number PRC-*****.
I am looking forward to speaking with you.

Thank you,

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