Business Profile

HMOs

WellCare Health Plans, Inc.

Headquarters

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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

380 total complaints in the last 3 years.
111 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:05/13/2025
Type:Customer Service Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Wellcare has been contacting me for the past two years for someone by the name of *******. I do not know (nor have I met) anyone with the name *******. I have spoken to 3 managers to remove my phone number and they have yet to do that. They stop calling for a week and then they are back at it. I know telephone rules and regulations state to never contact me again if I ask to be taken off the list. If they do not stop harassing me when I am not even the person they are looking for, I will not hesitate to move forward with a lawsuit. I have not yet as I have not had the time. I really would rather the calls to stop so we can all move on with our lives but if the calls do not stop, I have no choice. I have blocked their calls numerous of times and they somehow continue to get through. I AM DONE
Business Response
Date: 05/15/2025
Hello. We apologize for the dissatisfaction that you experienced. The complainant has been added to the Do Not Call List.
Customer Answer
Date: 05/16/2025

Complaint: 23320619

I am rejecting this response because this is the same answer I got from the 3 managers I spoke with during the past TWO YEARS and my number keeps being put back in their "autodialer". I believe that I will be getting calls within a week and I will be keeping all of the messages left to add to the ones I have already.

Sincerely,

******** ******
Business Response
Date: 05/20/2025
Hello. We apologize for the dissatisfaction that you experienced. Please be assured that your concerns have been addressed and resolved. The complainant has been added to the Do Not Call List and removed from the dialer. No further outreaches will be made. We are truly sorry for the inconvenience this has caused.
Customer Answer
Date: 05/20/2025

Complaint: 23320619

I am rejecting this response because I literally just received another call from your autodialer at 10:16 today 5/20/25. I am not trying to be difficult, it's just you do not believe that your removal is not working and your company keeps harassing me for someone I do not know and I am not affiliated with by any means. I am sorry that I have no faith - this just proves my point of after speaking to 3 managers it did not fix. Going through the BBB to be taken more serious, still not fixed. I would like for BBB to guide me on how to take this to the next step. I have already looked into attorney fees. It's the principle now.

Sincerely,

******** ******
Initial Complaint
Date:04/25/2025
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
My mother was disenrolled from WellCare as of April 1, 2025. The first notice I had of her potential disenrollment was via letter dated 4/1/25 which I did not receive until after she had already been disenrolled. They claim to have sent one notice in February that she would be disenrolled if the bill was. not paid, but I did not receive the notice. I find it outrageous that only one notice is deemed sufficient prior to disenrollment and seek reinstatment. I am happy to pay the mere $177 that was overdue. I would rather work this out with them, but they have been very uncooporative and not forthcoming as to the procedure to challenge the disenrollment.
Business Response
Date: 04/29/2025
Good afternoon, ********* *****,
I hope this message finds you well. My name is *******, and Im following up regarding your recent complaint. Ive left a couple of messages for you, but I wanted to reach out by BBB as well.
To continue researching your case, well need a bit more information from you. Please contact us at ************ and reference case number PRC-***** when you call.

Thank you for your attention to this matter, and I look forward to speaking with you soon.

*******
Initial Complaint
Date:04/07/2025
Type:Customer Service Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
It is for my prescriptions and I was told you did t have to reapply unless you changed anything. Nothing was changed on my end but when I went to get my meds filled they said it was canceled. I called them on march7 and was told I had to reapply. I did and the sent me confirmation and said we would receive my new care in 5-7 days. Nothing came so we called again. Literally after 2 hours on the phone I was told I cant be covered until January 2026 and cant apply with anyone else. What am I supposed to do to get my prescriptions and he said Goodluck. Please help
Business Response
Date: 04/08/2025
Thank you for bringing this matter to our attention. We appreciate you sharing your experience with us. We are sorry to hear that you had a negative experience, and we understand your frustration. We have reviewed your complaint and determined that your coverage was terminated at the request of ************. I made outreach to you via phone and email to provide you with this information. Please contact CMS ******** at 800-******** *************) to inquire why they requested your coverage to be terminated with WellCare. Please be advised CMS ******** governs your ******** coverage.

Thank you,
**** D
Initial Complaint
Date:04/01/2025
Type:Order Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I enrolled in WellCare Simple Open PPO as of January ******. I confirmed with the company and summary of benefits that ******************* is covered 100% in or out of network. Initially I went to my previous ***, who submitted a bill. The bill was denied as incomplete. Both their billing representative and myself reviewed the bill and were not able to identify any issues. I then paid out of pocket and submitted the bill myself and received a letter stating it wasnt covered. I then found an LMT on WellCares list of in network providers. They submitted a bill three weeks ago and have not received authorization, so will not guarantee coverage I have called but not been provided clear info.I have never experienced this with any other insurance company. Please help!
Business Response
Date: 04/10/2025
good morning, this issue is resolved and resolution has been sent to the member via email.
Initial Complaint
Date:04/01/2025
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I only recently learned that my monthly premium (by automatic withdrawal) for this drug plan went up from $3.70/mo. to $38.70/month! What kind of company increases their pricing over 900% from one year to the next? This is outrageous! And why did I not receive notification of this increase, because I very likely would have switched to another Drug Plan during the Open Enrollment period. I think most people would surmise that there is something very wrong with a company that chooses to increase their premium that much from one year to the next. Is it very poor management, or could it be something worse, because THAT is not normal. I am requesting reimbursement for the "monthly difference" for the four months (or $35 x 4 = $140.00, as I contemplate what to do for the rest of this year. I will also be taking the issue up with my elected representatives because there should be an 'exclusion' involved with the ******** Open Enrollment period when someone's premium goes up substantially without their knowledge. I need answers...promptly! Thank you.
Business Response
Date: 04/04/2025
Hello,
We appreciate the opportunity to respond to this concern regarding a premium adjustment for the prescription drug plan.
Our records indicate that the member was notified of the premium change via the Annual Notice of Change (ANOC), which was sent on September 11, 2024. This document provides members with detailed information about plan changes for the upcoming year, including any modifications to costs, benefits, and coverage.
Additionally, per regulatory requirements, WellCare submits its plan offerings to the Centers for ******** & ***************** (CMS) annually. These offerings are reviewed and approved before they are made available on the Marketplace. Adjustments to plan pricing are made based on multiple factors, including competitive market analysis and cost structures. Regarding communication attempts, our records reflect multiple outbound calls to the member on April 2, 3, and 4, 2025, to discuss the concern. However, in each instance, there was no answer, and voicemail could not be left due to a full mailbox.
We understand the members frustration regarding the premium adjustment. For those who may experience difficulty with increased costs, the Extra Help program may provide assistance. If the member is interested in exploring eligibility, they may contact the ****************************** at ************** or their ************** Office.
If the member requires further assistance, we encourage them to contact our **************** team directly so we can address their concerns promptly.
Customer Answer
Date: 04/07/2025

Complaint: 23140270

I am rejecting this response because: I find their response "TOTALLY unacceptable!" And I would like a copy of that letter sent in September, which I still haven't seen. Conveniently, Wellcare's response never adequately explained the reasoning behind so "substantial an increase from one year to the next," nor did they address the $140 "difference" in premiums, which I feel is due a subscriber who didn't know of this unrealistic increase!. Was there a more meaningful explanation (other than their silly & 'general' response:"competitive market analysis/cost structures") provided in their September letter? Future subscribers need to be made aware of a company that will increase their premiums by over 900%, and their business practices need to be fully investigated because "this type of increase" is not normal OR reasonable!

Sincerely,

******* *******
Business Response
Date: 04/08/2025
We understand your frustration regarding the premium increase and the lack of clarity surrounding the explanation provided. Please be assured that we take your concerns seriously.
As requested, we emailed you a copy of the **** on 4/4/2025 with the attached letter originally mailed in September. If there was any additional context or explanation in that correspondence beyond the general information previously shared, you will be able to review it in full.
We recognize that a significant change in premium, such as the one you experienced, warrants clear and thorough communication. While premium adjustments are influenced by a number of factorsincluding market trends, plan utilization, and overall cost structurewe agree that transparency is vital.
Your feedback has been forwarded to the appropriate departments, we appreciate you bringing this matter to our attention and will ensure it is taken into consideration in future evaluations.
Should you have any further questions or would like to discuss this in more detail, please dont hesitate to contact us directly.

Customer Answer
Date: 04/14/2025

Complaint: 23140270

I am rejecting this response because:once again they offer no 'meaningful' explanation for their illogical increase, while also conveniently ignoring my demand for the $140.00 difference in premiums for the 4 months. It should also be noted that I "still" have not seen a written notification for the increase. I earnestly feel that this company needs to be thoroughly investigated, and I will take this matter up with my elected representatives & the appropriate parties because there appears something very wrong with a company that chooses to increase their monthly drug premium by a "whopping 900%!" THAT is NOT reasonable!!

Sincerely,

******* *******
Initial Complaint
Date:03/25/2025
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I was referred by my primary care at the time, Dr. **** to have three general radiology scans. They referred me to ******* radiology six months later ******* radiology is billing me for those scans and when I called them, they said care never responded? I called well care and they said they never received a claim neither of them would speak to the other. I am getting a bill stating I will be sent to collections. I forwarded this statement to well care and I have not heard nothing back
Business Response
Date: 04/02/2025
Hello,
Thank you for reaching out regarding the complaint submitted by [Member's Name] concerning a billing dispute with **************************************. We appreciate the opportunity to provide clarification on the matter and outline the steps taken to resolve the issue.
Investigation & Findings:
It was confirmed that ************************ initially submitted the claim on September 2, 2024, and again on October 31, 2024. However, the submission was sent to ************ instead of WellCare, despite the member being covered under WellCare during the date of service.
On March 17, 2025, WellCare contacted ******* Radiology and advised them to resubmit the claim correctly. The provider confirmed they would rebill WellCare.
Further follow-up on March 31, 2025, revealed that ******* Radiology had mistakenly mailed the claim to an incorrect PO Box address. WellCare provided the correct claims submission address: P.O. **************************. The provider acknowledged the error and confirmed that the bill would be placed in a pending status while they resubmit the claim, a process that may take up to 45 days.
Resolution:
******* Radiology has been instructed to resubmit the claim correctly to WellCare.
The provider has confirmed that the members bill is now on hold, and no further collection action should be taken while the claim is processed.
The member has been informed of these findings and advised to disregard the bill while awaiting resolution.
We appreciate the member's patience and understand the frustration caused by this billing issue. WellCare remains committed to ensuring a fair resolution and will continue monitoring the situation until the claim is properly processed.
Should any additional concerns arise, please let us know, and we will be happy to provide further assistance.
Initial Complaint
Date:03/20/2025
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 mailed / fax the request HIPAA release form multiple times but Wellcare keeps replying back with a denial mail that they do not see my signature. This implies they do get my mail but for some reason will not acknowledge that I signed a release. I call multiple times to contest this point and then have to mail and/or fax with my signature. They again will reply back with a denial letter stating lack of signature. Please help
Business Response
Date: 03/28/2025
We acknowledge receipt of the complaint referenced in case PRC-***** and want to provide an update on the actions taken so far.
The complainant has expressed concerns regarding difficulties in establishing Power of Attorney (POA) and Authorized Representative (***) status. Specifically, they reported repeated issues with previously submitted authorization forms not being recognized. In response to these concerns, the necessary POA and *** forms have been completed and submitted for review.
Our team has:
Confirmed receipt of the required documentation.
Escalated the request to the appropriate department for expedited review and processing.
Requested confirmation on whether the *** form requires annual resubmission, per the complainants inquiry.
We will continue to monitor the case closely and will provide updates as soon as additional information becomes available. Please let us know if any further details are required at this time.
Initial Complaint
Date:03/13/2025
Type:Service or Repair Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
WellCare is charging me for a premium when I was not able to use the plan. They say I was approved 2/1 but sent letters saying that I would be dropped if I did not contact them. Contact was made on 2/18 yet they sent a Final Notice . I contacted them again on 2/26 and was told to reapply. I am disputing a charge for the February premium payment. They are refusing to waive the payment at this time.
Business Response
Date: 03/17/2025
Good morning, we have not been able to reach the member by telephone or email. Our billing department has agreed to do a one time courtesy and waive the February premium. Thank you.
Customer Answer
Date: 03/21/2025

Better Business Bureau:

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

Sincerely,

***** ****
Initial Complaint
Date:03/11/2025
Type:Customer Service Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Wellcare, KNOWING NOTHING about me or my health arbitrarily denied a prescription ordered by my doctor. Mind you, this was over the course of several hours and a couple days. Fortunately it was not a medication that was for avoiding death.I have spoken with Wellcare people: Sharika, ***** ******, ****** and many more ... including Chynna a supervisor who didn't call me back, as promised, as recent as late last week (week of03/03/2025)I have asked the same questions over and over and still do not have an answer:"what gives Wellcare the right to override my doctors orders" . "Why is Wellcare denying a weighloss-type drug in 2025 that they approved in 2023" "the entire US knows that obesity is a severe problem, yet Wellcare has decided to NOT cover weighloss-type drugs" Wellcare has:-Denied a prescription from my doctor. (they are suits they have no medical degree or education) How dare they override a DOCTORS orders?!-Altered a minimum of the prescription from my doctor. How dare they override a DOCTORS orders?!-Misquoted the prescription doses and how to use the product, on the phone to me. They are talking to patients about the dosage on medication instead of directing the patient to read the label or contact their doctor/pharmacist. How dare they prescribe ANYTHING?!-Approved the prescription that THEY revised. (they are suits they have no medical degree or training)-Then denied the same prescription (by a recorded message)-Without a medical degree told my doctor what I needed to do.Regardless of Wellcare justifications, they will find and they can't deny that everything described above ACTUALLY DID HAPPEN. One final comment it appears Wellcare NEVER responds to emails from a customer (probably because they don't want any of their stories to be in black & white) I'm not an expert, but maybe wellcare should explain their interpretation of HIPAA.
Business Response
Date: 03/25/2025
good morning, WellCare Health Plan received a complaint on March *******, concerning Ms. ***** ******, Complaint Case# PRC-*****. Due to federal and state privacy and confidentially regulations, we are unable to disclose any protected health information, including eligibility, claims, and billing information, with anyone other than our members or their authorized representatives. We will be providing a detailed response directly to ***** ****** addressing the BBB complaint case and support in any additional needs of the member. A member of our team will contact you within 5 business days. thank you.
Initial Complaint
Date:03/11/2025
Type:Billing Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
After reviewing your company credentials since last September 2024, I decided to join Wellcare for the ********************* Plan. I trusted your recommendation.I have to inform you sincerely that thus far, starting from October 2024 till present, this has been a truly horrible experience, and I have yet to fill a prescription!!since I joined, I requested that the monthly fee be deducted from my Social Security payment as I did with the previous plan. I followed up in late December and was told that it may take up to 90 days for it to happen. (Not a good start).I followed up in January and was told the same, meanwhile I never ever miss a payment, therefore and I sent a payment way ahead of time to ensure that I have done my part.After numerous phone calls, and hours being on the phone, I found out that I was getting double dipped. I was sending a payment and Social Security had already deducted the same fee for January also. Keep in mind that all along I was told that the auto payment had not taken place as of yet. I had sent another check for February. After more phone calls, I asked that I need to be refunded and even though I had stated that I was getting double billed they still cashed my check for February.I have had it, I can longer proceed in this fashion with a company which obviously does not care about their customers yet steals senior citizens' money in the interim and never gets back to **** sincerely hope that you may have a solution for this, or I will have no choice but to contact the ************************* for gouging senior citizens, including the BBB, and I will make it a mission to spread this all over the internet. The sum is *****; however the customer service is beyond absurd and not acceptable.Sincerely upset.******* ********
Business Response
Date: 03/12/2025
Dear *************************** you for bringing this matter to our attention. We are sorry for any inconvenience that you have experienced. I have emailed you per your request the resolution to your complaint. I made outreach to our Billing Department and wanted to provide you with a resolution to your complaint. On 12/12/24 you were sent a letter (letter attached) advising of *** acceptance which also advised that there may be a time delay between the effective date of plan when the plan premiums are deducted from SSA. It can take up to 90 days for SSA deductions to take effect and that is SSA timeframe not WellCare.Your current payment method is set to SSA deductions to be effective 01/01/2025. You submitted payment of $12.40 on 01/22/2025 from check ****** and was applied to January 2025 invoice. SSA payment was also received on 01/25/2025 for $12.40 and was applied to February 2025 invoice. You sent another payment on 02/26/2025 from check ***** and was applied to March 2025 invoice. SSA payment was received on 02/22/2025 and was refunded back to SSA on 02/26/2025 for the $12.40. SSA will refund back to you,this process can take up to 90 days for you to see refund back from SSA. No manual payments from you are needed and your SSA will be paying premiums. Next payment due will be for April. This payment will come through SSA deductions.

I have also requested a call review of your calls to be reviewed. During this time, any necessary coaching of our agents will be conducted. Thank you for patience while I investigate your complaint

If you have any further questions or concerns, please do not hesitate to contact us.

Sincerely,
Myra
Customer Answer
Date: 03/14/2025

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,

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

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