ComplaintsforWellCare Health Plans, Inc.

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Initial Complaint
08/22/2024
Complaint Type:
Customer Service Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I canceled my coverage with WellCare and was somehow put back on it. I recently sent them a letter. I am now on ******** where my prescriptions are free or even lower than ********* I should never have even been using WellCare and dont know how I received it. WellCare needs to terminate my service with them ASAP and never reinstate it.
Business response
08/27/2024
Dear ************************* ,
Thank you for bringing this matter to our attention. We are sorry for any inconvenience that you have experienced and it was determined that you were on auto-enrollment with CMS ********* We have terminated your coverage with WellCare effective 8/31/24 and based on our conversation the resolution has been accepted.
If you have any further questions or concerns, please do not hesitate to contact us.
Sincerely,
**** D
Customer response
08/27/2024

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
08/07/2024
Complaint Type:
Product Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I received WellCare as part ( D ) PDP prescription Supplemental G plans in February 2024 at 65.Since then WellCare in March of 2024 changed my PDP plan to an Advantage Plan because one of their employees along with a third-party vendor decided to make some money by doing this to me an unsuspecting client without my knowledge, I had to make calls to ******** and WellCare where upon WellCare explained that this was done by one of their employees and a Third Party Vendor for this thievery. I had to wait 30 days for them to switch it back and I filed a complaint with ********.Now in August of this year 2024, WellCare received a prescription from my Doctor for Ozempic but an incorrect code was put in for Hypertension instead of Diabetes. Now they are saying I have to wait 60 Days before they can accept another script from my Doctor, a simple correction of the code is all that is needed, they said they would call my Doctor but they never did, and then I was told to contact the third-party vendor C2C Vendor Solutions to handle it, in other words to their job. WellCare is a DISASTER and having incompetent people in their employment is not what anyone would sign up for when you need help or understanding in their day-to-day operations with the elderly clients!
Business response
08/21/2024
Hello,
We have contacted the member and informed them that the rejected transaction in question was valid. The rejection occurred because the plan requires updated lab results to support the member's medical condition. This case remains open, and the member has been advised on what documentation is needed from their provider for the transaction to be validated. We will provide further feedback once a final determination has been made.

Thank you for your attention to this matter.
Customer response
08/21/2024

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.

Sincerely,

*************************
Initial Complaint
08/06/2024
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I am a Wellcare customer. I have been getting phone calls from a number I do not recognize ***************, most recently today, 5-Aug-2024), purporting to be from Wellcare. When I answer or return the call, the first thing they want is my member id number, which I refuse to give out to a number I don't recognize, and end the call. When I call Wellcare using the phone number on my card, I have to waste my time on hold and jumping through their hoops, and finally get told "Yeah, that's us, you can return the call", but they don't transfer me to that department or give me the message.My complaint is that Wellcare customers are going to get tired of verifying the phone number (it's only human nature), and will simply get into the habit of giving out personal information to unsolicited callers, which is precisely the wrong thing to do. Yet, it is Wellcare's policy to encourage their customers to do exactly that, or they will be punished by wasting their time in a phone maze.Furthermore, the last time I called Wellcare about this, they said they would remove me from their call list, yet I am still getting these calls.When people get scammed by unwisely giving out information, the victims lose money, property, or their identities, and feel utterly foolish. The scammers are delighted and enriched. Yet the companies that habituate this behavior get away *****-free. This has to be stopped!
Business response
08/14/2024
An outbound call was placed to ****************** on 08.07.2024 at 4:38pm Est. I advised ****************** I was calling regarding his complaint received by the BBB. ****************** expressed his concerns about receiving unfamiliar calls on his landline. I then explained to the complainant, he was added to the *** (Do not contact list), per the *** guidelines there are some calls from WellCare that he will need to take. The complainant understood and was satisfied with the outcome of our conversation.
Customer response
08/15/2024

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is no less satisfactory than I expected. I do hope, however, that this complaint triggers a change in Wellcare's contact policy and procedures.

Sincerely,

*************************
Initial Complaint
08/06/2024
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.
On May 20th 2024 I contacted my insurance company WellCare because I was unable to find anyone that would strike my tooth for a list of dentists that carried WellCare I called over 10 dental services in ******* either they would take WellCare and was not taking new patients and the other dentists was not taken well care an assistant in the WellCare office even try to help also at no results I had insurance through WellCare at that time it was well care no premium HMO ********. While talking with the representative she realized that I could get WellCare assist open PPO ******** which went into effect 5.23.24 when she canceled the old insurance and the new one went into effect I did find a dentist by the name of urgent dental of Buffalo but I had to pay out of my pocket $635 an urgent dental told me that they would submit a claim to my insurance company because they did not take the insurance but I could get in on the 22nd of 2024 and that's what I end up doing ever since I have been trying to submit a claim to receive my money back on my own and now I just received a grievance statement from WellCare stating that I did not have insurance on May ***** which I did. I sent in a copy of the bill with the statement and I filled out also a reimbursement claim and I have called them so many times and I get the runaround each time. The person that looked into this name is *****.R Grievance Resolution Team. I even spoke with one of the representatives at one point of time claim that she tried to call urgent dental of ******* to speak with them after I had given her the phone number and the fax number and the email address she placed a call she said and she could not get through to them as soon as I got off the phone with one of the WellCare Representatives a place to call myself to urgent dental or Buffalo they picked up the phone right away and I asked them did anyone call from WellCare and the assistant that I spoke with said no one called from WellCare.
Business response
08/15/2024
Contact was made with complainant: ********************* on 08.12.2024 at 12:56pm EST. She was educated, provider: ********************* was out-of-network (OON) with WellCare insurance; therefore, we are unable to reimburse her the money paid, $635. Due to her explaining via her complaint and confirming during our call, she chose to see ********************* with the understanding they were out of network, she would be responsible for the services rendered. She made mention she doesnt understand why the plan was cancelled in one day and she didnt have coverage. She was educated, she spoke with someone to change and terminate coverage on 05.20.2024, but terminations of plans happen on the last day of the month if approved while enrollments take place the first of the month. This means the termination would not have taken place on 05.23.2024 leaving her without coverage. She was further educated; the previous plans termination was 05.31.2024 with a new plans effective date 06.01.2024. She shared, she had been speaking with someone to locate providers, but they were unsuccessful; therefore, she located this provider through her own research and decided to go there because she was in pain. While I empathized with her experience of being in pain, she was educated that the provider was OON, and she didnt have permission which caused her to be denied reimbursement.
Customer response
08/15/2024

Complaint: 22097010

I am rejecting this response because:

Sincerely,

*********************
Initial Complaint
07/22/2024
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.
In November of 2023, I had discussions with WellCare about prescription drug coverage similar to my husband's WellCare coverage which was free to him. SEE ATTACHMENT #1. I told them that my husband's application had required an appeal which had removed all costs. SEE ATTACHMENT #1 At that time we had been married for 55 years with identical insurance and ******** coverage so my application should follow my husband's as to cost for premiums. The WellCare customer service person agreed. So I submitted the application.Some History - When my husband submitted his application it was rejected and they began to threaten late enrollment penalties. He called and was told to ignore such notices. SEE ATTACHMENT #2. This at least was true as proven by ATTACHMENT #1. As time passed we received letters that said my application was incomplete which began a back and forth as shown in SEE ATTACHMENT #3. The amount of money they now want as threatened in their letter SEE ATTACHMENT #4 (two pages) is $10,764.30. ($67.70 x Which is a lot of money for nothing.I now want to stop involvement with WellCare completely and ask your help in doing this. The implied threats from WellCare are exorbitant and have no basis.
Business response
07/25/2024
Good afternoon,

My name is *******, I am currently reviewing this issue and will supply and update once this review is complete. If you have any questions or concerns, please contact me at ************ to the Presidental Escalation Team. Please use PRC-***** as a reference number.

Thank you,
Customer response
07/25/2024

Complaint: 22022381

I am rejecting this response because: there is no response yet. They have merely said that they received the complaint and were reviewing it. I await their next response.

Sincerely,

*******************************
Business response
07/26/2024
Good afternoon, ****************,

Per my review and research, the plan is confirming the update to shows 0 uncovered months and you do not have late penalty fees applied to your premiums. Your base premium amount is $ 0.00. Please feel free to contact me if you have any questions at ************ and please use PRC-***** as the reference number.

Thank you,
*******
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
06/28/2024
Complaint Type:
Order 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 Senior on ********* I am filing a claim because I feel WELLCARE HEALTH INS. *** IS OVERCHARGING ME FOR MY PART D PRESCRIPTION MEDICATION, AMPHETAMINE-DEXTROAMPHETAMINE; a medication I have been taking for many years for the condition of Narcolepsy. As is typical, at the end of the year, I go onto and search the ******************* Marketplace to choose the most cost-effective **** ******* in my area. My choice is based on the price estimates each company posts on the Govt. website. In 2023, I chose CIGNA, as it listed the best prices for the 2 drugs I take regularly. I had no problems with CIGNA and paid a total of $41.27 for the entire year for my amphetamine-dextroamphetamine prescriptions. Now for 2024, upon going onto the Govt. Marketplace website, I see that WELLCARE is the company offering the best drug prices. Thus, I switch to WELLCARE. At first things go well; from January through April, I only paid a total of $3.10. Then suddenly in May the price ballooned to $14.57. On top of this, WELLCARE just sent me a letter clawing back another $35.94, saying they made a "claim adjustment." So now I suddenly am paying out $53.61 in a 6 month period (THIS MEANS I AM PAYING MORE THAN DOUBLE WHAT I WAS CHARGED BY CIGNA LAST YEAR) I appealed to WELLCARE several times, feeling that it was unfair for them to advertise one price on the Govt. Marketplace and then actually charge me so much more (they are engaging in FALSE ADVERTISING). I NEVER would have enrolled with WELLCARE had I known what I would actually be paying! So far, WELLCARE has denied my appeals, and is being very deceptive. Docs I am including: 1) receipts for this drug so far in 2024, 2) the letter clawing back $35.94, 3) my drug costs in 2023 with CIGNA and 4) a screenshot from the Govt. Website showing a cost of $9.67 after the deductible. (Instead of $9.67, I am actually paying $17.87 per prescription - this is totally unfair. ) Also, included are denials letters from ***********
Business response
07/12/2024
We have made contact and are continuing to work with the member to find a satisfactory resolution. Recently I have confirmed contact with the doctor who prescribed the medication and provided information to the member regarding programs built to assist with **** instances. We will continue until resolution is met.
Customer response
07/16/2024

Complaint: 21913096

I am rejecting this response because: while I have been talking to ******* at executive escalation ****** no resolution has yet been reached. His one suggestion to investigate P.A.P. pricing turned out to be even more expensive. Also, the company's initial response above stated they had spoken to my doctor, but ******* says he has still not been able to reach her. I am reaching out to her today to try to connect them.

Sincerely,

*************************
Business response
07/19/2024
We are actively working and collaborating with the provider and C2C to have the appeal expedited as quickly as possible. Member aware of this information. Thank you.
Customer response
07/28/2024

Complaint: 21913096

I am rejecting this response because: I continue to be in touch with Will S at Wellcare's Executive **************** and he continues conferring with others and with my doctor. ******** far a resolution has not yet been reached. Also, **** was out of the office this past week. I hope by Monday we will be able to speak and move this forward to a conclusion.

Sincerely,

*************************
Business response
08/01/2024
Currently as it stands all appeals have been denied due to the medication not having any alternative. I've spoken with the doctor who has exhausted all options with the appeals. She stated she will discuss this with the member and then discuss possible further solutions. I will also be contacting the member about this via phone.
Customer response
08/07/2024

Complaint: 21913096

I am rejecting this response because: My doctor and I have filled numerous appeal and tier exception requests and applications....each time I am denied for the exact same reason: that there is no other lower price substitute for the medication I am taking. Yet, this argument totally skirts the original issue and repeating it over and over to us does not make it somehow more acceptable.
When I was onto the ******** marketplace at the end of 2023, Wellcare ADVERTISED my co-pay for amphetamine salts as being a certain price - ($9.67) - Yet, the last time I went to renew my prescription, I was charged $18.92. If I had known the actual price would have been so high, I would have just stayed with CIGNA INSURANCE which always charged less than $7. So, no matter what argument Wellcare is now giving, they still lured me into a 1 year commitment using FALSE ADVERTISING.
Furthermore, I just found out yesterday that the regular price for amphetamine salts for an uninsured person is $38, which means Wellcare is charging me 50% of the actual price. in their 2024 Welcome Kit, Wellcare lists Tier 3 drugs at 25%, which is again in alignment with the $9.67 price that the Company lists on the ******** Marketplace.
In conclusion, I feel Wellcare is being dishonest and not charging me a fair price.
I have included 2 docs: 1) the pricing page off Wellcare's ******** Marketplace promotion and 2) Tier pricing breakdown from the Wellcare Welcome Kit Booklet

Sincerely,

*************************
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,

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

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ComplaintsforWellCare Health Plans, Inc.

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