ComplaintsforWellCare Health Plans, Inc.

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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,
Initial Complaint
05/20/2024
Complaint Type:
Product Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I ordered a refill for zolpidem on 5/9 but wellcare would not approve it. ********* said it needed preapproval and a form was sent to the doctor which she filled out and returned but still no correct response from wellcare. The prescription expired by now so it was requested that wellcare take care of this. Then a call came from wellcare saying it was not approved because the med was not approved for what the prescription was written for which was insomnia!! This is a tried and true med for insomnia and it was written for insomnia!!!!!!! ******** approved their part but NOT WELL WE DONT CARE? I *** HELP WITH THESE PEOPLE! Also when trying to login to well care and gave them my id numer they responded with HELLO ***** which is my husband. These people should not be allowed to practice! We will be trying to switch providers but I dont think possible this time of year. I MIGHT ADD THAT THIS PRESCRIPTION WAS APPROVED IN THE PAST
Business response
05/22/2024
Good afternoon, *****,
Reference number PRC-12944

Per our conversation on 5/21/24, you picked up medication Zolpidem and had to pay out of pocket. But advised from an agent from the plan this medication was approved after the prescription had expired. I sent this to the pharmacy team to get details for future refills on medication Zolpidem. Once I have been supplied with the final finding will follow back up with you. If you have any question while this under research, please reach out to me at ************ with reference number PRC-12944.
Customer response
05/23/2024

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
05/14/2024
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.
THIS COMPANY CANNOT GET THAT I WANT NO PAPER ANYTHING TO MY HOME! I HAVE A ******** PDP WITH THIS COMPANY. THEY ARE WASTING RESOURCES, AND I HAVE AN UNSECURE MAIL DELIVERY SYSTEM WHERE I RESIDE! I HAVE FILED MANY GRIEVANCES AND PHONE CALLS AND I HAVE ALL THE ***** NAMES AND DATES I HAVE SPOKEN TO INCLUDING ONE CALLED THE "PRESIDENTIAL TEAM". YOU WOULD THINK THEY COULD HANDLE THIS SIMPLE REQUEST! NOPE, STILL GETTING PAPERS AFTER 3 MONTHS! WHY DON'T THEY GET IT? CAUSE THEY ARE ALL UNINFORMED. I GET THAT ******** FORCES THEM TO SEND OUT CERTAIN DOCUMENTS, BUT NOT ADVERTISING!PLEASE HELP ME GET THEM TO STOP SENDING me any papers!!!
Business response
05/28/2024
Wellcare has been working diligently with the member to resolve her issue. We currently have scheduled communications upcoming and hope to continue to fix her issues. Thank you.
Initial Complaint
05/14/2024
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.
Im making a complain here today because this is completely unexpected able what WellCare has done. I had not received any mail informing me of anything whatsoever. Into today my PO BOX was the only address on file. I just recently today gave a physical address to put on file. Unfortunately on the following dates listed below I was in the hospital. January 31, 2023 February 27, 2024 April 11, 2024 I not once received anything in the mail or over the phone that my insurance was canceled. On April 12, 2024 after coming out the hospital and trying to get my medication at the pharmacy. At the pharmacy was when I was informed that my insurance was not active. After not being able to get my prescription. I got in contact with WellCare where I then over the phone spoke with a representative and made a payment of $124.80 I was informed to wait a few days for WellCare to receive the payment in their system. One week went and nothing Two weeks went and nothing.Then today I called WellCare and Im told that my insurance is not active and not going to get activated. This is completely horrible how this matter was taken. I have life sustaining medication that Im unable to pick up at the pharmacy due to WellCare
Business response
05/21/2024
Good morning, we forwarded the complaint to our Billing department for review, they advised: Coupon book was sent to member on 12/18/2023. *************** was made to member on 03/18/2024. FTP notices were sent to member on 02/02/2024 and 03/16/2024. Member had to pay $41.60 by 03/31/2024 to avoid FPAY termination. Member made payment of $124.80 on 04/30/2024 but account was already term. No payment received by the due date indicated on the **** There is no plan error to be found. Member was termed for FTP correctly and is not eligible for reinstatement. Member can contact pre-enrollment ************, to see if they qualify for an SEP to be re-enrolled in plan. CMS guidance does not permit reinstatement based on receipt of a payment after the end of the grace ******* Any credits or additional payments made on these termed accounts will be applied to any open invoices and any additional credits will be refunded. thank you
Initial Complaint
05/09/2024
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.
Today, May 9 2024 I was sceduled for access 2 to care wheelchair van ride to physical therapy at 1:30, I also am asked by company to call three days in advance. I called at 12"30 to make sure driver was on its way I was told they had mechanical issues and NO ONE CALLED ME, I asked for another ride, tranferred to dispatch told I could not not stay on phone that I would receive a call within an hour, No one ever called me
Business response
05/23/2024
Hello.We apologize for the dissatisfaction that you experienced. The plan has made contact with the member/complainant regarding their concerns, and we are currently working on getting this matter resolved.

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ComplaintsforWellCare Health Plans, Inc.

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