Complaints

This profile includes complaints for WellCare Health Plans, Inc.'s headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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WellCare Health Plans, Inc. has 34 locations, listed below.

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• 

  WellCare Health Plans, Inc.

  PO Box 31370 Tampa, FL 33631-3370

• 

  Universal American Corp.

  6 International Drive Ste.190 Rye Brook, NY 10573

• 

  'Ohana Health Plan, Inc.

  820 Mililani St Ste 200 Honolulu, HI 96813

• 

  WellCare Health Plans, Inc.

  8735 Henderson Rd Tampa, FL 33634-1143

• 

  WellCare Health Plans, Inc.

  PO Box 25735 Tampa, FL 33622-5735

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:02/12/2025

  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 switched to wellcare for the 2025 year and constantly asked then if my medications I was on were covered and 4 times they assured me they were. Now it's middle of February and still one of my needed medications has been repeatedly denied.

  Business Response

  Date: 02/19/2025

  Thank you for bringing this matter to our attention. WellCare takes member concerns seriously, and we appreciate the opportunity to address and clarify the issue.

  Upon review, the members case was thoroughly researched using internal systems, including CareConnect and CPS. The medication in question, Mounjaro 15MG, was initially denied on February 6, 2025. However, pharmacy records confirm that the medication was successfully processed on February 12, 2025. Additionally, an appeal was identified in CareConnect and confirmed as in progress. Multiple outbound call attempts were made to inform the member of the status. On February 13, 2025, contact was successfully established, However, during the call, the member stated that the issue had been resolved and no further action was needed.
  

  We regret any inconvenience experienced and appreciate the members patience while the matter was addressed. If any further assistance is required, we encourage the member to reach out to our customer service team for support.

• Initial Complaint

  Date:02/11/2025

  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.

  My phone number was incorrectly put on a Well Care customer's account, and for over a year, they have been calling me to speak to her, and they cannot remove my number. They said that the user needed to call them to change the number, so I am stuck in this limbo. I was put on a do not call list but because my number is locked into her account they keep calling me.

  Business Response

  Date: 02/19/2025

  Thank you for reaching out regarding the complaint submitted by Ms. ***** concerning unwanted phone calls. We appreciate the opportunity to address and resolve this matter. Upon receipt of Ms. ****** complaint, we conducted a thorough review and confirmed that she is not associated with any member account within our system. Despite this, she had been receiving calls from the number ************.

  Actions Taken:
  On February 13, 2025, we submitted a request to add Ms. ****** phone number, **************, to our suppression list to ensure she no longer receives calls from our organization. We have verified that the number has been successfully added to the ******** Do Not Call (DNC) list as of February 13, 2025. Ms. ***** was informed that her request has been processed, and no further action is needed on her part.

  
  We sincerely regret any inconvenience Ms. ***** has experienced. Our team takes privacy and customer concerns seriously, and we continuously strive to improve our processes to prevent similar occurrences in the future.
  

  If there are any further questions or additional information required, please do not hesitate to contact us.

• Initial Complaint

  Date:02/11/2025

  Type:Customer Service Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

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

  Answered:

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

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I've been trying since January to activate my healthy food benefits because of my colon and digestive medical issue. I can't get any assistance until I use the BBB to file a complaint. Program specialist doesn't help. Just a terrible situation. I will be filing other complaints

  Business Response

  Date: 02/17/2025

  good afternoon, our case management team contacted the member and advised they were able to  successfully make contact with *** and have submitted a referral for home delivered meals benefit. *** is in managed status for care management and I will be following up with her for the next 90 days with the next follow up outreach scheduled for 3/12/25

  Customer Answer

  Date: 02/17/2025

   
  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:02/11/2025

  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 terminated services and need a letter and/or email to reinstate my old provider insurance. I was promised at time of disconnect I would get one in the mail and I haven't received it. I need it to reinstate my old provider insurance.

  Business Response

  Date: 02/12/2025

  good afternoon, we have been unable to reach the complainant by telephone. Email sent with the attached disenrollment letter sent on 01/30/2025. See attached, thank you. 

• Initial Complaint

  Date:02/10/2025

  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.

  Wellcare Advantage plan REFUSES TO PROVIDE TERMINATED BY NO FAULT OF CLIENT letter, which guarantees right to purchase Medi-gap insurance with no medical history review. Therefore, keeping cost affordable. Request assistance in promptly receiving this letter. Mother, ***** ****, dob ********, has resided in *************************** facility for 2.5+ years in ******************** Wellcare Advantage Plan. Member# ********. Had MO primary ** with claims paid. Her mail is sent to daughter, ***** *****, POA, ************************************ 72529.Wellcare terminated coverage 12/31/24. After numerous calls to obtain No-Fault Termination letter, even speaking with supervisors, I have been told different reasons for termination is: She moved (didn't), Insurance changed geographical service location & no longer has availability there, failed to verify address ( verified many times over years), etc. Only results from my calls was received multiple copies of a form letter stating verify address or insurance will be terminated on 1/31/2025. Insurance has already terminated 12/31/24. Reps state they can't send a no-fault termination letter because there is no such thing. Medi-gap insurance state they MUST have this no-fault termination letter to not do a medical History review to determine cost of the new policy. Thank you for your assistance.

  Business Response

  Date: 02/17/2025

  good afternoon, we were unable to reach the complainant by telephone, however the requested letter was mailed to the complainant on 01/30/2025. thank you.  

  Customer Answer

  Date: 02/17/2025

   
  Complaint: 22915980
  
  I am rejecting this response because:Any time I have called in to request, they send me a form letter stating Policy will terminate in a date.  See attached.  No where in this letter does it state that she was terminated due to NO FAULT OF HER OWN.  & therefore has the right guaranteed to obtain ***************** without a medical review.  

  Please send a letter stating that ***** Sue **** was terminated due to NO FAULT OF HER OWN.

  Thank you

  ***** *****

  Business Response

  Date: 03/06/2025

  Termination letter was mailed to the address on file, coverage termed as of 12/31/24. 

• Initial Complaint

  Date:02/04/2025

  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.

  I received a payment book from Wellcare(RX), who I wasn't familiar with but since it is connected to ******** I decided to pay the whole amount ( a year) at once and use this plan for my prescriptions. Upon using this insurance I found out it would be much cheaper to just use coupons then use this insurance. Myself and my partner contacted *********, first via email then via phone to cancel the insurance and get some of our money back. After being transferred on the phone several times, reportedly being connected to supervisors we were given a Fax number and an address and what to include on a piece of paper. We drove to a location where you can fax documents and the fax number didn't work. After coming home we decided to mail the document. After a few days we received a phone call from Wellcare that made no sense at all, we were left totally confused. After that we contacted them through their online chat. They said they would escalate the situation and that we would receive yet another call. This seems like a run around and after reading some of the complaints online here I worry we will never see our money back, which was over ****************************************************************************** money back, these people shouldn't be ripping off Seniors and it shouldn't be so hard to cancel.

  Business Response

  Date: 02/13/2025

  Good morning, *****, 

   

  
  Hope all is well. I wanted to supply and update the plan received the disenrollment request on 02/06/25 and disenrolled effective 2/28/2025. The plan does not cancel in the middle of the month it will be at the last day of month. From review the funds have been refunded back.  If you have questions, please contact me back at ************, using reference number PRC-*****.  

   

  Thank you, 

  Desiree  

  Customer Answer

  Date: 02/14/2025

   
  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,
  
  ***** ********

• Initial Complaint

  Date:01/28/2025

  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.

  For 10 years I buy the cheapest Part D drug plan to keep that Part D alive as suggested by ********. At the end of 2023 I noticed Wellcare Part D for $4.50 for the entire year, so I joined it. I needed a generic ******** (*********) for a hip replacement in May of 2024. Their favored pharmacy told me with that insurance it would cost over $100 for 200mg 30 capsules. I was blown away. I went to ****** and signed up for their gold for a free month. The cost for the exact same prescription was $11.79. For $10/month I figured I would stay with Good RX gold. I called Wellcare beginning of November to quit after trying to cancel on their website where I could not find a way to cancel because it does not exist. I could not understand the person on the phone due to accent and I was told they were going to cancel. At the end of the year I got a bill for $208.80, so on December 30, 2024 I did a chat with them and they said I could not cancel, but then said they will cancel. I called them on 1/16/2025 after getting another bill and they said they would send me a form for a special disenrollment. I never got it.I called ******** and told them what I believe to be a manipulation and scam to prevent or at the least make it extremely difficult to cancel. I have no proof, but I believe they do everything possible to prevent people from cancelling, like not communicating during the disenrollment period and when it ends then send the much higher bill and having people you can't communicate normally during the disenrollment period. Then when you can't find it on the website you call and they tell you in broken English that they will cancel it. My monthly payment of 40 cents that I paid for the year $4.50 went to $17.40/month - that is a *****% increase per month. I'm 76 years old and on ********. I should not have to deal with this corrupt company just to end their corrupt service. The bottom line is they prevented me from dis enrolling by lying and trickery and manipulation.

  Business Response

  Date: 01/30/2025

  Hello,

  We acknowledge receipt of complaint *********** and appreciate the opportunity to address the concerns raised. Our team is actively reviewing the matter to ensure a thorough and accurate resolution.

  Actions Taken Thus Far:
  We have conducted an initial review of the members plan details and confirmed the plan remains active.
  Multiple outreach attempts have been made to the member via phone, with voicemail messages left requesting a callback.
  The case has been escalated for internal review, including an evaluation of disenrollment requests, communication history, and any potential plan errors.
  Our Enrollment team has been engaged to assess the disenrollment concerns and determine next steps.
  

  We understand the frustration expressed and are working diligently to review all relevant records to ensure proper handling of the situation. Once the review is complete, we will provide an update regarding resolution/determination.

  Please let us know if further details are needed at this time. We appreciate your patience as we work through the review process.

  Customer Answer

  Date: 01/31/2025

   
  Complaint: 22866126
  
  I am rejecting this response because:
  In good faith I tried to cancel (disenroll) during the time period. Wellcare **************** was worthless to me during the year and I was forced to acquire ****** Gold to get the drugs I needed at a fair price. I believe the extremely low cost of 40 cents per month was the bait to get seniors onto their drug plan with no easy way to get the plan cancelled. This is unconscionable - the Part D drug plan is there to help seniors get low prices for drugs. My experience was a charge of $120 for a generic ******** drug that has been around for decades that I could buy with no drug plan Using ****** in many pharmacies for around $12. I changed from *** to Vons pharmacy because it was a preferred pharmacy of Wellcare. I would not be surprised if many seniors have been paying 10x more for drugs than they needed to and also paying for insurance premiums as well. As I stated, this is unconscionable and must be stopped by ******** cancelling their approval of Wellcare **************** or by a class action law suit to give back precious over payments to those seniors that have been taken advantage of. I had a conversation with an agent of Wellcare who said he would work to get me disenrolled, but I don't trust Wellcare to do what is right - he said he would get back to me by 2-4-25. Many seniors can't use a computer or search on a smart phone. When calling in to disenroll during the unenroll period you get broken English and come away with the hope that your effort to cancel was understood. Then there is no communication until you get the bill outside of the disenroll period. That bill went from $4.50 in 2024 for the year to $208 for the year 2025. Then I searched my account on their website again to cancel and could not find a way, so I did a chat and that chat transcript where I was told they would cancel is part of this complaint. Again, it is unconscionable or maybe fraudulent to create a system for seniors that is too complex to be able to cancel their plan. To this day, I can login to my password protected Wellcare account and NOT find a form to cancel or disenroll. After much hardship, I found that Wellcare makes you go out of your account to another website, struggle to locate their disenroll form, print it out, fill it out and mail it to them. If they need a signature they can do a docusign, but an approved account with them should be enough to cancel - again unconscionable to treat seniors this way.
  Sincerely,
  
  ******* ******

  Business Response

  Date: 02/06/2025

  Hello,

  We acknowledge receipt of complaint ID ******** and appreciate the opportunity to address the concerns raised by Mr. ****** regarding his disenrollment from WellCare. Following our investigation, we have taken the following actions to address the members concerns:

  The member was informed that disenrollment requires a written request along with a valid election period.
  A disenrollment form was triggered and sent to the member on January 31, 2025.
  The member was advised that their disenrollment request is subject to CMS approval based on eligibility criteria.
  The member was provided with alternative coverage options and informed of the potential Late Enrollment Penalty (LEP) should they disenroll.

  A follow-up call was made to the member but we were unable to make contact. The plan was unable to find plan error alleged as the member was advised a valid election period must be selected via chat and phone call by previous agents he spoke with. At this time the member has not submitted a valid election period and we are unable to process his request for disenrollment. 

  Thank you 

  Customer Answer

  Date: 02/07/2025

   
  Complaint: 22866126
  
  I am rejecting this response because:

  I made an effort to unenroll during the enrollment time period. WellCare made it difficult for a reasonable person to be able to find a way to unenroll. This is still the case saying that they sent me a form which as of today January 7th 2025 I have not received. Because they intentionally make it difficult to unenroll and that it's impossible to unenroll using their website where I can log in with a password to my account. This is an unconscionable way of doing business with seniors. I've already submitted documents showing that I acquired other insurance because of their drug cost rip off. If I receive the form they said they sent I will complete it and immediately send it to them. I spoke with ***** B from the executive department who said he would investigate and get back to me before February 6th. I have not heard back from him and February 6th was yesterday. WellCare has enough information from me to validate that I want them to terminate my enrollment as of 2024. ******** said they can do this but clearly they are money grubbing and that's all they care about and will waste seniors time and energy fighting their corrupt way of doing business.
  
  Sincerely,
  
  ******* ******

  Business Response

  Date: 03/07/2025

  The Member was informed that disenrollment requires a written request with a valid election period. Disenrollment form was triggered and sent to the member on 1/31/2025. Member was advised that their disenrollment request is subject to CMS approval. Coaching requests were sent to the representatives involved in the misinformation. Member was informed of alternative options for coverage and potential Late Enrollment Penalty (LEP) consequences. No plan error founded, as the member was advised on multiple occasions a valid election period must be selected in order for disenrollment be processed.

  Customer Answer

  Date: 03/07/2025

   
  Complaint: 22866126
  
  I am rejecting this response because:

  It is clear to me that wellcare does not care about the insured and only care about the premiums. It took a long time for me to receive the form and I completed it and sent it to Wellcare immediately. Well care will not admit that they intentionally and unconscionably make it extremely difficult for seniors to terminate insurance with them. They've been extremely dishonest in their dealing with me and with many others which can be seen on the internet complaint websites. WellCare, according to ********, could use good faith and disenroll me at any time and are unwilling to do so. They've been sued many times and it seems like a class action lawsuit by those who have been cheated by this company is past due. This case is simple. Well care put a system in place to make it extremely difficult for seniors to stop paying premiums and unenroll then they repeat that you have to fill out their form which is difficult to locate. During the  unenrollment time, phone support is the opposite of support giving false information by someone who is hard to understand and then outside the unenrollment time you get a bill with a massive monthly rate increase. I'll ask again, WellCare, please disenroll me from your insurance as of my subscription in 2024. I sent you the disenrollment form as soon as I received it from you. Of course it's outside the unenrollment time because my effort during that time was unreasonably blocked.
  
  Sincerely,
  
  ******* ******

  Customer Answer

  Date: 04/10/2025

  I interpret the response I received to be from BBB asking for a copy of the disenrollment form I have sent to Wellcare on 2-11-2025. I am responding to that by attaching that doc to this form and also I assume that this will keep this complaint open as I will continue to respond until Wellcare cancels or disenrolls me from their terrible insurance plan as of Nov 2024, that they made it unconsciously difficult to disenroll from intentionally trying to extort a massively higher premium from people who subscribed to their $4.50/year plan.

  Business Response

  Date: 04/18/2025

  We have reviewed the concerns raised regarding the individual's attempt to disenroll from their WellCare plan. After a comprehensive investigation, including internal call records and communication history, we offer the following response:
  

  The member reported attempting to cancel their plan around November 2024. However, we found no documented disenrollment requests or calls to support this claim during that timeframe.
  On December 30, 2024, the individual contacted WellCare via online chat. The representative advised that the cancellation process would be initiated; however, no formal disenrollment request was submitted or processed.A follow-up call occurred on January 15, 2025, during which the individual was informed that a disenrollment form would be sent. Unfortunately, this form was not mailed as promised. We acknowledge this oversight and have addressed it internally.

  After a formal complaint was submitted to ******** in January, our internal *** team contacted the individual in February to explain that disenrollment outside of the ******** Annual Enrollment Period (October 15 December 7) requires a valid Special Enrollment Period (***). In this case, no qualifying *** could be confirmed.
  

  The premium increase cited in the complaintfrom $0.40 in 2024 to $17.40 in 2025was the result of the continued enrollment, as no formal disenrollment request was received or processed in time.
  We recognize that errors and miscommunication occurred, particularly regarding the chat interaction and the unfulfilled commitment to send a disenrollment form. These issues have been addressed internally with the appropriate teams, and corrective actions, including staff coaching, have been taken to prevent recurrence.
  

  While we regret the inconvenience this situation has caused, WellCare must adhere to CMS (Centers for ******** & ****************** guidelines regarding disenrollment procedures. Outside of the designated enrollment periods, a valid *** is required to process disenrollment. We remain willing to assist the individual if a *** becomes available or if further support is needed in reviewing their options.

  We appreciate the opportunity to address this matter and value feedback that helps us improve the member experience.

  Customer Answer

  Date: 04/18/2025

   
  Complaint: 22866126
  
  I am rejecting this response because:

  I just got off the phone with ***** at WellCare who repeated to me that they were still not disenrolling me from the plan. I informed him I was not satisfied and that the plan for 40 cents a month was a hook to get seniors signed up for the drug plan Part D and at the same time to raise that plan $17 per month and make it almost impossible to disenroll by having no link or form available when I logged into my WellCare account. They could simply have put a link to the form that's on their main website but they chose not to for a now obvious reason. After putting the bait out for ******************************************************************************** their company and that's exactly what happened to me. That plan was a bait and switch which is a way to extort money. using the $40 a month plan did not get much of a discount if any discount buying drugs. I didn't expect much I only accepted that plan to remain enrolled in part D ********. I tried to disenroll but I could not do to their policies and their intentional action to keep me enrolled at the much higher price. I have ******** supplemental insurance through ****** which is a wonderfully run company. I've had other Medical insurances through other companies without incident but anyone considering wellcare beware that this is an unscrupulous company that's had many lawsuits against them and you can search ****** and find those lawsuits and you will understand how bad they are to deal with. There's also many other complaints which I will be adding my complaint to since WellCare refuses to disenroll me. Many seniors have difficulty with minor tasks and that should be taken into consideration which it is a Humana but not at WellCare because WellCare is just a money-grubbing company and they don't care about seniors and their needs. It's unconscionable to make it a convoluted process to disenroll from their crappy insurance.
  
  Sincerely,
  
  ******* ******

  Business Response

  Date: 04/24/2025

  Thank you for your additional comments regarding your recent experience. We understand your continued frustration and sincerely apologize for any inconvenience you have experienced. At this time, we would like to reiterate that after careful review of your account and in accordance with ******** guidelines, we are unable to process a disenrollment outside of the standard timeframes and procedures established by the Centers for ******** & ***************** (CMS).

  We acknowledge the concerns you've raised about plan transparency and the ease of disenrollment. Please know that our intent is never to cause confusion or create barriers for our members. We strive to provide clear guidance and multiple avenues for support, including phone assistance, written instructions, and online resources.

  While we are currently unable to process your disenrollment, we remain committed to supporting you and ensuring you have access to the resources needed to explore your options.Your feedback has been documented and escalated to the appropriate internal departments for further evaluation. We appreciate your patience and continued communication as we work to support your needs within the regulatory framework we are required to follow.

• Initial Complaint

  Date:01/28/2025

  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.

  I have been harassed by this company via telephone for over a year. I got my new cell number in early 2024 and I receive CONSTANT calls and voicemails from them for someone who does not have this number. I have told four different "agents" via phone that it was the wrong number. I asked to have my number removed. I asked them not to bother me after normal business hours. I pleaded with them to change their database. Nothing is working. This company is blatantly harassing me because they have multiple instances of me telling them that this number does NOT belong to ***** ***** and I have no idea who that person even is I have never personally known anyone named *****. This is absolute harassment. I want the calls to stop.

  Business Response

  Date: 01/28/2025

  Hello.We apologize for the dissatisfaction that you experienced.  The plan has made contact with the complainant, and they have been added to the Do Not Call List. No further action necessary.

• Initial Complaint

  Date:01/28/2025

  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.

  On January 15 an authorization was requested and to date it has not been approved. The doctors and the case management team has been in a battle with Wellcare since the hospital stay. I hope this can get taken care of.

  Business Response

  Date: 01/29/2025

  My name is *******,

  We received your complaint regarding the health plan. To further research your case, we need more information. Please contact me at ************ and reference case number PRC-*****. I am looking forward to speaking with you. 

   

  Thank you, 

  *******.

   

  Customer Answer

  Date: 01/30/2025

   
  Complaint: 22862439
  
  I am rejecting this response because: I have been on the phone with customer service about this ongoing issue and, they continue to give the hospital I am staying in the rehab ************************  Wellcare has been called many times and continues to say yes but; has not honored the hospitals requests. 
  
  Sincerely,
  
  ***** *******

  Business Response

  Date: 02/04/2025

  Good afternoon,  

  
  I hope all is well; there is a lack of communication between the patient and the utilization review team at the treating facility. The patient has been approved for all days thus far (1/16/25-2/6/25). There have been no denials issued for this case.  Authorization has been communicated both verbally and via fax to the facility with no issues. The initial authorization of 7 days was provided via phone and fax on 1/16/25. The second approval for an additional 7 days was issued on 1/22 via phone and fax. The third approval for 7 days (21 days total) was provided on 1/29 via phone and fax. No further action is needed from the plan.  
  
  Thank you,   

  
  
  

• Initial Complaint

  Date:01/24/2025

  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.

  No urgent care in the network near ******** after 30 minutes 01/23/25. The agent couldn't find me a urgen care. The application on my phone with doctor's and facilities for immediate care, Do not take Wellcare or the place doesn't exist. Their directory is not up to date, Why. What's the point of having Wellcare health insurance if I can't use it when i needed. I don't have any money to go anywhere else. I fell and i hit my left knee which i have a revision **********************. Still hurts more now that i hit it. My right wrist also was injured. The wrist hurts more every day, and the pain is traveling up my arm. has been 2 weeks and not a single place i can go that take wellcare. I need X-rays done, but i can't go unless i have a referral from my PCP. I can't see a pcp after February 1 because now they have a very stupid rule, if you tried to change your PCP after the 10th date of the month, i have to wait until the next month,because i tried to change my PCP, i couldn't do it on my app on my phone. The man who supposed to help, never did.I don't need for them to send me to the ghetto, dangerous ,and really far from where i live, to say that's the only place that they would see you. I need answers soon.

  Business Response

  Date: 02/06/2025

  good afternoon, we have not been able to reach the complainant, we are also in need of the list of urgent care providers advising they do not take Wellcare**