ComplaintsforWellCare Health Plans, Inc.

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Initial Complaint
04/26/2024
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.
On 11/8/2023 I received a letter dated October 20, 2023 asking me in bold lettering COMPLETE YOUR HEALTH SURVEY AND RECEIVE A $ 10 GIFT CARD which had the AUTHENTICATION CODE: ********. Also on 12/20/2023 I received another letter, this one dated December 8, 2023 asking me in bold lettering COMPLETE YOUR HEALTH SURVEY AND RECEIVE A $ 10 GIFT CARD which had the AUTHENTICATION CODE: ********. I both instances I spent the time and effort to answer the detailed health questions and mailed back the health surveys immediately on 11/8/2023 and 12/20/2023 respectfully. And I waited for the 2 $ 10 GIFT CARDS to arrive and they never did. On 3/25/2024 I called the Wellcare # listed on the letter ************** and was referred to Health Care Surveys at another # **************, who then referred me back to the previous # I had just called. I went to the website listed on my letter: ********************************************************************************** and that is an automated response site only. I then called Wellcare and was referred to Account Supervisor ****** at ************** who had me on hold while she tried the website address I had just tried and ****** got the same automated response. I then, on 3/25/2024, filed with Wellcare a Grievance Ticket: ********** and was told someone would get back to me within 30 days. 30 days has come and gone and NOBODY at Wellcare ever got back to me. Please help me resolve this FRAUD practice and get me the 2 $10 GIFT CARDS... Total value of $ 20 GIFT CARDS and help the untold others who have had the same experience I have been having in doing "THE RIGHT THING" by spending the time and effort in filling out these health surveys... And getting nothing in return, even though Wellcare has promised. The mailing address on both letters was: Wellcare HRA Correspondence **********************************
Business response
05/07/2024
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.
Initial Complaint
04/26/2024
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 am disabled and need all the healthcare services resources. This company is horrible. I dont get any benefits or checkups from case manager/specialist. No one answers the phone that speaks English to help. This company doesnt care. Im not getting the help or resources i need but i keep getting automatically enrolled. They switch my plans without me ********. Its horrible. I will try to reachout to ******** or any orher agencies that will help
Business response
04/30/2024
Good morning, ****************,

Per our conversations 4/29/24, I researched the plans Case Management team to help with your concerns. Someone from case management should be reaching out to you soon. Please contact me with any concerns while working with your case manager.

Thank you,
*******
Initial Complaint
04/23/2024
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I have an on going problem with them. My husband and I have WellCare ******** Advantage Plan. Before we see any doctor or have a procedure we check to make sure they are in network. The **st is less. Im told they are in my network, the doctor charges me the **-pay for in network. The doctors office see my benefits and charges me what WellCare tells them. 2 to 3 months later I get a bill for out of network and our **sts more then double. Right now were working on several clams that we checked are in network and now have changed. Even the doctors office are getting 2 different answers. **************** says they are in network and claims say they are not. One problem I have is an outpatient same day surgery from 2023. I keep getting different answers and I can not get a benefit booklet from 2023. I dont want what theyre telling me, its from 2024 benefits book, but there the same. Unacceptable, I had 2023 booklet but disposed it when 2024 came in and before they changed the ** pay prices.
Business response
05/02/2024
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.
Customer response
05/03/2024

Better Business Bureau:

I have reviewed the response made by the business in reference to complaint ID ********, and find that WellCare called me. I spoke to ***** in customer advocate. We have Not come to a resolution yet, ***** is working on it. I dont know if it will be satisfactory until he gets back to me. My health coverage has been questioned, I did what Im supposed to do and all bills should be covered as provider in network. They changed it on me after the bills were submitted. Until they cover it as the contract calls for I wont be satisfied. Thank you

Sincerely,

*********************************
Initial Complaint
04/18/2024
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 had to pay Galveston Dental $1,832.00 for a service that was originally approved through Wellcare last year. Last year I started the procedure of having an implant placed for an abudmant and a crown because it was originally approved through Envolve, Wellcare's dental plan for tooth number 9. The next year I started getting denials for pre-authorizations to finish the dental work they originally approved. When they switched carriers this year to Liberty Dental after I had already started the process of getting the dental work done they started denying the prior authorizations for the abudmant and the crown. I either need my appeals approved for this decision or a refund for having to pay out of pocket for costs that were originally approved before they unethically switched dental providers.
Business response
05/02/2024
Initial outreach to the member was made on 4/18/24 , complaint was reviewed and investigation started. Updated member outreach was made on 5/2/24 to provide and update to the member in reference to her appeal.
Initial Complaint
04/17/2024
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.
Welcare approved treatment, two implants were installed. I need the job finished and all the providers listed by ******* and Dentaquest no longer are in the network, no one wants to work with Welcare or Dentaquest.I have spent hundreds of hours following leads from Dentaquest and Welcare only to hit a dead end.Dentaquest promised to find a periodontist and never came back to me with any solution for this issues.If ******* promises dental care they should deliver. Looks to me that this is false advertising to get people to signup with them.Talking to Dentaquest is a waist of time. I have runout of time, my health is in jeopardy at thin point.My next step will be to seek legal remediation.Thank you
Business response
04/25/2024
Good morning, dentaquest advised: We have located 2 in network providers that confirmed they take the members plan. Haider Aljewari Sage Dental of Apopka PLLC ******************************************; ************** *********** is located 2.23 miles from the member's address We spoke with ***********; soonest available next week - member needs referral Haider Aljewari Sage Dental of ***************** PLLC ****************************************************; ************** *********** is located 6.99 miles from the member's address We spoke with ***********; soonest available next week - member needs referral.
Customer response
04/25/2024

Complaint: 21584445

I am rejecting this response because:
I was seen by Sage Dental of Apopka, **** is the dental clinic that did the initial implants. Im refusing Sage Because I already filed a complaint with BBB because **** tries to extort more money than what ******* was covering.
I have a recording where I stated that if it was not approved not to do it. Sage is very dishonest company and took me over 6 months of complaining for them to drop the charges.
The job they did was way below satisfactory. I rather go to my dogs vet before I return to Sage Dental.
Im sure Welcare have better providers somewhere else in the ******* area.

Sincerely,

*******************************
Business response
05/01/2024
Good morning, the dental provider advised: Coast Florida PA - Apopka
**********************************************************
*************
1.93
****
next available 04/29

Coast Dental - *****************
*************************************************
*************
5.76
****
next available 05/20

Coast Florida, **
*************************************
*************
9.2
****
next available 05/06
Customer response
05/02/2024

Complaint: 21584445

I am rejecting this response because: The dental offices referred above, I was able to communicate with only the office in *****************, The one in ******** does not exist, the one in ****** does not answer the phone.
Coast Dental does accept Wellcare, However I need a Periodontist for my issue and the ************** in ********* does not have one in the office, they refer their patients to an out side Periodontist, I was given their names and phone numbers, Upon calling them, I was informed that they don't accept Wellcare.
So after spending a great deal of my time, I still don't have a periodontist to take care of my issue.
I would suggest that any future information regarding a Periodontist be verified before passing it on to me.
Thank you for your prompt attention.

*******************************
***********************
************
Customer response
05/30/2024

Complaint: 21584445

I am rejecting this response because:

This response was taken verbally by BBB:
I went to Sage Dental - Winter Park, an in-network provider recommended by WellCare, and was seen by the same periodontist that I started treatment with last year. The periodontist is continuing the work he started last year and I need two crowns over the implants. Both Sage Dental and Dentaquest are telling me that my crowns are not covered. I can find nothing in my $5,000 policy that states that my crowns wouldn't be covered. I went to another in-network dentist (not a periodontist) who agreed to do the crowns but dentaquest refused to cover the crowns.

Sincerely,

*******************************
Business response
06/18/2024
Good afternoon, Dentaquest advised:

DentaQuest has not denied any crowns for the member at this time. Please find attached the benefit table for the members plan.
Customer response
06/20/2024

Complaint: 21584445

I am rejecting this response because:
Thank you for the attached PDF, Im not versed in dental procedures as listed in this PDF to understand its contents.
It also mention that this is " Wellcare ******** Gold Plans ". My plan as far as I know is ' Wellcare No Premium (HMO0.l
My Issue remains... Last year the procedure was approved and started, it needs to be finished. The dental office SAGE DENTAL states that the two crowns are not approved by WELLCARE / DENTAQUEST
I m requesting a special approval to have this prior approved treatment completed.
Thank you

Sincerely,

*******************************
Initial Complaint
04/08/2024
Complaint Type:
Product Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I am writing to asl to activate my daughter ********************* WellCare policy ID ********, ******** ID **********. My daughter just turned 19, a full time college student without an income, she lives with me and go to college, she fell seriously ill and need medical attention. She was on my ******** policy since ********************************** February the state health department renewed all our policies until 2/2025 including Zaura.Unfortunately, WellCare refused to activate her policy. On March 12, 2024, she had a lab work due to unactive policy we must pay for the lab bill attached, later on 3/19/2023 she had a doctor ************ and again her policy wasnt activated the doctors ****** asked us to call WellCare called they referred us to the ******** ******** department where they informed ** and the doctor ****** that her policy is active.On 4/1/2024 she was in the emergency room, and they asked her to follow up with a doctor, but again WellCare didn't activate her policy, again I called WellCare, and they told me that they will send a massage to their enrollment ****** to activate her policy, but nothing happed, and received and email saying its not activated.As you can see WellCare gave us a run around for three months refusing to activate her account while she is urgent need for the policy.I would like to ask for your help to activate my daughter's policy before it's too late for her serious condition.
Business response
04/11/2024
Hello and Good Afternoon, Contact has been made with ************** and we confirmed member is currently active. He inquired regarding reimbursement for services paid for out of pocket, attached you will find the submission form for review. Thank you!
Customer response
04/12/2024

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
04/03/2024
Complaint Type:
Service or Repair Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
I have been a member for about 3 years now unfortunately I've been harassed and called repeatedly buy them by a automated service!? I have begged and demanded that they stopped calling but it is got to be ridiculous even after I block them they could leave a message they also denied a emergency tooth extraction until they could approve it? They also supposedly did not pay my dental bill and I was taken to collections? After 3 years I suddenly get mail that says I'm a new member?
Business response
04/08/2024
Dear ******* ***********
Thank you for bringing this matter to our attention. We are sorry for any inconvenience that you have experienced. Your contact information has been added to our do not call list , there are articles that CMS requires us to shar with people. . If you have any further questions or concerns, please do not hesitate to contact us.
Sincerely,
Customer response
04/08/2024

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
04/02/2024
Complaint Type:
Order Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
*** repeatedly asked to be put on their do not call list and receive at least two calls per day, all from ******** numbers. I used to live in the state but no longer do.
Business response
04/04/2024
Good morning, please note that while this person has been added to the *** List, there are articles that CMS requires us to share with people, regardless of if they request Suppression.
Customer response
04/04/2024

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
04/02/2024
Complaint Type:
Sales and Advertising Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
August 2023 I had surgery to remove melanoma. WellCare is my insurance. As of this date WellCare has not paid the doctor despite requested paperwork sent to WellCare and numerous phone calls by myself. The doctor is still owed $1300..I want this paid.
Business response
04/05/2024
Upon contact, the doctor had already been paid after a certain timeframe, the member needed assistance finding new dermatologist and dentist, which I assisted with to reach satisfactory resolution.
Customer response
04/08/2024

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
04/01/2024
Complaint Type:
Sales and Advertising Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
Recent policy change without notice, the over the counter purchases from cvs I had used each quarters amount many times now I'm no longer able to access this, deductible change without notice I pay my 50 dollars at the doctors and then I'm billed another 49 dollars and again for for a EKG. customer service very unhelpful. Many calls from agencies or partners use the phone ID saying ********************** call. These are actually third parties that Wellcare has given my contact information to. receive calls even though our number is on states do not call list. ********* filed was answered with falsehoods and said by them to be resolved.
Business response
04/16/2024
Hello,
We're currently reviewing this case, and we've been trying to get in touch with the member via phone and email. However, we haven't been able to reach them yet, which has caused a delay in our investigation. We're also trying to connect with the billing team at the provider's office regarding the claim in question. Once we've completed our investigation and reached a final decision, we'll be sure to provide you with feedback.
Thank you.
Customer response
04/16/2024

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,

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

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ComplaintsforWellCare Health Plans, Inc.

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