As far as them actually doing their job, they provided me with insurance for the past year. I had a zero copayment to see my regular doctor. Unfortunately, I saw specialists mostly so that was a $40 copayment and that hit a bit hard. They like to refuse name brand medication so if you have to take the name brand, you have to pay for it. I was in a car accident and they refused to allow me to take my muscle relaxer afterward. I actually got into an argument with the representative and I won. They went ahead and let me take it but why should I need to argue over my medical care?! They're not doctors! They're insurance. I did not like that.
They did a couple things I liked, like sending me a box of fruits and vegetables, one time. They provided me with over-the-counter benefits. Those were nice. The problem is that for the first two quarters, I didn't know how to use this benefit. I tried calling to ask for help and they put me on hold for a half an hour + each time. I ended up getting frustrated and hung up having never gotten any help. I was constantly writing emails to them, explaining my situation, asking for what I needed help with, and I got no reply at all - ever. So I only got to use two of the quarters' worth of the OTC benefits that I was given. If you go to
I didn't have any terrible health problems, fortunately. But I did need dental work done. They gave me a flex card. This was to be used for eyeglasses, eye exams and dental. This sounds great and I did need this dental work. That was one of the reasons I chose WellCare.
Well, this is also where the biggest problem lies - on their website they have a list of dentists in my area. All of the dentists (within a reasonable radius to me) that I called didn't even accept WellCare or didn't accept new patients. I'm supposed to use my flex card to pay for the actual procedure, but there's no procedure to pay for if I can't find a dentist, right? These are all dentists named on WellCare's website, so what am I supposed to do, travel 100 + miles to get my teeth cleaned? I don't think so. So I haven't had any dental care at all since signing up with them a year ago. My flex card has a balance on it of $500 that I can't even use! (I've already spent part of it on a new pair of glasses and they only allow one pair.) So the remaining balance just sits there unused because I can't find a dentist. Lovely eh?
Now let's talk about their website. Going on to their website is ridiculous. Every single time you go to login it insists on doing a fancy little run around where you have to prove who you are. I had to do this consistently and it got to be so annoying I didn't even bother anymore, I mean I'm sorry there's crooks out there, but this is a bit much. So my biggest complaint is very, very poor customer service, and the flex card is a joke! If I can't get service near my home what good is this to me? Today is the deadline for Medicare and I chose another company for next year. Hopefully I won't be back again at the end of the year to give another bad review.
After hours on the phone, emails, attempting to get to the proper CSR person, I filed a grievance w/ Wellcare. The gist is, there marketing person flat out lied to me about dental coverage, after asking specific questions, knowing that I had a significant amount of dental work pending. They never mailed me one denial claim, and only found out I had dental coverage for a prophy/xray, after all the work was completed. I received an email with the words "Your complaint has been resolved," in bold yellow. Wellcare, in fact, did nothing. The attached email provides more detail:...
You most certainly have not resolved this matter. I was lied to about having dental coverage, I cancelled my HAP, and cancelled my employer paid dental coverage, based on the information provided to me. All while knowing, I had upcoming dental work that would need to be done. Explain to me, why I would cancel full coverage to go with a plan that only paid for a prophy a couple of times a year and few x-rays? I called WellCare to get a list of approved providers and selected New You Dental in Flint MI. A treatment plan was done and Amanda from the billing department called your office... was told I was 100% covered, which is why, they thought the "denials," were a fluke and just an admin error. After a time, they called me and told me all claims had been denied. Noting here, I never received a single denial of service from you... if I had why would I have continued obtaining services without finding out what was wrong?
I spent an inordinate amount of time on the phone initially trying to figure this out, I was disconnected a couple of times, requiring that I start over, transferred to 4 different individuals, and once was even connected with Delta Dental, who is not even the dental provider. After a couple of hours, I was able to file this complaint. I have already paid my portion of the services in full, and since I am a responsible individual, I will have to pay this balance, but not without significant cost to you. A couple of days ago, some individual from WellCare called me and only wanted to know if someone from WellCare has called me regarding this matter. The answer is no. The only communication I have received is this letter dated 3/23/22 and I am not at all happy.
My plan: (1) Research a new supplemental provider and change as soon as possible, (2) Make arrangements with the dental office to pay this outstanding bill that was payable by you, (3) Speak with an Attorney to sue you, and (4) File a complaint with Medicare for fraudulent marketing. If you think I am bluffing... try me...
The CSR department for WellCare is well-versed in saying a whole lot of words that mean nothing. Be wary when they use the phrase " we are accelerating your complaint." It means nothing, it is just to shut you up and for them to not respond for another 30 days. This is a totally unreliable company that does not hold themselves responsible for anything. They are not to be trusted with something as important as your health care coverage.
Currently: I filed a Medicare Fraud complaint, this afternoon, and have placed calls to an Attorney regarding the outstanding dental bills. I will keep this group updated on my progress.
MTT