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Well Care Medicare SupplementNon-payment of claim

I signed up for a Well Care Medicare Advantage Concert Plan, when I became eligible for Medicare at the time of my retirement. My plan went into effect on 4/1/08. In June 0f 08, my doctor sent me to the hospital for some tests, which were subsequently billed to Well Care. Over the past 14 months, I have repeatedly contacted Well Care about payment of this claim. They have continued to tell me that they never received the claim. I have been in touch with the hospital to request that copies of the claim be resubmitted to the addresses they indicated and Well Care has never acknowledged receipt of the bill and, of course, has not made payment to the hospital. Last month I sent a copy of the claim by registered main with a return receipt and they have not acknowledged that they have received the bill nor would they put me in touch with the person who signed the return receipt.

I plan to change carriers as soon as I can but I feel that Well Care is guilty of defrauding Medicare and its recipients and I would like others to know how difficult they have been to deal with. I would also like to file a complaint directly with Medicare. Can you point me in the right direction?

Responses

  • Ne
    Nelsonpr68 Apr 15, 2011

    Wellcare is thee exact example of health insurance that no one in their their right mind wants. I was prescribe durable equipment and the company ( Allmed of Florida) deliver
    the product to my house. It turns out that the equipment is a lease, not a purchase item by which I only have to pay the 20% deductible . I told Wellcare that due to my wife quadruple condition that leasing the equipment would be to expensive ( $100) a month, that buying would-be the best option for me. Wellcare then told me to get a prescription from my physician stating "equipment to own or purchase". Well I got the prescription and called Allmed to get their fax # and I was told that their contract with Wellcare is only lease.then I decided to call Wellcare and they told me that after the period of a 13 month lease the equipment would be mine . Then after deciding to pay for the equipment for 13 months, I decided to call Allmed to verify what Wellcare had told me and their response was an affirmative NO / that the contract with wellcare is a lease only contract. By then I already paid $400.So I went online an purchase the equipment for $440 and /'something that would have cost 13 months of paent, just to find out that I would have never own the equipment . Forgot to mention that I ask Wellcare for a verification letter stating that the equipment would be own after 13 month payments and was told that they couldn't provide me with such a letter. If anyone has a lawyer that may have an interest in pursuing justice with Wellcare please contact me at [email protected] / hope my experience will help does that are in Medicare and seek the best Heath plan.

    2 Votes
  • Ma
    Maddiemae414 Aug 24, 2011

    Although supposedly WELLCARE has changed since the feds went after them two years ago, it is not so. Instead they are now doing everything in their power to make it difficult for the beneficiary to fill their prescription. First they requested a pre-auth for a medication. After pre-auth was completed three times by the physician they continued to request each time I needed a refill. They then stated it was due to the pre-authorization being in the actual brand name not the generic. However, their formulary allows for the generic and most insurance will just state if you receive a script for the name brand it can be filled with generic automatically. Not Wellcare, they wanted a new pre-auth for the generic. Then Walgreens was out of my medication. I went to CVS and when they attempted to bill, it stated they needed a pre-authorization again???? They stated that it needed to have a pre-authorization for a different PHARMACY???? Right, they just are making it so difficult that the beneficiary ends up going without their medication rather than filling. There was a specific number that was the pre-auth for Walgreens, when the pharmacist asked for that number which actually is a general number for all pharmacies they would not give and hung up on her. When the cust service individual I was speaking with told me he would give it to her but she needed to call him, she could not receive it over my cell phone?????Even though she would give him all the necessary information, store i.d. license etc. He would not give either. I'm done with WELLCARE and I wish the Federal Government would be done with them as well.

    1 Votes

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