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Taking the CARE out of WellCare

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This is a directed bitch at WellCare. Yes, WellCare. I hope they read this, and I hope they give me an ‘offical reply’ to their stupid ass policies as you’ll see below. If you have a bitch about WellCare, then comment below. If I’m going to get a subpoena or court order to take this entry down (which I’m not, because its the truth), we mine as well go down swinging.
Its 5:30, right before closing. One of our terminal cancer patients (11159.2) came in with an Rx for some Duragesic Patches. He is out of oral meds, so doctor figured now would be a good time to put in him on the patch. He has WellCare. So we try to bill the Fentanyl Patches. Not covered. Hm, what about trade name? Nope. No fentanyl patches are covered. So we call the wonderful WellCare customer service number only to be told that there is NO provision for early, lost, or emergency override fills. We pleaded and told the douche that the patient has terminal cancer, and if there was any way to fill the Rx.
Short answer: No.
Long answer: No.
Who the fuck does NOT cover fentanyl patches? Its not like fucking that new quinine thats out. Fentanyl patches are used for one thing: Chronic or cancer pain. I bet they require a prior auth for all HIV medications too (because those arent important)! Anyway, back to the story:
They would fax to the doctors office a prior auth form which needed to be completed and sent back. This is on a Friday, at 5:30pm. Yeah, snowballs chance in hell of that being done. Even if he doctor did it that very moment it probably wouldn’t be processed until Monday.
Thats right, this terminal cancer, no pain medication, all because WellCare is ran by a bunch of fucking heartless idiots. The patient ended up shelling out a few hundred bucks for his patches so he wouldnt be hospitalized over the weekend.
I hope someone from WellCare reads this, and realizes how fucked up they are, what a shitty program they run, and how bad this makes them look. Figures they are processed by WHI AKA Wallgreens. “Pharmacy America Trusts” my ass. So to any of the big CEO’s or important people at WellCare: I, The Angry Pharmacist think you guys are fucking assholes and I hope someday when you get cancer from those $100 cigars and top shelf booze that YOU get to spend the weekend in pain because your insurance company dicked you over like you dicked over my patient.
Fuck Off and die.
The Angry Pharmacist

Comments #

Comment by #1 Dinosaur on 2007-08-04 04:43:54 -0700 #

They don’t give a flying fuck. They don’t care how they look, and they certainly don’t care about patients; it’s not like they can be sued, you know. They’re all about the money. Those fentanyl patches are *expensive*.
Who cares about a terminal cancer patient anyway? “Terminal” means they’re going to die, so they won’t be around to complain very long anyway.

Comment by marty h on 2007-08-04 06:23:42 -0700 #

the problem is wellcare is just one of many PBMs that have the attitude that the patient is just a part of the money machine. bottom line is king-screw the patient. I had a patient released from a nursing home with no meds and the pharmacy servicing the home did not reverse the claims and bill for correct day supply so Medco would not pay for her meds. their response-let the patient pay for them. the fact that the patient was a ward of the court and had no money made no difference-too freaking bad let her do without. the woman at Medco had the compassion of a fence post. Yes-there are some very nice people working at PBMs but they seem to be out numbered by politely incompetent dolts or uncaring louts

Comment by IDidntGetAChanceToPee on 2007-08-04 11:24:41 -0700 #

I don’t know what surprises me more–that WellCare doesn’t cover generic Duragesic or that you get to close at 6 on Fridays!
What a ridiculous rejection. That formulary committee should be lined up and shot.

Comment by DrRx on 2007-08-04 12:04:37 -0700 #

Insurance companies shouldn’t be dictating treatment!!! Course the physician should have known not to start a new med on a Friday late afternoon…. Hopefully, the patient had some of whatever they were using prior to the change to fentanyl in order to at least partially treat the pain secondary to those a-hole insurance freaks, and their ‘finger of God’ attitude. It is such a shame that pharmacists have to be dragged through the mud and even have to get involved with those fu*k-nuts!

Comment by DAVE on 2007-08-04 12:52:54 -0700 #

It’s not just un-wellcare, most of the D-plans will fuck the patient over if the rx needs a PA. The copay is screwed or the pharmacy is underpaid, the forms get “lost” between the dr office & the plan, or
the chick on the phone will tell you to dispence 1 month and there mail order will take care of the rest.
PBMs are destroying healthcare and causing needless pain just to make a buck

Comment by Biggest Fan on 2007-08-04 14:27:53 -0700 #

I don’t think I’ve ever, EVER disagreed with anything you’ve ever said. Keep up the good work.

Comment by drheidi on 2007-08-05 21:04:03 -0700 #

I bet they’ll pay for all the Vicodin and Soma in the world for all the dumbasses who don’t really need it and waste our time trying to get it, but no fentanyl patches for someone who is dying and needs it. WTF??
You’re the greatest.

Comment by Fred S on 2007-08-06 06:02:33 -0700 #

they have a nice comfy chair waiting for them in hell… where everything they ever ask for will require a prior authorization from satan himself.

Comment by drugmanrx on 2007-08-06 10:04:18 -0700 #

How can a company that is for profit make morally correct decisions regarding people’s healthcare when they lose money with the better care the person receives? It isn’t possible for those companies to be run morally, and this is just one of many examples of this.

Comment by Coop1701® on 2007-08-06 10:22:48 -0700 #

Once again the Angry Pharmacist is right on point. Most of these provider, couldn’t or wouldn’t help a patient if they were on fire standing in their lobby. I see the same thing all the time. I hope the powers to be at Wellcare reads his blog.

Comment by Curvy Cajun Cutie on 2007-08-06 15:12:31 -0700 #

I think I love you.
Are you married?

Comment by EdM on 2007-08-06 16:51:40 -0700 #

Many times I have called the insurance companies and have received the same respone you did. If money isn’t the main factor, I don’t know what is. Please keep up your blog. It says what we would all like to say, but you do it so well. I have been doing this ( and I love my profession) for 42 years and if I retired, I would either drive my wife nuts or me. Keep it up.

Comment by Carol on 2007-08-06 17:21:03 -0700 #

Angry, you need to let it out. I worry about you bottling up all this frustration. Let’s get together one day and practice throwing a big ax at a tree trunk labeled “INSURANCE COMPANY SCUM”. You’ll feel better. And I just like to throw and ax now and again.

Comment by Fat Hairy Guy on 2007-08-06 20:02:25 -0700 #

Back off Curvy Cajun Cutie,
he’s mine.
Fat Hairy Guy

Comment by Scott on 2007-08-07 13:43:03 -0700 #

Hi. Great post! I feel so bad for that poor patient! I really like what Fred S. said about them being in hell.
Until a year ago, I was blissfully unaware of how fucked up health insurance is. At the time I was under the naive impression that since I faithfully paid my money to the company, that if I ever needed it, they’d pay the bills they said they would with no questions asked. Boy was I wrong! When I got cancer I had to deal with their heartless games to screw patients and build their fortunes. And I was lucky! They didn’t KILL me like they do some patients! Bastartds!

Comment by Doug on 2007-08-08 22:10:15 -0700 #

God this is disgusting. We need socialized medicine now. And why are the patches so freaking expensive anyway? Fentanyl I think is a rather inexpensive chemical to make.

Comment by traven on 2007-08-09 00:27:42 -0700 #

not familiar with wellcare, but that is bullshit. also bullshit that pt’s are let go with rx’s at 5 pm and sent packing. i had a hospice pt’s kids bring me 12 rx’s at 7 pm one day and 3 weren’t covered… what to do with that? one was for oxycontin of course…”sorry, pay me cash or your mom can just suffer”? lucky they had old meds at home to cover until they could see another md.
also had one for midrin/epidrin today that wasn’t covered on our medicaid plan. so md changed to imitrex, which of course was covered… should have paid for the epidren myself and saved the tax dollars.

Comment by AnnR on 2007-08-10 12:44:30 -0700 #

Hi AP –
The email address you posted was weird so I thought I’d just post my question here — sorry!
Have they stopped making the brand name of Effexor 37.5?
My breast cancer friends are telling me that the generic doesn’t do against hot flashes as well as the brand name and the doof at Walgreens told them the brand name wasn’t available anymore.
Know anything about this?

Comment by Ian McKenzie on 2007-08-10 18:08:50 -0700 #

This is an awful situation. A cancer patient should never be in a situation like this.
I haven’t read any comments that consider the following:

  1. These types of pain patches are among the most frequently abused prescriptions out there today. Not that the patient in question is an abuser, but due to rampant abuse, special prevention measures are necessary, like prior auth, which makes things more difficult on everyone. (Think about how badly prescription pain meds are abused — these patches are the right up there near the top of the list.)
  2. The traditional Medicaid and Medicare programs are ill-equipped to root out fraud and abuse. Health plans are much better able to do that, which is one of the duties they are given in their contracts. They are therefore bound to prevent fraud and abuse of prescription drugs by virtue of their government contracts.
  3. The patient showed up at the pharmacy at 5:30 on Friday to fill a very important Rx, but which is also a brand new Rx for him/her, and which is a frequently abused Rx, and which his/her doctor should have known would require a prior auth, but there was no prior auth requested until it was too late? Seems to me the doctor and/or the patient (mostly the doctor) bear some level of responsibility for this break-down in the system.
    Sorry, but it’s not as simple as you all seem to want it to be.

Comment by been There on 2007-08-12 19:45:20 -0700 #

Obviously poor formulary management. However, how could a Dr. not also prescribe breakthrough traditional pain med for someone when they are starting duragesic? Especially for a terminal cancer patient? On a Friday….

Comment by Phil on 2007-08-14 06:31:51 -0700 #

They must be the worst insurance company in the world. The customer service people are mean and not helpful. The supervisors are the DEVIL as well.
Why people choose WELLCARE? Because they don’t know.
Somebody call Michael Moore!!!

Comment by Megan on 2007-08-14 20:52:14 -0700 #

IT seems most insurances (especially state ones) have stopped covering fentanyl… just an fyi

Comment by sarah on 2007-08-16 12:06:08 -0700 #

I work for a pain mgmt group and I HATE HATE HATE Wellcare. They have just become the new Medicaid providers in my state and have screwed their patients over.They screw everyone around. To qualify for a job at wellcare one must not have graduated high school and not have a soul/heart!

Comment by Blonde Pharmacist on 2007-08-17 12:25:56 -0700 #

Sad that this is happening. It’ll all come back around though. They’ll be in pain wanting patches and by then you won’t be able to get them an hour earlier.

Comment by MsRX on 2007-08-17 15:59:24 -0700 #

Thanks from a soon to be pharmacist, you really covered it this time.

Comment by Pharmacy Technician, Too on 2007-08-19 14:33:20 -0700 #

“I bet they’ll pay for all the Vicodin and Soma in the world for all the dumbasses who don’t really need it and waste our time trying to get it, but no fentanyl patches for someone who is dying and needs it. WTF??”
Yes, that is exactly true.
I worked for Wellcare on the pharmacy helpdesk. I hated my job and hated that I had to tell so many people no. I was there less than a year. Sordid story on my firing, but I don’t want to make myself too easily identifiable. I’d tell you privately if you are ever curious. (that is a real email address, BTW.)

Comment by Rxvettemaster on 2007-08-20 20:50:23 -0700 #

Insurance companies are actually the Devil himself falsley advertised as a legitimate and helpful business. And it isn’t just healthcare that their screwing up. These corrupt organizations are single handedly comprimising every American citizen’s ability to provide basic needs for themselves such as healthcare, shelter, and food. They’re responsibility for this meltdown is directly due to their sick and twisted pursuit of pure greed for the green stuff. I don’t understand how anyone could ever associate themselves as an employee of a business whose mission and goals are as simple and clear as this: OUR BUSINESS WILL RECRUIT AS MANY CUSTOMERS AS POSSIBLE AND COLLECT AS MUCH OF THEIR HARD EARNED MONEY AS POSSIBLE FOR SERVICES THAT WE WILL DO EVERYTHING IN OUR POWER NOT TO PROVIDE. Isn’t that kind of like communism in a way???

Comment by Hinsley on 2007-08-24 07:48:27 -0700 #

Thank you for this. As someone who lives in severe chronic pain, it’s so wonderful to see that you care. 🙂 I love nice pharmacists!! Mine is great too. I am wondering who I can write to give him kudos..prob. Rite Aid corp?

Comment by rxstudent on 2007-08-28 20:24:08 -0700 #

i have seen this happen so many times!! its ridiculous, despicable, ugh cant find enough words to describe it!! it angers me that so many people make a profit off illnesses. its one thing to pay medical professionals & research, but a completely different thing to fill the pockets of an insurance or pharmaceutical company CEO.

Comment by BagelFan on 2007-09-05 09:21:27 -0700 #

And why the hell did the prescriber ask for fentanyl when it was not a covered benefit? S/he had the most important job in the process to not fuck up by requesting the wrong drug (at a time of the day when a major prescribing fuck-up can’t easily be fixed). The fucking MDs, NPs, PAs all sign contracts to get cash from the insurance plans (and they got paid for their time to prescribe the wrong fucking medicine) and to work under the guidelines of the payer. That is, the insurance company is their employer! They like to say they “take” insurance. Fucking wrong and arrogant. They WORK for the insurance company the same way the kid who mows my lawn works for me. I have rules about my lawn and insurance companies (employers) have rules about prescribing. Prescribe off the formulary, check your god-damn ePocrates or the web and stop fucking patients over and blaming it on the insurance companies. The problem is far and away more at the feet of idiot precribers than the insurance plans.

Comment by Ruth Ellen Roberts on 2007-09-10 09:39:01 -0700 #

Would like to communicate with Pharmacy Technician, Too. Please send your email address to: Ellen Roberts at [email protected]

Comment by Bruce Bollinger,OTRL on 2007-09-10 12:13:14 -0700 #

Love your comments concerning Well Care (and all other CMO’s and Insurance Companies). This is a response to Ian McKenzie who has not seen any comments regarding #1. Abuse of the pain patches. The Px was written by a physician – are you claiming that he/she is abusing or assisting in the abuse of the pain meds??? It sure sounds like you are. #2. Medicaid and Medicare both have fraud units that were specifically formed to root out abuse. As for your statement that the CMO’s are obligated to root out fraud and abuse according to their state contracts I am calling you a blatent liar!!! How could anyone check since no one seems to be able to get their hands on a copy of the state contracts with the CMO’s. My understanding is that they were hired to process and pay claims, not police the healthcare industry!!! And as for #3. I hope that the next time you, or loved ones are in the ER with a broken leg, appendicitis, etc., and you want immediate service and relief, I hope it takes two weeks for the process to be reviewed and for you to recieve prior authorization and then your physician spends the next three weeks trying to sort through the CMO red tape bullshit and list of do’s and don’t’s before he/she can get around to performing surgery or setting your leg (if it is even allowed by the CMO and if it is preapproved – don’t forget to get your pre auth #).
As for Bagel Fan: it is obvious that you also work for one of the CMO’s or Insurance Co.’s. To blame the Dr’s for not memorizing the Ins. Co’s formulary, is ludicrous. How many Ins Co’s are there? I’m sure they all have their own little lists and the Dr’s have alot more than a formulary to be concerned about when diagnosing and formulating Tx for their pt.s. The Dr.s who are most involved with these cases are often the most overworked and underpaid in the healthcare field. They aren’t seeing Medicare and Medicaid patients because they want to get rich!!!!!!!! I am a provider and I personally resent any accusation, insinuation, or casual comment that I, in any way shape or form, work for any insurance co. or HMO/CMO. I may get paid by them but I am working for my patients!!! The CMO’s/Insurance co’s are supposed to manage the patient’s ins. funds like the bank handles their normal, everyday finances by paying out the bills (checks) that come in. The bank works for the consumer and the Ins. Co’s are supposed to work for the consumer too!! Instead, they act like the money that they control is theirs!!!!!!!!!!!!!!!!!!!!No wonder so many people think that our nation is going to Hell in a handbasket. We ought to put the Ins. co’s in charge of the Mexican-U.S. border. No one (and I do mean no one) would enter this country illegally then!! By GOD, we’d be the most secure nation in the world if they guarded the borders!! The old communist regime could have taken lessons from the Ins.Co’s and CMO/HMO’s. And the CMO/HMO’s and Ins. co’s are given free reign within the state of Ga. by the third anitchrist (so called Gov. Sonny Perdue). I’ve given away many free services and have paid for some equipment out of my own pocket. I have “donated” many hours of time to my patients and have not passed the cost (nor attempted to pass the cost) on to the insurance co’s. My concerns are truely for the patient and not the corporate coffers or the stockholder’s profits. Don’t blame the Dr.’s – blame the assholes at the HMO/CMO’s and insurance co’s that mire everything down in mountains of red tape. According to them, everyone that needs any kind of medication is attempting to abuse pain medication. You’d think that we were a nation of dishonest cheats, swindlers, crooks, drug dealers, and addicts! Don’t attempt to blame others for the shortcomings of the insurance co’s. If the truth hurts and you don’t like it – then quit your job and go to work for a reputable company. I defy you to present any rational argument that can successfully refute my claims. You’ll probably do what the Ins. co’s always do which is change the subject. We are not stupid. We know that the CMO’s are in collusion with each other. Peach State gives prior approvals for therapy but drag their feet when paying (or don’t pay at all), while AmeriGroup and Well Care won’t give prior authorizations but will pay in a timely manner for the occasional approvals that they do permit. Don’t treat us like we’re stupid because we aren’t!!! You (INS. industry) are cutting your own throats. Overpricing and denying healthcare to the people who are entitled to it will eventually result in socialized medicine and the Ins. industry will be gone and you will all be out of fuckin jobs!!! Of course it won’t bother the corporate CEO’s and upper management because they’ll be set for life with the profits they’ve gouged out of the taxpayers and private/corporate business contracts that they currently have. At least the banks ask us if they can “borrow” our money to invest instead of using it as if it were their own!! Any valid responses from you greedy, gutless, heartless, souless insurance industry bastards??? You can respond directly to me @ [email protected]

Comment by Bruce Bollinger, OTRL on 2007-09-13 10:22:15 -0700 #

From my sister, the R.N.
Zoe Tiller
Sorry�I worked for a physician�s office and we frequently prescribed medications which required pre-authorization for patients.
For anyone criticizing the time of day�.please know the patient may have called at an earlier time of day but the staff may have been unable to address this issue before this time of day�.the physician may have been on rounds or in surgery or unavailable to okay the script for a variety of other reasons�.the staff stayed late in the office to write the script and have the patient come pick up the script.
Ian McKenzie� argument that the patient and physician�s office bear some responsibility in this matter is rubbish.
Abuse is by the “Chronic pain patient” who travels from doctor to doctor seeking prescriptions for pain meds and comes in with suicide attempts or overdoses (one patient had seven fentanyl patches on recently). Insurance companies send faxes to physicians with lists of recent prescriptions filled at various drug stores on patients working the system. Is it not their responsibility to deny filling these scripts and alerting the drug stores not to fill the prescription as well??????
Bagel Fan is also incorrect. Although the brand fentanyl may not be covered under formulary, there are numerous generics out there of which one would be.
Pre-authorization is frequently required for medications�not just narcotics�so the statement it is to prevent abuse or selling the script or medication is hogwash. Preauth is frequently required for nonsteriodal antiimflammatories�not abused drugs by any stretch of the imagination. Also for aricept�a drug for Alzheimer�s which is also not an abused drug. This drug requires yearly preauth (not like the condition will get better and go away�why re-authorize yearly?????

Comment by qweenbe on 2007-10-24 09:00:06 -0700 #

Wellcare in trouble? Found this elsewhere.
The FBI has surrounded our building and is conducting a search warrant looking at IT servers at WellCare in Tampa. Not sure what is going on, but they sent home the IT staff. Not sure when we get to return.

Comment by Tom Bundock on 2007-10-24 16:02:40 -0700 #

I would like to talk to you about your experience with this company which appears to have lots of issues. Please contact me at the email address I provided.

Comment by Cindy Hunter on 2007-10-25 21:00:54 -0700 #

Wow, Wellcare stock dropped like a rock off a cliff today!
What comes around goes around they say…

Comment by MICHAEL MORRISON on 2007-10-26 07:02:05 -0700 #


Comment by CannonQueen on 2007-11-15 01:42:24 -0800 #

I am very disgusted with our healthcare system. I cannot believe the cost of insurance and costs of medication!! I think we all know that it doesnt cost that much to make the meds but its the marketing, advertising and pleasing the stockholders that drive up the costs. Same with insurance. Does it really cost hundereds of dollars a month to cover and individual for hospitalization? I dont think so. What drive up the costs are the hospitals paying outrageous prices for instruments, disposables, drugs etc. as well as their own advertising and upper management salaries.
One thing I would like to point out regarding this particular post that bothers me as well.
In the case of this terminal patient. The fault lies in several areas as far as I can see it.
The prescribing physician is at fault here for starting a patient on a new med that late in the day and probably knowing full well that prior authorization would be required for this med. Really give me a break, he/she has NEVER prescribed this before?? I think they are pretty familiar with these process in the industry and should know better.
Second, the patient even though terminal, has some responsibility here to know what is on his/her drug list with the company. Just as a patient should be familiar with whether or not a physician is in his/her insurance network. There is some patient responsibility her too. Lets not forget that. My parents are on Part D and when they go to the Dr. office they take the drug list with them. Just so you know they are not young they are in their 80’s! It just boils down to taking some ownership in what happens to you.
Last, the insurance company should have a better system in place for emergency fills. Isnt that a normal part of a prescription drug program?? I thought this was regulated in the industry??
Overall, there is more than just one group to blame here. Our system is !@#$* up and we need to change it. Also, patients need to be aware of their insurance, what it will and will not cover. READ THE DAMN POLICY!! If it doesnt make sense get someone else to help you read it or call the company and have them explain it. Ingnorance is a poor excuse. Dr’s put down the free lunch from the pharma reps and pay attention to what you’re doing with the patient. Sit down and actually spend two minutes looking at the @#$!* ing chart. Ive had several occasions where the Dr. prescribed meds to my mom that contained sulfur and shes allergic to sulfur. Its noted in her history and if he have two shits about looking at her history, even glancing at it, he would have seen it in big ass red letters. ALLERGIC TO SULFUR. Luckly we asked the question , This med doesnt contain sulfur does it?? Again patient responsibility!!!

Comment by little-whip on 2008-10-24 09:12:49 -0700 #

I suffer from chronic rheumatoid arthritis and have to take two seperate pills for pain because WellCare won’t pay for the combo. I take 5mgs of oxycodone along with 500mgs of Naproxen to manage my pain. ( I also take methotrexate once a week, and a daily dose of prednisone during flareups.)
I can take up to 25 mgs per day of the oxycodone without going over my allotted number for the month, but as anyone with R/A can tell ya, it doesn’t always work out that way. Some days I take none, getting by on the Naproxen alone, other days I have to take upwards of 100mgs of the oxycodone just to be able to wipe my ass without bursting into tears.
I am currently scheduled for lithotripsy on a troublesome kidney stone, and two weeks later, an open hysterectomy because during the exploration procedures for this stone, we discovered my entire abdomen is overrun with benign uterine fibroids. The gyn says there must be at least 30 pounds of ’em in there. Good lord. They’re going to have to cut me wide open due to the size of these tumors, no laparoscopic procedure for me. 🙁
Needless to say, neither my kidney doctor nor my gynecological surgeon want me to take ANY anti-inflammatories prior to these procedures, so that eliminates both the Naproxen AND the prednisone from my repetoir of weapons against pain.
My sympathetic rheumatologist suggested and wrote a prescription for Meprozine, which is basically demerol with something added to prevent nausea from such a high dose. Does Wellcare cover these?
Of course not.
And of course, I am rapidly running out of oxycodone this month because I cannot take any anti inflmammatories. Would Wellcare pay for an early refill?
Again, not a chance in hell, because the LAST prescription, written before we (me and my rheumy doc) knew what was coming down the pike, so according to Wellcare, they don’t even want to hear about it until day 29….
I found this page searching for ‘Wellcare prescription formularies, pain medication.’ Far be it from THEM to suggest an alternative that they MIGHT pay for, so I have to search this info down and then run it by all three doctors to make sure it’s something I can take with all these surgeries coming up.
Hey, Angry Pharmacist…got any suggestions?

Comment by Blah Blah on 2009-03-13 17:52:20 -0700 #

I am a past employee of Wellcare… which I have affectionately re-named “Hellcare”. It was the single worst employment experience I have ever had…

Comment by tampacares on 2009-04-19 20:15:08 -0700 #

I am a formal Wellcare employee and I agree with you the same. The management at Wellcare pushes the employees to deny any meds that’s not on the preferred drug list. The bottom line is to save the company money. They really don’t care about if a member is terminal ill or not. I left well care because they don’t really care about the patients and they would deny any drug even a child’s asthma medication.I really wasn’t surprised when the Fed’s audit them last year. They are taking advantage of or seniors and welfare recipient’s.Unfortunately, they are not the only insurance company that does that but I have seen and was once apart of cruel, cold hearted and unfeeling pharmacy help desk.I personally needed the job but after treating people wrong for so long it makes you feel like shit.

Comment by I hate my job!!! on 2010-01-14 20:34:06 -0800 #

I work currently with a wellcare branch as a csr and I had no idea what it would be like. I thought this would be a wonderful job and I could really help people. Man was I wrong… at first it wasn’t so bad… but now that it is 2010 so many things have changed and we have so many drugs off the formulary and higher copays…I am advised to let members know that it is CMS who controls these things and I have no idea if that is the truth but it sucks to have to tell these people things like this… they are on a fixed income and can not afford this shit… then I in turn get yelled and bitched at and it just ruines my day. I hate my job and want to quit but I need it to feed my children… What the hell do I do? I do try my damnest to try and help them. My supervisors get so upset with me because my aht is high and my calls are really long and i constinatly bug them for info and help… but I really am trying to figure out if there is anything I can do. The worst call I ever had so far is when a little old lady asked if she had transportation and I told her no and she didn’t have AAA covered either and her paralized son was in a the van and it broke down and there was nothing that I could do for her and she was calling me from the cold at a pay phone… My supervisor said there was nothing I could do and I had to have this woman just stay stranded without any help…

Comment by Angry Employee on 2011-06-26 21:42:32 -0700 #

I am a WellCare employee, and I’m ashamed of it. It’s truly a sick company… I’ve never seen employees so abused and taken advantage of. Their Customer Service policies are broken. My husband’s mentally-challenged aunt had WellCare, and her caretaker couldn’t get a simple Proof of Insurance Form from WellCare for the LTC facility. It look about 15 phone calls before it was finally sent, and then she received no less than 6 follow-up calls, asking “Have you been pleased with the outcome of our services provided?”. Needless to say, they are no longer with WellCare. Again, totally ashamed of my company and looking for an out ASAP!

Comment by Carina M. on 2011-10-11 15:38:40 -0700 #

my name is Carina, and I’m severely mentally ill. i refuse to use phones, it’s become a problem. my fiance has been making all calls for me, (he actually helped me write this message) and i have to “grant permission” every time they speak with him, I understand this security measure, at least as a general precaution, but with the people at Medicare my verbal authorization was good for 14 days. I receive ElectroConvulsive Therapy bi-weekly and the effectiveness of that treatment is increased when I take my prescribed medications every day, on schedule. HOWEVER, because I’m “covered” by Wellcare i CANNOT for the life of me get ANY of my prescriptions filled, at least any that are what they call ‘non-formulary,’ which seems to be anything that costs more than, oh say, $10 per script. One medication I’m Rx’d to is Vyvanse, and I’ve tried all the other ‘substitutions’ they’ve suggested (before they suggested them, mind you), because of its unique time-release mechanism it works very well for me. S*\**, even BIRTH CONTROL Rx are being denied! Now you’d think they’d be happy to provide some sort of chemical prophylaxis, seeing what kind of medical costs are incurred by a newborn, but given their previous policy of dumping coverage for newborns (Google ‘Wellcare whistleblower’), they probably just don’t give a f***! I was covered by Anthem through my father (he worked for the DOD, the federal government, which doesn’t even cover it’s employees with federal insurance HA!) until August of this year, and after this point I notified my state insurance, Medicare, and finally the almighty Wellcare of the change. My fiance has been on the phone with the folks at Wellcare PDP off and on sometimes over 3 hours a day, every weekday AND some weekends for two weeks and 2 days (AND COUNTING!!!) We even got in touch with some higher-up guy there who setup some sort of conference call with Medicare, and well, it could’ve just been me, but the Medicare guy seemed like he thought the man, who was head of a department, was nothing less than a F***ING MORON! So, even after all this, and no matter the pharmacy (although Wellcare always suggests I try Walgreens, for obvious reasons [WALGREENS Health Initiative!!??]), the error keeps being returned that I have a primary insurer aside from Wellcare. (Jesus, how many times I have used that dreaded W word in this reply!?) Multiple requests have been made for the changes to take place, many times AND more (the fact that that sentence doesn’t make sense should only serve to emphasize my frustration, and is analogous to how little sense “Wellcare Part D Prescription Coverage” makes). And still, according to them, even as of 30 or so minutes ago, I still have my father’s coverage…DIE DIE DIE WELLCARE FUCKING DIEEE.

Comment by Merriwynne on 2012-09-05 07:47:52 -0700 #

I have Wellcare for Medicare. The plan is horrible. It took be about 3 years to find a dentist and another 2 just to get my dentures. I’m still looking for a psychiatrist for my anxiety medications. Every time they would give me a list of doctors, none of them took Wellcare anymore.

They are calling me about once a month talking about how they are going to help me, but they never really do. Our entire medical care system is F-ed up good.

Comment by D Schuler on 2013-01-28 12:07:53 -0800 #

Really upset with Well Care! I went to pick up my monthly med’s for chronic pain today. The co-pay was $0.00 the first year I had Well Care in 2011. Last year it jumped to $20.00 for one, i didnt question it then, but i should have; the other stayed at zero. Today, I was informed by the pharmacist that the $20.00 one went to $45.00 and the zero one went to $6.00! I didn’t have enough money on me to cover this absurd cost.
I went home and called Well Care right away. They told me that my plan had changed for 2013 and that is now my co-pay! I selected Well Care when I started on Medicare because of no drug co-pay. I asked the rep why I had not been notified of the change in the plan. He told me that on page 4 of the booklet they send out each year, I was notified there. What???? The packet of reference crap they send in case I need to look up a drug? That book?? Wow, talk about a bait and switch! If I would have had proper notice, I would have changed my prescription plan to one with zero co-pay. Problem is, the enrollment period is OVER and I am stuck. Horrible and in my opinion illegal business practices. Now I have to ride out this crap plan for a whole year. Wow!

Comment by Grotesk on 2013-10-17 23:27:29 -0700 #

Wow. Late to the game as usual am I. And wishing I’d found this page before I signed up for Wellcare earlier this month. I just got their plan information and not only are they going to charge more for the monthly premium than was estimated on the website when I signed up, but the drug search tool had the 2013 schedule, in which almost all of my meds were Tier 1 and therefore essentially no-cost to me, but two days after getting the plan information in the mail I received their 2014 plan information packet, and wouldn’t you know it, all the stuff that I take is now Tier 2, which makes it rather more expensive to have the plan and pay for monthly prescriptions than it would be to have no prescription insurance and use the Walgreen’s Pharmacy Discount Club card for 90-day supplies. Isn’t there a provision in the ACA supposed to regulate these kinds of bait-and-switch shenanigans?

Now I have to start over looking for some kind of prescription plan, or possibly a health plan with prescription coverage that will work with Medicare and my SSA Disability. And not suck.

Comment by Lisa Ferguson on 2014-05-02 04:21:10 -0700 #

Yep! You are right on with your assessment of Wellcare’s policies regarding patient care.
I work for a physician who sees two patients that switched from Ga Mcaid to Wellcare. Did not realize that if you are not a participating physician they will not pay you at all even if you fill out a treatment authorization form which they told us to do anyway just so they could deny it. They said we could do a doc-doc review and they might reconsider. I have a feeling that is not the case at all based on everything I have read here. Keep up getting the word out about outliers like Wellcare.

Comment by EDDIE THE REAL DEAL on 2014-05-15 18:27:44 -0700 #


Comment by Melinda on 2014-06-16 06:34:45 -0700 #

I am a new patient of Medicare – insurance agent recommended I use WellCare for Part D drug plan! WHAT A BIG MISTAKE!!! 1.) my doc had to fax them 3x for my script, (a controlled drug) 2.) Every time I called WellCare was talking with people from other languages, which whom I could barely understand. Kept getting the runaround and a month later still now meds! 3.)I finally became so concerned and frustrated I called Attny General of my state – “consumer protection” and she was kind enough to give me the number of a Medicare Investigator who directly called WellCare.
I rcv’d a call immediately from WellCare after Investigator called them. The call was from an “Escalation Dept. person from WellCare. She mentioned to me that when calling WellCare to ask specifically for a customer rep within the U.S. Wish I had known that before. I don’t like or trust WellCare and will be pursuing this further – don’t know why under BBB they have an “F” rating with in red, “Alert for this business” and Medicare is still using them! I’m letting you know all the steps I took so you don’t get the round around like me: 1.) Ask for U.S customer service, if need be to call your Attny General’s office (consumer protection) and ask for number for Medicare Investigator..They will come thru!!! Hope this helps!

Comment by Lee Green on 2014-09-11 22:46:25 -0700 #

Mr. Bundock, i know this is a reply an old post but I need to talk to someone about Wellcare.
Specifically, I’m hoping you or someone you know can tell me how to speak to a true manager
with a full name with an ext. and phone number so I can reach them.
I’m writing from the future I hope you are doing fine.
Wellcare is actually harassing me when I call and I’m both mentally and physically disabled. They are creating problems where there are none, spending hours on an issue that they created, fixed and still
Require a PA the next time I’m to pick up a script. The blubbering reps on the phone will argue with me for 4 hrs about something that is authorized. I would think that management would still be looking at the bottom line, but no, they let them screw with me and pay them to argue over a cheap script.
They are evil.
If yer still out there and want to talk Wellcare , by all means please write.
Sincerely, Lee.

Comment by Lee Green on 2014-09-11 22:52:08 -0700 #

Blah, any insight into how to really get something done, contact someone who will allow you to contact them again, and…..did you guys “red flag” certain people.
Sorry you had to work there, glad you survived.
Thanks, Lee

Comment by Lee Green on 2014-09-11 23:30:24 -0700 #

Malinda, thanks for the tips they are huge.
We are in the same boat with these guys, can’t wait until January!
Would love to tell you the story of whats happening, but smashed my elbow in a near fatal encounter
With an out of control Fedex truck this morning and can’t type due to pain. Pain is caused by in-ability to pick up my regular script fro the last 5 months for my pain from knee surgery. We drive 4 hrs. One way
To come pick up the refill script. On the way we get injured, should have been killed then, sorry Wellcare needs a PA on this. So knee is killing me new injury would benefit and Pharmacy Tech who was an angel
Stayed on the line with these evildoers, for 90 minutes, 30 of that after they closed to have WC tell them
This script needs a PA, when asked why he said something to the PT and she reacted strange put the phone on speaker and the supervisor said: ” because we can ask for a PA anytime we want and if he’s got a problem with that tell him to fill out an appeal” freaking snot! When she replied that this is an ongoing authorized prescription that was not early, she told him this at least 5 times already. When she once again said he has a new injury from today also, he told her to have me appeal! I finally spoke up and told him that I already hear that before on speaker and can’t you just act human, what if I was his son? He replied, good you heard what I said so I don’t have to repeat myself. WTF. Hung up.
The other story is even worse. I got going, but my arm is screaming now, along with my inner voice.
Would you consider contacting me at. [email protected] to discuss some more?

Comment by Kevin Price on 2017-07-04 05:03:12 -0700 #

This is a feature not a bug. They can claim they are “taking the initiative on narcotic abuse” and save money on cases like this. The patient will pay himself if he can. Thus belying the claim the goal is to prevent narcotic abuse. If he ends up in the hospital that goes under someone else’s expense line not the PBM so they don’t give a fuck. “We decreased costs five percent this year! Bonuses for all!”

Comment by Sylvia Morrison on 2017-07-11 07:14:25 -0700 #

Mine isn’t as serious but over 5 yrs ago I began taking Armor thyroid because Levo & Syn were doing nothing for me. I barely had enough energy to go to the bathroom. I noticed an immediate difference with Armor. After about 9 months we got it tweaked perfectly. Wellcare had given it prior authorization “from date of this letter until no longer needed”. Last month they said it wasn’t authorized. After 3 days & numerous hours on the phone it was finally straightened out. Supposedly it was a glitch in how the computer read it. This wouldn’t happen again. This month it did it again. I have now been fighting for 12 days. I’ve been told everything from they fixed it to yesterday’s it’s never been approved and everything in between. I’m down to my last 2 pills. Wellcare is the only game for all of eastern Ky. that are on Medicaid. Which means they are in control of the pain & suffering of all the poor and/or disabled. If I mail a letter they can take up to 30 days. So far phone calls have cost me tons of stress & 12 days. No one is in charge of the zoo. They give & take as they see fit & no one calls them into accounting. As far as I know they aren’t discriminating because they’re screwing everybody. So you’re really at their mercy of which they have none.

Comment by Sylvia Morrison on 2017-07-11 07:21:56 -0700 #

Look at my response above & see if there is anyone to blame except WellCare.

Comment by alex l-m on 2017-10-26 18:51:55 -0700 #

Medicaide covers Morphine as much as you want and ultram,tylenol 4 very happily but not fentanyl or duralgysic and i have chronic pain migraines due to a closed head injury plus very strong fibromyalgia and chronic fatigue my doctors have tried often even as of today for a PA because he hoped for a change due to the news trump announced drunken brother but snafu they are ok with my becomming addicted and paying for detoxifying you know how much it costs per day to send you to one of rehab places?About $10,000 pd!

Comment by CHRISTOPHER on 2017-12-15 19:56:21 -0800 #

The reason we have an illegal drug epidemic in thIS country is because companies like WellCare could care less, If you call to complain that your needed medication is denied, they will tell you any lie to keep you as a customer. They DO NOT CARE, never did, if you get your medications. It is all about that almighty $Dollar, this is NOT the AMERICA I once would have given my life to protect. WAKE UP TAX-PAYERS; We don’t matter, IF YOU ARE NOT WILLING TO STAND UP AND FIGHT FOR FREEDOM, equality, then you are part of the problem. Get out, you do not deserve to be here. If perhaps someone cares why I now think this way, I will tell you. Contact – [email protected]

Comment by George Buncic on 2019-05-02 16:58:43 -0700 #

I have been taking sleeping pills ( ambient / zolpidem ) for over 10 years. I am addicted but without them I do not sleep. This is unhealthy and dangerous for obvious reasons! Now that I have turned 70 years old I am told by wellcare that I do not meet the criteria and am denied the script for zolpidem. I asked what criteria and he said ” my safety”. Amused I asked if he was serious and of course he said yes and told me I needed prior authorization!!. ” from whom ” I said, and he said from my doctor!!! I said he wrote the script as he has been doing for the past 10 years!!! sounds like age discrimination. regardless i am sure ill be looking for another insurance company!

Comment by Ray on 2019-10-17 11:08:27 -0700 #

WellCare are nothing but dirty thieves!!!! They up’ed their hospital co-pay up to $1,350.00 without a mention to their customers.
“Alright Mr. **, we’ll need a check for $1350.00 to begin your cancer treatment”