I read a story about Wellcare Insurance being stopped from taking any new members in March of 2014, by the feds. I didn't know about that when I signed up for the WellCare’s Medicare Advantage health plan in March. I got my PCP and he referred me to a urologist. That was back in mid-March. I called to make the appointment with the Urologist, only to find out that he was not in Network. So, they told me to call Wellcare. When I did, they told me that I could go to him if he accepted a POS (point of Service) which means that I would pay 30% of his normal fee. I said that is fine. They said I need an authorization form to go to the Urogolist. They also, said they would fax the form to my PCP for authorization.
I called the next day and they said they had faxed the form. So, I called my PCP. They said they never received the form. So, the next day I called Wellcare again and they said they had sent the form and would send it again. I waited two days and called again this was Monday 17th. My PCP said they had not received the form. So, I called Wellcare and told them to fax the form to me and I would hand deliver it to my PCP. They did so. I had the form filled out that same day. Then I faxed it back the Welcare. I thought everything would be fine and let it go for a couple of days. On Thursday the 20th, I called Welcare to see if there was any progress. They first said that they had not received it, until I said that I had conformation that they had in fact received it from my fax source. Then they told me, after a little investigating, that they had received it on Monday, but it was not in the system yet. I asked, "When will it be in the system?" They said it takes about three days. I said that it has already been three days. They said to call back later and maybe it will be in the system. So, I waited until the next Monday March 24th, and called Welcare again. This time they said that they received it in the system on Friday the 21st. They also told me that it takes 14 business days for it to be approved.
I had an appointment with my PCP for the 28th. I went to see him and he ordered a Ecco with Stress Test. I called the hospital to arrange the appointment for the Stress Test. They set the appointment for the 8th of April, and on the day before the test, they called me and said that Wellcare requires an authorization. So, they canceled the test. I called Wellcare and they said they would send the authorization form to my PCP. Which they never received (according to my PCP office personnel). So, I got on the phone to Wellcare again and had them call my PCP and fax the form. My PCP's staff said they would take care of it in the morning. So, now it is April 10th. I called Wellcare again to check the progress of the first authorization. They told me that it was on hold, they needed additional information from my PCP. I had another appointment with my PCP on the 11th. After my appointment I called Wellcare again. By this time I am so disgusted with them, I just want these things over with. They had the same excuse about needing additional information for both authorizations. So, I sat on the phone for an hour while they called my PCP and got this all straighten out.
So, I thought that it would be easy to finish up. Today is the 14th of April. I called again today, they said they need additional information for the first authorization and they would need my PCP to authorize the Stress Test. I sat on the phone for one and one half hours waiting for them to contact the Urologist and my PCP. The thing that bothers me the most. It is not my responsibility to be calling them over and over to get things done. But if I must, then I will.
As of today I still have NO authorizations. Next Monday will be one month since they started to process my first authorization. I am sure there will be some additional information needed to allow my to see an out of Network doctor. I am 69 yrs old and don't have the rest of my life to wait to see a Specialist.
I just wanted to let you know that your story about elders being abused by Wellcare, is still ongoing.