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I got talked into signing up with Wellcare around last October. Of course they told me there were doctors in my small town and I picked one. Hours and hours of calling around and being transferred did not find this doctor anywhere. He's either dead, retired, or on the run. Another doctor was found for me about 70 miles away. So I called to get off Wellcare and I've been fighting with them ever since.
First I had to send them a letter. When they finally got around to reading that and responding to it (in January, I think), it wasn't enough. Then it was trying to call them. And call them. And call them.
Meantime they switched me to a nurse practitioner and sent me a second card, which I promptly threw out (like an idiot). Then, during the last calls about a month ago, I couldn't seem to convince them I didn't have a primary care physician because they had assigned someone to me that I didn't know and had never heard of. And was 45 miles away.
So finally, finally, I've gotten someone to call me back but of course during this time, my toilet is stopped up and I'm trying to get someone out to pump it (I keep getting companies that promise to come out and then flake on me) and my sciatica is back and I just spend an entire day in the ER because of gallstones. Today I'm waiting for the third septic company to show up so I don't want to start any long calls and Wednesday the car goes in. So I'll finally call Wellcare back tomorrow.
Meantime, when I was in the ER, I was told I still have Medicare for Parts A and B, but Wellcare for Parts C and D. Oh, and my Medicaid is still active. Every year I apply for Medicaid when I recertify my food stamps and every year I'm told my SS is too much for me to qualify. And I thought Wellcare supplanted Medicare. So this is all news to me.
I feel like I've fallen down the rabbit hole of medical plans and aside from not knowing what I have, I also don't know what to do. I have prescriptions that will run out this month and no doctor to call in refills.
You should have bought insurance with a better known company like Highmark, Aetna and you would not have gone through this issue. I took Highmark Community PPO and pay an extra 27 a month - well worth it so I have my prescription drugs.
It is considered my main insurance.
Sorry your going through this...all I can say is call up Medicare and speak with someone there. It seems Wellcare is part of Medicare.
I feel like I've fallen down the rabbit hole of medical plans and aside from not knowing what I have, I also don't know what to do. I have prescriptions that will run out this month and no doctor to call in refills.
Does everyone go through all this crap?
To be brutally honest, the problems are all on you. Seems you have no idea what type of plan you have, how it works, what it covers and how it differs from traditional Medicare with or without a supplement/medigap. It could be you never took the time to do any research before becoming eligible so you were swayed by some slick marketing campaign aimed at the uninformed. But, whatever the reason, you made the choice.
Before you start changing anything, you better learn quickly about Medicare and the various plans along withe pros and cons. You just learned the first and most prevalent con of an Advantage Plan, so don't make the same mistake. Educate yourself!
To be brutally honest, the problems are all on you. Seems you have no idea what type of plan you have, how it works, what it covers and how it differs from traditional Medicare with or without a supplement/medigap. It could be you never took the time to do any research before becoming eligible so you were swayed by some slick marketing campaign aimed at the uninformed. But, whatever the reason, you made the choice.
Before you start changing anything, you better learn quickly about Medicare and the various plans along withe pros and cons. You just learned the first and most prevalent con of an Advantage Plan, so don't make the same mistake. Educate yourself!
It seems to me the OP is eligible for or has MediCAID, and if that is the case, options may be limited when becoming eligible for MediCARE, with regard to covering the gaps.
It seems to me the OP is eligible for or has MediCAID, and if that is the case, options may be limited when becoming eligible for MediCARE, with regard to covering the gaps.
Yes, she's a dual eligible. Living rural is often an issue for those on Advantage because of limited provider networks and limited number of Advantage plans serving rural areas.
She would be better served this fall during open enrollment to disenroll from Wellcare, go back to Original Medicare plus straight Medicaid and add a drug plan if necessary, This would allow her to see ANY doctor who accepts Medicaid patients, not just those in her Advantage plan.
Fortunately, she lives in Washington State which should be friendly to Medicaid people.
She should also, now, try to reach a Medicaid advisor and/or talk to the SHIP people in her state for guidance. SHIP is often very helpful for people in her situation.
It amazes me how much research people undertake when they are buying a car, TV, or new phone, but don't expend the same energy or time to research medical insurance coverage and choices.
They accept TV ads and presentations with a "free lunch" as all the information they need.
Insurance can be confusing, be it homeowners' insurance or medical insurance.
Don't accept the seller's oral promises; think of them as bounty hunters. More signups, more money.
Treat yourself as your most important possession; spend the most time taking care of it.
Friends and family can be a good starting place for selecting an insurance provider.
If you live in a small town, call the doctors (probably not too many) and ask around. The office staff in the local doctors' offices know which insurers pay and which ones give them problems.
I hope the OP will read Ariadne's post. Probably the best unbiased information and advice.
Everyone, thanks for putting up with me. It's just been a bad month so far. My black tank was pumped Monday and today the toilet backed up. Yesterday I brought the car in (it started acting up again on the way home), finally did my grocery shopping for the month, and did half the laundry at the laundromat. The other half fills a tall basket and still needs to be done. But I took two sleeping pills, went to bed at 8 last night and got 13 hours of sleep. I have no idea what normal is, but I feel better and ready to go back into battle once more. Charge!
Quote:
Originally Posted by Rabrrita
To be brutally honest, the problems are all on you. Seems you have no idea what type of plan you have, how it works, what it covers and how it differs from traditional Medicare with or without a supplement/medigap. It could be you never took the time to do any research before becoming eligible so you were swayed by some slick marketing campaign aimed at the uninformed. But, whatever the reason, you made the choice.
Before you start changing anything, you better learn quickly about Medicare and the various plans along withe pros and cons. You just learned the first and most prevalent con of an Advantage Plan, so don't make the same mistake. Educate yourself!
I'm sure you're right, but I also went through the Wellcare booklet umpteen times to make sure of what I was getting into. Really, the plan itself isn't too bad. It's the fact that I can't find a primary physician is what makes it a negative to me. And I was lied to when they said there were doctors in my town, let alone doctors that would accept Wellcare.
At any rate, this afternoon is when I can finally sit down on the phone for a couple of hours and call them. I'll keep you guys posted.
Quote:
Originally Posted by Ariadne22
Yes, she's a dual eligible. Living rural is often an issue for those on Advantage because of limited provider networks and limited number of Advantage plans serving rural areas.
She would be better served this fall during open enrollment to disenroll from Wellcare, go back to Original Medicare plus straight Medicaid and add a drug plan if necessary, This would allow her to see ANY doctor who accepts Medicaid patients, not just those in her Advantage plan.
Fortunately, she lives in Washington State which should be friendly to Medicaid people.
She should also, now, try to reach a Medicaid advisor and/or talk to the SHIP people in her state for guidance. SHIP is often very helpful for people in her situation.
This was more a rant than a solution seeking post, but thank you so much for the help. I honestly don't know if I have Medicaid. I am told twice a year I make too much on Social Security to qualify for it but every time I end up in the ER, I'm told I have it. One of these days I have to get my butt down to Social Services and really find out, although they're the ones who keep saying I don't qualify for it. The only reason I haven't yet is because the older I get, the more I hate the all day waiting to talk to someone, either in person or on the phone.
So. Five calls, six transfers, one disconnect, and three and a half hours later, I am finally off Wellcare and back on Medicare as of May 1st. Yay me.
Now tomorrow I get to either spend two hours at the laundromat and then two hours at the store, or I can call the ER where I was on Saturday and try to contact the doctor who saw me, since I finally had to walk out of there. They weren't happy with me then and I guarantee they will not be happy with me now. So which shall it be? I think I'll toss a coin.
It's the fact that I can't find a primary physician is what makes it a negative to me. And I was lied to when they said there were doctors in my town, let alone doctors that would accept Wellcare.
Once again, you keep saying "WellCare" as if's a single health plan. It's not! Wellcare has many plans, some good, some bad, some horrible in one area but a blessing in others. So whenever you discuss any healthcare plan, the name of the company doesn't really mean anything without the type of plan.
Quote:
Originally Posted by rodentraiser
So. Five calls, six transfers, one disconnect, and three and a half hours later, I am finally off Wellcare and back on Medicare as of May 1st. Yay me.
You know you were never Off Medicare so you didn't go back to Medicare! You may have a completely different Medicare plan but you may also have the same type of plan just talked into going with someone else.
You know you were never Off Medicare so you didn't go back to Medicare! You may have a completely different Medicare plan but you may also have the same type of plan just talked into going with someone else.
If she was on a Wellcare Advantage plan, which it sounds like it was, Original Medicare was no longer her insurer, Wellcare was and had the responsibility of dispensing her Medicare benefits.
Sounds like she's now back on Original Medicare as of May 1, probably under the trial right which allows her to drop Advantage within the first year. Hopefully, she's done with Wellcare.
Last edited by Ariadne22; 04-11-2024 at 07:59 PM..
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