To File A Standard Appeal

Within 90 days of receipt of a denial for services, you, your doctor or your authorized representative can ask that the denied services be reviewed by asking for an appeal by calling Member Services at 1-800-951-7719 (TTY/TDD 1-877-247-6272) weekdays, 7 a.m. to 7 p.m., ET, excluding holidays. Or, you can deliver a written report to WellCare, Appeals Department, PO Box 31368, Tampa, FL 33631-3368, or fax it to 1-866-201-0657.

To File an Expedited Appeal

You, your doctor or your authorized representative may ask for an “expedited” or “fast appeal” (resolution within 3 business days,). if you believe that waiting for a standard decision ( typically within 15 calendar days) could seriously harm your health or your ability to function.

If you ask for a fast appeal without support from a doctor, we will decide if your health requires a fast decision. If we decide that your medical condition does not meet the requirements for a fast appeal, we will make reasonable efforts to orally notify you. We will also send you a letter, within two calendar days, informing you that if you get a doctor’s support for a fast appeal, we will automatically give you a fast decision.  The letter will also tell you how to file a “grievance” if you disagree with our decision to deny your request for a fast appeal. If we deny your request for a fast appeal, we will then give you a standard appeal (typically within 15 calendar days).

WellCare will send you something in writing if we make a decision to:

• Deny a request to cover a service for you;
• Reduce, suspend or stop care you are already receiving; or
• Overturn our previous decision or continue to deny payment for a service you received that is not covered by WellCare.

We will also send you something in writing:

• If we did not make a decision on a request to cover a service for you by the date we agreed to respond by.

To file an Appeal

To File A Grievance

You have the right to file a grievance if you are unsatisfied/unhappy with WellCare, a provider, or healthcare services you receive.

A grievance is the type of complaint you make if you have any type of issue with WellCare or a service provider.This includes if you do not agree with a decision we have made. You or someone you want to speak for you can contact us. If you have a grievance, we encourage you to call Customer Service. We will try to resolve any complaint over the phone.  Please call the Member Services Department weekdays from 7:00 a.m. to 7:00 p.m., ET at 1 (800) 951-7719 or TTY/TDD 1 (877) 247-6272.  

If you prefer to submit your complaint in writing, please mail to:

WellCare of Ohio  

Grievance Department
PO Box 31384
Tampa, FL 33631-3384

You can also fax a grievance to: 1-866-388-1769. We will notify you of a decision within the specified timeframes (specific to your State requirements) from receipt of the written grievance. 

Also, an expedited grievance can be made orally by calling our customer service number above.

To file a Grievance