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Re: OptmRX scam

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With each new order of a prescription they come up with an entirely new condition /stipulation that they have created, each of which has absolutely nothing to do with the condition/situation that they've stipulated on the previously challenged prescription. Lately, they've just resorted to succesive delays amounting to weeks of time elasping with no explanation given for the delays.

I guess their creativity has finally been taxed to the max.

 

They seem to be dscouraging these prescriptions by creating aggravation.

 

Illegtimi non corborundum!

 

 

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Re: OptmRX scam

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@th9081509 wrote:

Each and every time I place an 'expensive-to-OptumRX' order I encounter a pattern of delays and denials for hat are obviously obsfucatonal reasons. Strangely, relatively inexpensive orders go right through. Both kinds of prescriptions are from the very same physician. Stay away from AARP's Medicare Advantage Plans if you want to avoid being harrassed and agravated on prescriptions.

 


Many Part C and Part D plans have a Medical Therapy Management component (see https://www.medicare.gov/part-d/coverage/medication-therapy-management/medication-therapy-programs.h... ) and/or a step therapy component (see   https://www.medicare.gov/part-d/coverage/rules/drug-plan-coverage-rules.html ). Perhaps your plan has these components and is especially agressive about following them. Next open enrollment period (or sooner if you qualify--see Note) you can try to switch to another Part C plan (or a Medigap plan with Part D) without such components. But these MTM and step therapy are major trends in all insurance, not just drug insurance and not just Medicare insurance, so there will be fewer and fewer plans without them in the future.

 

If on the other hand the problem is outright fraud on the company's fault, you should report them via a complaint (see https://www.medicare.gov/claims-and-appeals/file-a-complaint/complaint.html ) after you go through the appeals process. (It sounds like you do eventually get the prescriptions, in which case start with the complaint.)

 

Note: About half the people on Part C and Part D do not have to wait until the next open enrollment period to switch. Anyone on the Social Security Extra Help program can change  plans immediately with coverage starting the first of the next month (and you can do that every month if you want... but you shouldn't). Anyone on a state pharmaceutical assistance program (SPAP) can change one other time during the year in addition to open enrollment time (if your state has an SPAP, look into it because many mid middle class seniors qualify and it's worth being on just for the right to switch even if it does not actually save you any money). Anyone can switch to a 5-star Part C plan at any time (except there are not a lot of such plans and they are the plans most likely to have stringent MTM and step therapy components.)

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OptmRX scam

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Each and every time I place an 'expensive-to-OptumRX' order I encounter a pattern of delays and denials for hat are obviously obsfucatonal reasons. Strangely, relatively inexpensive orders go right through. Both kinds of prescriptions are from the very same physician.

 

This is very plainly a case of the insurance cmpany "playing doctor" with the object of saving money at the expense of the health of the insured.

 

Stay away from AARP's Medicare Advantage Plans if you want to avoid being harrassed and agravated on prescriptions.

 

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