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I DON'T THINK THIS IS CORRECT. I BELIEVE OPTUMRX IS A PBM WHO
BILLS THE INSURANCE COMPANY--AARP MEDICARE COMPLETE HMO AND PAYS THE PHARMACY. I THINK THIS AMOUNT IS SIGNIFCANTLY
DIFFERENT WITH UPTOMRX KEEPING THE "SPREAD" AND AT LEAST
SOME OF REBATES FROM WHOLESALERS/MANUFACTURES.
WHY THIS IS ALLOWED???
@gh2607 I have over 500 Medicare clients and can't think of a single one that has kept the same drug plan more than 3 or 4 years. Some clients can be stubborn, and that is certainly their prerogative. But their insistence on keeping their current plan can be costly.
Every year during AEP I review options and suggest changes when warranted. Most take my advice, some do not.
Most of those who opt to keep their current drug plan come back a few months later hoping to change to a different plan.
Of course this is not possible in most cases . . . so they are stuck until the next open enrollment.
As long as I have been working with Medicare beneficiaries I have NEVER seen a reason to KEEP the same plan year after year, much less for a dozen years.
You must truly be the exception.
Some folks think they can work the system and FORCE the carriers to bend to their wishes. Don Quixote felt the same way.
Having worked with DOZENS of health insurance carriers and THOUSANDS of clients for over 40 years I have found their are two ways to work the system.
Make up your own rules, waste a lot of time AND money.
Or pick up your marbles and move on to a carrier and plan that offers MOST of what you want.
Plan B is a much better choice.
You will NEVER beat the carriers at their own game. They make the rules.
Bark less. Wag more.
I have used Optumrx since 2007 and the formulary has changed a few times but getting an exception for any meds that were dropped in my case has not been difficult. Yes, it does get irritating when it happens but your doctor should be able to get it taken care of for you. Put a little leg work in yourself. I do not do autopay for any bill I have since I never know if someone with that access will take out funds that are not there and overdraft my account. Use common sense and you will be safer.
@aruzinsky said There is no law that forces you to use insurance that you already have. You just have to tell your pharmacist to use the GoodRx coupon instead of your insurance. And, most amazingly, that coupon price can contribute toward your insurance deductible.
The actual wording in your link says the following:
If you purchase a medication with a GoodRx coupon and the drug is covered by your insurance, you may be able to submit your receipt to your insurer and count that towards your deductible. That way, you’ll still be able to take advantage of your insurance coverage later.
This applies to almost all types of insurance plans, including those from private insurers, commercial health exchanges, Medicare and Medicaid. You’ll want to contact your individual provider to find out what information they’ll need from you and how to submit it.
And if you follow the embedded link you will find . . .
Paying with a GoodRx coupon is considered an “out-of-network” purchase, and it’s up to the insurance company to decide if they’ll pay you back—or whether they’ll count it towards your deductible.
The "fine print" indicates this is not a sure bet. The hassle of trying to get your purchase to count towards the deductible may not be worth it.
I work with hundreds of Medicare beneficiaries every year and help them understand how to save $$ on Part D. There are several informational videos on my YouTube channel that discuss the mechanics of Part D and how to get the most value from your plan.
Years of working with insurance carriers in an attempt to get reimbursement for a non-covered claim reveal an uphill battle. More often than not the easy path is to take your savings and be satisfied.
Bark less. Wag more.
I can only respond for myself but I will try and be as accurate as possible. When I called the number the person that answered I think was at their home as I heard a dog barking and some child in the backround. The first response to my asking why my drug was suddenly unlisted for formulary pricing was that I was sent information with the changes for 2019.....which was not true, no notification was given. Her response was yes I was and too bad kind of attitude. When I asked for a supervisor it took 12-15 minutes to get the second person on the line and again through the whole process of the drug etc. The basic response was get the doctor to select some other manufacturer....ok why?....what is the differences in the drug composition etc.....he of course did not know. Ultimately my DR....selected a different drug after numerous phone calls. I went out to see if other Ex plans also excluded this manufacturer ....NO NOT ONE.....5 different companies approved the formulary at a 30% less than what I am paying now. As I have pereviously stated I will be getting rid of all AARP recommended halthcare items as I have found better covereage in different areas for less money......shame on me for not doing my homework.....that includes silver sneakers coverage
I am not involved in this but from keeping up with the complaints here, the problem, or at least a few of them, seems to be involving situations when there is a credit card attached to the online account.
1. automatic refill option of maintenances meds is chosen and for one reason or the other, the benficiary does not need a refill at that time or perhaps it has been discontinued by the doc and
the med provider wasn't notified.
2. OR there is a price increase on the medicines being reordered and there is NO mention of this when the med is ordered online - many of the complaints say that there is no price given at check out. Thus there is a big surprise amount when the credit card bill arrives.
Those are some of the ones which I remember as complaints here. I do not know how the registration for online registration is done but what might seem to be a real convenient thing turns into a disaster - perhaps "online", supposed convenience, is not that great for some people - you still gotta inform and stay on top of it.
I am a long time AARP member but also a Health Insurance for Medicare agent & I sell only Med Supps as well as Part D Rx Drug Plans. This being the case, one of the health insurance companies I represent is UnitedHealthcare for the past 9 years. I am curious as to what kind of problem you have been having with which I assume is UnitedHealthcare's Mail Order Pharmacy Rx OPTUM Rx and when you call UHc's membership desk & explain the problem, what is their response?
Start calling United Healthcare AARP enrollment line in your state. Let them know you will NOT be renewing.
Additionally, I am starting to wonder if they are in violation of Medicare rules. Does anyone know an attorney or an advocate agency?
It won't let me paste link. Search Modern healthcare CMS fines 17 rx...... it lists MN UHC in that article.
Even if they have an agreement on their website or app agreements to terms to use, if they do not let you OPT out of prescriptions:
1. YOU didn't approve and/or you did NOT give dr authorization to do so,
2. or they told me by not keeping credit card on file then no rx would be sent (baloney they did anyway), they told me to follow their rules BUT didn't matter.
I think they are violating rules!
I didn't renew. Call YOUR local MEDICARE AARP line and start to complain.
Twice OptumRx has sent medications to my husband and I that have not been requested. Today my husband received a text message that OptumRx had reached out to his doctor and sent a refill of a medication that he has plenty of and did not order. He called Optum and, after listening to a recorded sales pitch, tried to tell the rep that he did not request and does not want this medication. She wouldn't listen, kept talking over him, and to top it off, kept calling him "Ma'm" because his name is Dana. Needless to say, sending medications not requested and billing Medicare should be a fraululent activity and I think they try to get away with it. The deductible for this will be declined through our credit card company and the medication will be refused and sent back to Optum.
So I went down the rabbit hole and tried to discuss why the formulary was changed so that previously covered drugs were no longer covered. All I can say to you is that the almost 2 hrs being bounced around United Healthcare (OptumRx) got me nowhere. They want their money and they dont care about you.
As an fyi I should have done my due diligence better and compared companies on my drugs.....shame on me for not being better informed. SHAME on AARP for not having the seniors backs and stepping up not just on this but all of the take aways United Healthcare did....silver sneakers etc......