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Re: Optum RX - STAY AWAY

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Message 21 of 63

BTW, I just received a response from them stating:

This situation is not ordinary and these incidents are not typical of us. We are very serious when it comes to our client’s satisfaction and have a zero tolerance policy in this respect.

 

Hahahahahahahahahahaha! They should read this forum! 

 

I was so glad to see here that others are receiving the exact same treatment that I have experienced.

I was beginning to think it was just me.

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Re: Optum RX - STAY AWAY

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Message 22 of 63

I whole-heartedly agree. AARP should use their influence on this bumbling, incompetent organization. Their website is a disgrace and they should be embarrassed to display it compared to even the most basic online retailer. It seems that every transaction I've had with them has either resulted in deceit or incompetence. On my latest order, I got a phone message stating that there was an issue to which I needed to respond. When I did, I was told that I hadn't paid for the order. Well, their website will not let you PLACE an order if you don't pay up front. The Optum rep looked it up and said, "oh...I see it is paid". Several days later, I get an email stating that they have contacted my Dr repeatedly with no response - therefore they are CANCELLING the order. Well, my Dr sends me a message each time she approves a script. So, now they have lied to meTWICE on the same order. Then later, I get a second email saying the order will ship. Meanwhile their website gives no useful  information on the order status reflecting any of this. PLEASE AARP!! Do something, as OptumRx clearly has no intention of improving their Customer service on their own. 

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Re: Optum RX - STAY AWAY

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Message 23 of 63

@lbuilta look for the formulary and tier pricing to change for 2020. Recent "consumer protections" proposed by DC call for more transparency. The "rebates/discounts" from PBM's are supposed to be passed on to the consumer.

 

I put this in the same category as the promise to close the donut hole which was supposed to result in lower drug prices. What did happen was higher premiums and higher copay's on many drugs, both generic and brand.

 

If carriers are required to pass along discounts to the consumer you should anticipate a formulary shift resulting in higher copay's.

 

If you rely on your drug plan to deliver the lowest cost (copay) you will be disappointed. Many times you can get a lower price paying cash or using a discount app like GoodRx.

 

Same is true if you keep the same drug plan year after year. If you want to save $$ you need to shop your plan every year during open enrollment. Too often consumers think the only reason to change is if there is a change in medication. That is faulty thinking.

 

https://www.cnbc.com/2019/03/22/humana-turns-to-game-theory-for-new-medicare-price-structure.html


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Re: Optum RX - STAY AWAY

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Message 24 of 63

I do not think the question is that these companies change the formulary but what AARP doest to protect their base against negative services. It would seem that the orginal practices or should I say directions ofthe organization have changed to a more political or maybe financil view

 

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Re: Optum RX - STAY AWAY

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Message 25 of 63

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???

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Re: Optum RX - STAY AWAY

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Message 26 of 63

@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.

 


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Re: Optum RX - STAY AWAY

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Message 27 of 63

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. 

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Re: Optum RX - STAY AWAY

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Message 28 of 63

@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.


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Re: Optum RX - STAY AWAY

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Message 29 of 63

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

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Re: Optum RX - STAY AWAY

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Message 30 of 63

@whatsupdoc 

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.

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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