Optum RX - STAY AWAY

[SarahH845050]

If you go to a pharmacy and they hand you a prescription then tell you it cost $160, you have the choice of handing it back.  NOT WITH OPTUM RX.  Website said no co-pay.  Prescription recieved then credit card bill arrives with $160 charge.  Called Optum RX.  They will not accept any return nor issue any refund.  Called Regions Bank to dispute charge.  They refused to accept dispute but charge penalties and interest while reviewing my case and reported a late payment to credit bureaus.  The whole experience has been BAD!!!

[dl83245791]

as was reported in the news, a lot of generics are coming in from China and some from India. The FDA is not monitoring the situation enough. Generics have skyrocketed in price, and they are often inferior if coming from foreign countries. I also have noticed that my pharmacy has gone to a new supplier of generics, and I feel like my blood pressure medicine has stopped working also. The problem is no one tells us which generic is coming from where? We are forced to buy generics when the brand name is more effective. the FTC needs to investicate. 

[whatsupdoc]

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?

[lbuilta]

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

[GailL1]

@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.

[gh2607]

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. 

[lbuilta]

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

[somarco]

@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

[somarco]

@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.

[MichelleS975644]

😩 bad idea here but i like readimg these. I am an advocate with optumrx. I read these so i can anonymously send management tickets on what wr can do better. I agree with some of this. But pricing wise please know we get prices from the insurance and they tell us what youll pay. Just know im here to express these concerns! Im so so sorry yall were not treated right!

[p218181h]

Seriously? In my opinion the only way Optumrx can help is to close up shop and let us deal with honest pharmacies like CVS and Express. You are the worst 

[GloriaH749221]

OptumRx is the WORST pharmacy we have ever dealt with. They are minimally competent. I would advise everyone to stay away from this company.  They seems to have little to no quality control. 

[RayAnita1981]

I agree!

What a nightmare they are to deal with.

[rtiredjoe]

I can attest as to the fact these people are frustrating and ridiculous to deal with. Some of this may be due to another fact that a lot of calls getr routed overseas. 

I had ordered a medication...thinking it was about $25.00. When I got it...it was $125.00!!! I called and after about 3 weeks and several "other phone contacts" with these idiots...was told to send back the mediaction and they would get my account in order my... as they had "locked" my account. This was back in early September. Medication was sent back (received by them on 9/30/19). 

They had  charged my credit card the $125 in early August...then reversed the charge same time...and then later tried to bill my credit card again ($125) in early September! The September charge was not placed! After another series of calls...by the end of September I was confident the issue had been resolved. Not to be! 

Late November...thinking my account was OK...I reordered 2 medications and was told it was fine. Just needed to contact my doctopr for authorization. A few days later I get an email from OptumRX notifying me of an issue (Dr. authorization). I call AGAIN and "supposedly" get it fixed. Asking them again about getting my meds and the time frame. They tell me about 12/13/19 I'd get them.

TODAY I get a letter in the mail...saying my meds have not been filled and for me to contact my doctor or call them. I call them and am told there's a "Lock on MY Account" due to the past due $125.00!!! WTF??? Now I'm really pissed!!! Had rep get me in toiuch w/a "Supervisor" (Stupervisor) and she tells me they will get account "unlocked" (she's waiting now for an authorization via email to do so) and she will ca;ll me back tonight to verify such. Offered to overnight meds once cleared up. We'll see if any of this actually happens. 

"A THOUGHT ON THIS": If they can't get this dine correctly...can I even count on the fact that they will fill my prescription w/the correct mediaction in the correct amounts of dosage??? 

[MicheleF434456]

I agree Optum is the worst. We had express scripts and they had great service. The non native English speaker customer support staff just read from a script. I am going to get hard copies of all my prescriptions and physically take them to Walgreens. I didn't do my homework on this decision. 

[PeggyW881599]

All AARP members who have been screwed by Optum should go to the "Contact Us' and send AARP a message. They should not be recommending them to the membership. Recently we changed insurance and had OptumRX forced upon us. We had Aetna before and used the Caremark system, which was great. I started over a month ago trying to move over my prescription. My doctor has had to call in the prescription three times. I've had to call 4 times. Each time the agent I reach first gives me the wrong information, several versions of the wrong info. First they say the reason it didn't ship was because it was set up as an auto refill (ugh?). Then they say it is fixed and I should receive by x date. Then I say that doesn't make sense, they look closer and then they say my insurance doesn't cover it because it is a brand name. I say the generic equivalent is fine, the don't make the brand name anymore. All you can get is the generic. Then they say they have fixed it and I will receive by date. X date comes and goes, no emails, no phone calls, and no prescription. Then I call again and go through the same routine. Four times. Today I was SCREAMING at the agent. I said I would not get off the phone until I had a tracking number. I refused to accept her lies and finally they transferred me to a US based agent (her words not mine). Turns out someone had clicked that I would only accept the brand name prescription (God only knows why) and that was why it kept crashing. Again, no phone calls, no emails, the request just disappears. The US agent had seen this happen before. The problem is the call center, the first person you get is out of country, new, inexperienced and they very simply lie. They tell you what you want to hear to get off the phone. I had to tell the agent, Maind, that I would not get off the phone without a tracking number that showed I would receive the drugs tomorrow. I basically refused to budge 6 times saying "nothing ia acceptable except these drugs will be received tomorrow." She finally said she would transfer me to a US agent but it was only because I said repeatedly I would not budge.

These are drugs I need to live. I have Parkinsons. Stress is very bad for me and this has caused incredible stress.

The link to check your order status in the email you receive confirming your order sends you to UnitedHealthcare. No way to get to the order status from there! And option to send a message from the 'Contact Us" on the OptumRx site doesn't work.

So they are incompetent at all levels! I plan to complain loudly to United Healthcare and to our employer for choosing a company that is so bad. Given the reviews posted I am not the only disgruntled one our there.

[sylvia2009]

I am having the same issues!!!!!!!!!!!!!!!!!!!!!!!!!!!  It has been a nightmare!!!!  I started with them Jan1 with our new coverage and I have been on the phone several times and my doctors trying to get my medications transferred.  They are useless!!!!

Caremark was awesome, NEVER had these issues, none!

I had a heart attack 2 years and I had to fight to get NITRO!!!!  Unreal!!!!

Why did United Health Care go to these idiots!!!!!!!!!!!!!!!!!!!!!!!!!!!

[PamelaM176692]

Same problems here. I’ve tried to order meds on three occasions each time I had to call. The app is horrible, missing prescriptions or meds listed under the wrong family member. No phone number listed to call and no prices visible until you place the order. Last call was an hour long to get my daughter’s arthritis med. They to deny my request to speak to the Pharmacist. I strongly recommended avoiding this company. Unfortunately we have no choice as it is through my husband’s employer. No customer service and meds are 3x the cost of Medco.

[JazzGirl9]

Hi Pamela

You’re Dr should to send refills or new Rx’s  to Optum either via electronic submission, call or fax. There is nothing you can do about their formulary if Rx is not on their list but whoever handles prior authorizations your Drs office can try to do that if your Dr thinks it’s detrimental to your health to change. Do not use the app to refill drugs. Call your Drs office for them to submit them. Not much else I can say. Did you call the phone number I posted? Sorry you’re going though this but Optum insurance is not the best. Good luck. 

Nina

[PamelaM176692]

Thank you for the help . Our Doctors have submitted scripts electronically and followed all the necessary procedures but this company has continued to make mistakes. We had two more problems since my first post that took hour long phone calls again. I’ve only had one problem with formularies that was resolved by a doctor appeal. Just a total lack of competence on the part of this company.

[m702796s]

Do Not submit scripts electronically unless you want Optum to fill it automatically. If you EVER give OptumRX a Credit Card they will keep it, store it until your next doctor-submitted prescription, and fill it whether you need it or not, and charge your card. ALWAYS ask your doctor for a printed prescription, and then take it or send it wherever you want it filled. Shop around for the best price. I have received free prescriptions after joining the Kroger savings club for meds which cost me $47 through my plan. Shop around.

[JazzGirl9]

I wonder if there is a way to change  plans if you call Medicare to complain. There also may be a time frame to be able to switch. 
Nina

[m702796s]

You can't change prescription plans unless you change insurance carriers. OPTUM is UHC's prescription drug plan and it is a part of UHC. You can change insurance carriers in NOV/DEC during change time and possibly choose a new drug plan. But you have to leave UHC.

[lbuilta]

if you are on the advantage system......only

[JazzGirl9]

Interesting. I have United Healthcare supplement and Express Scripts. Is that with Medicare Advantage only?

[m702796s]

Yes. It's an AARP/UHC Advantage Plan. It costs me nothing per month.  But I'm stuck with the idiocy that is OptumRX. After three years I have learned to work around them. There are many ways to do it. Don't expect them to change and don't expect AARP to help you. I think they are doing their members a terrific disservice, but AARP doesn't seem to care as they must be getting a great kickback from UHC.

[JazzGirl9]

Sorry, I don't know much about Medicare Advantage. I personally don't like any HMO coverages because I know how they operate. It's a big stretch for me to pay an extra $ $150 per month on top of the Social Security Medicare premium. It is worth it for me not having the headaches even though it's more expensive and I'm not a wealthy person by any means. I don't like insurance companies dictating to me how to handle my medical care. 

[m702796s]

Advantage plans don't dictate any part of your healthcare to you. You can go to any physician you want to. They are the same as any supplement plan, but they often don't have any monthly coverage costs. With your supplement plan, you are paying $150 a month in addition to your Medicare deduction from your social security check. That's $1800 a year extra.

I pay nothing for the same benefits with my Advantage plan. While you may have no copays for dr. visits, I have a $45 copay for a specialist visit (nothing for primary care).And no other charges. I would have to go to a doctor three times every month to get to the costs you pay monthly. That never happens. So I save money with my advantage plan even if I have up front costs. It's so much cheaper. It's like paying ala carte for food vs. paying a lump sum for a banquet you're not going to eat half of. Insurance companies under Medicare have to offer the same product. Medicare coverage is way different than private insurance plans. You are paying extra for no extra coverage.

[JazzGirl9]

I'm sorry but that's not true. A lot of Dr's don't take Medicare Advantage. You have to stay within a particular network of doctors and I don't like that. It's worth it to me to pay extra. The benefits are also better. It's a choice I made because I saw what those plans did to people and their health. I'm not being snobby but this is from my experience working with very upset patients who have been turned away from providers they've seen for years. HMO's have more control over your healthcare and the doctors have to put up with their BS. They often have to fight with them for procedures or tests they order. Look at the issues people are having with their prescription coverage and dealing with Optum. I want more control over my healthcare. Sad but true. 
Nina

[m702796s]

I"m not sure where you live and what your Advantage plans look like, but Medicare is Medicare. All payments from Medicare are the same to doctors. Medicare pays 80% and the supplement picks up the rest. You have no costs after treatment because you pay it up front with your $150 monthly premium. That will go continue to go up as you age.

I have no monthly cost. I pay a copay for each visit to a doctor of $45 if he's a specialist. Nothing for Primary care. I can control that by who I see and how often. And I can see anyone I like. After my copay, I have no bills for most procedures. An outpatient surgery is $405 copay. But there are no other charges. You will have paid that cost in monthly premiums over three months whether you have surgery or not.

As far as doctors not taking Advantage plans, they can't tell the difference. Having to stay within a network of doctors varies by plan and those plans are usually privately backed by local healthcare systems in one area trying to monopolize business. With UHC you can go almost anywhere. They are huge.

Private doctors may limit their practice for Medicare because Medicare as a rule does not pay well (Thank the Republicans and this will get worse if Trump is reelected. They've run up a trillion dollar deificit giving tax breaks to the wealthy and they will recover that by penalizing the old and poor) A doctor. will go broke if he has to subsist on Medicare. But hospitals don't care. If they take any Medicare, they have to take ALL Medicare.

Most salesmen who sell policies sell supplements because their kickback is better from the insurance companies. They also have to retrain in Advantage plans every summer to be certified to sell them. Most don't want to do that so they sell supplement plans as if they are better when they are not. The salesmen are just lazy. They don't get paid as much and they have to put out too much. Your welfare is not their concern. My salesperson told me this. I am very happy she talked me out of a supplement and into an Advantage plan. My only problem is that the best plan out there is UHC AARP and I have to take Optum with it. So I just work around Optum. She has saved me a ton of money.

[JazzGirl9]

I should also say that UHC pays all my Medicare deductibles (I was lucky enough to get Plan F because I turned 65 in December) but I don't think that's available anymore in 2020. There is another plan that's similar. Maybe during open enrollment you can change? It's not worth it to me to have the aggravation if you can pay but I know that not everyone has that option. My Medicare D is not an expensive plan. It's under $30 a month but I don't take many meds. I get a couple of them at Costco for dirt cheap out of pocket and don't use insurance. 
Nina