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!!!

[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

[JazzGirl9]

Hi Sylvia

I don't know much about the time line where you can switch insurances but I haven't had any trouble (yet) with Express Scripts. I don't take many medications and a couple of them that I don't take everyday I pay for of pocket at Costco but geez... Nitro is dirt cheap! Can you switch back to Caremark? If you have a high deductible you can call Costco (if there's one nearby) and ask them how much your Nitro is. I have an inexpensive coverage with Express Scripts that I pay about $23 dollars a month for. They are extremely helpfuI and I don't go through AARP at all. Good luck with everything, Sylvia. My old boss used to say "don't get old!" 

[JazzGirl9]

Peggy, that's terrible! I think they all suck, pardon the language. I worked in medical offices most of my adult life and it's getting worse and worse. I don't know if this pertains to you but sometimes the Dr's office (usually a provider) inputs I prescriptions wrong... I saw it happen all the time. Everyone is so rushed and crazy these days because nobody wants to pay to have enough staff regardless, of where it is. I do remember Caremark being pretty good, but the problem is, with all of them, they change their formularies all the time and want you to take what they cover and all the insurance companies have their own. It's horrible. I saw patients decide not to take their drugs because it wasn't covered! We're talking blood pressure and diabetes meds! I used to fight with the insurance companies all the time but it gets harder and harder. It brought me to tears, the injustice of it all. They have stupid people answering the phone that go through a cookie cutter form that has nothing to do with the patient's situation. It's a nightmare to get to a pharmacist on the line.  I'm glad I just retired but let me tell you, Medicare D was so scary for me to choose, even with all my 30 years of knowledge. I still don't know if I made the right choice! Good luck with everything, Peggy, you'd think now that we've retired, we'd have less stress. I miss my job paying for my insurance:( 

Nina

[GailL1]

@PeggyW881599 

You can also file a complaint with Medicare.

Medicare.gov - Filing complaints about your health or drug plan 

Time to switch - open enrollment is now going on until December 7, 2019

[j74451t]

 I have had it with this company!  Briova Rx was magnificent in their caring, meticulous handling of my mail order prescriptions, my pharmacy questions and truly caring about my physical ( and emotional!) well being. The opposite is true of Optum.  Among the problems I have encountered:

1) Overcharged $200. for a prescription TWO years ago....14 phone calls...promised tracking #’s then giving me a Reference #...with no follow up. Another 1 hour and 17 minutes of my life just now only to receive yet another Ref#.,

2) OptumRx CHANGED my doctor’s prescription order!  The amount of medication...and, of course, the price.

3) Orders promised, not received.  The required equipment to use this medication...not received.  

I would not only advise everyone to stay away, I would urge those of you who have been duped into using Optus (rather than companies like BriovaRX,) to send Op-Ed’s to newspapers, to Medicare, to your local representatives.  

This is company needs to be shut down immediately!!  Needless to say, I will be changing prescription drug plans this fall.

[pd6038]

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???

[lbuilta]

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......

[GregR112291]

Hi, I'm Greg and have been disabled since 2012. I had no other but to use SSDI due to moving from N.Y. to S.D. and osing my Health Ins. and clould not pay enough to get another company to pick me up. I wasn't even able to join S.D. risk pool due to prior condition ( L-4,L-5 ) fusion. I have so many problems here with the system here and recently presciption refills even with prior auths. I only last week found out from a Nurse trying to help me have my regular medications refilled that OptumRx is contracted by S.D. for mdication refills. I'm stepping into a huge mess at the moment because there is no accountability from anyone. Social Security is stone walling me as well as this " company" .I have only now also found an Advocacy group out here but they seem unsure as they have " never heard " of what's going on. This term is all I seem to hear.

[BigG77]

I did a price check on 3 drugs with the new AARP Optumrx discount plan.  None were covered making the cost very high on each drug.  Don't bother signing up for this bogus savings plan.  The prices with goodrx are much better.  Check all of you presciption prices on the goodrx  website before purchasing.  On certain medications they have saved us from 10 to 30 dollars compared to the costs of the part D plan that we have.  The aarp optumrx plan had us paying up to $200 for the same pills goodrx had for around $10 to $20  I agree, stay away from the aarp optumrx plan and don't even bother.

[timlay]

You can't use good rx if your on Medicare/Medicaid.

[JazzGirl9]

You’re right. In my previous experience working in the medical field getting prior authorizations for medication, all the pharmacist has to do is provide the insurance company with the ICD 10 code, which is the diagnosis code, and Medicaid usually will pay, at least in California. You also don’t have to use your insurance and look for a pharmaciy that takes Good Rx with a low co pay. You can save hundreds of dollars, seriously. 

[aruzinsky]

---

@timlay wrote:
You can't use good rx if your on Medicare/Medicaid.

---

Wrong.  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.  See

https://www.goodrx.com/blog/ways-to-beat-your-insurance-copay/

[scrapbookaz]

Absolutely correct! The GoodRX drug app even showed me where I could get my antibiotic for free on my own prescription just recently in November 2018.

[JamesB350656]

Upon SETUP of new account - the sign in page goes NO WHERE.

This is not trustworthy behavior for a site that requires passwords.

No Thank You.  AARP needs to take this program OFF their network recommendations.

[dochande]

Well, see that others are unhappy with OptumRx for one reason or another, I too have, long ago with another group been displeased, on more than one occassion, speaking with  Optum customer service (this excerpted from anothers reply-"called OptumRx to inquire and immediately found it difficult to communicate with a surly, impatient rep.").  Though it cost more, I am using my local pharmacy, a more pleasant, helpful and less burdensom business to deal with.

It is a shame to have to experience this as the on-line system is suppose to be more advantages for the customer-both courteous, helpful, and financially.

[j484502k]

Couldn't agree more!  Their website sux, I can't even log in.  I'll stick with GoodRx until this gets better...but I dooubt it will.

[roc195958]

AMEN.

[roc195958]

This is the most inept service that I’ve ever seen.

     I have been using them for about a year and I have been left without medication every time a refill was due.

     I am done.

[SandraS751024]

I hope someone at AARP actually reads these comments. When a contracted company gets so many negative comments, it’s time to review the contract. It’s a pity when one cannot rely on an affiliation with AARP to provide quality.

I have used the AARP prescription discount program since 2005. AARP has changed its fulfilling pharmacy several times over the years, and most of them have been satisfactory. Not OptumRx. I will never order from this company again. For one thing, the web site does not function properly. I couldn’t even register, and I’m reasonably skillful with computers. But that problem pales in comparison to price gouging, unethical practices, and incompetent customer service.

On April 2, I called OptumRx to request a refill and was quoted a price of $29.98 for a 90-day supply – the same price I had been paying for a very long time. I was asked if I wished to use the credit card I had on file to pay this amount, and I said yes. A few days later, I went online to pay my credit card bill. There I saw the charge I was expecting, but right below it was another charge for $20.99. What is that, I wondered? I called OptumRx to inquire and immediately found it difficult to communicate with a surly, impatient rep. She finally referred me to a supervisor, who was much more pleasant but equally unhelpful. The supervisor said she needed to consult with other departments, making for a slow process and a long hold time. Finally she informed me that the price of the medication had gone up and that OptumRx had no control over that. She did apologize for the fact that I had been given no notice of the additional charge (which was not actually applied until two days after the original amount). The lack of notice deprived me of the opportunity to decline the refill, which I might well have done because the increase was so extreme and I was not in desperate need of replenishment.

Since I had not known of the additional charge and certainly did not authorize it, I turned to my credit card company for help. The card rep arranged for a conference call in order to try to resolve the issue. We waded through FIVE reps at OptumRx, one of whom finally managed to locate my account, but she flatly refused to issue a refund for the $20.99. It appears that OptumRx thinks it is okay to charge a customer for an amount the customer did not authorize. News flash: it is NOT okay EVER for anybody, anywhere, anytime, to charge a credit card without permission. The amount involved here is trivial, but the principle is huge.

Thank goodness this refill, which I did receive, was the last one on my current prescription. I will take my new prescription elsewhere. The AARP program is supposed to reduce consumer costs, not increase them. Compare the amount OptumRx says is my current copay, $50.97, with the cost at a local brick-and-mortar pharmacy, $29.95. Note that the local price is within three cents of the original quote from OptumRx. That cited “price increase” appears to have been no more than an excuse for stealing money. I think I hate a liar even more than a thief, but here we have both.

Judging by the efficiency of the customer service department, this company’s right hand doesn’t know what its left hand is doing. It seems far too likely, however, that sooner or later, one of them will be in your pocket.