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!!!

[aw6946]

My MAIN issue was the credit card situation.  IF you agree to have it put in system, they AUTOMATICALLY send Rxs to you without your consent. They refer to the agree of ToS. THEY DON'T CARE. Then all the reps cared about was citing and reading their policy. Then it would meet their "liability/ EOC, .." standards, rules,.. and it was ON a recording for appeals or court action.

Even when I repeatedly asked to be transferred to the next level. The rep refused. It's what the rep has been trained to do bc I know how shady call centers can operate when they want to prohibit further complaints,... Were I worked DID NOT operate that way. FOLKS, I had many years in industry.

But in order for me to receive my Rx, I had to give them my credit card. Then they KEPT IT IN THEIR SYSTEM! SO, guess what, then they'd start the cycle over again.  Only way to hopefully stop cycle, was to call later AFTER ALL WAS PROCESSED, couple days, to have credit card removed.

You could NOT remove the card via the computer/online. Had to call back and SPEAK to someone.

So you tell me folks who think that I just want to complain, or don't know what I am taking about, how would you resolve?

I finally left at Open Enrollment. I also called their marketing team to let them know.

**********OTHERS: FILE WITH MEDICARE PER WEBSITE.  but by my time, it wasn't worth it bc I was switching. But I had option to switch.**********

UHC doesn't care unless the liability would be too great. AARP has become a data collection [via their tax program to now "ask" for your info to be shared with others who might have programs your interested in. No they don't share your personal tax info. The upper echelon paid ppl don't care.

[aw6946]

Excuse me, but I used to manage member services and was well versed in EOC, SPD, EOBs, etc. I managed call center teams, etc. Knew HMO, Medicare, PPO, POS, etc.

I set up group benefit plans. Worked for fully integrated delivery systems. Carve-out behavioral health, worked for the largest BHC in the nation as well as smaller models. 

Additionally, I also for the accreditation agency for hospitals, etc. My father taught MPH, MHA, biostats, etc. He created a GLOBAL independent study program over SIXTY years ago that were for COUNTRIES too. I've worked in a multitude of different systems, HC related and not.

Thus, now that we've established ingame some level of understanding, let me state your opinion was .... very condescending.

Obviously, you don't know me. When I call and have issues and know HOW these systems operate, can speak the language, and can't get matters resolved, then I think, geez how the the *%_=! does someone understand complex systems like this [or taxes, or underwriting, or ... BTW I understand those too].

If your intent was to be helpful it wasn't. NO you CANNOT change the PBM /RX for ALL plans. These also vary based on state laws even though Medicare is a FEDERAL program.

Yes, I could and I did. 

Yes, I understand most don't read EOC / SPD ..   Yes, I believe nearly everyone needs to take on more accountability in life. Yes, also learn. 

But as a person that has had to read legal contracts, RFPs, 400 PAGE SPDs, which took TEAMS of individuals to understand, write plans,...  well, sigh.. 

EVEN understanding formularies that change, tiers, etc. And this info can change on an annual basis as well.

So, please, as Stephen Covey states,,,, 

***********   "Seek first to understand, then understood." **********

ALSO, there are individuals who don't use computers, have a complex Rx numerous prescriptions, might now even use the internet, etc. So please consider those skillset differences too.

FYI: The job posting for UHC the person to handle the PBM services.. customer interface, etc has been posted A FEW TIMES. In fact, it might even be open now. I'd encourage you to please look into that opportunity and help all the individuals who have these challenges. 

BTW, I even volunteered for AARP tax. They are a MARKETING company. 

Also, UHC will not do anything either. 

Thank you.

[Cindoc95]

I am a pharmacist. This is the worst PBM (pharmacy benefits manager) I have worked with either professionally or as a patient. I was recently on the phone for 4.5 hours before the holidays trying to fix a mess up they made with not obtaining the right Rx, not shipping it correctly, and being transferred to 6 different departments and having to go thru their impossible to-get-off phone tree multiple times. At the end of the ordeal the problem was still never fixed. They refused to stay on the phone for 5 minutes to obtain a Prescripion from the transferring pharmacy even tho I was literally on the phone for hours trying to get the issue resolved. Luckily I joined late in the year and was able to switch insurance companies in time for the new year.  AARP should NOT be associated with this poorly managed company. Look up their BBB ratings.  It's not good and fits the poor reviews of this forum. I switched insurance companies specifically to avoid using their pharmacy service 

[RN362636]

This is ANOTHER  problem that I have seen with Advantage plans. If one has a traditional Medigap ( Medicare) plan they are allowed to choose or switch their part D plan ( pharmacy/ medication) benefit, even with United Healthcare. It is the Advantage plans that have too much control in my opinion. This is done to keep THEIR cost down, not yours.

[JazzGirl9]

Hi Cindoc95

So nice to hear this from a professional. Thank you for your input. We should complain to AARP. They could also be getting a big cut from Optum??? This is why I went with Express Scripts on my own. 

Nina

[m573000l]

United Healthcare owns AARP intellectual property. That's why AARP can't drop them as an advertiser. If AARP cared about their subscribers being ripped off they would do something about it. Everyone should cancel their AARP subscriptions.

[GailL1]

Why don't Medicare beneficiaries with a problem with their Prescription Drug Plan file a complaint with MEDICARE??  If you feel this strongly that OptumRx is not doing a good job for whatever reason - let them know.  They are the "bosses" for Medicare plans.

Medicare.gov - Filing Complaints About Your Health or Drug Coverage 

[GailL1]

Medicare.gov - Automatic refill mail-order service for prescription drugs 

from the link ~

Some people with Medicare get their prescription drugs by using an “automatic refill” service that automatically delivers prescription drugs when you’re about to run out. In the past, some prescription drug plans weren’t making sure that some customers still wanted or needed a prescription drug and this created waste and unnecessary additional costs for people with Medicare and Medicare prescription drug coverage (Part D).

Now, plans have to get your approval to deliver a prescription (new or refill) unless you ask for the refill or request the new prescription. Some plans may ask you for your approval every year so that they can send you all new prescriptions without asking you before each delivery. Other plans may ask you before each delivery.

This policy won’t affect refill reminder programs where you go in person to pick up the prescription, and it won’t apply to long-term care pharmacies that give out and deliver prescription drugs. Giving your approval may be a change for you if you've always used mail-order in the past and haven't had the opportunity to confirm that you still need refills.

. . . .  Contact your plan if you get any unwanted prescription drugs through an automated delivery program.  You may be eligible for a refund for the amount you were charged. If you aren’t able to resolve the issue with the plan or wish to file a complaint, call us at

1-800-MEDICARE (1-800-633-4227).

more at the Medicare.gov link above.

More info for you -

National Law Review: 06/06/2018 - The Hazards of Prescription Auto-Refill Programs 

from the NLR link above:

States may be starting to take aim at prescription automatic refill programs. Automatic refill programs have been proven to increase patient adherence, especially among patients with chronic conditions. However, these programs are not popular among regulators: Medicare Part D and several state boards of pharmacy have prohibited these programs for mail order pharmacies and an increasing number of state Medicaid programs are prohibiting automatic refill programs for both mail and retail pharmacies. Regulators argue that automatic refill programs result in waste to the system, stockpiling, and federal program payment for unneeded prescriptions.

more at the link above ~

[somarco]

@GailL1 this thread is over 2 years old and 100+ opinions.

Opinions are just like navels. Everyone has one and everybody thinks theirs is right.

The good thing about drug plans is this. If you don't like the plan you have change it during the next open enrollment. No one is FORCED to keep their plan year after year. There is no underwriting. No artificial barriers to changing the plan.

We have been through 2 open enrollment periods since this thread began and I see the same complaints, sometimes from the same people.

If someone felt wronged by Optum in 2018 and they are STILL using that drug plan then one has to wonder WHY they are still finding fault with Optum and unwilling to initiate a change.

There are 29 drug plans in my area. In the 4 years I have been on Medicare I have had 3 different plans. It's not a big deal to change.

But I guess some folks would rather complain.

Rant off/

[RN362636]

One must be aware that if they have an ADVANTAGE plan that they only have ONE year to switch to traditional Medicare (Medigap) plan without medical underwriting. That means that if you have a medical condition, especially a serious one that they can deny your application. There is a LOT to consider when obtaining health coverage. I highly recommend speaking to a good Medicare Insurance Broker and also SHIP ( State Health Insurance Assistance program) in your area BEFORE signing up. Don't believe everything you read; go get the facts.

[GailL1]

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@somarco wrote:

@GailL1 this thread is over 2 years old and 100+ opinions.

Opinions are just like navels. Everyone has one and everybody thinks theirs is right.

The good thing about drug plans is this. If you don't like the plan you have change it during the next open enrollment. No one is FORCED to keep their plan year after year. There is no underwriting. No artificial barriers to changing the plan.

We have been through 2 open enrollment periods since this thread began and I see the same complaints, sometimes from the same people.

If someone felt wronged by Optum in 2018 and they are STILL using that drug plan then one has to wonder WHY they are still finding fault with Optum and unwilling to initiate a change.

There are 29 drug plans in my area. In the 4 years I have been on Medicare I have had 3 different plans. It's not a big deal to change.

But I guess some folks would rather complain.

Rant off/

---

My suggestion about complaining to Medicare about a Medicare drug plan (or drug plan embedded in a Medicare health plan) is so that it will be noted for the Medicare star rating system - you do know that there is a monitary rewards for those insurers who get a 4- or 5-stars.

I find it odd,  all these (Medicare) complaints about Optum since they have a big foot print in many other (state and federal) public funded system and employer private systems as the contracted processing agent.

Somehow I wonder if people who are making some of the complaints here have reviewed their Evidence of Coverage, including the Formulary, procedures for the online ordering, pharmacy networks and understand this insurers system which should be spelled out specifically in the document and is updated annually(calendar year) with periodic updates during the year on specific medications.

[m702796s]

Opinions are just like navels. Everyone has one and everybody thinks theirs is right.

The good thing about drug plans is this. If you don't like the plan you have change it during the next open enrollment. No one is FORCED to keep their plan year after year.

EXCEPT...with this AARP Medicare Advantage plan with UHC, YOU CAN'T CHANGE DRUG PLANS.  Do your research before you offer yet one more opinion. With AARP UHC Medicare Complete advantage plan, the drug plan is attached. AND IT HAS TO BE OptumRX and it is so incredibly bad as to be almost criminal. That's why people are angry. The insurance plan is excellent. It's hard to get anything as good. But the drug plan which has to come with it, is horrible. And you can't opt for another drug plan.  No one can figure out why AARP doesn't do anything to circumvent the problem. So they write in the forum hoping to persuade someone to pay attention or to find ways around the ineptitude that is OPTUMRX.

One more opinion here, so be ready....I think AARP gets such a kickback for having their name attached to this Medicare plan and getting so many new enrollees for UHC, that they choose not to care about the drug plan. It's the only answer that works. It's beneficial for the organization that is AARP and they sold out their constituents for the $$$ they get from UHC.

[RN362636]

According to AARP IRS form 8879-TE filing they were paid $1,134,321,120 in "royalty" payments to be exact. This is their primary income source so it is no surprise that they do what United Healthcare wants rather than what members need.

[SpringIsHereVA]

Wow @RN362636 !!!  😱

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[*** @RN362636 wrote 4/17/25:

According to AARP IRS form 8879-TE filing they were paid ➡️*** $1,134,321,120 ***⬅️  in "royalty" payments to be exact. This is their primary income source so it is no surprise that they do what United Healthcare wants rather than what members need. ***]

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[steve6354]

Gail is just a walking book of knowledge.  She just loves to demolish any opinion She does not like. Not very opened minded.

[srk3cats]

Thanks  for the heads-up. Facebook does the same thing. Maybe she works for FB.

[m573000l]

I said that years ago. She obviously is a paid poster or employee of UHC or OptumRX 

[JimJ439704]

I have Optum through a UHC Advantage plan, not as a part of a separate drug plan.  In my area there are only three Advantage plan providers, Aetna/CVS, BCBS and UHC.  The Aetna plans are only two years old including this year so there is little to no feedback on them.  That leaves BCBS which is much more expensive across the board on everything and provides less benefits outside of prescription coverage which seems to be mandated by Medicare on advantage plans).

My single complaint is that Optum does not provide an English as a 1st language customer service option. It is not unreasonable to expect customer service especially for a US Government mandated service be manned by representatives that speak and understand English.  Medicare provides information ad nauseum about how people who do not speak English must be catered to - something I take no issue with - but they seem to have left the majority in limbo on that.  UHC has US based call centers that you can request when someone answers the phone and you hear their poor English right away - Optum does not.

In order to use a retail pharmacy through UHC my costs apparently would triple.

I do not have '29 different plans' to choose from.  I suppose if someone had a deficient reasoning process they might assume that their circumstances applied across the board to every single person on the planet.

[RN362636]

It might be less expensive to just use a goodrx coupon, CostPlus mail order or a CIPA certified pharmacy. None take insurance but it is still often less expensive than the insurance co-pay.

[JazzGirl9]

That really  sounds great to me. I hope you never get very sick, have to stay in a hospital and/or have to go to a skilled nursing facility, get cancer or have any other catastrophic health problems. You're costs can be thousands of dollars. You seem like a very intelligent person and I don't know where you live. I live in the San Francisco Bay Area and there is not a Medicare advantage plan like that. I just hope you've done your homework. That said, I'm happy I never have to worry about paying anything except my monthly premium. No co-pays for anything, no deductibles for A or B, I pay nothing if I need 1 surgery or 12. I also don't have perfect health and almost died last year so I'm happy being covered for whatever can happen. 

[m702796s]

My costs for a hospital stay are $405/ per day for 4 days. The rest is completely covered. If you do the math, in a given year,  I saved $1800 as we said without a monthly insurance payment, so that hospitalization is already cheaper than your costs for a hospital stay in the same year as mine.

Skilled nursing is much the same. I would have to incur more than one surgery in a year for me not to save more money on insurance than you. And the odds of that are slim. Knock on wood.

I'm not saying that plans are the same all over the country. In your area you have to compare similar things and not make gross generalizations about Advantage plans.  Advantage plans are cheaper overall than supplement plans. And supplement plans vary considerably in costs. Medicare requires states to cover the same things in their insurance plans. So when I was shopping around, I found supplement plans ranging from 150/mo to 300/mo. When I asked the difference in what was covered, the answer was there really wasn't anything of significance. Ultimately, what insurance companies are counting on is that you haven't done your homework. When I was looking I even had my son, an economics major, look at the portfolios of the companies I was looking at. Some of them were so shady, using payments to pay themselves, that they were not likely but to go bankrupt in a couple years. Curiously, if they do, you can just pick a different one and not have to wait for the change period.  Bottom line, buyer beware.

[RN362636]

A few of the downsides of Dis Advantage plans are: you must get referrals, you must stay within their network to get the most out of the benefits, you may not have coverage while traveling outside of your network area and they are being dropped like hot cakes by hospitals and physician groups because they don't pay in a timely manner and they have way too many denials for service which patients need.  This isn't just little hospitals either; Baylor in Dallas, Vanderbilt in Nashville, Scripps in SanDiego, Sanford Health, Mercy One, Avera Health and many others have quit accepting certain Advantage plans. I say buyer beware; your favorite doctor or hospital may accept the Advantage plan today but maybe not tomorrow.

[JazzGirl9]

I'm glad you have such good coverage. I hope you stay in good health. I don't think anyone can do the math hypothetically because you can't predict the future and you never know what can happen. I've seen a lot of tragedy in the 30 years or so I was in the medical field and I prefer to be covered for anything that can happen. The choices where I live may not be the same as yours but if you google Medicare Advantage, you can see the possible pitfalls. I sincerely hope you never have to go through a horrible illness or accident and have to have ongoing medical care. 

[jbrough]

We're new to Optum Rx as of Jan 2020. So far it has been nothing but a nightmare. They keep trying to fill my mother's perscriptions with the most expensive product they can find. I've been on the phone with them 6 times now for over a total of 12 hours to get this resolved & get their website correct so I can order the correct product easily and efficiently. Nothing! I've been dealing with this for over 4 weeks and they still have everything screwed up. Meanwhile , they created an order that we didn't need yet, and shipped it!    Horrible, Horrible, Horrible company. Run away as fast as you possibly can.

AARP - If you're listening, you need to step in and advocate for the people that are now stuck with your United Healthcare/ Optum Rx affiliate. Drop them like a friggen rock! They need a huge class action lawsuit and subsequent bankrupcy to put them out of their dang misery!

Regards,

Steve & my 95 year old lovely mother Dolly

[m573000l]

Their method is to give bad info, disconnect you, send you to someone else, frustrate you and wear you down till you can't take it anymore. 

[m702796s]

OptumRX can't and won't exchange your mom's scripts with the most expensive thing out there.  They are by law ONLY allowed to fill for whatever your doctor wrote. If they err on any side at all, they will choose the cheapest generic they can find with which to fill your prescription. They will not give you choices for generic manufacturers when one might work better for you than another. They say they are too big and they can't provide that service. Some private pharmacies will do that though. You can call around and find the manufacturer you like at the pharmacy of your choice. They have to tell you which company they use to fill which medicine's generic and you can request one over another. You are not obligated to use Optum. If you are having an issue with a medication, ask your doctor to rewrite the prescription and get it in paper form. Then take that script to wherever you get the best deal. My husband's script for Indomethacin at Optum costs several hundred dollars. At Costco we got it for less than $30. Kroger has a savings club you can join for a few bucks a year. My $47 prescription at OptumRX costs me nothing at Kroger as long as I subscribe to the club. The subscription is less than the cost of one script with Optum. So you have to do your homework but you can beat the idiots at Optum.

[somarco]

@m702796s OptumRX can't and won't exchange your mom's scripts with the most expensive thing out there.  They are by law ONLY allowed to fill for whatever your doctor wrote. 

Where did you get your law degree? You should ask for a refund.

http://www.gleevec.com/assets/pdf/health-care-professional/GLI-1159132_daw.pdf

[m702796s]

Oh....A little harsh.....

DAW is completely different than what the gentleman was referring to. In order to dispense a more expensive prescription than what the doctor wrote for, the pharmacist would have to call the doctor and ask for permission to change the drug, either because it's not in the formulary or it's not indicated or it's in conflict with another drug the patient is taking. But a pharmacist cannot just change IndomethacinXR (expensive in some formularies) for DiclofenacER or Diclofenac (very cheap)  just because they want to. That means the pharmacist is practicing medicine without a license.

As far as DAW is concerned, it mostly pertains to dispensing BRAND over generic. OptumRX and Novartis (in your cited article) are more likely to dispense generic as it is considerably cheaper for them. This is listed in their policies if you go research them or ask them. So they are more likely to go cheaper than more expensive. That's the need for DAW.

This forum is meant for people who are getting the run around from Optum. There are ways around the headache. The gentleman can always ask his doctor what the script was written for. And insist on that. I have learned not to have any of my doctors send electonic scripts. Optum fills them whether you want them or not. And I NEVER again will leave a credit card on file with Optum. Same reason. You can always ask your doctor for a paper script and then make a photocopy and have that as evidence. The paper script also allows you to shop around for the best price for your drug. And if in fact Optum or any other Pharmacy subsitutes expensive for cheaper, you have the option to report it to Centers for Medicare Services as Medicare fraud. They're pretty serious about that. 

[JimJ439704]

One thing that needs to be done is for Congress to mandate companies providing Medicare have their customer service based in the US. It's a mockery of a US Government system being serviced by people from another country. With UHC when I reach an overseas call center - I immediately say 'transfer me to a US call center' and they do so without complaint. I've tried that with Optum and end up with another Philippine's rep who I can barely understand. Try performing a search for how to reach an English language call center rep for Optum, all the results come back about how someone who cannot speak English can reach a rep who speaks their language. So English is not a priority with them. I have emailed their support in the past and received no reply whatsoever. At least in writing it would be more difficult for them to misunderstand you.

[LeslieS242412]

Outsourcing is killing the US - let’s pay this company 12$ per hour instead of 16 here we will save so much money, yet welfare and all assistance services go up. Outsourcing should be illegal.  We cannot employ non citizens IN the US why can we employ them outside the US? Lame