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Re: Optum RX - STAY AWAY

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Message 21 of 129

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.

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Re: Optum RX - STAY AWAY

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Message 22 of 129

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.

 

 

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Re: Optum RX - STAY AWAY

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Message 23 of 129

@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/


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Re: Optum RX - STAY AWAY

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Message 24 of 129

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 

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Re: Optum RX - STAY AWAY

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Message 25 of 129

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

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Re: Optum RX - STAY AWAY

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Message 26 of 129

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 

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Re: Optum RX - STAY AWAY

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Message 27 of 129

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. 

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Re: Optum RX - STAY AWAY

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Message 28 of 129

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. 

 

 

 

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Re: Optum RX - STAY AWAY

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Message 29 of 129

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.

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Re: Optum RX - STAY AWAY

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Message 30 of 129

@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

 


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