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!!!

[steve6354]

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

[srk5cats]

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.

[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.

[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 

[m155186b]

Whom do I complain to about the BAD customer service at OPTUMRx? I have been trying since January 3, 2020 to get my Rx moved from CVS to OPTUMRx. Here I am leaving for Wave 1 and I still don't have my medication and I am out. OPTUMRx does not have:
Decent voice recognition system on automated system…..keep having to repeat information
Information given in automated system does not transfer over to customer service representative. I have to tell them all information again, this make 3-5 time of repeating myself.
Mail order is a mess, I can only get 30 day supply and not 90.
Can we switch to CVS again?

[PeggyW881599]

Optum (or UnitedHealthcare, which owns Optum) actually called me and assigned a personal rep for me to contact anytime I had a problem. She figured out what was causing the problem (there was an erroneous indication on my record with them that I would not accept the generic equivalent) and fixed it! While she didn't OK my posting her direct line she did say I could give you the corporate 

number 800-343-4227 so a case can be assigned to her (Patricia Esparza) or other corporate agent. She is very helpful, competent and empathetic but it appears the core issue still exists, poor training of the frontline call center staff.

[JimJ439704]

How did you ever get them to do that for you? 

I almost never reach someone who can understand me or that I can understand. If I ask for a US call center - something that works immediately when I reach an English as a 2nd or 3rd or 4th language call center when calling UHC - I always get the same slurred jumble of whatever they are trying to say.

They constantly repeat the same lines over and over 'we're so happy you chose Optumrx' etc and lately have taken to start asking me when my next doctors appointments are and other none of their business questions.  They butcher my name which they also repeat endlessly.  

I would pay extra to reach a US call center where people could understand what I am calling about.  

The US should mandate that all medicare call centers and medicare prescription service call centers are based in the US.

[JazzGirl9]

Hi again 

Did you call 800-971-7658? Just wondering. 
Nina

[JazzGirl9]

Hi Jim

I know, it's more than terrible. I think calling from a Dr's office made a difference. When you call, do you get an option that asks if you're a patient or calling from a Dr's office? If not, I can call where I used to work to see if I can get that number for you. So sorry you're having trouble. It is unconscionable for anyone not to be able to get their meds. As far as outsourcing... don't get me started. They also have a ridiculous cookie cutter thing they have to go through and you HAVE to tell them you want to speak to their manager, and be persistent. If their manager doesn't help, insist for customer service and don't let them intimidate you. If I were you, I'd switch to Express Scripts any day. They are always polite, helpful and knowledgeable. They transfer you to whom ever can help you. I've even spoken to a pharmacist to ask if there was another pharmaceutical company that made a med I take because the one I was taking bothered my stomach. They gave me a lot of options and I did research on google to see what other people say. You're Dr can indicate on the Rx what brand you want. Also,  If you're on a controlled substance, you can only get a months worth no matter where you go because insurance will not pay for more. Hope this helps and let me know if you need that phone number. 
Nina 

[JazzGirl9]

Your Dr should be able to send your prescription anywhere where you are covered whether it's CVS or Optum. Does your Dr send yours electronically? Most do and it's easier for them. Just tell the office or Dr where you want it to go. As far as complaining, I'd call customer service if you can reach them. Please don't wait until you're out 😞 

[PMDL57]

I don't know what to do. Can someone help me.

I've been on tramadol for over 20 years for my fibromyalgia and arthritis.  I hurt all the time but it makes my life bearable. As I work full time in retail all my life. I have three adult children, two wonderful grandsons and great friends that keep me busy in my life.

Optum RX now once to limit my pain medicine and send me to pain management. They lied on my phone and told me my doctor sent a referral to send me there. Which she didn't they asked her for one 

My problem is I have friends in pain management and the stuff they're dealing with still don't help their pain. I have come up with many techniques to help my pain not be so bad all the time. Plus I don't have to pay a $2,000 a year copay to do it. Because they won't be paying my co-pay or deductible I will be. What gives them the right to tell me to go to pain management and to limit my medicine. 

I'm just called my doctor to find out how I can get my medicine without being limited to getting one week at a time and go visit her one week at a time. Cuz I can't afford that.

What are my rights.? I don't want to call Optum RX after hearing all the problems you all have. What should I do now? Thank you for listening prayers to all. Pam

[CKM816]

I have fibromyalgia as well, and have tried a lot of prescription medications to no avail. I ended up going to a physician who is focused on holistic medicine, and she has helped me A LOT. She recommends using an herbal medicine called 'Tranquility' which you can get on Amazon. I take 2 capsules 4x/day and it really helps. There is another herbal medicine called 'GABA' which works well and is also available on Amazon. Same dosage.  You can even take them together if you are really suffering,  but I find I rarely have to do that. 

I would also recommend that you check into getting a blood test called 'MRT'. It tests to see if you have food sensitivities that could be making you suffer. Food sensitivities are not food allergies. I did it as did 2 of my friends with other horrible problems (they were not diagnosed with fibromyalgia,  BTW) and we all had problems with different foods.  If I stay away from those foods I feel much better! 

There is also a book called 'Prescription for Nutritional Healing' which has been my bible for almost 30 years. It's a wonderful resource for lots of ailments, and is updated regularly.  It combines traditional medicine with herbs, supplements and diet and has helped me with my many health issues.  

Lastly, opioids are not a good solution for fibromyalgia.  Get help weaning yourself off of this drug and try changing your diet and using the herbal medicines that I  have mentioned.  And if you don't want to spend money on the MRT test then look up 'Anti-inflammatory Diet' online and follow that as closely as possible.  I went to a pain management doctor 20+ years ago after a spinal fusion,  and all the meds did was make me a zombie.  Diet and herbal medicine is more effective and not addictive. 

Good luck! 🤗

[GailL1]

---

@PMDL57 wrote:

I don't know what to do. Can someone help me.

I've been on tramadol for over 20 years for my fibromyalgia and arthritis.  I hurt all the time but it makes my life bearable. As I work full time in retail all my life. I have three adult children, two wonderful grandsons and great friends that keep me busy in my life.

Optum RX now once to limit my pain medicine and send me to pain management. They lied on my phone and told me my doctor sent a referral to send me there. Which she didn't they asked her for one 

My problem is I have friends in pain management and the stuff they're dealing with still don't help their pain. I have come up with many techniques to help my pain not be so bad all the time. Plus I don't have to pay a $2,000 a year copay to do it. Because they won't be paying my co-pay or deductible I will be. What gives them the right to tell me to go to pain management and to limit my medicine. 

I'm just called my doctor to find out how I can get my medicine without being limited to getting one week at a time and go visit her one week at a time. Cuz I can't afford that.

What are my rights.? I don't want to call Optum RX after hearing all the problems you all have. What should I do now? Thank you for listening prayers to all. Pam

---

This isn't the fault of the pharmacy - New Guidelines have been issued by the CDC on the prescribing of opioids and related pain meds for those with Chronic pain - This differs from those who have cancer-related pain or are at the end of their life from cancer or other painful conditions.

CDC GUIDELINE FOR PRESCRIBING OPIOIDS FOR CHRONIC PAIN - Factsheet 

Tramadol is similar to an opioid (narcotic) analgesics.  It is a controlled substance and thus is regulated.  There is a risk for abuse and addiction, which can lead to overdose and death. This is why your pharmacy wants you to be re-evaluated by your doctor.  The doc will evaluate you to see if something else will work that is not so addictive - pharmaceutical, medical or physiological - or a combination.

I don't know about Tramadol per se but sometimes there is an addiction offset to other addictive meds that the doc can also prescribe.

Yes, your doc may ask you to work with a pain management specialist  He may want you to try other methods of pain control in addition to weening you off the Tramadol slowly.  If you are kept on this medication, most likely you will have to see your doctor more often for refills. 

Nothing against you or your pain, health care providers did it wrong previously and now they are having to reevaluate their patients.

You are like millions of others - prescribed a pain medication as an easy fix to whatever - many of these people are now addicts or they may be no longer with us.

20 years on this medication - time for a review - there maybe something better for you depending on your chronic problem.

[JazzGirl9]

I totally agree with you!! I spent 45 minutes with customer service and a pharmacist on the phone today. I am in the middle of choosing a Medicare D provider and I was appalled at what I was told. I just retired and I worked in the medical field for over 25 years. One of my jobs was to get prior authorization for patients mediation so I know the ropes and what constitutes good medical care. I take a particular medication and one of companies who manufactures it makes a product that causes side effects and makes me sick. I was told I had no choice of pharmaceutical companies to choose from. I would get whatever they had on hand for the day or week or whatever!  I asked if it mattered if it made me sick and was told I could try to get a prior authorization for brand name. Ha ha... what a joke. Medicare will not pay for brand names, even if you’re dying on the street and even if the medication is brand name only. You have no idea how long I have spent on the phone arguing with an idiot or idiots who want to practice medicine without a license and give someone something THEY think would be an appropriate substitute. No no! I spoke to Express Scripts today and they take these things into consideration and had more than 6 pharmaceutical companies to choose from. I’m not sure how their prior authorizations go because Medicare keeps changing their formularies but I’ll go with a company who cares if I get heart palpitations from a medication and have a pacemaker anytime! 

[p218181h]

The WORST pharmacy ever. Refused to refill a prescription and flat out lied to me about trying to contact me and the doctor. I’ve had nothing but trouble with them since my first encounter. Horrible horrible company. Someone should investigate them. 

[hpbob]

My doctor prescribed a medication which was very pricey and I was able to use Optum Rx to find an alternate more affordable medication. I am sure it helped that   my Optum Rx profile is set not to autofill any prescription  but to wait for me to make an order.  I was able to take the information I got from Oprum Rx back to my doctor and got him to change my prescription to the cheaper medicaiton.

[SusanK442205]

I am totally fed up with this company. Will be changing Part D in October. Have had this company for 3 years. They have screwed up more scripts than I can count. I have spent endless hours with them and United healthcare. They are all the same outfit. STAY AWAY is correct. They have billed my card when not approved to. Caused overdrafts in my bank. Sent drugs when not ordered. Now there is a disputed charge and they said they would remove but will not. Bad outfil all around. AARP should be better at helping us sort this out. Get a new company. Things really went downhill more with Optima in the past 6 months. So something has changed there..Whether foreign drugs or mismanagement.

[w161299c]

Totally agree with all! This company is horribly inefficient. Something needs to be done.

[w161299c]

I just had another nightmare experience with Optus RX. Without a doubt, they are the most woefully inadequately run business ever. Hours on the phone with people who cannot answer questions. Here was my question...would you please email me instead of calling me when you need prior approval? The answer was ‘I’m not sure.’ No kidding, the idiot actually said that. I am absolutely outdone with them. But it appears we have no recourse. What would it take to get support from AARP on this?

[aw6946]

I do NOT think AARP cares.

1. Look at Wikipedia, AARP undercut having a better universal healthcare for citizens. I don't believe in a single payer system for many reasons (1st of all the other options FUND Medicare's shortfalls).

2. They are a marketing company. Even with their Tax-aide program, they are now collecting more and more data FROM YOU. 

BEWARE OF AARP. I am not a member anymore.