Contributor ⭐

Optum RX - STAY AWAY

Forum|Forum|8 years ago
January 26, 2018
194 replies
204828 views

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!!!

optum rx

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PMDL57

Contributor ⭐

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

GailL1

Community Champion ⭐⭐⭐

@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.

IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna

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RN362636

Contributor ⭐⭐⭐

Oh my, she has been taking it for 20 years with success and hasn't overdosed. The government and pharmacies need to stay out of the doctor patient relationship. My mother is 86 and not a good surgical risk for a ruptured disc and her doctor gives her pain medicine but the pharmacy didn't want to fill it because she has been it on a regular basis. Are you kidding me!! She has legitimate pain and all the physical therapy or whatever isn't going to fix her problem...she needs and deserves pain control. Unfortunately, what sometimes happens is that when a patients pain medication is cut or eliminated they will reach out to illegitimate medication off the streets and then they don't really know what they are getting. It may be mixed with Fentanyl or something. It is those who most often overdose. The other thing that makes no sense to me is getting a patient to quit pain medication by getting them into a Methadone program. That is just legal synthetic heroin. Is that really better than taking pain medicine?

M

MarcusG840519

Contributor ⭐

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?

J

JazzGirl9

Contributor ⭐⭐

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 😞

R

RN362636

Contributor ⭐⭐⭐

With a United Healthcare ADVANTAGE plan the choice is OPTUM only. However there are other options that are often less expensive than an insurance co-pay that are worth checking out: CostPlus Drugs, Goodrx coupons, Costco pharmacy, Kroger (Dillons) Health Savings Club, CIPA certified pharmacies, etc. They don't take insurance but the cost is often less than the insurance co-pay. Why should a co-pay be more than a cash price? Most don't know that if you go to a local pharmacy that they are not allowed to tell you that a script would cost less if you just paid cash; you must ASK them what the cash price would be. That doesn't seem right to me either but that is the way the drug industry controls their profits. Our whole system is broken and is in need of many changes which actually help the public instead of the industry profit.

J

jbrough

Contributor ⭐

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

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JimJ439704

Contributor ⭐⭐

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.

L

LeslieS242412

Contributor ⭐

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

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JazzGirl9

Contributor ⭐⭐

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.

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m702796s

Contributor ⭐⭐

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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JazzGirl9

Contributor ⭐⭐

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.

C

Cindoc95

Contributor ⭐

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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JazzGirl9

Contributor ⭐⭐

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

srk3cats

Contributor ⭐⭐

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

A

aw6946

Contributor ⭐⭐

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.

D

de7763889

Contributor ⭐

I'm very tired of the lies from Optum RX. I would love to see them go out of business they are so furstrating and hold no intergerity with me.
My prescription doen't cost me a thing, but they will not allow me to use their automated system unless I give them a credit card. But when I talk to someone, they give me the prescription without asking for a credit card.
I've had my credit card number has stolen before. If there is no charge, why do they require it? And then later send me the prescription without any credit card number?
This issue happens every 3 months and every three months they say they will notify management. But nothing changes. I don't trust them with my credit card number and it's not needed. So why do they want it?
AARP needs to get rid of Optum RX

A

aw6946

Contributor ⭐⭐

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.

R

RayAnita1981

Contributor ⭐

I was able to call United Health Care/Optum RX and opt out of home delivery. This allowed me to use a local pharmacy.

A local pharmacy that is able to fill my prescriptions in a timely manner and correctly!

The number I called 1-866-236 1495

Hope this helps!

J

j74451t

Contributor ⭐

Thank you for providing phone number.
Why AARP is still using them ( rather tha BRIOVA) is beyond me.

I know your calm information will help a lot of people!

R

RayAnita1981

Contributor ⭐

Briova is no more. They are now OptumRX. 😞

Drucifer

Contributor ⭐

Someone tried to sign me on to Optium RX or they're fishing.

First I got an autocall where I just had to say YES to join -- I hung up.

Then I got an email asking me to auto-reply -- didn't reply

Stay Away doesn't describe the above.

P

p243396w

Contributor ⭐

I am being charged $600 when the price at Walmart for the same item without insurance is $36. Had Drs office contact optum twice now without response.

Best plan seems to be switching to different company asap. Filed complaint with Medicare, bbb, consumer affairs., and bank of america. Maybe there using the current pandemic situation to steal from seniors. Could be possible.

GailL1

Community Champion ⭐⭐⭐

@p243396w wrote:
I am being charged $600 when the price at Walmart for the same item without insurance is $36. Had Drs office contact optum twice now without response.

Best plan seems to be switching to different company asap. Filed complaint with Medicare, bbb, consumer affairs., and bank of america. Maybe there using the current pandemic situation to steal from seniors. Could be possible.

Every insurer negotiates their own prices on different drugs. Medicare dictates via law which different classifications of drugs they have to carry on their formulary and how many of a certain type. You have the right to chose the insurance that is best for your needs - including which meds and their cost. You have the right to change a Medicare Part D plan or a Medicare Advantage Plan with or without a built-in drug plan every year during open enrollment.

But, if you are correct in your price check on this medication, then why not just buy it at Walmart without using your insurance. You might even check GOOD RX to see if you can find an even cheaper price. How Good Rx Works

You are mandated by Medicare to have drug coverage or face a premium penalty if you ever need the coverage. But they don't mandate that you have to use it.

Insurance is a share and share alike instrument - you pay your premium not just for yourself and your coverage but to also share with others to help them cover themselves and their needs.

IT‘S ALWAYS SOMETHING . . . . .. . . . Roseanne Roseannadanna

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