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Periodic Contributor

Optum RX - STAY AWAY

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!!!

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Newbie

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.

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Honored Social Butterfly


@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. 

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Newbie

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.

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Periodic 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!

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@RayAnita1981 wrote:

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!


Can you order a 90 day script through the local pharmacy at the same cost or rather what is the cost difference?

 

I have been to my local CVS who told me yes they would fill a 90 day script yet the UHC site states you cannot fill a 90 day script through a local pharmacy though that may mean there are charges for 3 30 day scripts rather than 1 charge for a 90 day script.  UHC implies my costs would be 3 times as much to walk to my local CVS. Once a CVS clerk looked up a script for me based on my plan and said the charges would be the same but on every other occasion I have asked they have always said that I would have to actually have a script to them in the system in order to get a correct answer.

 

I could also get three different answers on that from 3 different reps so the opportunity to get an answer from someone who is actually doing it is pure gold - thank you in advance for any info you can impart.

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Periodic Contributor

My insurnace is United Healthcare, through my spouse's employer. OptumRx is a division of United Healthcare.  That is why they push (to put it nicely) people to have their RX filled through OptumRX.  

 

United Healhcare will not allow Walgreens to fill my prescription that is WRITTEN for 90 days, to be filled for 90 days.  30 days is max allowed.     

 

The same medicine, when my insurace was Blue Cross Blue Shield, was 20.73 for 90 days when filled at a Safeway pharmacy.

I now pay a little more then $20 for a 30 day supply.

 

Hard to say if the difference in price is due to me changing insurance companies, if medicine went up in price over the last few months, if the one pharmacy is more expensive then another, if I am being "punished" for not going with Optum Rx, or a combination of factors.  (I lean towards United Healthcare is punishing me.) 

 

At this point, it is worth it to me to pay more (for this particular medicine) to NOT have to deal with OptumRx!  

 

Maybe they only increase the price for certain meds?  I have a VERY expensive RX coming up.  I hope to find out this week IF Walgreens can fill it (it is a speciality medicine) and how much it will be through them.  If I remember 🙂 I will post what I find out. 

 

 

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Newbie

I have United Healthcare Medicare Advantage also.  Three of my drugs are 90 day and I can only use Optimum for 90 refills.  If I go through CVS or Walgreens, I must make 3 co-pays.  Virtually every time I need to get a refill, there is a problem with Optum RX.  I've never once had a prescription filled with them without either a run-around or a problem occurring.  You often get contradictory explanations depending on whom you speak to.  They also show little or no concern that your drug has not been filled and never follow up with you.  Horrible!  

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I am having similar problems with OptimRX.  The have told me they issued a refund check, but it never came.  I went through their messaging center on line. And they first told me they couldn't reverse the charge and put the money back into my checking account, that they would have to issue a check, that never came.  I have called them about 10 times, and have 20 messages.  They still have my money.  I will NEVER recommend them again.  In fact I may even change my  health care to a different company than AARP Complete/United Health Care.  Senior citizens don't need this kind of frustration.

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Periodic Contributor

FOLKS....

 

PLEASE start contacting Medicare to report both OptumRx and your Healthcare plan if it's provided through your advantage type.  Also report AARP UHC to Medicare.

 

This is the ONLY way it will be rectified. This could be considered fraud because people aren't receiving their money.

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Honored Social Butterfly

@aw6946 

🏆

Let's Make it Easy -

Medicare.gov - Medicare Complaint Form 

 

High star-ratings should not be given to companies that don't perform well.  Part of their payment from Medicare is based on their star-rating.

 

You can also vote with your feet - you can switch to another Medicare Advantage plan, a Medicare Prescription Drug Plan, or a combination Medicare Advantage Plan with an included Prescription Drug Plan during Open Enrollment in the Fall each year.

 

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I agree that Optumrx is a terrible company! I have had nothing but headaches dealing with this company and their denial of coverage even when you jump through all of their

hoops ! 

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Regular Contributor

Thank you, actual feedback such as this is much appreciated.

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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!

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Periodic Contributor

Briova is no more.  They are now OptumRX.  😞

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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

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Periodic 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.

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Periodic 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.
 
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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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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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Honored Social Butterfly

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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Honored Social Butterfly

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 ~

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Bronze Conversationalist

@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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Honored Social Butterfly


@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.

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Periodic Contributor

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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Bronze Conversationalist

@m702796s .I think AARP gets such a kickback for having their name attached to this Medicare plan and getting so many new enrollees for UHC

 

Of COURSE they earn a "kickback" for promoting products, INCLUDING those from UHC. Those revenues go to a subsidiary (AARP Services).

 

AARP Services is a wholly owned taxable subsidiary of AARP and provides quality control on behalf of AARP for AARP-branded products. Through the branded products of our service providers, we make available new and better choices to our members. Among these are health and financial products, travel and leisure offerings, and life event services.

 

Fiscal year 2018 showed $299,865,000 in dues revenue and $1,648,795,000 in TOTAL revenues. $938,892,000 came from "royalties" which include "kickbacks" from insurance products.

https://www.aarp.org/content/dam/aarp/about_aarp/annual_reports/2019/2018-audited-financial-statemen...


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Bronze Conversationalist

41 MA/MAPD plans in my area including 7 who do not have a drug plan paired with their MA plan. Five different carriers INCLUDING UHC offer MA without requiring a drug plan.

 

All MA/MAPD plans are "off the shelf, one-size-fits-all" coverage. 

 

If you don't like what's on the menu, go somewhere else. 

 

Or you can complain even though it accomplishes nothing but makes you feel better.


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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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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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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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