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Re: Optum RX - STAY AWAY

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Message 21 of 126

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 


* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Optum RX - STAY AWAY

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Message 22 of 126

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 23 of 126

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 24 of 126

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 25 of 126

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 26 of 126

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 27 of 126

@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

 


Bark less. Wag more.
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Re: Optum RX - STAY AWAY

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Message 28 of 126

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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Re: Optum RX - STAY AWAY

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Message 29 of 126

I"m not sure where you live and what your Advantage plans look like, but Medicare is Medicare. All payments from Medicare are the same to doctors. Medicare pays 80% and the supplement picks up the rest. You have no costs after treatment because you pay it up front with your $150 monthly premium. That will go continue to go up as you age.

I have no monthly cost. I pay a copay for each visit to a doctor of $45 if he's a specialist. Nothing for Primary care. I can control that by who I see and how often. And I can see anyone I like. After my copay, I have no bills for most procedures. An outpatient surgery is $405 copay. But there are no other charges. You will have paid that cost in monthly premiums over three months whether you have surgery or not.

As far as doctors not taking Advantage plans, they can't tell the difference. Having to stay within a network of doctors varies by plan and those plans are usually privately backed by local healthcare systems in one area trying to monopolize business. With UHC you can go almost anywhere. They are huge.

Private doctors may limit their practice for Medicare because Medicare as a rule does not pay well (Thank the Republicans and this will get worse if Trump is reelected. They've run up a trillion dollar deificit giving tax breaks to the wealthy and they will recover that by penalizing the old and poor) A doctor. will go broke if he has to subsist on Medicare. But hospitals don't care. If they take any Medicare, they have to take ALL Medicare.

Most salesmen who sell policies sell supplements because their kickback is better from the insurance companies. They also have to retrain in Advantage plans every summer to be certified to sell them. Most don't want to do that so they sell supplement plans as if they are better when they are not. The salesmen are just lazy. They don't get paid as much and they have to put out too much. Your welfare is not their concern. My salesperson told me this. I am very happy she talked me out of a supplement and into an Advantage plan. My only problem is that the best plan out there is UHC AARP and I have to take Optum with it. So I just work around Optum. She has saved me a ton of money.

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Re: Optum RX - STAY AWAY

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Message 30 of 126

I'm sorry but that's not true. A lot of Dr's don't take Medicare Advantage. You have to stay within a particular network of doctors and I don't like that. It's worth it to me to pay extra. The benefits are also better. It's a choice I made because I saw what those plans did to people and their health. I'm not being snobby but this is from my experience working with very upset patients who have been turned away from providers they've seen for years. HMO's have more control over your healthcare and the doctors have to put up with their BS. They often have to fight with them for procedures or tests they order. Look at the issues people are having with their prescription coverage and dealing with Optum. I want more control over my healthcare. Sad but true. 
Nina

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