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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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United Healthcare owns AARP intellectual property. That's why AARP can't drop them as an advertiser. If AARP cared about their subscribers being ripped off they would do something about it. Everyone should cancel their AARP subscriptions.

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 

It's Always Something . . . . Roseanna Roseannadanna
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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 ~

It's Always Something . . . . Roseanna Roseannadanna
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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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@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.

It's Always Something . . . . Roseanna Roseannadanna
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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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Gail is just a walking book of knowledge.  She just loves to demolish any opinion She does not like. Not very opened minded.

Super Contributor

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

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I said that years ago. She obviously is a paid poster or employee of UHC or OptumRX 

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@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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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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Periodic 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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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. 

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

Regular Contributor

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. 

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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.

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@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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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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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.
Newbie

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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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?

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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.

 

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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.

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Hi again 

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

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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 

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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 😞 

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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

 

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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! 🤗

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