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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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All AARP members who have been screwed by Optum should go to the "Contact Us' and send AARP a message. They should not be recommending them to the membership. Recently we changed insurance and had OptumRX forced upon us. We had Aetna before and used the Caremark system, which was great. I started over a month ago trying to move over my prescription. My doctor has had to call in the prescription three times. I've had to call 4 times. Each time the agent I reach first gives me the wrong information, several versions of the wrong info. First they say the reason it didn't ship was because it was set up as an auto refill (ugh?). Then they say it is fixed and I should receive by x date. Then I say that doesn't make sense, they look closer and then they say my insurance doesn't cover it because it is a brand name. I say the generic equivalent is fine, the don't make the brand name anymore. All you can get is the generic. Then they say they have fixed it and I will receive by date. X date comes and goes, no emails, no phone calls, and no prescription. Then I call again and go through the same routine. Four times. Today I was SCREAMING at the agent. I said I would not get off the phone until I had a tracking number. I refused to accept her lies and finally they transferred me to a US based agent (her words not mine). Turns out someone had clicked that I would only accept the brand name prescription (God only knows why) and that was why it kept crashing. Again, no phone calls, no emails, the request just disappears. The US agent had seen this happen before. The problem is the call center, the first person you get is out of country, new, inexperienced and they very simply lie. They tell you what you want to hear to get off the phone. I had to tell the agent, Maind, that I would not get off the phone without a tracking number that showed I would receive the drugs tomorrow. I basically refused to budge 6 times saying "nothing ia acceptable except these drugs will be received tomorrow." She finally said she would transfer me to a US agent but it was only because I said repeatedly I would not budge.

These are drugs I need to live. I have Parkinsons. Stress is very bad for me and this has caused incredible stress.

The link to check your order status in the email you receive confirming your order sends you to UnitedHealthcare. No way to get to the order status from there! And option to send a message from the 'Contact Us" on the OptumRx site doesn't work.

So they are incompetent at all levels! I plan to complain loudly to United Healthcare and to our employer for choosing a company that is so bad. Given the reviews posted I am not the only disgruntled one our there.

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Newbie

I am having the same issues!!!!!!!!!!!!!!!!!!!!!!!!!!!  It has been a nightmare!!!!  I started with them Jan1 with our new coverage and I have been on the phone several times and my doctors trying to get my medications transferred.  They are useless!!!!

Caremark was awesome, NEVER had these issues, none!

I had a heart attack 2 years and I had to fight to get NITRO!!!!  Unreal!!!!

Why did United Health Care go to these idiots!!!!!!!!!!!!!!!!!!!!!!!!!!!

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Contributor

Same problems here. I’ve tried to order meds on three occasions each time I had to call. The app is horrible, missing prescriptions or meds listed under the wrong family member. No phone number listed to call and no prices visible until you place the order. Last call was an hour long to get my daughter’s arthritis med. They to deny my request to speak to the Pharmacist. I strongly recommended avoiding this company. Unfortunately we have no choice as it is through my husband’s employer. No customer service and meds are 3x the cost of Medco.
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Regular Contributor

Hi Pamela
You’re Dr should to send refills or new Rx’s  to Optum either via electronic submission, call or fax. There is nothing you can do about their formulary if Rx is not on their list but whoever handles prior authorizations your Drs office can try to do that if your Dr thinks it’s detrimental to your health to change. Do not use the app to refill drugs. Call your Drs office for them to submit them. Not much else I can say. Did you call the phone number I posted? Sorry you’re going though this but Optum insurance is not the best. Good luck. 
Nina
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Thank you for the help . Our Doctors have submitted scripts electronically and followed all the necessary procedures but this company has continued to make mistakes. We had two more problems since my first post that took hour long phone calls again. I’ve only had one problem with formularies that was resolved by a doctor appeal. Just a total lack of competence on the part of this company.
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Periodic Contributor

Do Not submit scripts electronically unless you want Optum to fill it automatically. If you EVER give OptumRX a Credit Card they will keep it, store it until your next doctor-submitted prescription, and fill it whether you need it or not, and charge your card. ALWAYS ask your doctor for a printed prescription, and then take it or send it wherever you want it filled. Shop around for the best price. I have received free prescriptions after joining the Kroger savings club for meds which cost me $47 through my plan. Shop around.

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Regular Contributor

I wonder if there is a way to change  plans if you call Medicare to complain. There also may be a time frame to be able to switch. 
Nina

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Periodic Contributor

You can't change prescription plans unless you change insurance carriers. OPTUM is UHC's prescription drug plan and it is a part of UHC. You can change insurance carriers in NOV/DEC during change time and possibly choose a new drug plan. But you have to leave UHC.

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Periodic Contributor

if you are on the advantage system......only

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Regular Contributor

Interesting. I have United Healthcare supplement and Express Scripts. Is that with Medicare Advantage only?

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Periodic Contributor

Yes. It's an AARP/UHC Advantage Plan. It costs me nothing per month.  But I'm stuck with the idiocy that is OptumRX. After three years I have learned to work around them. There are many ways to do it. Don't expect them to change and don't expect AARP to help you. I think they are doing their members a terrific disservice, but AARP doesn't seem to care as they must be getting a great kickback from UHC.

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Regular Contributor

Sorry, I don't know much about Medicare Advantage. I personally don't like any HMO coverages because I know how they operate. It's a big stretch for me to pay an extra $ $150 per month on top of the Social Security Medicare premium. It is worth it for me not having the headaches even though it's more expensive and I'm not a wealthy person by any means. I don't like insurance companies dictating to me how to handle my medical care. 

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Periodic Contributor

Advantage plans don't dictate any part of your healthcare to you. You can go to any physician you want to. They are the same as any supplement plan, but they often don't have any monthly coverage costs. With your supplement plan, you are paying $150 a month in addition to your Medicare deduction from your social security check. That's $1800 a year extra.

I pay nothing for the same benefits with my Advantage plan. While you may have no copays for dr. visits, I have a $45 copay for a specialist visit (nothing for primary care).And no other charges. I would have to go to a doctor three times every month to get to the costs you pay monthly. That never happens. So I save money with my advantage plan even if I have up front costs. It's so much cheaper. It's like paying ala carte for food vs. paying a lump sum for a banquet you're not going to eat half of. Insurance companies under Medicare have to offer the same product. Medicare coverage is way different than private insurance plans. You are paying extra for no extra coverage.

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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

Periodic Contributor

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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Regular Contributor

I should also say that UHC pays all my Medicare deductibles (I was lucky enough to get Plan F because I turned 65 in December) but I don't think that's available anymore in 2020. There is another plan that's similar. Maybe during open enrollment you can change? It's not worth it to me to have the aggravation if you can pay but I know that not everyone has that option. My Medicare D is not an expensive plan. It's under $30 a month but I don't take many meds. I get a couple of them at Costco for dirt cheap out of pocket and don't use insurance. 
Nina

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Hi Sylvia

I don't know much about the time line where you can switch insurances but I haven't had any trouble (yet) with Express Scripts. I don't take many medications and a couple of them that I don't take everyday I pay for of pocket at Costco but geez... Nitro is dirt cheap! Can you switch back to Caremark? If you have a high deductible you can call Costco (if there's one nearby) and ask them how much your Nitro is. I have an inexpensive coverage with Express Scripts that I pay about $23 dollars a month for. They are extremely helpfuI and I don't go through AARP at all. Good luck with everything, Sylvia. My old boss used to say "don't get old!" 

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Peggy, that's terrible! I think they all suck, pardon the language. I worked in medical offices most of my adult life and it's getting worse and worse. I don't know if this pertains to you but sometimes the Dr's office (usually a provider) inputs I prescriptions wrong... I saw it happen all the time. Everyone is so rushed and crazy these days because nobody wants to pay to have enough staff regardless, of where it is. I do remember Caremark being pretty good, but the problem is, with all of them, they change their formularies all the time and want you to take what they cover and all the insurance companies have their own. It's horrible. I saw patients decide not to take their drugs because it wasn't covered! We're talking blood pressure and diabetes meds! I used to fight with the insurance companies all the time but it gets harder and harder. It brought me to tears, the injustice of it all. They have stupid people answering the phone that go through a cookie cutter form that has nothing to do with the patient's situation. It's a nightmare to get to a pharmacist on the line.  I'm glad I just retired but let me tell you, Medicare D was so scary for me to choose, even with all my 30 years of knowledge. I still don't know if I made the right choice! Good luck with everything, Peggy, you'd think now that we've retired, we'd have less stress. I miss my job paying for my insurance:( 

Nina

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Honored Social Butterfly

@PeggyW881599 

You can also file a complaint with Medicare.

Medicare.gov - Filing complaints about your health or drug plan 

 

Time to switch - open enrollment is now going on until December 7, 2019

It's Always Something . . . . Roseanna Roseannadanna
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 I have had it with this company!  Briova Rx was magnificent in their caring, meticulous handling of my mail order prescriptions, my pharmacy questions and truly caring about my physical ( and emotional!) well being. The opposite is true of Optum.  Among the problems I have encountered:

 

1) Overcharged $200. for a prescription TWO years ago....14 phone calls...promised tracking #’s then giving me a Reference #...with no follow up. Another 1 hour and 17 minutes of my life just now only to receive yet another Ref#.,

 

2) OptumRx CHANGED my doctor’s prescription order!  The amount of medication...and, of course, the price.

 

3) Orders promised, not received.  The required equipment to use this medication...not received.  

 

I would not only advise everyone to stay away, I would urge those of you who have been duped into using Optus (rather than companies like BriovaRX,) to send Op-Ed’s to newspapers, to Medicare, to your local representatives.  

 

This is company needs to be shut down immediately!!  Needless to say, I will be changing prescription drug plans this fall.

 

 

 

 

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I DON'T THINK THIS IS CORRECT.   I BELIEVE OPTUMRX IS A PBM WHO

BILLS THE INSURANCE COMPANY--AARP MEDICARE COMPLETE HMO AND PAYS THE PHARMACY.  I THINK THIS AMOUNT IS SIGNIFCANTLY 

DIFFERENT WITH UPTOMRX KEEPING THE "SPREAD" AND AT LEAST

SOME OF REBATES FROM WHOLESALERS/MANUFACTURES. 

WHY THIS IS ALLOWED???

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Periodic Contributor

So I went down the rabbit hole and tried to discuss why the formulary was changed so that previously covered drugs were no longer covered. All I can say to you is that the almost 2 hrs being bounced around United Healthcare (OptumRx) got me nowhere. They want their money and they dont care about you.

As an fyi I should have done my due diligence better and compared companies on my drugs.....shame on me for not being better informed. SHAME on AARP for not having the seniors backs and stepping up not just on this but all of the take aways United Healthcare did....silver sneakers etc......

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Hi, I'm Greg and have been disabled since 2012. I had no other but to use SSDI due to moving from N.Y. to S.D. and osing my Health Ins. and clould not pay enough to get another company to pick me up. I wasn't even able to join S.D. risk pool due to prior condition ( L-4,L-5 ) fusion. I have so many problems here with the system here and recently presciption refills even with prior auths. I only last week found out from a Nurse trying to help me have my regular medications refilled that OptumRx is contracted by S.D. for mdication refills. I'm stepping into a huge mess at the moment because there is no accountability from anyone. Social Security is stone walling me as well as this " company" .I have only now also found an Advocacy group out here but they seem unsure as they have " never heard " of what's going on. This term is all I seem to hear.

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I did a price check on 3 drugs with the new AARP Optumrx discount plan.  None were covered making the cost very high on each drug.  Don't bother signing up for this bogus savings plan.  The prices with goodrx are much better.  Check all of you presciption prices on the goodrx  website before purchasing.  On certain medications they have saved us from 10 to 30 dollars compared to the costs of the part D plan that we have.  The aarp optumrx plan had us paying up to $200 for the same pills goodrx had for around $10 to $20  I agree, stay away from the aarp optumrx plan and don't even bother.

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You can't use good rx if your on Medicare/Medicaid.
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Regular Contributor

You’re right. In my previous experience working in the medical field getting prior authorizations for medication, all the pharmacist has to do is provide the insurance company with the ICD 10 code, which is the diagnosis code, and Medicaid usually will pay, at least in California. You also don’t have to use your insurance and look for a pharmaciy that takes Good Rx with a low co pay. You can save hundreds of dollars, seriously. 

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Bronze Conversationalist


@timlay wrote:
You can't use good rx if your on Medicare/Medicaid.

Yes, you can. I use it quite often


Bark less. Wag more.
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Recognized Social Butterfly


@timlay wrote:
You can't use good rx if your on Medicare/Medicaid.

Wrong.  There is no law that forces you to use insurance that you already have.  You just have to tell your pharmacist to use the GoodRx coupon instead of your insurance.  And, most amazingly, that coupon price can contribute toward your insurance deductible.  See

 

https://www.goodrx.com/blog/ways-to-beat-your-insurance-copay/

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Bronze Conversationalist

@aruzinsky said There is no law that forces you to use insurance that you already have.  You just have to tell your pharmacist to use the GoodRx coupon instead of your insurance.  And, most amazingly, that coupon price can contribute toward your insurance deductible.

 

 

The actual wording in your link says the following:

 

If you purchase a medication with a GoodRx coupon and the drug is covered by your insurance, you may be able to submit your receipt to your insurer and count that towards your deductible. That way, you’ll still be able to take advantage of your insurance coverage later.

 

This applies to almost all types of insurance plans, including those from private insurers, commercial health exchanges, Medicare and Medicaid. You’ll want to contact your individual provider to find out what information they’ll need from you and how to submit it.

 

And if you follow the embedded link you will find . . .

 

Paying with a GoodRx coupon is considered an “out-of-network” purchase, and it’s up to the insurance company to decide if they’ll pay you back—or whether they’ll count it towards your deductible. 

 

The "fine print" indicates this is not a sure bet. The hassle of trying to get your purchase to count towards the deductible may not be worth it.

 

I work with hundreds of Medicare beneficiaries every year and help them understand how to save $$ on Part D. There are several informational videos on my YouTube channel that discuss the mechanics of Part D and how to get the most value from your plan.

 

Years of working with insurance carriers in an attempt to get reimbursement for a non-covered claim reveal an uphill battle. More often than not the easy path is to take your savings and be satisfied.


Bark less. Wag more.
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Periodic Contributor

Absolutely correct! The GoodRX drug app even showed me where I could get my antibiotic for free on my own prescription just recently in November 2018.
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