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OPTUM RX IS PRACTICE MEDICINE WITHOUT A LICENSE, BREACHING THEIR CONTRACT BY WAY OF BAIT AND SWITCH, AND CAUSING SEVERE PAIN AND SUFFERING BY UNESSESARY HOLD-UPS IN THEIR PRIOR AUTHORIZATION DEPT. They are denying medications previously covered, stating they are no longer in their formulary, then changing the terms of the agreement without prior notice, holding up medications in their prior authorization department by requesting a second prior authorization on an already approved medication that they have requested the patient switch to.

Then when the local pharmacy calls on the status of the second prior authorization of the medication, they blame the doctor or the local pharmacy for medication held up in the Optum RX prior authorization department. We pay over $1300 per month for United Healthcare insurance with Optum RX for our prescriptions. They have denied necessary procedures and surgery, that we have to pay full price out of pocket for, but now they want us to pay full price for our medications that were once covered. Unethical tactics, misinformation, misplaced blame to the doctors or local pharmacy and unwarranted denials are standard practice and should no longer be tolerated!!

Rather than wait for someone to die at the hands of this horrible company there needs to be a class action lawsuit! Optum RX prior authorization department has gone way too far in their unfair practice and breach of contract by holding up desperately needed medications on the day it is due, leaving the patient suffering. They have decided to deny the medication (they requested the patient switch to, then requested a prior authorization from the doctor) then when the patient goes to fill the prescription on the day it is due, it is then denied because a demand for a second prior authorization they call "Morphine equivalent dose" needs to be done by the doctor's office. This, without warning to the doctor or patient.

When United Health is called, and after being transferred and on hold for 45 mins, not one person had the same answer as to what this second prior authorization was for. They confuse the issue, blame the doctor for not doing the prior authorization,(until a letter of proof to the first prior authorization was read). Then after being transferred again, and going through the whole thing all over again, they blamed the delay again on the doctor saying they did not prescribe the correct dosing when that was not the case. Then after numerous calls to United Health, the Pharmacy, the doctor's office, the prior authorization department, 3 days after the medication was due, Optum Rx states the holdup is because the doctor did not put URGENT on the request?

This is now the excuse for this whole mess? When the doctor made several calls and it was stated it was urgent, not only by way of the medication and the fact that the patient is 4 days late but, the fact that the patient, doctor, and the pharmacist, stated it was URGENT! Then after another round of phone calls to Optum Rx all the representative could say was the doctor did not write that it was URGENT, So in order to speed the request, the doctor should have made the request for the prior authorization to be urgent! Knowing the patient is without medication, they gave no alternative, and would not fill the prior medication either.

They also would not do an emergency override on this particular medication to get a 5 day supply, so nothing is done by them!! The brilliant solution the representative could come up with, was to go to the hospital, (wait in the waiting room for 8-9+ hours), to ask and ER doctor to write a prescription for the pain medication (with no guarantee of getting one), and then pay out of pocket for that medication, how absurd is that??? WHAT DO WE HAVE INSURANCE FOR? On Day 5 I called the pharmacy and they were told my prescription will be ready from the prior auth department today.

After waiting all day nothing happened so I called the doctor again, told them I am in pain, and now much unnecessary anxiety waited for her to call the prior authorization department to put urgent on it again. She stated the order was then put on urgent status and will take another 72 hours or more!!

Reason of review: Poor customer service.

Monetary Loss: $10000.

Preferred solution: Have them investigated, not allow them to hold orders that have already been prior authorized and cover the prior medication while they take their time waiting to authorize the other medication. They cannot keep people in pain, play dr, withold med..

OptumRx Cons: Treatment and lack of solution.

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Guest

Bravo I am actually considering a lawsuit, I am sick of being treated by a drug company!

Violet Mmi

As a Walmart manager and person who is forced to deal with OptumRx I would love for somebody to tell me how to join or instigate a class action lawsuit against off tomorrow ask for exactly the same practices their pre-authorization department and the way they handle their practices are absolutely ineffective when it comes to a persons health somebody please tell me how to get involved with a class action lawsuit or how to open one personally because I would love to do it I am so sick of dealing with these *** ***

Guest

This horrible and greedy company is denying my Amitiza medication which I have been on forever. This medication works wonderfully and with no side effects.

They are instead trying to make me take Linzess, which I am sure they get a huge price break on! .Linzess (linaclotide) to be the primary suspect in at least 7 deaths, 85 hospitalizations, 16 disabilities and 10 cases of adverse events which required intervention, all in just 3 years since its launch in 2013. Backed by FDA case files, we believe that the findings outlined in this report will lead to the removal of Linzess from the market. unknown, unreported and unlabeled severe systemic adverse events, including documented cases of rapid weight gain, renal failure, seizures and strokes.

- See more at: http://www.drug-injury.com/druginju...eports-safey-issues.html#sthash.ZqJSmyxn.dpuf They are nothing more than peddlers of death for profit!!!! I hope they go under and their CEO and board members are all sued personally!!!

Izeyah Yjl

It is now 2020 and I am still having the ver same issue with OptumRx!!! I have had an ongoing migraine since the 1st of the month.

It. is now the 25th and NO Migraine medication has been approved for me. This is the same medication I had with my last insurance. My doctor office stayed on the phone with me while they completed the PA denial and marked it Urgent as they stated.

They say they have no information on file. Liilet S.

Guest

I agree they waited to approve my RA med last year for 2 months. When my med wasn't scheduled I called them and they said it needed prior approval every year So I missed that months shot. * weeks later they denied the med I have missed 3 months of medication and I am in horrible pain and can barely walk now I will need to get a leave of absence cause I am a RN and can't take pain meds and work

Wilburt Usv

This is still the exact same issue that I am having now, 2 years after you wrote your message. I am SO angry with Optum RX and United Healthcare.

Been on the same pain meds for 15 years.

No change in dosage or usage and now they are denying it. The exact reasons listed above.

Guest

Please contact me if you can help as ive asked in next comment,thank you.Italiaboy1956@***.com

Guest

I started with Optum Rx(part of United Healthcare) quite awhile back & its been a living nightmare one thing after another screwing me up.Near the end of January this year was the culmination of my frustration with me sending them sending a check for $ 40 for 3 meds of which they had changed from 2 daily to one & from ER to SR(bp med!!) after having been on ER since i started with them.I tried to reason with them but they mostly ignored me & never sent any of the meds i needed one being blood pressure med.Still they have not refunded my money & thank God the primary np mixed up & sent to local pharmacy after i never received from Optum.They cashed/deposited my check near end of Jan. & despite me making numerous requests to refund me this also has been ignored still never sending me meds i needed.Thank God also to my HR director who has helped me so many times with their screw ups.Now if I had been dependent on them in life or death due to meds id be dead.So sad that the dollar means more to them than human life,We also had a problem with my wife being denied Baritric surgery & even worse they called on her birthday in early 2000's to say they dont cover for it.Later i learned they dont cover compeltely for it again we tried with surgeon assuring us after we told him we had a problem with insurance he would help get it.After she went through 7 mos.of bariatric pre surgery requirements the Dr's office calls & says "they only cover for $5,000" for everything:surgery,hospital,anestesia which is basically saying they dont cover for it unless your well off.Now i hope to find an attorney who can help us vs them since ive had lots of sleep deprived nights ,lots of stress,almost having driving accidents in morning due to lack of sleep driving to work,marital intamacy stolen,headaches, & general tiredness & irratability at work.

Guest

My Employer just switched to Optumrx.. I am experiencing the exact samething!!

I've been on the same medication for yrs. They denied the pre Auth and asked to have the meds changed to generic, so my doctor changed it. Then they still denied it!! It is on appeal right now.

I can pay for this medicine completely out of pocket.. However what is the point of paying for insurance ?

Optumrx is claiming that it is the company I work fors policy! Since when does an Corporate Company or insurance company override a doctor on medications I neee or don't need!!

Guest

This person clearly doesn't understand how insurance or PAs work. Educate yourself or don't complain

Guest

I too am going through a similar situation. They have been jerking me around since the first of about eight meds I take had to be refilled.

Optum RX does need to have a class action suit brought against them. My Dr had me on a name brand preferred Pain med. I saw him on this past Monday. I asked that he please prescribe the generic equivalent because of the cost factor.

Don't know if this has been done as I to am getting the run around on just everyday prescription's. We got a letter prior to effective date this year stating after two consecutive fills at a retail Pharmacy we had to switch to CVS or mail order with Optum. Highway robbery, Plus why then is our regular Pharmacy show in network when on their web page!!!! All you get are lies and frustrated dealing with reps, who do indeed leave you on hold up to an hour with no resolution.

Just a promise we have escalated this for you. Malrkey!!when your in pain and need your meds what then you suffer.

Guest

Currently experiencing every detail of this comment. Along with the fact, everyone I spoke to said I could have the medication if I paid $1,036.00.

Hmmm.

$0.00 vs $1,036.00. Why are they still in business?

Guest

I totally agree with everything that is stated in this complaint of Optumrx. I had a similar situation with prior authorization on a pain medication that I was out of.

I called and placed the order and received emails that it was approved and processed. I was even given a delivery date! After a week I called to inquire about the medication and they told me the order had been cancelled! I was never informed either by email or phone call.

In addition I was told the prescription would require a prior authorization which would take at least a week to 10 days!!!!! This company is run by YAHOOS who don't know what they are talking about and contradict each other.

You get different information each time you talk to someone! There is no communication only *** Top management all needs to be FIRED.

Guest

I agree, every year I miss months of praluent injection for cholesterol due to this prior authorization request. When did a physician prescription become useless to fulfill a medicine.

Why does a Doctor need to "justify" his prescription with an authorization also? How can we all get together for a class action suit against the prior authorization clause?

Guest

All the complaints on this site are true... I have had the same experience every year when filling my two year old daughterโ€™s Nexium prescription..

After one year the authorization expires per Optimims policies and you have to get jerked around for a month to get the Rx again. If your lucky...This year... round two with these jerk offs... I have called them four times a day for the past week...Yes...For Nexium 10mg packets..Reflux medication..Once the whole process kicks off my doc sends in the form via fax...

they claim they never received it (lies, I have record of it) then they force the doc to call a 1800 number and state its urgent... Then Two days later OptimumRx blames the doctors for not stating Urgent on prior auth.. Another lie I was standing next to doctor when he called...Then it goes to the wizard of Oz for up to 15 days(their so called approval pharmacist) . Finally, one week later (10 days total) they say itโ€™s approved and you go to pharmacy to find out they lied..

Called Optimim back and they said the lead I spoke wasnโ€™t correct and entered the wrong date for approval (10 days prior) so itโ€™s invalaid and back in the wizard of ozs queue...OptumRx is a bunch of crooks and *** They hurt innocent people men women and children... Dirtbags....Unfortunately, I am forced to use these crooks because of my companyโ€™s health insurance ( Fortune 500 company).

Guest

UNC needs to clean up both their website and practices

Guest

I smell CORRUPTION! Do not believe the good reviews about the Parmacy for the OPTUM RX company!

I was harassed by mail from Optus RX to get my 90-day prescriptions from them because I would not have pay a copay! So, I gave in and had my scripts mailed! Let me tell you all - I received my scripts that sat in my mailbox for hours and sometimes a day or two in 100-degree weather. I started to take my meds from OPTUM RX AND I was SICK every day after taking them!

I told my doctor about the change and my DOCTOR told me it was from the FILLERS in the meds and to back to buying the prescriptions from Walgreens, SO, after receiving my meds three different times from OPTUM RX, I noticed that each of the same med was from a different manufacturer!!!!! So, I called the OPTUM RX PHARMACY DEPARTMENT and I spoke with an employee. I asked why when they send me my meds are they always from different manufacturers! The employee said YES!

When I asked why I was told it is because they buy from the manufacturer that is the cheapest at the time they are filling my scripts! God only knows what kind of fillers are in the meds and where my meds are really coming from!!!! If they are coming from China, God knows what fillers are in them! Just like the dog and cat food from China that killed all the animals!!

There are employees who work for OPTUM RX that could very well know if there is unhealthy fillers being put in our meds and if so they need to come forward and be the whistblower to stop people from being ill or possibly dying from some unhealthy ingredients in the meds!!!! Since I stopped getting that med from OPTUM RX and now get them from WALGREENS, which by the way is from Walgreens is from the same manufacturer each month, I have NOT been SICK everyday day! So word of caution - DO NOT GET YOUR MEDS FROM OPTUM RX! Like someone else said on the reviews for OPTUM RX the people who are stating the company is great - DO NOT believe it!

Getting meds from the cheapest manufacturer is very fishy to me, especially when I got SICK EVERY DAYI I am sure someone who works for them must know there is some type of corruption going on, but probably is afraid to come forward to help save people from getting ill or possibly even dying from the fillers!!! If they came forward, they may have a lit of people like me who would support them, THANK GOD MY DOCTOR KNEW WHY I WAS SICK SINCE CHANGING TO OPTUM RX! PROOF IS - I HAVE NOT BEEN SICK SINCE GETTING MY MEDS FROM WALGREENS WHO USE THE SAME MANUFACTURER EVERY MONTH!

And not only this, MEDICARE NOR OPTUM RX WOULD PAY FOR MY ARMOUR THYROID THAT WAS MEDICALLY NECESSARY, THEY WANT HUNDREDS OF DOLLARS! Count me in on suing OPTUM RX AND MEDICARE!

Guest

My doctor is not going to jump through hoops so I can continue to get the meds I have been on for the past five years or more. If I gain weight and become diabetic because I have been denied medication,, I will sue. Next, your not doctors and shouldnt be practicing medicine without a license.

Guest

Same here. They refused to fill my morphine & Dilaudid.

Didn't tell me, my adjustor who approved to be filled. They demanded to speak with my pmd. They called & all the pharmacist"Stephanie" sd refuse to fill my narcotics while I'm out dying in pain.

Attorneys need to step up and sue them. Even refused to give info y to OOWC-LA .

Guest

I have had almost every problem with Optum RX that has been posted in this thread. I too would like to actively pursue a class action lawsuit against them!!! How do we get this initiated???

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