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!!
Product or Service Mentioned: Optumrx Prescription Refill.
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..
I didn't like: Treatment and lack of solution.