State of Michigan employees, teachers and retirees insurance changed on 1/1/17 and I now have a full time job in trying to get crucial medications for my husband and myself. The first medication to refill was for diabetes and quite necessary.
It now needed a Prior Authorization. With past insurances, it was simple. This became a nightmare. It took 6 days, 7 different reps and none were trained well enough to even understand what they were asking for.
2 had major language issues and only 1 rep actually tried to help. In the end, they were requesting proof of a drug taken 30 years ago! I tried to get them to think outside that box to realize NO ONE could provide what they were asking, but it was of no use. The Dr office finally worked for 2 days and got an approval.
My husband had a kidney transplant and must have medication on time, with no exception, to avoid organ rejection. Our contract requires that medication must be ordered by mail. With frequent dose changes, this is a problem. Then we find that they require a 5 day ship time.
The order was placed on Wednesday morning and on the 4th day he got a phone msg saying they needed "more information for shipping". If they had not yet shipped, we knew it would not arrive on time! When he returned the call, he got a message saying they were closed. Monday morning he was told the shipment was "delayed" and would not reach him before the following Thursday, 3 days after he would be out of pills.
We began at 9am. First, they would authorize a local fill. They did transfer the Rx, but OptumRx continued to decline it saysing "only can fill through Briova". The next rep said she would "override it" and 2 hrs later as she had the pharmacy try, it still gave the decline.
She got a Supervisor, who told me it was impossible to override and that Briova had "local offices" and would deliver it to our door. After 30 minutes, she still had not found a "local" office and I informed her I was reading the list online and there were none in Michigan. At that point, she told me we would just have to wait! I explained he could be in danger of losing his transplanted kidney.
At 6pm she finally told me it was "done" (although she had claimed impossible) but did not want to wait as I had the pharmacy test the claim. 1 hour later my husband went to the pharmacy only to find that MY prescription had been denied! I had checked and no prior authorization was required. I began the calls again.
The first rep stated I was under "quantity limits". When I asked him to explain, he tried, saying you can get 120 mg per month. I showed him that I only get 10 mg Again, untrained. He refused to discuss it saying "sorry it is declined".
On to the next rep who said "you need prior authorization" (did not). Then she said "it conflicts with another drug you take". (it does not and I have taken the combo for 5 years). THEN she said that she called the pharmacy and "tried to override, but the pharmacist won't do it".
I called the pharmacy who admitted if I walked in and paid for the prescription, there was no way they would deny it! Since it is now after 7pm and I have spent 10 hours on the phone with OptumRx, I will begin again tomorrow. I cannot imagine continuing life like this, especially with a husband who must have medications to live. I looked up the company who seems to "service" many insurance companies and self insured companies.
Their entire goal is to cut costs, which they are doing by denying people at every turn. They specialize in cost cutting for government plans (state employees, teachers, etc) as per their own website. Each rep has no problem giving an answer that they cannot explain, changing the answer and trying hard to end the call. They are going to kill people and simply apologize, if you are lucky.
To get medication, you must stay on the phone and keep moving from one ridiculous answer to another.
I can't imagine how many people will die from lack of medication. This company must be breaking laws.
Review about: Optumrx Prescription Refill.
Reason of review: Poor customer service.
Monetary Loss: $5000.
Preferred solution: Unless there is improvement immediately, I am seeking legal representation..
I didn't like: Untrained and disinterested customer service, Delay tactics, Evasive response to customer inquiries.