Optum RX — prior authorization department
Optum rx is practice medicine without a license, breaching their contract by way of bait and switch.
They are denying medications previously covered, changing the terms of the agreement without prior notice, holding up medications in the prior authorization department without any backup medication coverage, denying an already approved prior authorization, denying procedures and surgery that should be covered, and to top it off you get a different excuses or answer as to why your medication is held up in the optum rx prior authorization department. We pay over $1300 per month for united health care insurance with optim rx for our prescriptions. They have not only denied necessary procedures and surgery, that we then have to pay full price out of pocket, but want us to now 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? This was actually not truthful 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 3 days late, but the fact that the patient, doctor and the pharmacist stated it was urgent! Again they state in order to speed up the prior authorization on the second prior authorization request the doctor should have written urgent, (On a phone call) ?? They gave no medication alternative to use, would not fill the prior medication the patient was on with no problem, and stated they could not do an emergency override on this particular medication to get a 5 day supply, so nothing is done by them!!
Optum rx is denying patients medications (They have been using for years without problems) and telling them to switch to something else because they no longer want to cover it, then hold it up in the prior authorization department for days, after it was supposed to be dispensed, leaving the patient in severe pain, withdrawals and worse, is not only a breach of contract but malpractice!
Their solution: go to the hospital, wait for 8-9 hours, to get a prescription (With no guarantee of getting one) , and pay out of pocket??? What do we have insurance for?