Optum RXprior authorization department

C Review updated:

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?


  • La
    LaughnJar Feb 24, 2020

    Your comments do a nice and succinct job of delinesting OptumRxs willfull amd conscious disregard for the very individusls to whom they hold a feduciary obligation to by acting in ways that are de idedly CONTRARY TO THE BEST INTEREST OF THE PATIENT. I have been outright lied to about aspects of prescription drug law, about submitting a pa assp "orcelse you wont be ablecto get coverage amd have to pay the entire cost out of pocket. Informed 6 weeks after taking over the PBA side of my ins plan that the employer/self insurer was offering plan participants a grandfathering period until March1. Andxwhen I asked how to be reimbursed for the 150 oop I had to pay to get the other 1/3 of the maint med Ive been using effectiveky for over 7 years, that the note was for the fda RECOMMENDED dose. And was then told that thefda decides how much medication people may use. I replied, "If this is what your training provides, seel employ elsewhere. Because that is absolutemy WRONG. Dont even try and maintimaim that position because I jave a law degree and a masters in climical addiction counseling. So think twice about trying to toss up another smoke screen of bs. I forgive once...silly person did it again regarding drug diversion and that clinicians are bound by the fda regs. Strike two my man...eletsxjustcescalate this toxaxlevel where people know what they are talking about even if they are committimg ethical, moral and legal violations! Im in for a class action!!! Need to ne taught a lesson! Peace

    1 Votes
  • Th
    The Daughter May 13, 2021

    @LaughnJar They are currently slowly killing my father with no remorse because they didn’t want to pay for one medication...and they took my complaint down same day. No response, me email or call to me. Cowards

    0 Votes
  • La
    LaughnJar Jan 16, 2020

    Optum RX priorcaithorizations are DESIGNED AS AN IMPEDIMEMT to allowimg patients access to medications, interferring with the continuation of effective and successful pharmacotherapy for patient with a substantial documented long term clinical record that conclusively proves the efficacy of the treatmemt regemin, by cherry pickimg data on an in part basis from various sources such as fda and pieces of research compemdia that suits their limitations, and excluding the most salient and most widely observed truth about maintainance medications: the principle that prescribing such medications is dependent and specific to detailed knowledge and experience in finding the correct type amd amount of a medication being a process that must be conducted in a manner amd achieve optimal results that are individual and specific to every patient. They are using data from studies on a population to superficially assess a drugs efficacy then playing doctir dangerous by distance and applying general test outcomes to intervene amd change effective existing treatment for specific individual people and placing every one at significant risk to each persons life amd health. They are engagimg in malpractice id these decision makers hold an MD, violating the tmm hippocratic osth taken by all MDs, and should have their license to practice medecine revoked for life. If not MDs, then these people should be prosecuted for practiving medecine without a license and put in prison. Apaulling, disgraceful amd discusting lack of ethical standards. Maleficense in every respect, fully absolutely totally and irrefutably!

    2 Votes
  • Lo
    Lostmyself May 27, 2019
    This comment was posted by
    a verified customer
    Verified customer

    I was on a medication since, I was a teenager for over 18yrs. I tried generic that gave me side effects or didn’t help me at all. I have taken brand name that has always helped me after, generics have failed. Since, I was told I needed a PA for brand I would have had to pay full price as I was out of my medication that you can’t just discontinue at the dose I was on. The PA was denied for brand medically necessary for the fact is was “off label use” even though, they had told me if, it was written for a different off label Dx I would have been approved. I have been fighting for over a year. As, I have not been doing well since I have been off of it. They told me even if, I had been approved I would have to pay over $600. Only a hundred dollars less than full price for the lower dose (depending on the dose it would increase possibly over $1700. for my normal dose.)... They kept going back and fourth that it was and wasn’t approved then, they spring that I would have “ a brand name penalty copayment” my doctor would need to submit to decrease. Now, they are again targeting a medication I am currently taking that only comes in brand for them to determine if, the medication is medically beneficial?! How is and insurance company supposed to determine what is a medically beneficial use ? I had to suffer last year for almost a month because, a medication was increased they couldn’t override the medication in their system - I couldn’t get the medication until, my refill was due ?! I went from medically stable to holding on by a thread as I don’t do well on many medications. They caused a major relapse in my illness and getting targeted again. This is the worst company I have ever been with. The only company that has needed PA for these medications the only company that has told me “they can’t override my increased dose” I have suffered so much distress as they continue to target my medications that I have no other options. I don’t know what to do as I am stuck and getting worse. Between my insurance and doctor pretty much giving up trying to work with or around this company that you can’t even, understand what they are saying. If, I get cut off anymore medications I can’t afford to pay for out of pocket. I will die. They don’t care it’s all about money to them. I tried everything went directly to the source of the pharmaceutical companies they can’t help me with getting my needed medication.
    What is the point of having drug coverage when, the medication you NEED most isn’t covered brand or not ..? What I pay out of pocket for copayment now doesn’t save me much money at all. What am I supposed to do now I have medical issues that were in remission to square one?

    1 Votes
  • Ca
    Cardiac R.N Jan 16, 2018

    Optumrx= worse company ever!
    I felt like you were writing my experiences with this shady company for me!!
    They are deliberately harming
    Patients! would gladly join a class action lawsuit against these greedy
    [censor]! optumrx

    1 Votes

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