Complaint Review: Optum rx - mesa

optum rx is practice medicine without a license, breaching their contract, using bait and switch, raising rates with no regulations.  my experience is we pay more than ever, we are getting less care, less coverage, and total neglect. where are the laws and regulations that are supposed to protect the people?

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 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 health care insurance with optim 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. even though the prior authorization was done for this medication it is then denied when the patient is out because optum Rx decides they now need second prior authorization from the doctor, without prior notice to the patient. they call it a "morphine equivalent dose" and needs to be done by the doctor's office. 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, then after being transferred again, and going through the whole thing all over, they blamed the delay again on the doctor saying they did not prescribe the correct dosing, when that was not the case, (they were just confused about the request being called a "dosing authorization"). then after numerous calls to united health, the pharmacy, the doctor's office, and optum RX prior authorization department, there still is not a consistent answer as to why is still held up in the prior authorization department. now 4 days after the medication was due, and the patient not only suffering pain, but now severe anxiety, depression, and anger, 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! but there is no moral obligation by optum rx to do anything? 

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?

day 5 after medication was due, and after another round of nauseating phone calls, all the optum rx representative could say was when the doctor called for the prior authorization for the second prior authorization request,  they should have written urgent, in order to speed the request. it was a phone call the doctor made requesting the prior authorization be urgent, how is the doctor supposed to write 'urgent'' on a phone call?? 

day 6 of no medication and knowing they are leaving the patient with no medication, they gave no alternative to use, and would not fill the prior medication the patient was on 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!!

it is now day 7 and after waiting on hold again and being transferred i am told the medication was just flat out denied, (after being approved), now it is just denied. now the doctor has to fill out an appeal to the denial with urgent on it this time?? why can they just deny something they have the patient switch to in the first place, why are they not obligated to give the medication they covered for the  patient prior to them "no longer having it on their formulary", why are they getting away with this form of abuse, neglect, and breach of contract to the patient?  again, why are they allowed to do this, where is the law that should be protecting patients??? something needs to be done before someone dies!