OptumRx
Reviews and Complaints

I was denied a TDAP vaccine that I was given at the dr's office on 01/18/]2023 by Medicare B. So I went through my Medicare D plan OptumRx (AARP Medicare Rx Plans) for reimbursement. After several attempts, I received the following denial: "The paperwork to process your claim was missing the following required info: proof of payment receipts from the pharmacy." Since I didn't get my TDAP vaccine through a pharmacy, what am I supposed to do? Can you please advise. Thank you. Sandra Gretta

My name is Elizabeth Schell. My husband, Andrew M Schell was a member of OPTUM RX. Andrew passed away on October 8,2022. I have called 4 times about no longer needing his medications. I have advised that he pass and that meds were no longer required. You company has caused me undue pain with in way you handle you busness. Not only did I still get his meds again and again but I then receive a BILL- he never paid for his meds in the past so why now? The gaul of you company! I have called and been made to repeat myself and cry and relive the trauma again and again by your agents. Yes they say how sorry they are and that it will not happen again and the account has been note and update. BUT it obviously it is not. I was told to just toss the meds that came after his passing- what a waste of money. Thankfully I have not gotten more meds. But once again I open my mail and have a bill from you in the amount of $74.78! The account number on this bill is [protected]. Please, please stop all contact and actually UPDATE you systems. STOP sending bills.

My physician put in an order for Trulicity without my knowledge This was an

incorrect medical order. OptumRx delivered a 90 day supply of Trulicity -with refrigeration packing - without my knowledge or consent. This happened over Thanksgiving holiday 2022. Since it was a refrigerated medicine, I tried to contact Optum to pick it up before it was no longer viable. I made multiple attempts to reach the pharmacy but since it was Thanksgiving weekend, no one answered.

In my attempt to save the medication (the co-pay of which was $404.04 , I contacted the shipping company, who picked up the medication on the Monday following the holiday. Optum credited the original incorrect order but rebilled me saying they can't give me the credit due, until I return the medicine. I told them they need to contact the shipping company that they used for the return delivery since it is not my responsibility, since I tried to do the right thing. I am a senior citizen and cannot afford to pay for something that is not my responsibility.

I called Optum Specialty Pharmacy today (03/07/2023) to ask about my infusion med delivery. I have an infusion every 6 weeks and have not heard anything since my last infusion. My scheduled infusion is on Mar 10, 2023. I guess it's good that I called because they told me my prescription had expired and needed to be renewed. I asked if anyone was eventually going to make me (or my doctor) aware of this fact? I was quite upset with the lack of notification due to the fact I had previously gone without my infusions for just about 8 months, also due to failure on the part of Optum Pharmacy. Now here I am again having to rush around and perform the due diligence the Optum should have done. Doesn't instill confidence that's for sure

I'm so sick and tired of the service and lack of help from this organization. Whatever you do AVOID buying any plan associated with OptumRx. I have been in the health insurance business for over 40 years and never dealt with a company so incompetent. Calling for any support sends you to a call center where the support staff has little to no knowledge about what they are doing. You can't trust whatever they say to you. Just keep telling them to leave the call until you get to someone who actually works for Optum. Repeated calls, always the same result, pathetic.

This morning I called and asked to talk directly to a pharmacist as it says I can on the site. I was blocked and sent back to the person who I knew had no idea what she was talking about. I asked again to get to a pharmacist and was blocked again. The pharmacist refused to speak to me. Clearly I would be wasting her time with a potential $10K out of pocket coming.

Again, avoid any plan that uses OptumRx. I wish I could change now but next year I'm out and will do all I can to spread the message.

Since August 2022, Optum Rx specialty has been harassing me when I have two insurances. They outsource their billing to India, which they have told me themselves, and the billing department in India does not know how to so the billing, which in turn, has held up my medication, unless I call up telling them how to do their jobs. They have forgotten, EOB's from primary insurance company, they did not put on ID numbers, now they are holding up my medication, stating that need a prior authorization, as per the billing department, but yet I have a pre auth dated from 11/3/22 good thru 12/2023 as per Optum pre auth department themselves, stating they do not need anything and yet, they are holding up my medication. I went as far as calling Champ VA, my secondary insurance and they said they never asked for a prior Authorization. This company has lied to me over three times, for their internal billing, which is overseas. This is not a customers' problem. I am disabled and should not have to be dealing with these issues. Optum must change their billing department, to people who know what they are doing.

My husband has a spinal cord injury and has been on pain medication for 30 years. We were just switched to Optum rx from express scripts. They have repeatedly denied the PA for a prescription that he has been on for 13 years. This is a medication that you can’t just stop cold turkey without repercussions. I have spent countless hours on the phone trying to rectify this situation. It has been nothing short of a disaster. Why do they think they know better than his doctors? I am beyond infuriated with this company.

I have spent a week attempting to get my Skyrizi order filled. My doctor of record has 3x the prescription and all documents, including prior authorization. No one has called me back. I saw my nurse Jessica two weeks ago, as I recall. Really tired of talking to folks in India or Philippines or where ever only to get false promises. I am a pre existing customer and never experienced such nightmare before now.

This company has gone above and beyond to make sure that I do not get the medication that myself and my doctor have decided that I need. They refuse to put the prescription on automatic refill. I was part of a co-pay program which now every two weeks I have to call and completely redo it taking ridiculous amounts of time when I was told by the company that issued it that it was good for 2 years. This company is absolutely should be shut down. People need medications. How many people has this company killed? All in the name of Their Own profits. And customer service what customer service?

OptumRx has continually engaged in mis-leading and inconsistent health care practices to the extent it has jeopardized my personal health and moreover, provides slack and incompetent support staff to assist in reconciling these perpetual disfunctions.

One database would indicate that a particular medication status as "nothing on file" while yet another system utilized by my provider would indicate that the presriptoin is "in process".

Medications that are mailed out, frequently reach their destinations beyond any reasonable timetables and often times, lack the necessary oversight mecxhanisms to ensure timely delivery of said medications going forward.

OptumRx support staff is rarely accessible to assist wth these chronic snafus, and moreover, depending who you may be speaking w/at any given time, rarely results in receiving consistant information. Case #s issued in relation to complaints filed often appear unretreivable requiring an additional submittal which, yet again, cannot be located to guaranty any sufficient resolution.

There are so many OptumRX sites available to sign in on google that you cannot tell which one you should use. None of them work easily and most are unusable.
Further, asking me for a NCPDP # is stupid as I don't know what that is.
So not even being able to sign in anymore, I may have to switch to another provider such as Walmart. Their prices are about the same as yours.

Optum is withholding my diabetic meds. I had a 3rd refill at my local pharmacy. My daughter had a house fire Christmas morning and lost pretty much everything. I was busy assisting her getting keys made new phone looking at emergency housing super busy. On 12/30 When I tried to get rx told need pre-auth. Why? It's the 3rd refill. Been messaging daily.

I have been trying to get my Dexcom sensors refilled for 6 weeks now. Ive been on the phone for 3-4 hours at a time and just found out that on the call that said they were overnighting them to me for the third time, the rep actually cancelled my order, sent it to a local HEB pharmacy (which cannot fill dexcom orders), and my copay and out of pocket were met for the entire year. Ive been lied to numerous occasion and every time ive spoken to someone. It is now 2023 and I have been out of cgm sensors and it has made me cery sick. So sick, ive had to miss work. I am now told I will get them “today” but when I finally go the tracking number, it says a label has been made for two days and the package has not wven been pucked up by UPS. Wow the constant lies about things that impact my health and wellbeing. OptumRx should be shut down and reorganized from the ground up. My meds are all incorrectly dispensed when they actually get dispensed and the customer service is not even in the same country. My dr wont even send rx to optum rx because he has sent so many scripts to them and he feels that he isn’t sure what is fraud or over sending rx to them. This is HORRIBLE service for someone who is responsible for helping people with their livelihood and their health and well-being. I am including photos of just a few of the orders that I have requested that have been canceled and as you can see, they include my insulin pods from Omnipod and my Dexcom sensors for my continuous glucose monitor those of which I cannot perform diabetes management without. Optum RX has been miss handling my prescriptions for the entire time I have used it and they need to be looked into as to why they’re miss handling these items there’s always an excuse, and there’s always a promise that are actually lies. They are told to keep phone calls within a minute instead of actually a goal of taking care of the member they get into trouble if a problem occurs, and they cannot solve it by using a script instead of actually having a conversation with a human being they should not be a part of a fortune five company, and they need to be held accountable for all that they’ve done to miss handle things that people’s lives depend on me being one of them

Spent at least 8 hours on the phone with Optum - ridiculous! Unable to get my diabetic medication (who denies that!) and now the stupid mail order program they FORCED me into - has now denied the medication I have been on for OVER 30 years. Why - because apparently the uneducated buffoon who signed me up did not put this on auto refills and they now need to "reach out to my doctor" they never even informed me of anything - NOT ONE THING. One gal told me it was not medication on my approved list - uh, not like this is January 1...been taking these medications for a while...what should be $25 for my diabetic meds is now a whopping $477! So ANGRY AT THIS ENTIRE SITUATION. Last time they "reached out to my doctor" nothing got sent or faxed and not a single phone call was made by them. I just want them to be gone. I work for the LARGEST COMPANY IN THE WORLD. Going to ask to drop this garbage. Why is this even allowed to happen?

I have been using them through uhc for 2 years now and I am done. This is the most incompetent bunch of people I have ever dealt with. Every reorder is just another problem. Just moved, sent them 3 emails with a change of address and not to send out scrips to the old address... They don't allow you to change your address on your own account, like we are children. Well I just notification this morning that my order was shipped... Guess where? My old address. They are a bunch of idiots in thailand. She says she appreciates my feedback after I reamed her a new [censored]... And if I want my address changed to call another number. I wont' call those people if its the last place on earth that I can get meds. I will be getting my scrips from goodrx. From here on... Can't believe how stupid these people are!

This med service is managed like 'squirrels in a nut house'. I've attempted for weeks to get a refill processed. While there IS a supply shortage on the supplier side, this facilty responds like they're on precisely all the drugs that they dispense. For instance, once the patient submits the refill such that it remains in que until filled, their system blocks any alternate pharmacy that may HAVE it in stock, from filling the order. While an override can be initiated, most people are not bureaucrat-Savvy enough to navigate through their myriad of obstacles that confront them.

Clearly, they need to modify this to allow for payment to any provider if no payment has yet been processed upon the order completeing. Since payment is not made until the order completes, no patient should have to suffer, let alone, possibly perish, simply because their system is unable to make this essential distinction between an order in-que, and one that's been paid. THIS IS JUST TOALLY ABSURD!

In short, they SUCK!

Was just on the phone with a customer service rep & she sounded like she didn’t want to bother looking up my order that I’m waiting for. I said I got a text msg it’s processing but then it says out of stock. She goes well then you have to wait 30 days. I said can you double check on your end?! My God I didn’t call for nothing. She doesn’t even say ok or please hold just clicks me to music. I said yes for the survey & after holding 10mins she reiterates the same 30 day wait garbage & didn’t offer anything else. She was a horrible rep & to boot she never put me through to the survey cause she knew I was giving her a terrible score! I kept holding and she was there too but wouldn’t say anything. I said connect me to the survey please & nothing. Terrible customer service or at least this 1 was. Hopefully I never get her again!

We've had nothing but problems ever since we had to switch from Express Scripts to Optum Rx. They call constantly, always in the morning before I'm even awake. They've called me at least five times in the last week. The messages they leave rarely include any actual information, forcing me to call them back and wait on hold until a dazed and confused employee speaking indecipherable English finally picks up. Usually they call to tell me that one of my meds is out of stock, despite my having told them repeatedly that it isn't urgently needed and I'll wait until it becomes available. That medication has been out of stock for months, and they have no idea when it will become available (maybe never, who knows?), so they just call periodically to wake me up and make sure I know they still don't have it, just like they didn't have it yesterday, last week, or last month.

Another time, they left a message about a prescription transfer I had initiated on their website, saying that they had called my doctor for prescription approval. A day or two later, an identical voice mail was left, but this one included a request for me to call my doctor on their behalf. The supposedly easy prescription transfers apparently do not actually exist.

Despite my calling them back every time, they just keep calling over and over for the same reasons. And In spite of the fact that I just had to call them again today (11/4/22), I fully expect to receive another call tomorrow, either informing me that: (1) my prescription is still out of stock; or (2) they called my doctor's office for prescription approval on a different prescription, and it's too much trouble for them to call again, so would I please do it for them, allowing them to get back to their busy schedule of doing absolutely nothing.

Also, the survey they ask you to complete at the end of the call is kind of a joke. A short survey is supposed to be offered to you if you want to give feedback. If it's good feedback, they're happy to have it, but if the representative you speak with can tell that you aren't happy, you can hold the line after the call until the cows come home, but the survey won't show up.

On 7/9/2022 I was billed $40 for Lantus Solistar Insulin which I did not order. The prescription was returned to Optum and I was told a $40 credit would be issued.

As I did not receive the credit, I requested my credit card to give me a conditional credit for $40 which they did on 7/13/2022.

When I tried to fill subsequent prescriptions, Optum said I had received duplicate credits for the $40; one from the bank and one from Optum and requested I allow the $40 to be recharged to offset the duplicate credit. The charge was recharged on 9/2/2022.

However, I never received a credit from Optum for the original order, so in fact have been billed twice for this prescription.

I contacted Optum via telephone on 10/2/2022 requesting a prescription refill. Delivery was scheduled for 10/7/2022. The medication was not delivered. I called Optum 10/8/2022 to inquire regarding status of delivery. I was informed that due to a clerical error by Optum personnel/employee(s) the delivery was not made. I requested a delivery of the medication for 10/10/2022. I was informed the delivery could not be made until 10/11/2022. I informed the Optum employee that due to a family emergency I would be out of town for several days beginning 10/11/2022. The employee would neither assist with a delivery of the medication on 10/10/2022 nor transfer me to a supervisor for assistance. I informed the Optum employee the medication is for a serious medical condition and due to Optum's clerical error resulting in non-delivery on 10/7/2022 and refusal to deliver on 10/10/2022, I would be without the medication for a period of at least 7 days. Note-there are no other pharmacies or location from which the medication is available. Given the refusal of Optum to deliver the medication on 10/10/2022 I had no other option but to request delivery of the medication on 10/17/2022. The employee refused to refill the prescription for 10/17/2022 delivery and informed me I must call back, although an explanation for the refusal was not offered nor a date given for my required call back to request a medication refill.