Consumer Complaints and Reviews
I would give them a no star if I could. I am up for a class action as well but unfortunately the previous reviewer's contact information was not provided. I have been on a testosterone supplement for over 3 years. They first denied what I had been taking ** because it was not on their formulary. My doctor prescribed their preferred supplement **. That was then denied for lack of pre-authorization. My doctor attempted to get preauthorization. That was denied. OptimumRx told me I had to stop taking testosterone for a few months (not caring about the consequences) then produce two lab reports showing total testosterone levels below 285. I have appealed (requested expedited review) providing three labs below 285. Two weeks have passed with no response.
My wife has an eye condition that when it flares up her cornea warps and requires an prescription allergy drop and a steroid drop. Both were denied. On their website, they show the similar generics for each drop that they will approve (no pre authorization needed). Her Dr. wrote scripts for the generics and they were denied with OptumRx claiming she can get both equivalent drops over the counter. According to our pharmacist and her Dr. No steroid for the eye is available OTC because they if abused could be dangerous to the eye. They represent everything that is wrong with healthcare. They disregard their own guidelines and published formularies and are not concerned with the health of their patients and customers. I would bet that with a lawsuit, discovery would show that they are incentivized to deny claims. If you have a choice go with another insurance company with a different PBM. Aetna was much better.
I'm sure it made a lot of sense for the insurance company to own its own mail order pharmacy business. But have you seen their ratings...one star at best. Although the customer service reps on the phone are usually nice and pleasant, their system stinks. Prescription orders can sit there un-filled...no status updates for weeks if you don't call them...ask what going on and the reason. And then...maybe, they will find a way to fulfill and ship order. It's the slowest process...and always a 30 min waste of time ever time you have to cal...which is literally every order. And if there is a mistake...HOLY COW...it could take 5 calls and 4 weeks to correct.
And if it's a narcotic or controlled substance, they make life so difficult as compared to walking into your retail CVS or Walgreens. I like saving a little bit of money (check, not all medications are cheaper) AND THEY DONT TAKE COUPONS which are so common now with most drugs, where the retail pharmacy is probably cheaper. And I think they actually found some way to use the USPS in a way where instead of 3-4 days for package to arrive...it's coded as some ridiculous method/rate could take 10+ days from Florida. But I'm sure they're saving money. Lousy service and processes. I use them sparingly.
I have called this company dozens of times, and EACH TIME have been told false and contradicting information. I don't normally write reviews, but we are talking about people's lives. This company literally makes things up as they go along and consistently denies, cancels and severely delays prescriptions, and when I have pointed out their inaccuracies the rep will make up a completely different reason for the issue. (This happens over and over.)
There seriously needs to be a full investigation into the practices and procedures of this company before someone's health is gravely affected by their shenanigans. They are literally the WORST company I have ever dealt with, and believe me, I have tried to give them the benefit of the doubt at every turn and tried to be patient, but I kid you not, something is very, very wrong with that organization. And to add injury to insult, at the end of my last call, the lady said, "Please hold on for a survey," and of course it disconnects right to a dial tone.
They said that I ordered a prescription and charged me for it. I called their customer service and they told me I could not return it for refund. This prescription is still at post office in San Diego, CA. I told them they could stop it, and they said that since shows shipped it's mine. So I asked if I send it back could I get a refund, and they said no. So I said why they couldn't take it back and reuse it and they said no. I don't understand that I didn't open bag and still sealed why they can't take it back. This company is run by morons.
Very uneven experience. Customer service reps. I have spoken to have been friendly, professional. The website is "down" every time I try to log in so I can't check on order status or order refills online. It is very time consuming and if I could switch companies I would.
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I have previously ordered online with no issues through OptumRx aside from them taking a week to "get" my prescription from my doctor when my doctor faxed it over multiple times and having to call 3-4 times to get my prescription put in. Today I go in to order a refill and my account will not work. I call the IT team who tell me my OptumRx used to be through Catamaran and now has moved over so to re register. No problem, I go to do so but it keeps telling me my information doesn't match the card.
40 minutes later of being bounced back and forth between IT and customer service, both of them "can't help me" and "all my information is correct" but I still can't login. I tell them I need to be able to to get my prescription and ask if there's anyone else I can call. Both of them say, "No ma'am. I'm sorry". WASTE OF MY LIFE and NO HELP. Seriously why do I pay for this? So now I have no online account, IT can't/won't help, and how am I supposed to get my medicine? They are the worst. AVOID AVOID AVOID.
They send me ** and it is burning my lungs and causing me to have trouble breathing. I have complained with them before. Then they sent me my ** and I have to have a special coating on my pills as I am allergic to Soy/MSG, of course what they sent came from Tuas, Singapore. I don't do business with companies from a third world country. If it is not made in the USA then forget it. They are killing me with bad DRUGS. I guess that is one way to take over our country. DON'T BUY from them at all. OptumRX is a hoax and they are liars to the fullest. Stay away from the MURDERERS. They don't give receipts and I did not receive any order #. I feel that anything that comes from a third world country should never happen. The ** came from Tuas, Singapore and I am not happy about this at all. USA only.
The last time I used OptumRx for an ** inhaler, the copay was 5 dollars. I recently got another prescription for ** again and no matter what inhaler I chose the copay was 50 dollars. Isn't that around a 1000 percent increase? I had to decline the purchase because of the cost. Now I'm online trying to find coupons to use. Everyone else I know that uses a rescue inhaler seems to have a zero copay or 5 dollar copay. Thank you, OptumRx and also to the major drugstore that I work for, who goes above and beyond for their employees.
I've been attempting to get a refill for a few weeks, but the ball hasn't started rolling yet. First, Optum sent the wrong med; when I phoned Optum, the operator wasn't able to mail out a return kit because the computer wasn't working. Or something. So, he asked me to call back tomorrow. Really? And listen to the 15-minute recording again? So I'm in the hole for the money they charged for the wrong med because I can't return it. Every time you phone, you have to listen to a robot for 15 min which has absolutely nothing to do with your call. Then, when you're finally able to speak with a live person, they ask you those questions again.
I've been receiving conflicting emails from Optum, stating my meds have been shipped, or "Your doctor has failed to return our call so the presc. hasn't been filled." Well, which is it? Today, I was told my doctor never responded to Optum's faxes to refill my meds. I phoned my Dr, but of course, I had to talk to the machine. Now I have to hang around the phone. She did call & stated she DID fax Optum two times, once last month & again a few days ago.
I called Optum AGAIN, answered all the robot's questions, listened to her spiel, then finally talked with a live person who was a bit testy, stating they hadn't received any faxes from my doctors office. So my doctor was lying??? After I banged my head against the wall, I asked where I went from there, since I just spoke to my doctor's office & they stated they HAD sent the faxes. The rude woman told me to call my doctor's office again. So, I called the office AGAIN & got the machine. I'm going to transfer my prescriptions to Target. This is nuts.
I am a physician. This insurance company systematically does not pay for things. The most recent "trick" is denying a medication I prescribed while the exact same medicine - by another name - is on formulary. Since they suggested I needed to try that drug first, I know that they knew....I clearly indicated that THERAPEUTIC substitution was OK. The patient bought the drug, and OptumRx escaped paying another claim. This happens all the time, and I'm sure they are acting in BAD FAITH!!!
The transfer from Caremark to OptumRx was cumbersome. Their website kept bouncing us off. Then we were inundated with paperwork requesting information by mail. They need over a week for delivery of meds. Finally, they require prior authorization on standard meds which Caremark filled without questioning the doctor. OptumRx has a huge list of prior authorization meds and they deny freely without explanation. The only recourse is an appeal which wastes both the doctor's and the patient's time. Missing Caremark.
How United Health Care thought partnering with OptumRx was a good idea is beyond me. They're the worst. They auto-enroll you in their mail order prescription refill and start denying prescriptions at regular pharmacies unless you opt out. Ok, that's annoying, but fine, whatever. I login to my account just like the letter they sent me says to do and proceed to opt out of their mail order program. Next month, at the pharmacy, my refills are denied. I opt out AGAIN. Next month my prescriptions are denied again. I call and opt out a third time. Time will tell if it actually sticks this attempt. I've never had to deal with such nonsense from an insurance company before. I pay UHC way too much money to have their partner, OptumRx, play the games they seem to like to play.
I received a check from OptumRx. I deposited it into my checking account. It bounced. I spoke with the accounting dept. and followed their instructions to fax the info. on check. I have tried to follow up and was told OptumRX customer service refused to give me the Accounting Dept. phone number to follow up. This is unacceptable.
I've been using OptumRX for the past 18 months or so and have had no problems. They respond well when I need to call and they deliver my meds (7) on time. I've had trouble recently getting in to my online account and was told today that their "site was down" and would not be back up for "24 to 48 hours". Hard to believe that during a work week, this would be the case.
If anyone read Dante's Inferno you will know what to expect from this company, 9th circle of hell indeed. I needed specialty medication, kept calling their number, was transferred to 5 different departments before they could find my ID# and transfer me to the supposed right one. Then waited 4hr. Yes 4 hours, their system kept disconnecting me because the hold was so long. My medication was time sensitive.
So long story short, I couldn't get through during business hours. Next day either, took time from work to deal with it, to no avail. I paid $900 (a small fortune for me to get it) because I was not going to wait any longer and risk my health. I still don't know if I would have gotten the meds or not, all I got was "Thank you for continuing to patiently holding we apologize for the extended delay" several hundred times.
I called my insurance to complain but hey why would they care? Their motto is take it or leave it, you are ** one way or another. We don't care. Well that's not what they said except that what it boils down to, I am stuck with getting my benefit only through this pharmacy or doling out hundreds of dollars out of pocket, short of losing my job. I have done everything I could but can't risk losing my job and then insurance all together because I need it.
I got a letter stating if I want to get my medicines by mail for cheaper cost then I should enroll in OptumRX. I tried to do that a multiple of times to no avail. So I called them to no avail. I am an 86 year old man who worked at IBM when it was in its heyday as a manager. I would have been fired if the customer service I provided was bad as OptumRX. I don't understand how they stay in business.
My wife has a daily prescription for 90 mg of medication. They don't make a 90 mg dose, so she's been taking a 60 mg and a 30 mg on a daily basis. As of 1/1/17, they informed us that a daily 90 mg dose exceeds the "quantity limitation." The OptumRX formulary only allows two doses of a given medication on a daily basis. My wife was only taking two doses (30 mg and 60 mg) on a daily basis. But OptumRx chose to ignore that fact, and elected to treat a 90 mg daily dose as THREE 30 mg doses. THEY LIE. We spent at least 3 hours on the phone, to try to logically explain the situation.
Finally, we were told to file for a "prior authorization." That process included three (four?) separate phone authorizations by my wife, giving me authority to speak on her behalf. The request was denied, because OptumRx said the doctor had not responded. The entire process was totally opaque, in that the patient has no access to the actual communication among the pharmacy, the doctor and OptumRx. I went to the doctor's office and went ballistic. The doctor's admin assured me they had responded, but would do so again. Again we spent another three hours to apply to OptumRx for a "prior authorization", including another phone authorization for me to speak on my wife's behalf. The application was denied because the combination of a 30 mg and a 60 mg daily dose exceeds the two-dose daily "quantity limitation." Simply put, two is NOT more than two. THEY LIE.
We called OptumRx to file an expedited appeal. That was another 1-1/2 hours on the phone, including a verification of the fact that OptumRx's records showed I already had authorization to speak on my wife's behalf. The Optum representative told us to contact the doctor again, and have them prescribe THREE 30 mg daily doses, which provide a clear basis to gain an exception to the 2-dose-per-day "quantity limitation." We went back to the doctor, who by this point was also frustrated. The Optum rep assured us that we would have a decision within 72 hours.
Three days later, we received a denial from OptumRx because we had not filed the proper form to establish my credentials to speak on my wife's behalf. Since I had already been assured I had that authorization, OptumRx was lying one way or the other. THEY LIE. Moreover, the response submittal had to be delivered within 72 hours, and we were on the other side of the country for a funeral and didn't even see the decision letter for another 10 days. The saga will continue, but it's time to start recording the phone calls with OptumRx, because THEY LIE.
OPTUMRX is Total TURD GARBAGE!! The internet site doesn't give data to the phone reps. so you have to go through the whole registering thing again and after 10 minutes of giving your private info to verify. Then they won't transfer from a pharmacy. They will only take a new prescription from the doctor which requires you to go and pay another copay to the greedy scumbag doctor. After 3 weeks of waiting and no notifications they never shipped anything and I gave up on this garbage. Supposedly even after the doctor sends it they have to talk to you again before they will send it and send it snail mail. How ridiculous!
Millions of American citizens who are weak and sick are subjected to this horror of back and forth and waiting and suffering without any help and they won't even let another person help because of HIPAA. What a DEVIL LAW that does nothing except make things worse except for the paper and file cabinet industries and they sell our info and data breaches. What a sham America is!! The only way to get your medicine is to go to the local pharmacy and hope they stock it because lately they stopped even that and must wait for them to order it.
The customer service rep and managers at this company is deplorable, unprofessional and uneducated. After 45 days of trying to get my mother's prescription refilled, a call to the insurance company & we figured out Optum reps has been looking at the wrong insurance plan.
My doctor prescribed 3 tubes of medication for 90 days. They sent 2 tubes for the price of 3. When I asked for the extra tube, they said the doctor's directions indicated 2 tubes. THIS WORD FOR WORD WHAT OPTUMRx CUSTOMER SERVICE SAID ABOUT THEIR PRICING: "Your copay would be the same for two tubes, three tubes, four tubes, etc... If the prescription had called for only one tube you still would have paid the same price as you would two or three, so it is more appropriate to say that you paid your copay for 90 days worth of medication. We dispensed the correct amount and the copay is correct."
Twice now I have had major issues with trying to get a prescription for migraines. Tell first time took well over a month and probably 20 phone calls between myself and doctor's office. This time has been well over 2 weeks and maybe 20 phone calls and 5 faxes that were supposedly never received and fingers crossed we are almost there. The issue is there is no communication between departments and you always get a different answer every single time you speak with someone. It is unfortunate that we cannot use an alternative provider.
Basically money **. OptumRx is a broken arm of United Healthcare Insurance, Optum doesn't care about patients or increased pain and suffering. As long as they can cut cost at your expense you will get every run around and catch them in straight out lies, trying to discourage you from pursuing the right path. Don't bother calling them, they purposely hire mentally challenged people to serve as their front lines. No doubt they are trained on how to give you the run around. Never fall for the "Well let me give you a number to call routine" or let me transfer you to that fictional department. All you will get is a discontinued nonexistent number.
I really hate this company, terrible service, No compassion, there is no such thing as a pre-existing condition with this company. Blatant disregard for the law. Its administrative nose pickers who think they are Doctors. They are not board certified physicians. That are making dangerous decisions to save a buck. If you are reviewing Insurance Companies to purchase insurance from, and If that Company is using OptumRx as their prescription delivery system "RUN don't walk but RUN for your life because it may depend upon it". I strongly suggest going to AETNA or Blue Cross and Blue shield. Optum RX is filled with nose pickers who are trying to be recognized for cutting costs, and in a sense they are illegally practicing medicine at your expense.
Someday someone will die or commit suicide based upon what these nose pickers are doing to United Healthcare patients. If United Healthcare were smart they would dump OptumRx otherwise they will end up losing business in the long run. I am suggesting to my wife to become very vocal about how bad OptumRx is when her company entertains new Insurance Companies. RUN YOUR LIFE - IT MAY BE DEPENDENT ON THE NOSE PICKERS. "Hey Harold I saved $36.00 for the company today by denying medications to this old helpless man." Harold: "Oh Yeah that's nothing. I denied 7 medications for one guy today because he couldn't meet my new medical criteria I created to receive those medications and I saved the company $589.00 per month or until the old geezer starts pushing up the daisies and then the company will save $869.00 per month. I can't wait until I get my cost savings bonus check this month."
We have UnitedHealthCare Medicare drug plan. They claim to save us money by using their "preferred" mail order pharmacy, OptumRx. On 12/20/16 we got a prescription for ** 300 mg. #90 for $67.06. On 4/27/17 we got a refill for EXACT SAME prescription and our insurance was billed $169.99. When I called OptumRx to question huge price increase they claimed a large price increase from their manufacturer. I went online (and called to confirm) price from Costco and was given a price quote of $83.12 for this Rx.
After hours (NOT EXAGGERATING) on the phone to get my scripts transferred to this UHC mail order pharmacy, I still do not have them! I am a new member of UHC, so 3 weeks ago decided to transfer my scripts. Called OptumRx and they took down the information, said they would contact my doctor. Waited a few days, nothing shows up in the website. Called again, they said the doctor did not respond. I called the doctor's office and they said they faxed the scripts. OptumRx calls to say one cannot be filled because they cannot send 2 tablets per day for 90 days. They suggested the double strength of the same medication; since I take the 2 tabs together (because of my previous insurance) I thought that was a great idea and heartily agreed.
A week later, still no indication they received the scripts; called my doctor again. They said they sent them. Then after 3 weeks, I check and they have the script for the 2 tabs in my cart at $509, not the UHC price! I called immediately and told them, "NO, stop that, not going to pay." They said that was how my doctor ordered it. I drove back to my doctor and they sent new scripts while I was there. Gave OptumRx to get them online; they canceled the 2 tabs, nothing else. Called OptumRx and they said they got the update, would be a while before it was in system. I asked about the other 2 scripts. They said they were faxed but didn't have the doctor's name on the script; to resolve it, the doctor's office had to call and verify the provider. They hung up on me went I started to vehemently complain. I called back to speak with a supervisor who said they couldn't help at all. WTF?? UHC is going to hear about this.
I just switched jobs, and unfortunately, I have UnitedHealthCare for my health insurance. United HealthCare is fine, but I had HORRIBLE experiences with OptumRX in the past. They still haven't gotten their act together. First, when I had my doctor send over prescriptions, I got an email that there was a problem with my order. I called in, and they said my account was inactive. Their system couldn't handle that I used to be with UHC and was again covered by UHC. Got that fixed, and everything seemed like it might be OK. Then I get a letter that one of my drugs isn't covered in 75mg strength. I call the doctor and have them send over 50mg instead. Meanwhile, it seems that the other drugs are OK to ship. I call in about the other drugs on April 24th, because the website says that they were filled on April 20th. "Oh, no, they haven't shipped yet."
April 30th, I notice that the hold on my credit card was released by OptumRX, and there wasn't any charge. Did my order that supposedly filled April 20th have a problem? I called in, and she said my account was on hold! Called in again, and the pharmacist now has a problem and wants more clarification on the order that they had marked as shipped on April 20th! Oh, and the order for the 50mg strength instead of 75mg strength?? They put that on my inactive account!! And the supervisor that (hopefully) cleared this up for me? His name was Michael, but he refused to give me his last name -- company policy!! I'm the CFO at my company, and I can't wait to tell the insurance broker how horrible the service from OptumRX is.
I mailed in my prescriptions overnight express $24.00 my cost. Gave 3 weeks for the Pharmacist to review, call my Doctor with any questions as she was leaving on vacation. I wanted to make sure nothing went wrong. WHAT A JOKE. They called, confirmed and confirmed and then when all we thought was done she left on vacation. Now they have another question. She can not respond now. I am 3 days away from needing my pills and everything is on hold. I asked to send them back, called back, no mention in notes still waiting.
Now they gave me an override number to give my pharmacist of 10 years to try and get filled. Can not do anything till Monday am. Now I will be entering the hospital in three days if it does not work. WORST EXPERIENCE. STRESSFUL, NON-COMPLIANT SERVICE I HAVE EVER BEEN THROUGH. Just save the time. DO NOT USE this service. It is life threatening situation. THEY DO NOT CARE. Joke of all pharmacies.
I called twice asking about my prescription and how much it would be. Both times I was told it would be a $0.00 copay, so I decided to go ahead and get it through mail order instead of through a pharmacy. When the prescription came in the mail, they charged me $46.52. I called back, and the person working there said she couldn't see anywhere that the prescription would be $0.00. OptumRX needs to get their act together and stop giving out incorrect and inconsistent information. The employees apparently have no idea what's going on in their own company.
This is not going to be long. But in short OptumRx cannot keep their story straight from phone call to phone call. After many calls to come to a solution they revert to not knowing what is going on and start from square 1. I have made at least 20 phone calls about a particular prescription, this year alone (it happens every year), and each time after a maddening hour or so the situation appears to be fixed. But somehow it gets messed up and I have to call again. Tonight I was so mad I told them to cancel all my prescriptions and send me a return box so I could send my unopened ones back. Too long of a story to go into. But take my word, stay far far away if you value your sanity.
This is one of the worst companies I've dealt with in years. Absolutely horrendous follow-through and communication protocols. If there is an issue of any kind they sit on information, neglect to communicate, and ignore giving ways to resolve it. When you call OptumRx to get something resolved the only answer they can give you is: "It's not in our policy to do that." They never get any issues resolved, just an on-going circle of poor customer service and absent communication.
I called OptumRX to reorder prescriptions. On 4 out of the 5 they told me I could not reorder and that my doctor had cancelled the prescriptions. On the prescription bottle labels it clearly stated the prescriptions were renewable and I had copies of the prescriptions showing refills were approved by the doctor. The OptumRX representative argued with me and said it was clear, in their database, that my prescriptions could not be renewed. I told her she was wrong. She put me on hold and came back and said a pharmacist determined OptumRX had put in the incorrect prescription expiration date at the time of the earlier order. This is not the first time OptumRX has messed up. UnitedHealthcare needs to get rid of OptumRX and get a new mail order pharmacy.
ConsumerAffairs Research Team
The ConsumerAffairs Research Team believes everyone deserves to make smart decisions. We aim to provide readers with the most up-to-date information available about today's consumer products and services.
OptumRx is a healthcare management company that offers pharmacy benefit management solutions to organizations across the healthcare industry. Their pharmacy solutions include home delivery services, member engagement, pharmacy management and specialty pharmacy management.
- Member engagement: OptumRx focuses on educating its members through personalized tools and 24/7 support. Their mobile application lets members refill or renew home delivery prescriptions, locate a pharmacy and find generic drug prices and discounted prices. OptumRx also gives its members the option to receive text messages to remind them when to take their medications.
- OptumRx home delivery: The OptumRx home delivery service includes free standard delivery to United States addresses and territories. New prescriptions will arrive within 10 business days, while refills will arrive within seven business days. Members can create accounts with OptumRx, select their medications and place orders. OptumRx will contact primary care doctors and licensed medical professionals for approval as needed.
- Pharmacy benefit management: OptumRx pharmacy benefit management solutions focus on optimizing its members’ health through monitoring and engagement. It teaches members about safe medication use and cost-effective treatment options.
- Specialty pharmacy management: OptumRx helps specialty pharmacies by identifying trends in specialty care and creating clinical programs to help alleviate costs. Their website includes resources on specialty conditions, one-on-one video consultations with pharmacists and information on how to increase adherence to specialty drugs.
- Accreditation: OptumRx holds multiple accreditations with URAC, including one for specialty pharmacy services, pharmacy benefit management and drug therapy management. They are also accredited by VIPPS and the NABP.
- Best for organizations needing pharmacy benefit management solutions.
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OptumRx (formerly Prescription Solutions) Company Profile
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