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OptumRx specializes in the delivery, clinical management and affordability of prescription medications and consumer health products. Our high-quality, integrated services deliver optimal member outcomes, superior savings and outstanding customer service. We are an Optum company - the world's largest provider of integrated health services.
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It is my personal belief that the purpose of this company is not that of providing healthcare prescription coverage but rather its goal is to cause stress to the patient/subscriber for mysterious reasons that until they are investigated can only be extrapolated. This company changes its policy with every phone call I have made to them.
This company is labeled as a mail delivery prescription/pharmacy. This is absurd for many reasons; I live off-grid, remote in deep wilderness. There is no mail service at my home where I live. I have to drive to my PO box 32 miles (one way). Winter is severe here.. having snow covered one lane gravel roads that seldom get plowed, a trip to the post office box can take up to 2 hours one way. Medications in the PO BOX can be exposed to extreme temperature in winter. Also it has short hours and closed on weekends. I informed OptumRX of this problem and their solution was to approve pick up at a local pharmacy. However OptumRX will only supply 21 days of a 30 day prescription. OptumRX says the pharmacy is "OUT OF NETWORK" and therefore I am penalized with having to go 1 week with no medication every month. This is unacceptable.
One time I called and I was told I could pick up my prescription at a CVS pharmacy and the OptumRX rep. told me to go pick it up right away because it was ready. It was a 70 mile drive to CVS and when I got there I was NOT able to pick up the prescription because OptumRX instructed the pharmacist to hold the pills for 4 more days because I was there too early. You can plan on spending approximately 24 hours a month on the phone with OptumRX because they have set up a hoop-jumping process for every patient. My health has deteriorated since my employer hired this company to provide insurance benefits as of 1-1-2021.
On Aug.4th I called to have a delivery made of one RX Dr. had ordered. Initial order last month was two, he cut back so only needed one. I was on phone for 55 minutes with four young ladies and pharmacist saying I only needed ONE RX. After 55 minutes we hung up. Aug. 5th BOTH prescriptions came!! I called again, talked to two young ladies and another pharmacist, no one knew why, no one cared, and no one offered to rectify situation. If I were dying of thirst I would not go to these people for water. They just don't care! I talked to six ladies and two men from pharmacy, all I could get was, "we don't know why this happened". Strongly suggest anyone looking to do business with them, beware!!!!
I used to get IVIG from Diplomat until they were bought by Optum. Every delivery (three of them) I've had since the acquisition has been a failure and I've had to miss at least one treatment all three times. The first one happened when my advocate resigned and my patient file was never re-assigned to a new advocate. When I called, I discovered they don't have any process in place to ensure that doesn't happen. So ALL of this person's patients were forgotten - not just me.
The second time was when my insurance policy went from being a group plan to a COBRA Plan for the month of June. NOTHING about my insurance changed. It was a continuation of my group plan - I paid my premium out of pocket to my former employer. My deductible didn't restart, my calendar date didn't change, my ID didn't change. Even my group number remained the same. But Optum insisted that I now needed REauthorization. They finally managed to get that authorization on Jun 27th and ship the medicine - four days before I would be getting new group insurance through a new employer.
Coincidentally, my new group plan was also the same exact plan - but with a different group. But all of the same benefits and coverages. You'd think by this point Optum would have the process down. I gave them my new insurance information just before July 1st for the next shipment. Thankfully, my nurse was able to do my infusion with the medication I had. But on July 14th, I got a call from Optum asking for all of my new insurance information. AGAIN. It turns out, they hadn't done anything with the information I already sent them. And it took them two weeks to realize they needed to rush an authorization because my infusion was due in a few days. So on the 14th, I gave them all of my insurance information again and was reassured they'd make sure everything was taken care of for my next shipment. I was scheduled to receive infusion on August 4th.
On August 3rd, I called the pharmacy to make sure it had been shipped and found out 1. it had not been shipped, 2. none of my new insurance information had been forwarded to their authorization team and 3. no one even seemed to be aware that it was due! In the last three days I have been shuffled from one advocate to another, each promising to make a note in their system or to "escalate" my order or to notify a supervisor. An urgent message was sent to my advocate's supervisor so that he could put a priority status on my order the next day when he got in. I called at 3pm the next day and found that he hadn't even opened my file! Today is Friday. I spent a painful amount of time on the phone trying to RESEND a copy of my insurance card to them.
First, they couldn't seem to open a pdf attachment. Then they couldn't seem to open a screenshot. Finally it went through around 4pm and my advocate promised to call me back to let me know the status. She tried to call me once, around 5:30 and I missed her call. I called back and spoke to another advocate who confirmed my order was STILL NOT APPROVED. I am so done with this company. And I advise anyone who can to steer clear of them if you can. If you have to choose between this company and ANY other option, do yourself a favor and go with the other option - even if you have to travel to a doctor's office.
An active case file should NEVER just sit in some queue. There are ticketing systems designed to prevent these kind of snafus. A ticket is opened for an order and assigned to a person with a date due. The person has to mark it as resolved OR reassign it to another team by that date. And the next team has to do the same, until the order is resolved/closed. Tickets can be prioritized as urgent. Reminders and alerts are automatically sent to the people assigned to the ticket. Alerts can be set for tickets that are not assigned. A backup person can be assigned to a ticket. This is 2021 people - get with the program. GitLab issue tracking is FREE! You don't even have to pay for it. If you don't care enough about your customers to invest some effort in using the right tools, you shouldn't even be in business.
From day one it has been a headache. They spelled my name wrong, won't allow me to correct it, made it a hassle to correct my address, won't allow me to make changes unless it's through my employer-provided health insurance. They wouldn't provide authorization for antibiotics I needed until two weeks after I needed them (after I had already been hospitalized on IV antibiotics and had surgery for an internal infection instead). Oh, and after I called and asked pricing on Botox (for migraine treatment) and was told $240, I ordered it, and then they charged me over $1,100. I understand insurance is involved, but I called and asked the price for a reason! So then I asked them to please NOT refill the Botox as I would NOT be able to pay for it again. And they refilled it and sent it to my doctor and are harassing me for payment, even after I said not to send it.
I don't have another thousand dollars and I told them that after I got ripped off the first time. I even contacted Botox directly and got an insurance code from them to cover the cost so that I can get this resolved, but Optum refused to take Botox's payment and is demanding that I pay them personally with money that I don't have. I have asked several people and get a different explanation every time (I am keeping a record of each conversation so I do have proof of this). If I had any legal recourse to get them to stop harassing me, I would take it (their billing department called me 3 times today) but the resolutions department has yet to contact me, even though I've been asking to speak to them for months. Nobody will give me contact information for the resolutions team and just keeps promising to pass my information along to them. I can't imagine a worse series of experiences with a pharmacy.
My mother has this Optum Rx Plan through her employer. She recently experienced a cardioembolic stroke on Memorial Day and after being hospitalized for 3 weeks it is vital that she has her anticoagulant medication along with her hypertension medication. Optum Rx delayed the shipping of her 90 supply of medications but she received a message that it was delivered on August 6th but it was August 2nd when the message came through. She experienced confusion after the stroke. It is difficult for her to read and fully understand. Her medicine is now expected to be delivered in 3 days but she hasn’t had her medication. A local CVS filled the medication but we had to pay out of pocket since it was an emergency. This was not helpful and extremely inconvenient.
Horrible, horrible, horrible. The depts. must not be on the same system or communicate with each other. If you think a prescription is filled and on its way, it's not! You have to call at least 3 times in 2 weeks, and be transferred depts. 10 times. They will just hang up on you, switch you to other people without telling you, and they don't listen to a word you say nor do they jot any notes. BE prepared to never get your medications on time. It's only for your health and life and well-being.
Insurance changed and Alto is no longer our designated specialty pharmacy. Since OptumRx is both the insurance company and specialty pharmacy we anticipated a smooth transition. Not. The. Case. After a month’s worth of phone calls and transfers to “someone else who could help us” we finally had the prescription processed and scheduled for delivery. That, however, was not the end of the run-around. They are also not accessible. Managers/supervisors apparently only work Monday-Thursday. Do not bother to ask for one. Also, they can’t deliver on the weekends even though every other industry (including pharmaceuticals) can. Makes no sense. Not coordinated. Not organized. Not a service. More of another hoop to jump through. If we had another option, we’d consider it. To the organizations negotiating health care options, there are others and they are better.
Have been trying to obtain a specialty medication following all instructions from Optum to do so. Pre-Authorizations done, appeal done and finally independent review. Have been told 4 times that medication had been approved and was being sent. 3 of these times in the past 2 days only to end up getting a call telling me it was a mistake and the medication is not approved and will not be sent. The drug manufacturer was providing the medication to me until we could complete the steps for coverage with Optum however, due to Optum erroneously telling them that it was approved and being sent to me, the drug company closed my case and stopped sending the medication.
Repeatedly called Optum and requested to speak to a supervisor or manager and given to someone who was not a supervisor. On one occasion, the person falsely stated they were a supervisor only to find out on the next call that was made to them that they are not a supervisor. Repeated request to speak to management ignored. Told someone would call me back from management and this still never happened. Each time Optum calls, I explain the errors made previously and instead of checking further, they just repeat the same information regarding my medication being approved and sent followed by a separate phone call from them telling me it was an error and it is not approved nor being processed. I have several emails from them telling me the medication is being sent. Outcome: I am running out of medication that takes weeks to become effective with no hope in sight to obtain it was promised from this company.
Every time my doctor sends in a prescription, if OptumRx doesn't have it in stock they don't let me know and if I call asking when my prescription will be filled they say they never received the prescription. This has been going on for the last year and it's very annoying. I need my prescriptions and waiting a month for a medication is not something I want to do. When I spoke with a liaison with optumrx I found out that the prescriptions that the customers service reps kept telling me were never sent by my doctor actually had been received by optumrx but because they didn't have the medication in stock they figured lying was easier than just admitting they couldn't fill the prescription.
I sent in a letter of complaint and they responded with an encrypted email that can't be opened! This pharmacy is a JOKE! Not only do they lie about whether your prescription is there but they change the price to a much higher amount than what was quoted. Optumrx are a bunch of thieves and liars. I would rather pay the extra amount at CVS than put up with optumrx's **.
This company should be put out of business! They will kill someone sooner or later. They fail to refill prescription on time. When called about it they do nothing but give excuses for their failure. Then they take 2 to 4 weeks to get a needed prescription to you unless you pay for shipping. This company's failures are unacceptable and I personally will never use them again.
OptumRx (formerly Prescription Solutions) Company Information
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