This has been a year long problem that has gotten nowhere through many phone calls.
I used to have UHC and received an infusion medication through OptumRX specialty pharmacy every month for 4 years. The infusion center I went to ordered the medicine each month from OptumRX.
In 2020 my insurance changed and I no longer used OptumRX. My infusion center was notified on January 4th about the new insurance. OptumRX still sent the medicine to the infusion center on January 18th. I was charged $10k. OptumRX said I was in a program that automatically ordered the medicine every month, but that is not true because the infusion center ordered it every month. The program I was in was so I didn’t have to give them permission to send the medicine every month and that program was for 12 months every year from January to December. The infusion center did not order the medicine (I know the woman who orders it and trust that she didn’t order it because she already knew about my new insurance).
So I’ve spent all of 2020 on the phone with OptumRX trying to get this straightened out. I get the run around every time and they promise to call back with updates in 24 hours, which has never happened. The furthest I’ve gotten was they confirmed with my infusion center that they still have the medication that was erroneously sent in January 2020. One representative said they could just send it back and this would all go away. I never got that one on the phone again and the next one said it’s not that simple and they’ll call back with more information.
To make matters worse, I have another charge of $1.5k from OptumRx that was sent to collections last year. They claim it was from June 2019 and it was because the drug company didn’t pay $1.5k of my copay assistance. This whole thing is completely wrong because I only received copay assistance for the first 3 months of the year until my deductible was met AND I have the EOB from my insurance company showing that the full amount was paid by the insurance company for the June 2019 infusion. OptumRx has been “looking into it” for about 3 months now. I disputed the claim with the collections agency and they put it on hold for now.
So where do I go from here? The calls are not doing anything and I’m beyond frustrated. I want to send them some sort of formal letter to request an answer to all this and dispute all these charges before the $10k goes to collections too. Does anyone with experience in the health insurance industry know what my next steps should be?
Thanks so much for any advice and for reading this long post.
submitted by /u/Aloftfirmamental
[link] [comments]
This has been a year long problem that has gotten nowhere through many phone calls. I used to have UHC and received an infusion medication through OptumRX specialty pharmacy every month for 4 years. The infusion center I went to ordered the medicine each month from OptumRX. In 2020 my insurance changed and I no longer used OptumRX. My infusion center was notified on January 4th about the new insurance. OptumRX still sent the medicine to the infusion center on January 18th. I was charged $10k. OptumRX said I was in a program that automatically ordered the medicine every month, but that is not true because the infusion center ordered it every month. The program I was in was so I didn’t have to give them permission to send the medicine every month and that program was for 12 months every year from January to December. The infusion center did not order the medicine (I know the woman who orders it and trust that she didn’t order it because she already knew about my new insurance). So I’ve spent all of 2020 on the phone with OptumRX trying to get this straightened out. I get the run around every time and they promise to call back with updates in 24 hours, which has never happened. The furthest I’ve gotten was they confirmed with my infusion center that they still have the medication that was erroneously sent in January 2020. One representative said they could just send it back and this would all go away. I never got that one on the phone again and the next one said it’s not that simple and they’ll call back with more information. To make matters worse, I have another charge of $1.5k from OptumRx that was sent to collections last year. They claim it was from June 2019 and it was because the drug company didn’t pay $1.5k of my copay assistance. This whole thing is completely wrong because I only received copay assistance for the first 3 months of the year until my deductible was met AND I have the EOB from my insurance company showing that the full amount was paid by the insurance company for the June 2019 infusion. OptumRx has been “looking into it” for about 3 months now. I disputed the claim with the collections agency and they put it on hold for now. So where do I go from here? The calls are not doing anything and I’m beyond frustrated. I want to send them some sort of formal letter to request an answer to all this and dispute all these charges before the $10k goes to collections too. Does anyone with experience in the health insurance industry know what my next steps should be? Thanks so much for any advice and for reading this long post.
submitted by /u/Aloftfirmamental [link] [comments]Read Morer/HealthInsurance