I’m investigating a denial of a prior authorization request sent on my behalf by my rheumatologist for biologic treatment (autoimmune condition).
The boilerplate Notice of Denial from OptumRX states that i can request and receive the materials used as a basis for the denial (i.e. coverage limitations, eligibility guidelines, etc.) by calling OptumRx at 800-711-4555. I called and gave all of the necessary identification verification information and Optum told me that i needed to call United Healthcare (member services) to receive that information. I then called United Healthcare’s member services and they directed me to OptumRx (800-711-4555) to get that information– the same number I called previously.
All i want is to receive the information that was used in the denial determination, which OptumRx’s Denial letter represented as available to me. It seems like neither organization has any interest in providing this information or giving a clear answer on the status of my provider’s appeal.
Has anyone dealt with a similar scenario or been able to get a straight answer from UHC or OptumRx?
submitted by /u/raccoon4garbage
[link] [comments]I’m investigating a denial of a prior authorization request sent on my behalf by my rheumatologist for biologic treatment (autoimmune condition). The boilerplate Notice of Denial from OptumRX states that i can request and receive the materials used as a basis for the denial (i.e. coverage limitations, eligibility guidelines, etc.) by calling OptumRx at 800-711-4555. I called and gave all of the necessary identification verification information and Optum told me that i needed to call United Healthcare (member services) to receive that information. I then called United Healthcare’s member services and they directed me to OptumRx (800-711-4555) to get that information– the same number I called previously. All i want is to receive the information that was used in the denial determination, which OptumRx’s Denial letter represented as available to me. It seems like neither organization has any interest in providing this information or giving a clear answer on the status of my provider’s appeal. Has anyone dealt with a similar scenario or been able to get a straight answer from UHC or OptumRx? submitted by /u/raccoon4garbage [link] [comments]Read Morer/HealthInsurance