Public Mediation

T.M. vs. Optum Specialty Pharmacy

  • 10% of recovery offered for best resolution

OPTUM SPECIALTY PHARMACY CAUSING STRESS TO MS PATIENT

T. M. vs. Optumrx
11000 Optum Circle, Eden Prairie, Minnesota, 55344, United States
Amount Involved: $50,000.00
    • Status: In Negotiation
      This claim has posted for public comment and negotiation. It will remain posted until resolved to the claimant's satisfaction. Suggest a resolution to help these parties reach a settlement.
       (seeking public comment)
    • Claimant Seeks: View.
    • Claim #: 1312793
    • Amount Involved: 50,000.00
    • Filed On: Feb 11, 2022
    • Posted On: Feb 22, 2022
    • Complaint(s):
      • Rude or Unprofessional Behavior
      • Incompetence
      • Negligence
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Statement of Claim
Complaints Involved (4) - View
Claimant says:
"I am a 40-year-old woman who has been living with MS for 20 years. The cost of my medication after insurance is 681.93 for a 1 month supply. Last me after a lengthy back-and-forth process I was awarded a co-pay assistance program. I spoke with a very helpful woman Chaquita Taylor for an extended time plus emailed back and forth to finally get it added to my account.

The very next time I had to call for a refill, no one saw any notes of the previous conversation, no one saw that I had a co-pay assistance on my account. I had to be on hold and be transferred just to finally come back and they saw it after they dug.

My question and concern is why does your system not populate when a person has co-pay assistance? Does Optum RX not understand that stress is horrible for a person with multiple sclerosis? Every time I call for a refill, which is every month, the agents do not see any other previous conversation and I am on hold back-and-forth getting upset.

I am very fortunate that I am still able to talk and I have no issues I have all of my working faculties; however not all MS patients can do this. I end up in tears every time I get off the phone because it's so much stress and worry. I need this medication for my life sustenance.

I called on 2/5/22 To start my refill because I received a call to do so. When I called them that agent was actually very rude, she did not seem to have a care in the world for my situation. She also did not see any notes about my co-pay assistance and she was asking for me to give her the 681.93 to schedule my delivery.

Yet again I explained to her the whole situation and explained to her how I did not understand why I have to keep going through this each time. She put me on hold and came back to say the department that handles my account because of my co-assistance was closed on the weekend and I wouldn’t need to call back. Horrible horrible customer service. Why would this not be notated on my account?

Getting my prescription filled should not be a source of extreme stress and anxiety for me every month. I always feel bad for other people with MS who cannot communicate as well or make these calls or keep being a detective with a company that has an inadequate, insufficient, or non-existent note-taking process.

I spoke to someone on 2/7/22 - again they saw NO NOTES, no pop up, I had to explain all over again, be on hold, ridiculous! Thought it was set for delivery by 2/9. Nope! I just called today and spoke to Raina. Very nice lady but same story - different person. I actually started to cry.

I can’t take this. Optum Specialty Pharmacy is going to cause me to have a nervous breakdown going through this every month. Stress is horrible for people with MS and unfortunately for me, the pharmacy I have to get my refills though is a source of stress and anxiety for me. Regularly!

I am going to inform the National MS society about this. This has to be changed and updated with your systems. It’s 2022. This is unacceptable and I will take this to the media if I have to. I don’t want other MS patients to deal with this.

I did tell Raina that although she seemed nice and claimed she would note my account, as did countless others, I have zero faith in Optum Specialty, so I let her know that the same way I know their calls are monitored, I was also monitoring the call and I recorded it.
"
...
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What Claimant Wants Hide
1. Compensation: pain, suffering, stress and anxiety Feb 26, 2022 $50,000.00
2. Other – Pay for claim posting cost Feb 26, 2022 $14.99
Cash total : $50,014.99
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Respondent's Counteroffer

There has been no response to this claim from OptumRx. This claim will remain posted until resolved
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