OptumRx
Complaint 351683 Details

Refusing to cover a medically necessary medication, saying that the med is not covered while covering a different dose.

Company stated that it was too late for a prior authorization, that I needed a benefit appeal. The benefit appeal was then denied due to lack of prior authorization. This process took 6 weeks at which point, the process began again. This time the prior authorization was denied based on "medication not covered." Meanwhile, they covered that med at a different dose.

I have previously had the med covered as I have been on 25 mcg, then 38 mcg (25+13), then 50 mcg and now need 63 mcg which would be a 50 mcg caplet plus a 13 mcg. The 50 mcg is ready but, OtpumRx is refusing to cover the 13 mcg now.

Dozens of phone calls by the doctor and myself have still not resolved the issue. I have had to take 2 pills of the 50's every 3rd day to compensate which is dangerous.

A dose of 63 mcg of a hypo-thyroid medication is still a relatively small dose. For me to have to fight with this company for the medically necessary medication, while having to take a dangerous dose to compensate for their neglect is ridiculous.

As of today, August 22nd - the issue is not resolved.