I keep getting requests for referrals for patients to keep seeing the other docs the see (allergists, therapists and so on). If I don't send them, I get urgent calls for referral. If I do send them, I get back my referral fax with a second page attached. The second page always says "this does not require prior authorization." That is all that the second page says.
I just completed a pharmacy C.E. sponsored by this company. It was an excellently devised and informational program about diabetes.
Within the last six months, when I needed to find out what medications an elderly woman who was 'found down' was taking for pharmacy medication reconciliation, I could get ahold of no actual pharmacist, but going through the series of phone taggers, hoop switchers and transferers, I could access the insurance reimbursement records to have an idea of what possibly she might have been taking.
It used to be that a state-regulated professional obligation for pharmacists (and physicians and their nurses) to 'share' professional information about our patients. Now, the 'system' has conspired to withhold this in a banking or 'insurance' repository manned by high school-age debuntes.
At one time the insurance company I work for contracted with Optum for the RX. We no longer do. We currently use Weldyne and Cigna. Cigna seems Okay, but Weldyne keeps telling our clients that their insurance is cancelled. They call us, frantic, and we have to jump hoops to get Weldyne to admit they are covered. Still haven't figured out where the glitch is, with Weldyne or with us.
Makes your head spin. When you call they probably say we don't do authorization for this drug, please refer to the cantact on the prior fax.
ReplyDeleteSigned Joseph Heller
ReplyDeleteI keep getting requests for referrals for patients to keep seeing the other docs the see (allergists, therapists and so on). If I don't send them, I get urgent calls for referral. If I do send them, I get back my referral fax with a second page attached. The second page always says "this does not require prior authorization." That is all that the second page says.
ReplyDeleteAnd I'm sure the phone number for Optum was nowhere to be found.
ReplyDeleteWe are the Borg. Resistance is futile. You will all be assimilated.
ReplyDeleteOptum Rx is a subsidiary of Rectum Care so you should have anticipated dealing with assholes.
ReplyDeleteBrent:
ReplyDeleteI am Dyslexic of Borg. Your ass will be laminated.
This is my specialty pharmacy and I'm forced to used it by my insurance company. Unfortunately, this isn't a joke.
ReplyDeleteThought you'd find this interesting: https://medium.com/backchannel/how-technology-led-a-hospital-to-give-a-patient-38-times-his-dosage-ded7b3688558
ReplyDeleteFrom my view in community pharmacy - OptumRx is BY FAR the worse company we have to deal with.
ReplyDeleteI just completed a pharmacy C.E. sponsored by this company. It was an excellently devised and informational program about diabetes.
ReplyDeleteWithin the last six months, when I needed to find out what medications an elderly woman who was 'found down' was taking for pharmacy medication reconciliation, I could get ahold of no actual pharmacist, but going through the series of phone taggers, hoop switchers and transferers, I could access the insurance reimbursement records to have an idea of what possibly she might have been taking.
It used to be that a state-regulated professional obligation for pharmacists (and physicians and their nurses) to 'share' professional information about our patients. Now, the 'system' has conspired to withhold this in a banking or 'insurance' repository manned by high school-age debuntes.
At one time the insurance company I work for contracted with Optum for the RX. We no longer do. We currently use Weldyne and Cigna. Cigna seems Okay, but Weldyne keeps telling our clients that their insurance is cancelled. They call us, frantic, and we have to jump hoops to get Weldyne to admit they are covered. Still haven't figured out where the glitch is, with Weldyne or with us.
ReplyDeleteSounds about right. Bastards.
ReplyDelete