In January, UC’s preferred provider organization (PPO) medical plans for retirees with Medicare (UC High Option Supplement to Medicare, UC Medicare PPO and UC Medicare PPO without Prescription Drugs) and for employees and retirees without Medicare (Core, UC Care and UC Health Savings Plan) made a transition to new administrators for medical, behavioral health and prescription drug benefits.

Unfortunately, issues related to this transition have made it difficult for some members to access their prescription drug benefits, leading to inconvenience and frustration. Please be assured that many people have been working diligently to correct enrollment errors, streamline the authorization process for prescriptions and improve the service UC’s members receive.

UC Human Resources (HR) is committed to making things right for UC’s faculty, staff and retirees. To do this, HR is working with OptumRx to improve members’ experiences going forward, and will ensure that members are reimbursed for any unnecessary pharmacy expenses they incurred because of past problems.

Improving members’ experience

As soon as UC Human Resources became aware of the problems members were experiencing with their plans, staff members began meeting daily with OptumRx and Anthem to resolve critical issues and look for long-term solutions. For example, programming was developed to resolve complicated problems with electronic data transfer that were responsible for many of the enrollment errors affecting members.

HR has also been working with the OptumRx customer service team to help their representatives better serve UC members. In the past, the burden was too often put on the member to research and resolve problems with enrollment, eligibility and authorizations, requiring multiple time-consuming phone calls. Effective immediately, OptumRx has committed to a new process that minimizes inconvenience for the member, with the customer service representative taking full responsibility for:

  • Authorizing a short-term prescription fill while a problem is being resolved
  • Working with Anthem and/or UC Human Resources to research questions about enrollment or eligibility
  • Contacting the provider for any information needed to authorize prescriptions
  • Following up with the member in the promised timeframe to explain the problem resolution

If you need reimbursement for a prescription

If you paid for a prescription out of pocket that should have been covered by your plan, OptumRx will reimburse you for the amount that should have been covered. To request a reimbursement, complete the Member Reimbursement Drug Claim Form and mail it to OptumRx at:

OptumRx
PO Box 968021
Schaumburg, IL 60196-8021

You can also call OptumRx at 855-798-4682 to request the form. You have 365 days from the date the prescription was filled to submit your request.

Here are a few reminders from the OptumRx website to ensure your claim is processed quickly:

  • A separate member reimbursement claim form is required for each patient.
  • Allow up to 30 days from the time you mail your member reimbursement claim form until you receive an explanation of benefits from OptumRx.
  • The cardholder must sign the claim form.
  • The claim will be returned if the required information is missing. 
  • Please keep a copy of the member reimbursement claim form and documents submitted for your records.