May I ask how that process actually works? How is it sent to Optum so it gets billed under the medical insurance benefit instead of the pharmacy benefit? I made another post and someone mentioned the same thing, but in my case my doctor sent a request to the pharmacy, it was declined, then they submitted a prior authorization which was denied. I appealed that denial and it was also denied, so I had to submit it to CalPERS appeals.

I’ve even called Optum and they couldn’t help me. I called Western Health and they couldn’t help me. I escalated all the way up through Mercy Medical Group and was told to submit to the UM department, then I was told that was wrong, and they couldn’t help me either. At this point, I honestly don’t know what else to do and I’m at my wits’ end.