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Get your patients the treatment they need

Our appeals team overturns nearly eight out of 10 denials.

Optum Specialty Pharmacy and Optum Infusion Pharmacy Appeals Team manages the appeals process so that you don’t have to. Our team overturns nearly eight out of ten denials and has helped 2,500 patients get coverage for their medication after they were previously denied.

Video Component

Meet the Optum Specialty & Infusion Pharmacy Appeals Team

(Light music playing.)


(Title slide reading: Optum Specialty Pharmacy & Optum Infusion Pharmacy Appeals Team, Changing Dynamics in Healthcare)


The team was created in response to


the changing dynamics in healthcare.


So at that point in time, we started to see a lot of denials.


And patients having difficulty


getting access to the mediations and treatments


that they really needed.


(Title slide reading: Combined 100+ years of clinical experience across the team)


When we get a denial on a patient,


the first thing that we're going to do


is review medical polices for the insurance company.


Every insurance company is different, and


things that they ask for are going to be different


and specific to each patient's plan.


So, once we have that knowledge base,


then we focus in on what that individual patient


is experiencing, what their symptoms are,


what medications they may have tried in the past are,


and we write a letter that is specific to them.


(Title slide reading: In 2021, the teams had an 80% overturn rate after previous denial)


I called the patient, and I said, you know,


Not only did we get it approved,


but we got it approved for you for a year.


I remember saying, "That just made my day."


And the patient said, "You just made my life!"


And I get goosebumps just every time I think about it.


Because it's such an incredible feeling


to know that you had that kind of impact.


You know, it's challenging ...


and rewarding all at the same time.


(Title slide reading: Since 2018, over 10,000 patients were approved after previous denial)


We are an advocate for these patients.


We treat them ... I always think of them


as my mother, my brother, sister, father.


How would I like to be treated if I was in this situation?


And I treat my patients the same way.


(Title slide reading: Contact your Optum representative to learn how we can help with your appeals.)


(Optum logo appears.)



Help you and your patients can count on

Insurance denials are a common obstacle for many patients. Even patients who desperately need medication can be denied by their insurance company. That’s why our appeals team is so critical.

Our team manages the insurance appeals process so you don’t have to. With more than 100 years of combined experience, our clinicians, nurses and administrative experts work together on your patients’ behalf.

Our team helps you and your patients:

  • Conduct initial clinical reviews
  • Submit for prior authorization
  • Review and assess any denials
  • Write customized appeal letters for insurance denial
  • Provide talking points to help with peer-to-peer review 

Contact us today using the information below, or by completing the form on this page.

Visit: Optum Specialty Pharmacy

Visit: Optum Infusion Pharmacy

To get in touch with a member of our team, complete the form below
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