I have gout since 2014 and take medication. Got a new PCP since switching jobs in 2020, and when I got rashes, he changed me from allopurinol to febuxostat. Later we found out the rashes were due to unrelated reasons, and he didn't want me to switch medications frequently so I stayed on it. When my refills ran out, CVS usually requests to renew it and I have no issues.
I got laid off in May 2025 and went to see if I could get my usual prescription before my insurance expired since febuxostat is $300+. CVS told me to go contact my PCP. I contact my PCP and the receptionist said I need to speak directly to the doctor about my medication and there would be no charge. He called me back a couple days later, refilled my prescription, and I thought I was good to go.
A couple months later I get a bill for $79.60 for a doctor visit. I called Optum talk to them and then opened an appeal. They changed my in-office visit, to a telecommunication visit. Appeal got denied so I opened an appeal with UnitedHealthcare. While that appeal was going on they kept sending me bills and I called Optum. They told me they'll note it in my profile and to ignore it. Optum sent me to collections while I was appealing with UnitedHealthcare. UnitedHealthcare appeal got denied. I then appealed with DHMC and that got denied too.
Optum said any medication needs/discussions is billed as a doctors visit and it was considered an "office visit". UnitedHealthcare pretty much said they only handle billing so take it up with Optum. DHMC said due to their terms and conditions I am liable for any services I receive. They told me "my issue is with the quality of service" from Optum which they have forwarded to them and it will be investigated.
I got a collection notice from Professional Credit Service to pay the bill again. Is there anything I can do? To me $79.60 is not a lot, but I feel like I got scammed. It was the entire reason I went through the long arduous path of appeals. I feel like I should just take the L and just pay it. My friends were telling me to not pay the scammers and since it is below the $500 limit it won't effect me.
I have since changed pharmacy from CVS to Costco and through this experience. Costco dude told me the reason is febuxostat requires a doctors visit for the prescription and allopurinol does not. I had to my prescription changed back to allopurinol through Costco, they renewed my refills, and they've handled everything so well for me since. I am gonna stick with Costco. I am just going to have my pharmacist handle everything from now on.
This ended up being a rant. Thank you for reading this far and any advice is appreciated.
tl;dr CVS told me to contact my PCP to renew refill. Optum charged me for a doctor's visit when I did not visit the doctor's office. Appealed with Optum, changed in office visit to telecommunication visit. Appeal failed. Appealed UnitedHealthcare and DHMC and both failed. I feel like I got scammed. Should I just pay it?