Denials, appeals and grievances

Find appeal teams, faxes and mailing addresses. Use the denial notice to confirm the appeal level, filing deadline and recipient.

appeals grievances

Pharmacy MAC reimbursement appeals — Optum Rx Lists 1 and 2

Official page read

Phone800-613-3591 ext. 9Fax

866-285-8652

Pharmacy MAC price/reimbursement appeals for Optum Rx Lists 1 and 2.

Published email

MAC@optum.com

Pharmacy MAC price/reimbursement appeal inquiries for Lists 1 and 2.

Published hours

Monday–Friday 6:00 a.m.–4:00 p.m. Pacific.

Product, plan and location

Confirm the exact product or service
National contact — confirm product and location

Mailing address

Not researched for this route

Menu guidance in the source record

Use extension 9, as published; not live-call verified.

Menus can change. No live call verification is claimed.

Page 22: pharmacy reimbursement/Maximum Allowable Cost price appeals for Lists 1 and 2. List 3 workers compensation and auto no-fault have separate routes. No general claims or clinical appeal scope inferred.

View source ↗ · Source checked 2026-10-22 · Source published 2026 Fourth Edition, version 4.1; exact publication day unstated

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Wait time: not establishedBest time from caller reports: not established. Published hours are not a wait forecast.

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Call preparation · editorial guide

Make the call count.

Find appeal teams, faxes and mailing addresses. Use the denial notice to confirm the appeal level, filing deadline and recipient.

Have ready in your secure workspace

Denial notice, remittance and reason codes
Previous appeal confirmation and decision
Supporting evidence and any required authorization to represent the member

Questions to resolve

Is this a claim correction, provider dispute or member appeal?
What deadline and submission channel apply to this case?
How can the office confirm receipt and track the decision?

This is a general administrative checklist, not payer policy or advice about a particular patient. Confirm the current plan instructions.

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