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Topic: Re: Triptans: Insurance Company BS/Mumbo Jumbo (Read 289 times) |
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Cerberus
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Re: Triptans: Insurance Company BS/Mumbo Jumbo
« on: Jun 9th, 2004, 3:32pm » |
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Yup....sounds about right....hehe, Fuckers 
Ramon
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Lizzie2
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Re: Triptans: Insurance Company BS/Mumbo Jumbo
« Reply #1 on: Jun 9th, 2004, 4:15pm » |
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Hmmmmmm I posted that twice before and I think someone else may have even posted it before I did! 
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Gator
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Re: Triptans: Insurance Company BS/Mumbo Jumbo
« Reply #2 on: Jun 9th, 2004, 6:00pm » |
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Interesting Article. Definitely one I will follow up on.
My insurance company tried to pull that 6 shots a month crap. I kept calling them until somehow I luckily talked to someone who had to be new (who probably no longer works there) who said they would pay for how ever many a Neurologist prescribed. A regular doctor could only get me 6. I got on the horn with my neuro and explained the situation to him. He wrote up a letter of medical necessity and prescribed 30 per month. The insurance company is now paying for 30 of these $26 a pop Zomig NS ($780) and all I pay is my $35 per month schedule 3 drug cost.
You gotta love it when someone actually wins for a change.
Gator
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Lizzie2
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Re: Triptans: Insurance Company BS/Mumbo Jumbo
« Reply #3 on: Jun 9th, 2004, 6:35pm » |
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Glad for you, Gator. 
Teri Robert (who wrote the article) is a friend of mine and she was going to go to bat for me over Blue Cross limiting my triptans for Amerge. When I called BC, they kept dancing around and passing me back and forth from the regular insurance policy to Merck who was our prescription carrier. Well finally, I told them that if they wouldn't pay for my medicine, then they could pay for my ER visits instead. Well, that got their attention. In the end, my neuro had to send a medical letter of necessity. I JUST switched insurance co's to Aetna and I will be getting my Amerge filled on Friday. My neuro wrote for 18/month. We'll just have to see how Aetna deals with this, or if I will need to go to bat against them, too!
Sure glad you beat the system down, though. I'm all for taking initiative and doing something about this kind of crap!!
Hugz,
Lizzie
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Cerberus
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Re: Triptans: Insurance Company BS/Mumbo Jumbo
« Reply #4 on: Jun 9th, 2004, 6:52pm » |
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Blue Cross Blue Sheild is notorius for pulling that kind of crap. When I first started getting meds for CH they tried to limit me to 5 pills a month. When I got the stat-doses it was again 5 a month. Not sure if we ever got it straightend out with em or not Woobs would know more than I....but when I got the doc to prescribe the vials and syringes...well, lets just say I've been lucky and havent had to "test" the will of insurance against my script. I haven't had much problem but the Woobster fields the ball on insurance when I'm in cycle
Ramon
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Lizzie2
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Re: Triptans: Insurance Company BS/Mumbo Jumbo
« Reply #5 on: Jun 9th, 2004, 7:09pm » |
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Kop, I apologize!! This is the one I always post:
http://headaches.about.com/cs/advocacy/a/trip_limits.htm
Both are GREAT articles...when I was having my problems with Blue Cross of PA, Teri told me she would gladly smear their name all over her website, too. We'll get em all yet!! One company at a time
Lizz
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purpleydog
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Re: Triptans: Insurance Company BS/Mumbo Jumbo
« Reply #6 on: Jun 9th, 2004, 8:45pm » |
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My insurance covers only 18 triptan pills a month. When I was using stadol nasal spray and got that refilled, they made me wait to get the triptan (think it was imitrex that time) filled because they said the triptan was a narcotic and I had to wait another week to get it!!??? WTF. I told them the trex isn't a narcotic. The drug store told me it was the insurance and the insurance told me it was the drug store who laid down those rules. (??) I had to have my doc write a letter of need to the insurance. Then my doc charged me $150.00 to do it!
purpleydog
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Kevin_M
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Re: Triptans: Insurance Company BS/Mumbo Jumbo
« Reply #7 on: Jun 9th, 2004, 10:43pm » |
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on Jun 9th, 2004, 6:35pm, Lizzie2 wrote:I JUST switched insurance co's to Aetna
Hugz,
Lizzie |
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I got Aetna too Lizzie. They pay for everything pretty good. But I got switched to them with all the scripts already ongoing treatment.
The only thing I had to straighten out was, like all insurance, it's a smaller co-pay for generic and more for name brand. They charged me a name brand co-pay for Imitrex. I had to call them to tell them that as of yet there is no generic for Imitrex. I got the lower co-pay rate for Imitrex then, because they have to charge you the lower generic co-pay rate for a brand name med when it has no generic.
Hope things go well.
Kevin M
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Sean_C
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Re: Triptans: Insurance Company BS/Mumbo Jumbo
« Reply #8 on: Jun 9th, 2004, 10:52pm » |
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I did what Gator did except instead of getting my 6, my script is now unlimited usage. Explanation to insurance company was 6 ER visits a day can't be cheaper than 6 imitrex inhalers, when their going to give it to him there anyway except at 15x the cost............. BINGO I was in 
Makem pay in other ways guys, then they'll get the message. Givem a low blow...................Hittem in the wallet
Sean
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Lizzie2
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Re: Triptans: Insurance Company BS/Mumbo Jumbo
« Reply #9 on: Jun 9th, 2004, 11:14pm » |
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on Jun 9th, 2004, 10:43pm, Kevin_M wrote:
I got Aetna too Lizzie. They pay for everything pretty good. But I got switched to them with all the scripts already ongoing treatment.
The only thing I had to straighten out was, like all insurance, it's a smaller co-pay for generic and more for name brand. They charged me a name brand co-pay for Imitrex. I had to call them to tell them that as of yet there is no generic for Imitrex. I got the lower co-pay rate for Imitrex then, because they have to charge you the lower generic co-pay rate for a brand name med when it has no generic.
Hope things go well.
Kevin M
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Kevin,
Thanks for this info! I never knew that they couldn't charge more if it has no generic. I always paid the top rate for amerge on the Merck prescription plan. Now I'm going to look up all the meds I pay that much for to find out if they have the generic or not! Glad you shared this!
Lizzie
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BarbaraD
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Re: Triptans: Insurance Company BS/Mumbo Jumbo
« Reply #10 on: Jun 10th, 2004, 5:45am » |
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It's gotten to where the INSURANCE COMPANIES are running the medical field. I know some people abuse the drug cards, but when the DOCTOR says meds are needed WHO the hell is the insurance company to disagree? That's been a complaint on this board since day one.
My doc and I have been talking about how the docs used to practice medicine - Now they Practice Insurance Company policies. Maybe OUCH should get with the AMA and the ANA and lobby Washington to get them off the backs of the medical profession. I think it will take a strong lobby to get anything done cause the insurance companies have it made now. They tell US what we need and how many days we can be treated for it.
I agree = this is BS!!
Hugs BD
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Lizzie2
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Re: Triptans: Insurance Company BS/Mumbo Jumbo
« Reply #11 on: Jun 10th, 2004, 7:38am » |
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Barb,
That's one of the tactics that we can use as patients to nail the insurance companies. If they do something like change our prescriptions from 18 pills a month to 6 pills a month, well...they are practicing medicine without a license. If they say they have a doctor working for them, then that's illegal too because he is writing a prescription without ever seeing you. It takes a lot sometimes, but there's ways to get them!
Lizzie
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OneEyeBlind
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Re: Triptans: Insurance Company BS/Mumbo Jumbo
« Reply #12 on: Jun 10th, 2004, 9:37am » |
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The letter of medical necessity worked for me. 30 shots of Imitrex a month = heaven !
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