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Topic: Will it never stop???? (Read 389 times) |
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Gator
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Will it never stop????
« on: Aug 16th, 2004, 3:02pm » |
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The last 3 days have been a biotch. 8 hits on Saturday plus shadows; 5 hits yesterday plus shadows and now as I type this I feel my third one of the day coming on and it feels like it's gonna be another bell ringer, too.
To top that, I heard back from my wife's insurance company today (Aetna - the bastards) and even with a letter of medical necessity from my neuro they approved 12 Zomig NS. They didn't see a medical necessity for more. WTF??? They're gonna graciously allow me to abort 12 out of 90 to 150 or more attacks per month? How fucking nice of them. I wonder how they will feel about paying for 30 trips to the ER per month?
AAAAAAAAAAAAAAAHHHHHHHHHH!!!!!! I want the power to give the people (doctors and administrative staff) doing the disapproving a 3 hour K10 with no meds and no ER and then give them another K10 and an abortive. Let them see what the difference is and see if they can find a medical necessity.
Gonna go suck O2 now. Hopefully that works, cause I'm running low on Zomig.
Gator
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E-Double
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Re: Will it never stop????
« Reply #1 on: Aug 16th, 2004, 3:20pm » |
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Hang in there brother!!!!!!!!!
"Charlie Brown"
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The mad viking
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Re: Will it never stop????
« Reply #2 on: Aug 16th, 2004, 3:49pm » |
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Hang in there brother!!!!!!!!!
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Always Look on The Bright Side of Life
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Jeepgun
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Re: Will it never stop????
« Reply #3 on: Aug 16th, 2004, 3:59pm » |
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Hang in there, Gator. I wish there were something I could do...
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magman
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Re: Will it never stop????
« Reply #4 on: Aug 16th, 2004, 4:12pm » |
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I have found one needs to be very persistent. If the person you are conversing with on the phone is not changing viewpoint or being stubborn, ask to speak too the supervisor. If that person has the same steadfast attitude, as for the next person up the line.
I eventually reach someone with the authority to change terms or offer assistance in special situations. My tact is one of ‘you will do this or you will be hearing from so and so’.
Insurance companies never want to hear that an insured will be talking to the State Insurance Commissioner as soon as your current conversation is completed. Don’t take ‘no’ or ‘it is our policy’ for an answer. They are simply holding back in offering assistance until one gets nasty and threatening.
I recently took on BCBS concerning a $69.00 co-pay for oxycontin….their reasoning for the 69.00 versus the normal 10.00 co-pay….oxy is an expensive drug. My reply…..’not my problem, and I intend to pay only 10.00….end of story’. I am pleased to report, the RX is in-hand and only $10.00 out-of-pocket.
Modified for spelling 4:42pm
Peace & Big PF’s Bro,
-dan
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| « Last Edit: Aug 16th, 2004, 4:36pm by magman » |
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Re: Will it never stop????
« Reply #5 on: Aug 16th, 2004, 4:27pm » |
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Go Dan ! Sounds like good advice.
Gator,
Sorry your getting it bad these last few days. Is there something in the air or what ... cause I had a bad last few days and so did a couple of others. ??
Hang in there Bro !
PF WISHES,
Unsolved
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kimh
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Re: Will it never stop????
« Reply #6 on: Aug 16th, 2004, 4:46pm » |
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Gator,
Good advice from Dan. Also, see if you can raise holy hell with your neuro and get him to give you samples, too. My neuro got me a truckload of samples last week. If your neuro is worth his weight in salt, and is aware that insurance cut you off, he'll step up to the plate and help ya out. Hope things get better for you.
Good luck and well wishes
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Carl_D
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Re: Will it never stop????
« Reply #7 on: Aug 16th, 2004, 4:49pm » |
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Sending you all the vibes I can muster up.
Hope PFDAN's are headed your way very soon
Peace Bro,
Carl D
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Big Dan
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Re: Will it never stop????
« Reply #8 on: Aug 16th, 2004, 5:08pm » |
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Hang tight, Al...
... it stops... it may be a shitty ride to the finish, but it's always worth the trip.
-Big Dan
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Gator
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Re: Will it never stop????
« Reply #9 on: Aug 16th, 2004, 5:37pm » |
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And after an hour of toe to toe, Gator exits the ring tired, but victorious. On the way to the showers he was noted as saying, "Bastard has a killer left cross." 
The 12 Zomig NS's Aetna are willing to give me are up from the 6 in their initial offer. They have an appeals process, which I intend to use. In order to be able to use an exclusionary type med, one of the criteria is that at least 2 of the covered meds have failed. They fully admit they get rebates (aka kickbacks, which I thought were illegal) from the drug companies in their literature.
It just kills me that their rationale is that it may be unsafe to abort more than 2 migraines per week, so they keep the limit at 6 per month. We don't have fucking migraines. They are not the same thing. I wish the dumb fucks that named these things had never called them headaches in the first place. We're stuck with the stigma of being pill popping drug seekers when all we are trying to do is stop the pain and because Tommy Turdhead so many years ago called it a "headache" we're screwed.  Sorry, pressure relief valve got stuck.
Upon further research, Aetna does include trex in their formulary. They do not include Zomig. They will allow 10 vials per month, which done right could be as many as 30 injections - assuming I can get by on 2 mg. That's how many Zomig NS's I was able to get before. As much as I don't like the thought of injections, I hate the thought of this pain. Sooooo...
I thank those of you who posted here and also those who pm'd me. Your support is life giving. Thanks for listening to the rant.
Mike
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Jonny
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Re: Will it never stop????
« Reply #10 on: Aug 16th, 2004, 6:14pm » |
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Keep kick'in ass, Bro!!....its all we can do
..............................jonny
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Grandma_Sweet_Boy
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Re: Will it never stop????
« Reply #11 on: Aug 16th, 2004, 7:49pm » |
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Mike - try going straight to the ombudsman for your insurance company or am I out of line here and is that a Canadian thing? We have lots of places to go to complain about insurance companies here, but as I read a lot of stuff from you fine folks south of the border, it seems you have a ton more trouble than we do with scripts. It's a huge PITA for all of you.
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Kevin_M
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Re: Will it never stop????
« Reply #12 on: Aug 16th, 2004, 7:52pm » |
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on Aug 16th, 2004, 5:37pm, Gator wrote:| In order to be able to use an exclusionary type med, one of the criteria is that at least 2 of the covered meds have failed. |
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Has trex failed you? Why not go with a trex script insteaad? Trex is not exclusionary with Aetna.
Quote:| just kills me that their rationale is that it may be unsafe to abort more than 2 migraines per week, so they keep the limit at 6 per month |
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Trex can be prescribed twice a day, not unsafe in Aetna's book.
Quote:| Upon further research, Aetna does include trex in their formulary. They do not include Zomig. They will allow 10 vials per month, which done right could be as many as 30 injections - assuming I can get by on 2 mg. That's how many Zomig NS's I was able to get before. As much as I don't like the thought of injections, I hate the thought of this pain. Sooooo... |
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Although not as time efficient, a trex nasal script might due, they may give more per month, two a day is not unsafe unless your doc thinks otherwise.
Only thoughts Mike, but I have Aetna and have gotten much more trex than that from them. Could depend on policy, but they do accomondate up to 90 a month. Of course with doc's help. Good luck and vibes Mike.
Kevin M
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| « Last Edit: Aug 16th, 2004, 7:53pm by Kevin_M » |
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Redd
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Re: Will it never stop????
« Reply #13 on: Aug 16th, 2004, 8:26pm » |
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Quote:As much as I don't like the thought of injections, I hate the thought of this pain. Sooooo...
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Mike dear it's not that bad. I never thought I could do the syringes myself either and only used the stat pen. Guess what? I got used to it fast, and I don't even feel it anymore and can almost do it blindfolded. Suggestion? Ultra fine short needle insulin surynges. Less chance of hitting a muscle which will turn you right off to shooting yourself, and the boxes of 100 at Kmart for the generic are about $15 out of pocket.
$1.95 for a box of alcohol swabs...
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BlueMeanie
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Re: Will it never stop????
« Reply #14 on: Aug 16th, 2004, 8:28pm » |
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Go get em' Gator. Don't blame you a bit for being pissed. It sure sucks to abort a lousy 12 CH's a month when your getting hit 3 or more times a day.
Hang tough dude. Hope it gets better.
PFDAN
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IndianaJohn
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Re: Will it never stop????
« Reply #15 on: Aug 16th, 2004, 8:35pm » |
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Kick ass Gator. I'm rooting for ya! Make that insurance company squeeeeel!
Best wishes
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Did my brains fall out or is this headache over?
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thebbz
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Re: Will it never stop????
« Reply #16 on: Aug 16th, 2004, 11:41pm » |
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My doc and I faced a similar situation, he gave relpax ,imitrex tabs, frova, all vascular constrictors, all free samples. All this due to the dipshit insurance regulating what really works...Imitrex statdose. Careful of the rebounds and all the best. BB
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miapet
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Re: Will it never stop????
« Reply #17 on: Aug 17th, 2004, 12:19am » |
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I totally agree with going over people's heads until you get to someone who will help you . . .
I also agree with getting samples from your doc . . .he/she is there to help, and sometimes it's with samples (and lots of them).
There is also a form they can fill out, for the drug company (sorry, can't remember if you send it in, or if they do, or if they give it to the rep), but it will get you meds sent from the company, skipping the pharmacy and insurance company totally . . .works great, is cheap to free, and for the benefit, not much hassle . . . I don't know if the drug company always says yes, but it's worth a try.
Hope your night is going better.
*positive light and energy*
miapet
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Clusterbusters Rock
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Re: Will it never stop????
« Reply #18 on: Aug 17th, 2004, 12:27am » |
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on Aug 16th, 2004, 5:37pm, Gator wrote:| As much as I don't like the thought of injections, I hate the thought of this pain. |
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I use the injections everyday. It's better than the pain !
Neuro's have samples of the injections (auto injector samples ... not vials). That's how I get my Trex.
Goodluck
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I'm STILL alive ?
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Tim_Z
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Re: Will it never stop????
« Reply #19 on: Aug 17th, 2004, 12:51am » |
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Gator,
Hang in there Buddy.
Using Statdose pens isn't bad compared to the HA, I got used to it rather quickly.
If your neuro cares at all they have access to ton of samples. I've walked out of my GP's office with easily over $1,000 worth of trex on several occasions. Every time I'm there I ask for samples and try to load up.
I know these are tough times for ya but things will turn around and get better so hang in there brother.
Vibes coming tour way,
Tim
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ExPat_jac
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Re: Will it never stop????
« Reply #20 on: Aug 18th, 2004, 2:45am » |
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Hang in there Bro......
Jac
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Superpain
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Re: Will it never stop????
« Reply #21 on: Aug 18th, 2004, 3:00am » |
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Ditto on the shots... It's not like you're doing heroin intaveniously.
After the first one it's smooth sailing.
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Chris
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Gator
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Re: Will it never stop????
« Reply #22 on: Aug 18th, 2004, 3:35am » |
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Thanks again everyone. Y'all are the absolute best. I shudder to think where I'd be without you.
I'm still getting hammered, but not as often. I had 2 hits this weekend and one on Tuesday where neither O2 nor Zomig NS killed the attack. Hopefully the Zomig isn't getting ready to fail me. Whatever was in the air this weekend seems to be disapating.
I'm gonna hit up my doc for some trex samples and see if it works for me and if I have any funky reactions to it. If not, I'm gonna get him to write me a script for trex.
Peace, Strength & Love to you all.
Mike
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Tiannia
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Re: Will it never stop????
« Reply #23 on: Aug 18th, 2004, 2:52pm » |
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Dont let them try tabs for you - NS. if you keep it cold it helps with the aftertaste... spray and hold your nose shut... but it has been a good send.
I hope that you find some relief Gator... I know hta tyou are hitting a year soon. I love you and all but dont want you in the chronic club.
PF Wishes my friend
_Tia
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PittsburghJoe
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Re: Will it never stop????
« Reply #24 on: Aug 18th, 2004, 3:16pm » |
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Gator Man,
Keep fighting the good fight man. BIG Pittsburgh vibes heading your way. And when it gets really bad, just make a Beast Pinata and beat the fuck out of it!
Joe
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Nothing worth having comes without some kind of fight. Gotta kick at the darkness till it bleeds daylight. - Bruce Cockburn, "Lovers in a Dangerous Time"
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