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TimJohnson
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Imitrex and Insurance
« on: Jul 6th, 2006, 10:32pm » |
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I have had CH for 12 years. I am still not quite sure how to handle my insurance co. My MD prescribed Imitrex injections, and my insurance company will only approve 2 doses every 30 days. They will only approve 9 tableys every 30 days or 6 nasal sprays every 30 days. This doesn't help when I am wracked with headaches. I guess I could just go ti the ER and have them pay for that.....  Can anyone give me any suggestions?
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Bob_Johnson
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Re: Imitrex and Insurance
« Reply #1 on: Jul 7th, 2006, 10:15am » |
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Pop over to the OUCH site. They have some material on this subject.
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TimJohnson
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Re: Imitrex and Insurance
« Reply #2 on: Jul 7th, 2006, 10:02pm » |
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Thanks, I'll do it. Doc gave me some samples, Get this, Insurance company approved Maxalt 6 doses within the 30 day period and then another script of Imitrex (9 tablets) within the same 30 day window. But they won't approve refills of the same med within the same 30 day time frame???????
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BMoneeTheMoneeMan
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Re: Imitrex and Insurance
« Reply #3 on: Jul 7th, 2006, 10:28pm » |
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You might try to press the doctor to press on the insurance company. If the doc says you need this medication to function in society, and that your quality of life is suffering tremendously, the insurance company will sometimes approve it on that.
I guess each state is different, but in my state if the doc says you NEED a medication because your affliction is devestating your family life and your quality of life, the insurance company steps up just to cover their own ass.
Good luck. Be demanding. Take the time to explain to your doc how this affliction is taking the emotional toll.
PF wishes
BMonee
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Bob_Johnson
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Re: Imitrex and Insurance
« Reply #4 on: Jul 7th, 2006, 10:48pm » |
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Couple of ideas from my junk files:
This paragraph from CONSUMER REPORTS ON HEALTH, 11/05:
"Negotiate with your health plan. Learn how to resolve disagreements about health coverage or benefits with the updated...'Consumer Guide to Handling Disputes With...Health Plan." [How to use the internal grievance and appeal procedures of the plan.] ...(H)ow to appeal a decision to your state's external review program (currently available in 43 states.) Download a copy at www.ConsumersUnion.org/health/hmo-review." Free copy by writing to, including the state about which you want information, to Consumer Reports, 101 Truman Ave., Yonkers, NY 10703, Attn: CCHC.
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Old message posted long ago:
IF HMO/insurance won't cover treatment....
Posted by Bob Johnson (208.234.124.40) on December 06, 1999 at 10:03:15:
Several months ago there was a good message about the need to educate HMO/insurance outfits which don't know anything about CH and so deny adequate coverage. The suggestion in that message was to provide material to the medical director of your plan to help remove the scales from their eyes.
Have found a good piece written by Dr. Seymour Diamond, one of the oldest hands in the U.S. on headaches, in which he shows that it's cost saving for HMO/insurance to provide proper treatment. It's worth printing out and giving to your doc to be forwarded or else for you to send directly to the HMO/insurance medical director.
Don't be put off by the title: cluster is included in the the body of the article.
Go to www.medscape.com Need to sign up; free and easy and will exposure you to a professionally oriented medical site. At the top of the page, select "managed care"; then look for the article entitled, "Clinical and Financial Implications of Migraine in a Managed Care Setting." About 15-pages to print out.
In addition to this article,at the bottom of any page you will find a search box. Enter "headache" and select the "article" box. You'll get some good material.
This site has some links to other good medical sites. Material on headache appears under the "neurology" and "primary care" pages from time to time.
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| « Last Edit: Jul 8th, 2006, 11:28am by Bob_Johnson » |
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BlueMeanie
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Re: Imitrex and Insurance
« Reply #5 on: Jul 7th, 2006, 10:48pm » |
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Hi Tim,
Are you episodic ? Us episodics have learned to get year round prescriptions and stockpile when not in cycle. You may be able to send the insurance company a letter of neccessity in which they will up the amount of alotted meds per month. As suggested, I believe you can get that info from the OUCH site. I never have a problem getting the prescriptions, it's just getting the insurance to pay for them.
ps: I'd return the pills and trade them in for either the spray, or the shots as pills don't give you time to tame the Beast.
Good luck & PFDAN to ya.
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TimJohnson
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Re: Imitrex and Insurance
« Reply #6 on: Jul 8th, 2006, 11:34pm » |
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Thanks everyone, I think I'm turning to chronic. This cycle has been going on since April. A headache a day since then. I have really been hammered.
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chewy
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Re: Imitrex and Insurance
« Reply #7 on: Jul 9th, 2006, 11:24am » |
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Have your Doc write a "Letter of Medical Necesity".
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| « Last Edit: Jul 9th, 2006, 11:24am by chewy » |
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marlinsfan
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Re: Imitrex and Insurance
« Reply #8 on: Jul 9th, 2006, 7:17pm » |
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on Jul 8th, 2006, 11:34pm, TimJohnson wrote:| Thanks everyone, I think I'm turning to chronic. This cycle has been going on since April. A headache a day since then. I have really been hammered. |
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You're into your 4th month, depending on what day in april you started. 3-4 month cycles for me are the norm. Don't get discouraged, you're not chronic yet!
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TimJohnson
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Re: Imitrex and Insurance
« Reply #9 on: Jul 10th, 2006, 10:50pm » |
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thank goodness!
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bambina
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Re: Imitrex and Insurance
« Reply #10 on: Jul 19th, 2006, 10:07pm » |
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 Hi: I've also had problems with my insurance company which is United Healthcare that only lets me have 9 tablets per month. I do fight everytime I need the prescription refilled but your doctor has to request a special form to complete requesting your need for more than the 9 they will supply and if not then you complain to consumer protection of the insurance company. good luck
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chewy
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Re: Imitrex and Insurance
« Reply #11 on: Jul 20th, 2006, 7:14am » |
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Quote:| This cycle has been going on since April. |
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You still have 9 months to go before being dx as chronic. My cycles can last up to 9 months of 3-4 CH a day.
I would rejoice with only one attack a day.
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NotH20
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Re: Imitrex and Insurance
« Reply #12 on: Jul 20th, 2006, 10:12am » |
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Tim, just a few suggestions.....
If you take the 50 mg Imitrex and they work, have your doc prescribe the 100 mg pill instead and cut it in half - doubling your quantity.... 
Also, I have my neuro write my Rx for more than just the standard 2 injections per box. I usually get 6 shots for the same copay. Also, try the imitrex tip located to the left - you may be able to get more mediciation that way as well.
In the meantime, I agree with the others - get a letter from your doc stating your necessity and fight the insurance company for your "required" medication.
Good luck,
Mia
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ccbiggsoo7
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Re: Imitrex and Insurance
« Reply #13 on: Aug 16th, 2006, 3:02pm » |
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i had united healthcare insurance and they pulled the same shit w/ me. doctor wrote a letter saying i had to have more shots and they ok'd everything. good luck.
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chris
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big guy
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Re: Imitrex and Insurance
« Reply #14 on: Aug 16th, 2006, 9:44pm » |
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I also have united healthcare. I called them and Imitrex is on the list that can be appealed by phone. my Dr called them and i have been approved for additional refills each month for a year.
Don't give up. keep trying
Big Guy
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