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Topic: Imitrex and Insurance (Read 179 times) |
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72wick
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Hello Everyone. I have had episodic clusters about every 18 mos. for the last 14 years. I have in the past had to work with the insurance company to have the imitrex injections covered. This time no luck. They have absolutely refused. I have a wonderful doctor who sent a letter of medical necessity. Somehow by reading this letter they have decided it is preventative medication and therefore not covered. My doctors office called with no result. I called the H/R Benefits admin. She basically at first acted like she was not familiar with my situation. Then she told me that injectables were not ever covered (except insulin). I asked her then why I needed to have my doctor send the letter--she said they wanted to be fair and see all the facts in case they decided to make a rare exception. But in my case no, this according to them is not worthy. Has anyone ever had this happen? Does anyone have any advice on what i might do? I have spent up to this point 1200.00 on credit (on the insurance companies advice i might add!) I am trying not to be incredibly upset about this but i dont know how i will pay for what i already have much less anymore i might need.
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eyes_afire
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Re: Imitrex and Insurance
« Reply #1 on: Jun 19th, 2002, 7:49pm » |
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Something similar happened to me. At my place of employment we are required to sign a benefits agreement. In the fine print, it specifically states that imitrex injections are not covered. Therefore the only way I can get it covered is if my employer gives the okay. The insurance company is willing to cover imitrex injections but my employer is not. I think that if my employer makes the exception to cover imitrex injections it will cost my employer more for insurance as part of some sort of agreement between employer and insurance company.
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kristi
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Re: Imitrex and Insurance
« Reply #2 on: Jun 19th, 2002, 9:17pm » |
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What a scam!  Insurance companies make me crazy!!! I wish I had some great advice - unfortunately I don't. 
I can only offer sympathy and hope it works out for you. But I would get a copy of your health insurance contract for your plan and read every single word and I would also try to go over her head ..... find out if you have the right to appeal.
Good luck!
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NotH20
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Re: Imitrex and Insurance
« Reply #3 on: Jun 20th, 2002, 12:44pm » |
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Hey 72 - I share in your anger. I hate the fact that we not only have to deal with the beast, but we have to deal with the awful insurance company!
If it's the injection that your insurance won't cover, will they cover the medication instead? If so, get the vial of Imitrex and use the small needles at the pharmacy. Just a suggestion and not sure if it will work or not.
Good luck to you,
NotH20
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MarkHW
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Re: Imitrex and Insurance
« Reply #4 on: Jun 20th, 2002, 1:22pm » |
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I'm in insurance hell over my imitrex!
My dr. wrote a script for 10 - 2 packs of injections.
The insurance sent me 3!
My Dr. wrote a letter.
I still only got 3 the next time.
I called and my Dr. called.
I still only got 3 the next time.
My company put in an over-ride for me that went into effect 2 weeks ago.
Ordered a refill - got 3!!!!
The prednasone is no longer working... I'm back to 2 chs a day at kip 8..... and they send me 3 f'n packs.
So... I called again!!! They said it is a mistake and I should receive the rest in a week.
yeah.. right!
Mark
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The clusterhead formerly known as williamsmh.
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