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        New Message Board Archives >> 2002 Posts >> Insurance Denied -- Appeal Question
        
(Message started by: MyHeadHurts on Aug 28^th, 2002, 5:05pm)

Title: Insurance Denied -- Appeal Question
Post by MyHeadHurts on Aug 28^th, 2002, 5:05pm

This SUCKS!!! My insurance company denied me my Imitrex injections and I'm in the process of writing a letter to appeal their decision. Have any of you ever had to go through this? Are there any buzz-words that I should include that may be helpful in getting my Imitrex approved? I have to wait until 9/18 to see my Neuro (he won't write the medical necessity letter until the visit from what his office told me). I know Imitrex is expensive (and I can't pay it out of pocket) but I'm barely functioning on 3-4 hours of sleep a night and the alternating ice and hot water ziplocks just aren't a viable substitute for the shots. (I literally have a large bowl of used ziplocks building up next to my bed) ;D Any suggestions would be appreciated.

Hope you're all doing well...

Title: Re: Insurance Denied -- Appeal Question
Post by Drk^Angel on Aug 28^th, 2002, 5:33pm

Personally... I'd prolly threaten to fire bomb their office, but somehow I don't think that'd help too much... Good luck!

PFDAN........................... Drk^Angel

Title: Re: Insurance Denied -- Appeal Question
Post by forgetfulnot on Aug 28^th, 2002, 5:47pm

Your G.P. should and can prescribe the injections without a nuro being involved, sometimes the insurance co. will ask for a medical necessity statement from your doctor. If Imitrex inj is on their formulary, legally they have no basis to refuse the treatment ordered by your doctor. Give the not a very nice persons hell, they will FWU :o any chance they get.

Lee

Title: Re: Insurance Denied -- Appeal Question
Post by MyHeadHurts on Aug 28^th, 2002, 8:12pm

Thanks Drk Angel and Lee... Yeah, this is a real pain in the a** Of course they're more than happy to take my $$ all the time, they just don't want to pay out. Hell of a scam they got going!

Title: Re: Insurance Denied -- Appeal Question
Post by Not4Hire on Aug 28^th, 2002, 11:00pm

hey ......My head hertz...... try these words with your Doc:

I know where you live, A$$hole...

.... and for your fucking Insurance Company....... how many $3000.00 trips to the ER do y'all want to pay for?....... YMMV...(your mileage may vary) ;D

Don't Let the MOFO's get you down......RAGE....RAGE....Against the dying of the LIGHT...... we got yer back here......

best....Steve

Title: Re: Insurance Denied -- Appeal Question
Post by NancyMcFree on Aug 29^th, 2002, 12:50pm

On page three of this board there is a post called "Insurance" that had some good info in it including the letter that my doctor sent to my insurance company and a web site for "getting your imitrex approved through your insurance company".

Title: Re: Insurance Denied -- Appeal Question
Post by oringkid on Aug 29^th, 2002, 4:00pm

Am I confused or is this the second person recently that has had an insurance company deny them sumatriptan (imitrex)?

What is up with that? I don't understand the reasoning behind it. Is it just because it is so expensive?

Sherry

Title: Re: Insurance Denied -- Appeal Question
Post by NancyMcFree on Aug 29^th, 2002, 4:08pm

I was originally denied because the "manufacturers recommended dosage" was 6 injections per month .... their recommended dosage was probably based on using it for migranes. It was a hassle and took me a few days but once my doctor wrote the note to the insurance company recommending 30 shots a month, I was approved. I do have to be re-approved every year though so I guess they could change their mind next year ..... but hey ..... I am living this year pretty much covered for meds.

Title: Re: Insurance Denied -- Appeal Question
Post by echo on Aug 29^th, 2002, 4:55pm

30? :o,

That's amazing!

Title: Re: Insurance Denied -- Appeal Question
Post by NancyMcFree on Aug 29^th, 2002, 5:05pm

What ..... they don't give you that many??? They also approved me for oxygen ............ I know .... I am living in the lap of luxury here with pain meds and am very grateful !!!

Title: Re: Insurance Denied -- Appeal Question
Post by MyHeadHurts on Aug 29^th, 2002, 6:21pm

Hi Everyone! My doctor's office has been amazing throughout allthis, they made all the phone calls, faxed over the information, sent 2 more physical prescriptions and spoke with the pharmacy dept. at the ins. co and they're still denying it... uuuuuugh! So, I sent off a letter and now have an R.N. as my case practicioner appealing... Total BS, if you ask me. It simply boils down to the fact they don't want to pay for my prescriptions. ::) Amazing!!

Thanks for your support through all this -- it really means a lot to me.
;D