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        New Message Board Archives >> 2004 Posts >> I'm feelin a little DOOM'D............. 
        
(Message started by: cootie on Aug 27^th, 2004, 10:33am)

Title: I'm feelin a little DOOM'D.............
Post by cootie on Aug 27^th, 2004, 10:33am

Oh good grief.......here I am skippin down this dam road again and I don't like it........grrrrrrrr.........anyhow..........I'm tryin to be such a good lill supporter and get prepared for this comeing cycle.......and I am already trippin over rocks ! Called the insurence co like doc said to do first about the trex injections we want to try verses him be out of it 3 hours and get caught with attacks while at work with big machinery freaking out or driveing or out. He's wacked when he gets nailed for a long time. OK....injections SEEM'D to be the thing to try. Insurence told me they will cover ONLY 4 a month 'period'......they said I can have the doc TRY to get him more....but he said TRY real loud !? They told me we can NOT get injections from any pharmacy......they have to be order'd directly by our doc and he recieve them and dispense them ONLY. WTF......is that how it works ??? I didn't know that ? Gawd I must be so stupid and here I thought I was readin up gatherin all the info I needed. Looks like I missed somethin. So is that how you all do it.....yer doc gets it and you go there ? They said for the Zomig NS he could have 6 a month but the guy kept callin em inhalers and I told em it was nasal spray I thought.....he didn't seem to understand what that was so I shut up. Now I can't reach anyone is the docs office cuz all the options leave recordings......must be havein an office party for someone's birthday or baby. I told the insurence guy Brad would need up to 4 injections a day at times let alone only 4 a month. Were callin this intractible migraine by the way.....doc wanted to do it that way to SQUEEZE more coverage and more trex out of them cuz they don't understand CH and give him SHIT. He's a great doc.....he's really tryin to help. OK.....thanks pals. Disgruntle Pam

I'm so pissed..................................................

Title: Re: I'm feelin a little DOOM'D.............
Post by Redd715 on Aug 27^th, 2004, 10:40am

Coots dear....

any possibility of doc providing samples to supliment the script? And if so, then work out the tip for breaking down of the shots into halves or thirds to strech the supply out longer.

Title: Re: I'm feelin a little DOOM'D.............
Post by Linda_Howell on Aug 27^th, 2004, 10:54am

Quote:

they have to be order'd directly by our doc and he recieve them and dispense them ONLY. WTF......is that how it works ???

Pam, I have NEVER heard of an Ins. Co. doing things this way. Maybe you should call again and ask to speak to whoever you talked to's Superior.

And this may not make any difference one way or another, but you told someone Brad needs Imitrex 4 times a day and that might raise some eyebrows as to the safety factor. Tell them he needs Imitrex once a day while in cycle...(and then he can do the splitting of it into 3rds.)

Let me know if Brad wants me to send him some of the things you guys "left at my house when you were visiting" ;)

Linda

Title: Re: I'm feelin a little DOOM'D.............
Post by Lizzie2 on Aug 27^th, 2004, 11:00am

Cootie,

Lots of insurances do work that way. You should ask them specifically what their policy is on covering injectible meds. My insurance company did the same thing, and my doctor's office had to jump through hoops to get my DHE IM injections, but they still would never allow the toradol injections. I don't use trex injections, but I have the feeling the policy would hold the same for that too. Sometimes the policy states something about subcutaneous injections being allowed when IM injections aren't. That might be something you'd want to look into.

The zomig nasal spray (and all nasal sprays for that matter) are often referred to as a "nasal inhaler" so I wouldn't worry about that terminology!

I would definately try to get your doctor's office to go through the insurance and try to get the Imitrex injections, even if it has to go through their own pharmacy and be sent right to the doctor's office. They also need to try to get more than 4/month due to medical necessity. I would try to see if you can get the vials of trex and then get a script filled for syringes/needles. Honestly, I only ever pay about $7.00 for a bunch of needles...and that does not go through insurance...they are pretty cheap.

Let me know if I can help any more than this, Pam! Hang in there and keep calling the doc's office till you get someone!

Hugz,
Lizzie :)

Title: Re: I'm feelin a little DOOM'D.............
Post by Redd715 on Aug 27^th, 2004, 11:00am

Yeah Linda,

They left some stuff here last time they were up too! ;)

Title: Re: I'm feelin a little DOOM'D.............
Post by OneEyeBlind on Aug 27^th, 2004, 11:02am

Coots, certain injection need to be dispensed directly to the doc, but not Imitrex injections. The guy you talked to didn't know what he was talking about (probably new). The "letter of medical necessity" that your doc needs to send in to the insurance company is required to get above what they consider a standard amount. Make sure if you get approved for additional trex to find out if they will require "a letter of medical necessity" with every month you fill the script (I got screwed on this one and had to wait days for a second approval to get processed).

Anyways, good luck. You are doing great PamTheSuperSupportor !!!!!!!!!!!

Title: Re: I'm feelin a little DOOM'D.............
Post by OneEyeBlind on Aug 27^th, 2004, 11:05am

Hey, I was typing while Lizzie was typing ! Lizzie, are you sure it wasn't because of the type of med in the shot vs it just being a shot. I got Trex Injections straight from the pharmacy, Red has gotten boo-coo injections straight from the pharmacy ... but our insurance would not fill a Hepatitis B vacine script for our doc cause they require the shot to be dispensed to doctors only.

That's what I have run in to.

Title: Re: I'm feelin a little DOOM'D.............
Post by cootie on Aug 27^th, 2004, 11:09am

Hey thanks guys......yeah I wonder'd if I shouldn't of said the 4 a day trex deal but shit......I don't know what to say or what not to say in this matter.......not used to playin games !!! And I don't wanan screw stuff up tryin to play THEIR game. Still can't get the docs office......must be a big party goin on and soon they'll be out for lunch for an hour. He doesn't need the trex rite now.......has never even used an injection before...and were nervous about tryin it. But when this shit comes back it don't mess around for him......so I am tryin to be ahead of the game. And gettin very freaked out. Ran into problems before last cycle with the pills. But never heard of havein to buy shots from the doc himself ? Far as I know my doc has NO samples on any of that stuff what so ever. Thanks for the insight cuz I need it to keep runnin (hobblin.....crap that's anouther whine) down that road to get this figured out. If I feak and loose it he is really in trouble.....and I am close !! Wah baby Pam

Title: Re: I'm feelin a little DOOM'D.............
Post by Lizzie2 on Aug 27^th, 2004, 11:15am

on 08/27/04 at 11:05:42, OneEyeBlind wrote:

Hey Nan,

Yeah it is the insurance company policy. I had always gotten DHE and other injectible meds (including trex when I used to use it) straight from my Eckerd pharmacy. Then in January of this past year, I went to get the toradol script filled after I got out of the hospital and they told me they didn't cover injectibles anymore. I called the insurance company cuz I was pissed and they never even gave us notice on this! They said that the DHE would no longer be covered either. So I called my doctor's office who contacted the insurance company to get it. They said I could have the injectible meds (not the toradol) if Merck (I think?) sent the meds directly to the doctor's office and I picked it up there. They'd only allow this for DHE...haven't tried to get any other meds through the injectible route since then. However, I didn't have to "buy it from the doc." It would still just be a copay and run through the insurance like usual...it just went through their pharmacy instead of the regular pharmacy, so it got delivered to the doc's office instead.

Good luck!
Lizzie :)

Title: Re: I'm feelin a little DOOM'D.............
Post by Peppermint on Aug 27^th, 2004, 11:18am

Cootie hon.... is he getting statdoses (those come with the pen-like injector) which can be difficult to split for some people... OR is he getting the vials, which you'd use with syringes/needles? The doseage would be easier to split that way.

Hang in there hon, you're doing a great job. That LETTER OF NECESSITY can be the key, so mention it to his doc to write that for the insurance.

Its really amazing the types you run into when dealing with insurance, seems like no one ever knows the right info across the board. ::)

Try not to freak Coots, hugs to you both.

Pep

Title: Re: I'm feelin a little DOOM'D.............
Post by cootie on Aug 27^th, 2004, 11:22am

I know less and less as the day goes on. I actually DON'T know the difference between the vials and auto injectors or whatever.....I thought they jus came in individual shots or bottles you filll in a pack like aniamal vaccines. I jus never seen em before bein prepared. So I dunno if I should be requesting doc get us a certain type or style or size or what......more whine from the whine queen wah girl. So kick me and call me stupider Pam

Title: Re: I'm feelin a little DOOM'D.............
Post by Lizzie2 on Aug 27^th, 2004, 11:23am

on 08/27/04 at 11:18:12, Peppermint wrote:

Its really amazing the types you run into when dealing with insurance, seems like no one ever knows the right info across the board. ::)

Pep

You got it girl! Yesterday my mom and I played ping pong ball between the hospital in State College where I had a couple of ER visits and my insurance company. My mom and I were both on the phone with the guy at the insurance company, and we wound up telling him that we feel like everyone needs a course in insurance company info so that we know the right questions to ask and how to handle things! Part of it is that some people at the insurance companies have no clue what they are talking about. And part of it is that the insurance company Doesn't WANT to pay....so you have to know how to ask the right questions to get them to pay. After about 45 minutes on the phone with them yesterday, we finally got the guy to look back at a previous State college ER visit that they paid for, and he finally agreed to run it through again. Because the State College hospital is "out of network" for a Philly blue cross insurance, we had issues with me going there. It shouldn't have been a problem because I went as an emergency visit. One of the visits they had no problem running through because it was for cardiac problems. The other visit they were arguing "wasn't coded as an emergency" because of the "diagnosis" which was "headache." How bout that?!?! I asked the guy for a hard copy list of what constitutes an emergency and what doesn't so that I know for the future. He said he didn't have a list like that. I do intend to do as much as I can to fight insurance companies and help other people do the same!!!

L2