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Title: Insurance wont cover Itrex???? Help Post by Tiannia on Jul 22nd, 2005, 12:55pm Just got my doc to prescribe my imitrex shots. 6 sets (so 12 vials) a month. Took it to the Pharmacy, and was told that they can not fill it. That my insurance wants to send info to the doc, have the fill out paperwork and then they will decide if it is a medical necessity to fill it. Called the doc and she said that she would call in the tabs (woohoo 6 for a month ::)) for me for now and would get the insurnace the paperwork that they want. Can anyone help tell me who the hell I need to contact that might be able to help me get my meds. My insurance is PacifiCare - Signature POS. Any help or a point in the right direction would greatly help. |
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Title: Re: Insurance wont cover Itrex???? Help Post by LeLimey on Jul 22nd, 2005, 12:59pm Tia IM either Donna or Blossom, they both know a hell of alot about insurance and will be able to give you the best advice. I hope this helps - shudering thinking about this for you lots of love Helen |
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Title: Re: Insurance wont cover Itrex???? Help Post by saintslair on Jul 22nd, 2005, 1:50pm Hi Tiannia, I had problems with my insurance company not covering enough Imitrex injects. I contacted GlaxoSmithKline Reimbursement Resource Center and they helped me go from 6 injects a month to 18 injects a month. Don't let the name scare you, you don't have to pay for them up front. They worked with my insurance company to get me the extra injects. The process takes time (it took approx. 9 weeks), but it was worth the wait to get the extra injects. The information is below: http://rrc.gsk.com/ Reimbursement agents are available Monday through Friday from 9:00am - 6:00pm Eastern Time by calling 800-745-2967 (800-7-GLAXO-7). Voice messaging is available after hours during the week, as well as on weekends and holidays. All voicemail messages are returned the following business day. I hope this works for you. Good Luck. PFNAD to all, Andy |
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Title: Re: Insurance wont cover Itrex???? Help Post by Svenn on Jul 22nd, 2005, 1:54pm Reading about this all i can say is: DAMN WE ARE LUCKY TO LIVE ON THIS SIDE OF THE POND Im so so sorry Tianna Svenn |
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Title: Re: Insurance wont cover Itrex???? Help Post by LeLimey on Jul 22nd, 2005, 2:05pm Andy I have to say that is one fantastic post with really good info for so many of the family here. Hats off to you mate, you've done good! Helen |
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Title: Re: Insurance wont cover Itrex???? Help Post by Bethany1 on Jul 22nd, 2005, 3:21pm check your pm's Tia... |
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Title: Re: Insurance wont cover Itrex???? Help Post by don on Jul 22nd, 2005, 3:40pm Quote:
Unless I read this wrong your Doc is already doing that. |
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Title: Re: Insurance wont cover Itrex???? Help Post by Tiannia on Jul 22nd, 2005, 4:18pm on 07/22/05 at 15:40:38, don wrote:
No you did not read that wrong but I did not know if anyone knew where to call from the insurance side. Because according to the Pharmacy, even with the docs paperwork, they can still decide that it is not medically neccessary and wont cover it. :-/ |
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Title: Re: Insurance wont cover Itrex???? Help Post by blossom on Jul 22nd, 2005, 10:43pm Tiannia- Ok - insurance geek here. What your doctor has to do is get a prior authorization for the medication. What that means is he has to fill out paperwork explaining why you need the additional quantity per month and USUSALLY show that you have tried other meds that haven't worked. There are quantity limits on medications that have a lot of side effects and are very "potent" (sorry can't think of the word I want right now! been a long day!). I have seen prior auths be done over the phone and I have seen them take 3 days to 2 weeks. If the company is worth a damn it won't take long. Don't let your Dr's office snow you either - keep on them! This always seems scary to people but it's really not that big of a deal. Let me know if you need help, I'll be more than happy to help you through it! Good luck! Karen edited to add: I don't mean the "it's really not that big of a deal" to start an uproar. I know it's difficult to deal with the insurance company and some people can't get their meds filled but I am working on something to try to get everyone some help! That's right, folks, Blondie is up to something! ;;D more to come.... |
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Title: Re: Insurance wont cover Itrex???? Help Post by Sean_C on Jul 22nd, 2005, 11:00pm Go to the E.R. 6 times a day if you need to, the hell with them. They don't want to bare the expence of the trex, then let them bare the expence of the E.R. They'll back of then T. PF wishes comin at ya Sean............................. Those asssholes always say, "we're not denying you health care, we're just denying you PAYMENT" >:( They SUCK >:( sorry for the rant :-/ |
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Title: Re: Insurance wont cover Itrex???? Help Post by cootie on Jul 22nd, 2005, 11:09pm I 'think' most insurence co's have a doctors hotline the doctors office can call to explain directly to your insurence co....that's what our doctor did. But our ins. would only pay for 9 tabs a month......doc had to call and explain why Brad needed more.......he had to do that with each refill tho. So then our doc wrote out a script for the trex injections we have yet had to try (been 4 years and counting) but doc explained it to the insurence co as intractable migraine.......he said if he mentiond clusters the ins co gets alarm'd so 'he said' he found a way around them doing this for now. Brad was allowed more of the injectibles this way then normally permitted and then I explained to him there is a way to get 2 or three shots out of each one. Brad hasn't tried it yet......am HOPEING he rememebers how to do it cuz they showed him at the convention in Nashville. That stuff is TOO precious and expensive to waste and expirement with as everyone here knows. We had to pay for the tabs tho when insurence refused till doc could call and straighten a few things up. I think we blew 600 bucks out of pocket till we got some that they'd start payin on. 'Headgames' Pam Good luck Mel.......hope it gets straighen'd out.......what his is now allowed I have stashed and been stocking up still won't be enuff if he has a cycle like last time but it's better then what little they wanted to allow. It's all BULLSHIT. |
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Title: Re: Insurance wont cover Itrex???? Help Post by unsolved1 on Jul 22nd, 2005, 11:12pm Tia, Check your PM's. I hope you get this mess with your insurance company straightened out soon. Goodluck & PF wishes Unsolved |
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Title: Re: Insurance wont cover Itrex???? Help Post by Tiannia on Jul 23rd, 2005, 1:06am Thanks Blossom, Michael and everyone else. Talking tot he insurance company, they are saying that they have up to 9 weeks to determine if it is medically necessary. So I am going to keep on the doc to make sure that she gets them watever they need. I have gotten her all the backup from all the docs I have had over the past 2+ years since this shit started so she can say what meds I have tried and all. I just am praying that this works. Will ahve to make sure that I keep good records of what they say and such so that I have ammo if I need it to go higher up the chain. One step at a time. Love you all. I'll keep you posted as we go. Tia |
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