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        New Message Board Archives >> 2005 Cluster Headache Specific Posts >> insurance companies
        
(Message started by: dagger on Jun 20^th, 2005, 12:19pm)

Title: insurance companies
Post by dagger on Jun 20^th, 2005, 12:19pm

Hey all - I haven't been around too much lately as I am not in cycle, but I was wondering if anyone had any tips for dealing with the insurance companies. My doctor had faxed some misinformation to my company which resulted in refusal to pay for my imitrex. I bought it myself and then my doctor faxed the correct info to them and they sent me a letter saying that I could get the Imitrex. So then I asked to be reimbursed for my out of pocket costs and I got the major runaround. I made repeated phone calls and received assurances that these would be returned after they did some "checking", but nobody ever calls back. It is very frustrating. I've never had problems in the past being covered for oxygen, but this last time the company is claiming that there are limits as to the amount they will cover. It appears as though the condition of clusterheadache receives disriminatory treatment by my insurance company because the only drugs that have limited coverage are the ones I need. They will pay for any other type of medication as long as the doc prescribes it. It doesn't make sense to me that they won't pay for something that I need for only 2-3 months every 3-5 years, yet they will pay for drugs needed on a daily basis. Fortunately, I don't need any of those. I rarely get prescriptions for anything and it ticks me off that when I do need one, I can't get it unless I pay for it. Does anyone have any ideas? Thanks - dagger

Title: Re: insurance companies
Post by marlinsfan on Jun 20^th, 2005, 1:08pm

Same thing happened to me on my current cycle and new round of trex prescriptions. I paid myself, then the insurance finally approved. The pharmacy gave me my money back, and I only paid the co-pay.

Talk to your pharmacy, not your insurance. Worst case, change pharmacy....

good luck.

Title: Re: insurance companies
Post by Bob_Johnson on Jun 20^th, 2005, 2:25pm

I suspect a major barrier in paying for Imitex is that these people know about migraine but not cluster. With migraine, usage will be for longer times, hence, greater costs to them.

It might be helpful to get a medical article/material which describes the limited cycles and point out that costs may be high for short periods.

If you can't get a response from the first line people you talk to, ask that person for their supervisor or high level office which has authority to handle unusual cases/problems.

But I would be sure and ask them to specifically tell you the reasons for not providing coverage. It's impossible to deal wih them if you don't know what the barrers are!

Title: Re: insurance companies
Post by maffumatt on Jun 20^th, 2005, 4:58pm

Call the insurance company, ask for the full name of the person you are talking to, after you get their name tell them you are recording the conversation. Ask them why you have not been reimbersed for your out of pocket expence, and when they are going to get it to you. Nothing like haveing your name on tape to get the ball moveing. Tell them if you do not recieve your money by the date they provided, you will report that Person to the state insurance board.