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        Cluster Headache Help and Support >> Cluster Headache Specific >> Whats the name?
        
(Message started by: 5yearsteve on Jan 3^rd, 2007, 12:39am)

Title: Whats the name?
Post by 5yearsteve on Jan 3^rd, 2007, 12:39am

There is a specific name for the action taken by the doctors office when they request an insurance co to pay for more medication. It is a request to override the amount that they pay for. I cant remember the name of this. Does anyone know it?

Title: Re: Whats the name?
Post by brewcrew on Jan 3^rd, 2007, 12:44pm

Pre-authorization?

Title: Re: Whats the name?
Post by seasonalboomer on Jan 3^rd, 2007, 1:07pm

Miracle?

Title: Re: Whats the name?
Post by aubmari on Jan 3^rd, 2007, 2:47pm

on 01/03/07 at 12:44:46, brewcrew wrote:

Pre-authorization?

That is right or Prior Authorization. The pharmacy should be able to call the insurance co.

Title: Re: Whats the name?
Post by thebbz on Jan 3^rd, 2007, 3:28pm

;) Need for medical necessity. Often used to slap up insurance companies for payment of 02 expenses, without blood gas testing.
all the best
jb 8)

Title: Re: Whats the name?
Post by vietvet2tours on Jan 3^rd, 2007, 3:32pm

My wife does this stuff.I need to know if your group is self funded or wholly funded

Title: Re: Whats the name?
Post by 5yearsteve on Jan 3^rd, 2007, 5:11pm

Need for Medical Necessity. Thats what I'm looking for. I have a Nurse in my neuros office that simply refuses to give me a "Physicians letter of necessity for an exception/override of the limitation policy". The neuro prescribed me maxalt with 3 refills. This idiot nurse will not even call my ins co to even ask them to help cover the expense. She says that 9 maxalt mlt's are too many for a 20 day period! I'm definetly going to find another neuro and staff with more experience with CH.

Title: Re: Whats the name?
Post by brewcrew on Jan 3^rd, 2007, 5:42pm

on 01/03/07 at 17:11:20, 5yearsteve wrote:

I'm definetly going to find another neuro and staff with more experience with CH.

Please do! Look for a neuro who specializes in headaches.

Title: Re: Whats the name?
Post by purpleydog on Jan 3^rd, 2007, 9:57pm

on 01/03/07 at 17:11:20, 5yearsteve wrote:

The neuro is the one who writes a letter of medical necessity, and it's not the nurse's decision to have or not have the neuro write it. It's also not her place to comment on how much medicine you are taking, it was prescribed by your doc, not her.

Call your neuro's office, and tell the nurse you want to have the doc call you back personally, you need to discuss something with him, If she asks, tell her you have a medical need to discuss your meds with the doc, then say no more. Wait for him to call, and let him know how involved with the decision making the nurse has become. He would be interested to know. In the past, there was a nurse giving out advice like you say she is to you to patients in my neuro's office. She got fired for it.

She has no business making comments like that to you. Your doc needs to write that letter. I had to have my GP write one for the insurance to cover more trex. I then recently had to have my neuro write another letter for the same thing. My GP charge me $75.00 to do it. My neuro did it at no charge.

Good luck.

Title: Re: Whats the name?
Post by 5yearsteve on Jan 3^rd, 2007, 10:37pm

Thanks for the replies everyone.
Purpleydog, I have thought and thought about it. What I am going to do is find another neuro with more HA experience. I am going to write a letter to the neuro and make sure she knows everything and why I have chosen to find a new neuro. At my last appt I told the doc that I was having problems with her staff and getting abortive drugs. All she did was give me refills this time for maxalt. Apparently she didn't even have a talk with her nurse. For that reason it leads me to believe that neither the nurse or the neuro have any CH experience.