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        Cluster Headache Help and Support >> Getting to Know Ya >> Insurance problems
        
(Message started by: GJ on May 21^st, 2008, 12:20pm)

Title: Insurance problems
Post by GJ on May 21^st, 2008, 12:20pm

hi folks,

This is my first post ... I can't really say that I've suffered from cluster headaches for 8 years. Actually, I had an episode 8 years ago that lasted two months ... then, I think the distance running helped, because I didn't have one for 8 years ... until ... "They're back!"
Since the end of April, I've been waking up at about 2 a.m. every night ... droopy right eye, nasal blockage right side ... then, the sooner I reach the Imitrex, the better, because ... "WHOOOOOAAAAA!!!!"

So, I have three issues I would like to discuss. First, insurance! I have two forms of medical insurance ... one from the place I work and I'm on my wife's plan. Well, here's the deal. The first batch of 6 Imitrex sprays costs me about $25 on my wife's plan. Then, the second batch, $60. Well ... after that, for some screwball reason, the insurance company won't allow me another one until after 21 days. For crying out loud, 6 + 6 does not equal 21. And, even if I have a doctor's prescription for the intermediary period, I have to shell out $250 for another batch. I understand a generic form of the injection is supposed to be coming out soon. Any advice on how to alleviate this situation would be helpful.

My second issue is ... how long can we take this sumatriptan medicine (I'm currently using 20 mg per night) without it (a) turning the blood green through the binding of sulfur with hemoglobin, and (b) turning into a health risk?

By the way, I tried running again to ward this off, but although at first I thought it helped (3 days, no headache), I just ran Sunday 10 miles and had 3 nights of excrutiating pain (followed by a dose of Imitrex, of course).

The third and final issue is ... is this a disease? Is this a disorder? What's the difference? Who gets to say what it is? Why is the insurance company so stingy?

Okay, that's the end of my first post. I'm glad I got that all off my chest. I do kind of feel better.

:)
GJ

Title: Re: Insurance problems
Post by Audre on May 21^st, 2008, 1:27pm

Ugh, insurance companies. *cringe* My insurance company will only pay for 9 Maxalts a month. And they're they lowest dosage amount so I usually end up having to take 2 to just get it under control. I guess 9 is better than none especially since they don't normally cover it. My mom's insurance is the same way. She has fibromyalgia, the doctor recommended lidocaine infusion and/or TENS unit. She called the insurance company to get it approved, they told her no. My dad came home to her crying, he called them back and chewed them out. They said it wasn't on the approved treatment list for fibromyalgia so he asked what was. They said there was no list....... Eventually they did allow her to get the TENS unit.

Title: Re: Insurance problems
Post by Brew on May 21^st, 2008, 1:35pm

Most insurance companies limit the amount of expensive drugs their clients can purchase. Insurance companies are not usually non-profit enterprises.

If your doc writes the script for you to have 2 doses a day for 30 days, looks to me like your insurance company will pay for 12 (with your copay, of course), then you get to pick up the tab for the other 48 doses.

I'd be taking some kind of preventative once that whole thing started, as I wouldn't want to be taking high-test abortives for that long.

Title: Re: Insurance problems
Post by Bob_Johnson on May 21^st, 2008, 2:03pm

Look at the OUCH site (left). They have some material on how to deal with this insurance issue, basically, getting your doc to write, explaining the need.

No time limit on using Imitrex unless there are preexisting problems which you doc will have to evaluate.

From a cost perspective, some of us have had excellent results with Zyprexa (olanzapine). See,

http://www.plainboard.com/ch/chtherapy.pdf

Here is a link to read and print and take to your doctor. It describes preventive, transitional, abortive and surgical treatments for CH. Written by one of the better headache docs in the U.S. (2002)
================
Michigan Headache & Neurological Institute for another list of treatments and other articles:

http://www.mhni.com/clusterheadaches.aspx#treating
==========
Running may help BUT some people find that elevated body temperature will trigger an attack. Your judgment call.
===
CH is a disorder arising from some misfunction of a portion of our brain. Mechanisms not yet understood and even what is known doesn't affect us day-to-day on coping. Spend time exploring the buttons (left) and the multitude of links you will find.

Title: Re: Insurance problems
Post by DennisM1045 on May 21^st, 2008, 4:41pm

Just to add a bit to Bob's advise, look into Oxygen. No side effects and fast relief. Works as quick as 10 minutes for me.

You need to use 100% O2 @ 10-15lpm using a non-rebreather mask.

I also add an energy drink to my O2 therapy to keep reattacks to a minimum.

Using this abortive strategy I've significantly reduce the number of triptans ($$$) I'm using.

-Dennis-