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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> Need help fighting ins co for Zomig NS
        
(Message started by: jon019 on Oct 26^th, 2006, 8:36pm)

Title: Need help fighting ins co for Zomig NS
Post by jon019 on Oct 26^th, 2006, 8:36pm

Hello All,

Currently my insurance co only allows me 6 Zomig NS per month. It has worked wonderfully . Besides aborting a current hit, it gives me 12 hours of added relief. Best abortive I have found when the O2 doesn't work. I need more than 1 out of 5 days help.

My question is how do I approach them for increased allowance (hate that word, feel like 10 yrs old asking Daddy for a quarter raise in my "allowance"?) I am sorry if this has been addressed before. I cannot access either of the two archive search features here.

I know I need to contact my neuro but I want to be able to tell her exactly what I need and exactly how I need her to help. May have a fight with her re more doses, but that is another problem I will deal with later.

Thanks,

Jon

Title: Re: Need help fighting ins co for Zomig NS
Post by TxBasslady on Oct 26^th, 2006, 9:01pm

The way to your insurance co is probably best served thru your doc.

To my knowledge, this is the best way. Have your doc write a letter...or whatever it takes. I don't think you'll get to first base on your own. Supporting documentation is your best bet, IMHO.

This problem is real common...all of us, at some point in time have been in the same position. Luckily, for me, 02 is my savior....it works like a charm. It's the only "med" I take for my CH.

Lots of good luck to you, Jon....I hope you're successful with getting your doc to step in...and help out.

Jean

Title: Re: Need help fighting ins co for Zomig NS
Post by Giovanni on Oct 27^th, 2006, 8:28am

As Jean said above, your doctor has to take the lead on this one requesting from the insurance company an "override" in your RX amount.

The doctor I have has been excellent in obtaining the amount that I have needed over the years.

The insurance companies are used to Migraines amounts which are far less per month than hits from CH.

John

Title: Re: Need help fighting ins co for Zomig NS
Post by big guy on Oct 27^th, 2006, 9:15am

I called my ins. co. (United Healthcare) customer service phone number and asked them the exact procedure. Strangly Imitrex and verapamil had different procedures. Imitrex required my Dr to contact them directly. Verapamil required me to forward a letter from my dr to the Ins. co and then call them. Both worked and I got approved for the prescribed dose of verapamil and almost unlimited Imitrex. Don't just accept what the ins. co gives you, fight for what you need

Big Guy

Title: Re: Need help fighting ins co for Zomig NS
Post by CLivingston on Oct 27^th, 2006, 2:25pm

I just phoned our insurance company today to see how to increase the number of imitrex injections DH is covered for each month (it's currently 10).

Blue Cross advised that the Doc must write a letter of medical necessity and fax it along with all supporting documention (clinical notes). He must also specify exactly how many injections he estimates DH will need per cycle.

Once that is completed, a decision is made within 72 hours.

On a side note - I've made myself a tickler file to remind me to get his injections refilled each month, whether DH is in cycle or not, in order to create a stockpile of sorts for those really desperate times (like now, he's gone through 15 shots since Monday!!)

Title: Re: Need help fighting ins co for Zomig NS
Post by BigCoffinHunter on Oct 27^th, 2006, 2:33pm

My ins only wanted to cover 6 Zomig NS per month. Doc was able to get them up to 18. I'm filling all the refills before they expire, so I have them on hand for next time.

I prefer the Zomig, I like how it lasts for many hours after taking it.

Title: Re: Need help fighting ins co for Zomig NS
Post by Linda_Howell on Oct 27^th, 2006, 8:58pm

Jon, Try this link and see if it helps.

http://headaches.about.com/cs/advocacy/a/trip_limits.htm

Title: Re: Need help fighting ins co for Zomig NS
Post by jon019 on Oct 28^th, 2006, 1:36am

Excellent. Thanks for the info folks. I called insurance co today who told me the steps (Docs gotta write a letter and supply evidence of need) Now will find out how committed she is. Will let you know.

Great site Linda, thanks for the link. I will be prepared if ins co comes back with some crap. Very interesting info on triptans too. Didn't know how many there were and their relative arrival time on market. Information is power, and that's a rare thing when you got CH.

Regards

Jon

Title: Re: Need help fighting ins co for Zomig NS
Post by thebbz on Oct 28^th, 2006, 7:56pm

Here's another one for ya Jon
http://www.patientadvocate.org/help.php
be well
jb

Title: Re: Need help fighting ins co for Zomig NS
Post by jon019 on Oct 28^th, 2006, 8:43pm

Thanks jb, and it offers free assistance. Have found others on the web that charged, but had not seen this one. I'm downloading the "Guide to Appeals Process" right now. Have a feeling I will need it.

One VERY interesting item I have found in research is that Costco retail price for 6 (5mg) Zomig nasal sprays is $152, and 5 (.5ml-6 mg) vials for inj of Imitrex is a whopping $655. I think they relatively are comparable in coming to market so the disparity is boggling. Then again, Zomig is manufactured by Astrazeneca (UK) and Imitrex is GlaxoSmithKline (US). Hmm, guess they are paying for all that friggin advertisement I see EVERYWHERE.

What it does is give me ammo for the sure to be appeal. I can get 3X the amount of Zomig for the price of 1 Imi, YET they won't give me more Zomig but will fill BOTH scripts at the same time (with same limits, 1 per month).

Regards

Jon

Title: Re: Need help fighting ins co for Zomig NS
Post by stacy3675 on Nov 2^nd, 2006, 12:00pm

I get 8 boxes of the imitrex injections(the vials) and they are only 275 a box without ins you may need to shop around

stacy

Title: Re: Need help fighting ins co for Zomig NS
Post by jon019 on Nov 13^th, 2006, 9:45pm

OK, the result, and thanks all for the advice.

Neuro came through (sorta). Will not OK more than 12 Zomig per month but she did whatever ins required and got me from 6 up to 12/mo approved.

Very interesting letter from ins reporting authorization. 5 out of 6 paragraphs of gobblydgook warning me of this "temporary" authorization (5 months, then I have to fight again) and disavowing responsibility for this coverage unless blah, blah ,blah... Jeez, a yes or no would have done just fine. It was like, we'll do this this time you bastard but you will pay, one way or the other!
No one sees me get hit, no one, but I would drive a hundred miles to have a kip 8 or so in their office.

I sorta won, sorry for the bitterness. It's just that these people have been pissing me off for 20 years...

Jon

Title: Re: Need help fighting ins co for Zomig NS
Post by LeLimey on Nov 14^th, 2006, 7:45am

Jon honeybun have a read of this thread
http://www.clusterheadaches.com/cgi-bin/yabb/YaBB.cgi?board=supporters;action=display;num=1163320706

It may help you alot, its only one post long so it shouldn't tax you too much :P

I'm sorry you have had such a crapy time of it and I'm even sorrier you need more than you can have. Stockpile out of cycle if you can [smiley=hug.gif]

Helen

Title: Re: Need help fighting ins co for Zomig NS
Post by jon019 on Nov 14^th, 2006, 11:24am

Thanks dear. I'll keep fighting til its Bob's your Uncle.

Title: Re: Need help fighting ins co for Zomig NS
Post by Linda_Howell on Nov 14^th, 2006, 12:59pm

I just came back to this thread to follow-up and I didn't catch this the last time I was here.

Quote:

(like now, he's gone through 15 shots since Monday!!)

(That is 4 days if I looked it up correctly on my calendar._

This seems like an VERY scary amount her husband is going through in way less than a week.

If you stop back in here CLivingston....please respond :o