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        New Message Board Archives >> Medications, Treatments, Therapies 2005 >> help on trex
        
(Message started by: maffumatt on Mar 16^th, 2005, 4:56pm)

Title: help on trex
Post by maffumatt on Mar 16^th, 2005, 4:56pm

For those that have had problems with the insurance companies I found a way to get them to increase the amount of trex they will cover. When I got my diagnosis the doctor copied the chapter out of his med textbook and gave it to me. Well when I tried to get my 2nd perscription of 6 sprays filled the insurance wouldnt cover it. They would only cover 6 in a 45 day period, after talking to the ins. company I found out that is the amount that is covered for migrains. They did not consider CH as different than migrains. Now back to the chapter that my doctor gave me it states as follows:

An overriding problem in acute cluster headache therapy is that the attacks begin rapidly, peak very quickly, and subside over less than 2 or 3 hours. To be of any value, a therapy must therefore be rapid on onset. Oral preparations that are used for migraines may not be effective; indeed TREATING CLUSTER HEADACHES AS A FORM OF MIGRAINES IS A VERY CONSIDERABLE THERAPEUDIC MISTAKE. ACUTE CLUSTER HEADACHE IS PERHAPS THE WORST PAIN KNOWN TO HUMANS; IT FOLLOWS THATITS RELIEF IS A RESPONSIBILITY THAT TRANSENDS FINANCIAL CONSIDERATIONS. IN OUR VIEW, WITHHOLDING EXPENSIVE BUT EFFECTIVE TREATMENTS IN CLUSTER HEADACHES IS SIMPLY UNETHICAL. The options for acute treatments are oxygen, tripans, ergot derivatives, and internasal lidocaine.

Your insurance agency is not bound by ethics, But they have doctors on their staff that are. I talked to the insurance companys doctor and faxed him the information that my doctor gave me, he called my doctor and shortly afterwards they called me and informed me that they increased the amount allowed from 6ML in a 45 day period to 54ML for 45 day period. It worked for me so I do not see why it wont work for you too.

Matthew

If anyone needs the information message me with a fax number and I will send it to them.

Title: Re: help on trex
Post by E-Double on Mar 16^th, 2005, 5:00pm

[smiley=thumbsup.gif]

Good to know and worth a try!!
I have very good insurance yet.........the same holds true

Title: Re: help on trex
Post by jokrs2 on Mar 16^th, 2005, 6:50pm

Thanks big time Matthew. I printed out your statement and am giving it to my doctor tomorrow. This is exactly why I had to look for an alternative approach to controlling my chronic condition. Price & quantity per month were too much and not enough. Thank God Kudzu is working for me. Your letter should help many others who need more than their insurance says is acceptable since migraines are not CH. Thanks again, Joe PFD's

Title: Re: help on trex
Post by Bob_Johnson on Mar 16^th, 2005, 7:30pm

It would be helpful if you would put the full citation for this chapter in a message here:

title
author
chapter, etc.
copyright date

Title: Re: help on trex
Post by TonyG1 on Mar 16^th, 2005, 8:26pm

I was looking at my plan -- it provides a good deal as standard allowances. If I need more than that, there is a form I and the doc can complete and fax to them to get that approval for more. One thing I noted on my form and some of your plans may be the same is the diagnostic code (ICD-9) seems paramount in terms of whether or not approval is given:

From my form:

NOTE: The generalized headache code of 784.0 and/or the diagnosis of “Vascular headache” will not be approved. Please choose an ICD-9 code and diagnosis more descriptive of specific headache type.

Title: Re: help on trex
Post by lionsound on Mar 16^th, 2005, 9:17pm

Way to be proactive, Matthew! :)

Thank you for sharing the info!

-lionsound

Title: Re: help on trex
Post by hzzz on Mar 16^th, 2005, 9:30pm

I called the makers of Imitrex and they called my Dr. and insurance company. They got my Dr. to write a letter to the insurance company and the insurance company has now given me an override of their normal nine dose monthly limit. But of course now that I have that, I am taking Kudzu and having no attacks.

But I won't complain. [smiley=laugh.gif]

Title: Re: help on trex
Post by don on Mar 17^th, 2005, 7:17am

It would also be helpful to know the insurance company.

Is it an HMO or private carrier ?

Title: Re: help on trex
Post by maffumatt on Mar 17^th, 2005, 10:32am

My insurance company is a private carrier Starmark, and they suck. As for the information about the information about the source I dont have that, I will get it at my next appointment on tuesday of next week. Like I said if you want it I will fax you the whole chapter if you want it. Its 18 pages long so its a little long to post. I will post the following information tuesday or wednesday.

title
author
chapter, etc.
copyright date

Title: Re: help on trex
Post by eyes_afire on Mar 17^th, 2005, 6:08pm

One thing I wonder about... how does this work for 'Self-Funded Groups'? My insurance company doesn't really provide prescription insurance.... they just do administrative management. My (stingy) employer is the insurance. According to BlueCross:

"If your group has chosen to 'self-fund' or 'self-insure' its benefits, please note that BlueCross provides only administrative services and assumes no financial risk or obligation with respect to claims."

I think I'm SOL since I can't fight my employer and ever hope to 'win'.

It seems like a pretty intelligent (sneaky) way for insurance companies and employers to keep prescription costs down since a 'smart' employee will not fight their employer...

Any thoughts... anyone?

thanks in advance

--- Steve

Title: Re: help on trex
Post by LadyLuv on Mar 18^th, 2005, 1:36pm

Thank you so very much for the information... I will be contacting my doctor today... I have had a problem with my insurance company every since I started taking Trex.. When I cann't get it, I end up at the ER (which cost me $125.00 a pop), and cost the insurance company twice that... But they would rather pay that, than pay for the medication.. I

Once again, thanks for the tip and may God Bless you..

Peace & Blessing
Lady Luv

Title: Re: help on trex
Post by vig on Mar 18^th, 2005, 2:37pm

Nice letter Matt
thanks