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        New Message Board Archives >> Jul-Sep 2003 >> Insurance liability?
        
(Message started by: ebk3 on Sep 16^th, 2003, 10:23pm)

Title: Insurance liability?
Post by ebk3 on Sep 16^th, 2003, 10:23pm

I'm sure the number one issue with all of us is a cure, but may i suggest number 2.

TREATMENT
I am an aggressive salesman. I get mine. If I'm suffering i feel entitled. I am an American, don't fuck with me.

Recently I have heard from posters that they are receiving 3 imitrex doses per month, Chronics!!

I am not a lawyer, but have been in court enough times to know that judges respond to logic and common sense.

Here is an argument that I think has merit:
If the Ins Co okays any dose of imitrex, they are signing on to it's thrapeutic value. In for a penny in for a pound.
If indeed it has value to reduce arguably the worst pain humans can suffer, then why are they only willing to treat such a small number of attacks? Obviously cost.

Judges respond to common sense. Why Mr HMO are you willing to accept the premiums of Mr Jones, then when he needs you you agree to treating and fixing 3 headaches a month. What about the other 80 attacks?
No? Cost too high?

I'd love to see this case in front of a judge.

I know i'm up against all the CHers who want to be kind to th Drs.

Its up to you, personally I am strong enough to not alow this foolishness to impact my Chs.

They try to condescend to me and they get both barrels.
Including these ER idiots who try to marginalize our affliction. I get what I need.

Gene

Title: Re: Insurance liability?
Post by Patrick_A on Sep 16^th, 2003, 10:34pm

Well Gene, Success story number 1 here! I took it all the way to the top with Blue Cross/Blue Shield. Companion Health Care. They originally would only give me 9 inhalers every 30 days, so i took it to my Plan administrator and we looked it up in the health book and found out that it wasnt the HMO but it was how the Doctor was writing the prescription. So i called the Blue Cross people to find out just exactly how it needed to be written. They sent me back a letter with the exact phrase and i now get 60 Imitrex inhalers per month and 60 ,100mg pills per month.
You should have seen the look on the Pharmacist face when i gave them the prescription. They didnt beleive it, and told me they would only give me a 3 day supply till they could find out more information from Blue Cross. So i came back 3 days later and they started boxing up my order with the most incredulous look on their faces.
Now i don't know if it was just luck, or maybe my HMO is of the better sort. But i tend to believe it is because i attacked the situation and made them pony up or else.

Pain Free now, Patrick

Title: Re: Insurance liability?
Post by UnsolvedEquation on Sep 16^th, 2003, 10:40pm

I wish everyone here could have a doctor as generous, compassionate, and understanding as mine. He GIVES ME approx 100 injections a month, more if I need it. Thank god for him. I know he has saved my life !

Title: Re: Insurance liability?
Post by ebk3 on Sep 16^th, 2003, 10:42pm

congrats,
Only one mans opinion but it seems to me that the system works so welll for the HMOs because majority says nothing. You kicked and screemed as did I.
I've got the meds I need!!
Gene

Title: Re: Insurance liability?
Post by Patrick_A on Sep 16^th, 2003, 10:57pm

Oh yes i definitly agree. If i had stayed passive, then i would still be getting the original amount.
Like i said in a previous post. I wish i was a rich lawyer, I'd do Pro Bono work here for the sheer enjoyment of it!

Pain free now for 3 weeks, Patrick

Title: Re: Insurance liability?
Post by ebk3 on Sep 16^th, 2003, 11:06pm

I tell you, I'm an auto salesman now, It's so obvious that one must take responsibility for their own treatment
every case is different, mostly by how informed and agressive the client.
Gene

Title: Re: Insurance liability?
Post by TxBasslady on Sep 16^th, 2003, 11:10pm

8)

Wow, u hit the nail right on the head there, Gene. It is a shame that more folks don't kick and scream.
We pay for the insurance.....the Dr. gets paid.....and then to limit quantities due undoubtedly to costs, is absolutely ridiculous.
And it does seem that the argument is there.....if they give you ANY amount of the prescribed meds....how in the hell can they come back and say "no more."
My husband is retired from Fed Gov't. We have very good ins., but they delayed my medication for 7 days....because my Dr. didn't get a pre-approval!!!!
The insurance co's have teeney boppers sitting in the offices, refusing our medication. Like, how the hell do they know what and how much we need? If my Dr. writes a script....somebody better fill it!!!!!!
Gonna stop now.....I could really get on a roll, here...LMAO ;D

Jean

Title: Re: Insurance liability?
Post by TxBasslady on Sep 16^th, 2003, 11:16pm

;)

Hey Michael.......quit spillin that stuff on the floor LOL

I read that post...and the the other where the guy said he's be lickin the floor...........LMAO ;)

Jean (ummm, think I better get back to rowin' this boat)

Title: Re: Insurance liability?
Post by ebk3 on Sep 16^th, 2003, 11:27pm

Tx,
What"""

Title: Re: Insurance liability?
Post by TxBasslady on Sep 17^th, 2003, 12:01am

:)
Oops....sorry Gene. The 2nd post I did was a comment to Unsolved Equation....
The 1st one was my response to you..

Didn't mean to confuse ya......

Jean

Title: Re: Insurance liability?
Post by Ueli on Sep 17^th, 2003, 2:16pm

Patrick, could you repeat for all here the magic words the doctor has to write to convince the ins. co.?

Thank you
Ueli

Title: Re: Insurance liability?
Post by ozzman on Sep 17^th, 2003, 3:01pm

Er... I have to add to Patrick's experience. Apparently it DOES make a difference the way the Neuro writes it. I too have Blue Cross Blue Shield and Advance Rx for pharmacy. I checked online for pricing, it didn't matter that I put in 60 NS a month for three months. Then I followed up with a representative over the phone. She said, that they'll give whatever the doctor thinks is necessary. The copay was still the same. She asked me how many sprays do I get out of each bottle. I laughed and said only ONE!!! She couldn't believe it. But said no prob. Then... I called my Doc and asked him to write me a script (actually I talked to the nurse, sometimes it's easier) for 2-3 a day (didn't want to be too greedy), he gave a script for 2 a day. Put it in and a week later lo and behold I had 180 NS Trex boxes at my front step. The literature that came with it from the pharmacy only mentioned the safety of a max of 2 full doses per day. And I believe there my friends is the catch #2. No mention of max per month, anywhere.

The lesson is: ask your doctor for a mail order script 3 month supply, twice a day. I prefer the mail order route because you save money and sometimes the local pharmacists can be asses. Not to mention that they don't stock more tan 2 or 3 boxes at the time. I have had to wait 3 or 4 days to refill a prescription.

Give it a try.

Ozzy (who for the first time, feels quite relaxed about this cycle)

Title: Re: Insurance liability?
Post by don on Sep 17^th, 2003, 3:20pm

Quote:

He GIVES ME approx 100 injections a month, more if I need it

That adds up to 26.33 Mg per day. Recommended dosage is no more than 16 Mg per day.

Nice he cares about your pain but sounds a little medically irresponsible to me.

And MORE if you need it?

Title: Re: Insurance liability?
Post by UnsolvedEquation on Sep 17^th, 2003, 6:03pm

Yes ... I honestly do think I've used more trex and still do use more trex than ANYONE on the face of the earth. When I die ... I should donate my body so they can study the effects of the HUGE amounts of trex ive used. Right now, I'm still 'spillin' 2 mg per shot...but not for long. I've got the vials ordered !!My record still holds at 32 mg in 20 hours (injections). Has anyone done more than that ?

Title: Are you kiddin' me?
Post by Not4Hire on Sep 17^th, 2003, 6:42pm

...only because i read ffrom the bottom UP... and I should *quote* all of this thread....

this is a thread that fookin lights my JETS.....

every day since i washed up on these shores, i have had a HARDON for insurance companies and the whiners who pay their premiums.....

of course i HAD *no insurance* because i was ,,,, (almost) ,,, homeless and fer GAWDAM sure outta work.....

that said, i ALSOFUCKING have a problem with doctors who *appear* to have a cozy relationship with INSURANCE companies.... i mean, yer sayin' that these doctors would prescribe MORE... but they are *worried* that your INSURANCE won't pay it.... WHAT-THE-FUCK?

...a doctor's Hippocratic Oath is : "First, Do No Harm....."

and then, apparently, ..... "what's yer handicap?.... i got $50 ya can't hit that Mexican greenskeeper with a 4 iron..."

"oh, yeah, what's yer *handicap?*... do ya have Muscular Dystrophy? ... or colon cancer? .... or ALS? .....or mebbe something ... sexy? ...like droopin jowls? ... need BOTOX? ... we can make yer chin look like the Sphinx.... (hasn't moved in 2,500 years(tm)...

... but back to the point: y'all are *TO BE COMMENDED* for gettin up off yer knees... and demanding that what you paid for with your premiums is actually DELIVERED.... i am FUCKING sure that you would not be whining if the drugs they gave ACTUALLY worked....

... these RANTS don't happen very often... please write your rebuttals on a $100 bill and send them to MrHappy or Den-and-Georgia-and-Adam ... who will distribute the proceeds to ..... vestal virgins or ... something.....

(just squiggles.... take what ya need/agree with... and hit DELETE with the rest)

...shit....

Title: Re: Insurance liability?
Post by ebk3 on Sep 19^th, 2003, 7:20pm

What in the world did your post mean?
Gene

Title: Re: Insurance liability?
Post by ebk3 on Sep 19^th, 2003, 7:24pm

Are you kidding? You;re quite sure that we wouldn't be whining if the meds actually worked?

You are so far off the playing field it's ridiculous!! Imitrex kills a CH attack for me in minutes!!

What the hell are you talking about?

Gene