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medical neccessity (Read 1706 times)
jayrobinson
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medical neccessity
Oct 12th, 2009 at 4:52pm
 
Insurance covered me for a month and then denied me. I am working on that, Imitrex injectible. It is a sad state
that my caseworkers do not have the sympathy and knowledge it takes to improve our lots in live. I am dis enchanted with them all. I have little time to prepare for what looks like an epic battle, and I being David with no stone. I am mad for all eternity that knowledge is only powerful in the hands of the powerful. So is  there something that I can do to help? I am a believer. I can testify from the mountain top of my head blowing off. Forgive me my small rant for I am hopeless. I s there anything I can do to help the big picture? Need help
Jay
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Brew
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Re: medical neccessity
Reply #1 - Oct 12th, 2009 at 5:00pm
 
You don't provide a lot of specifics, but how about getting a lawyer?
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deltadarlin
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Re: medical neccessity
Reply #2 - Oct 12th, 2009 at 5:21pm
 
I'm with Brew here about *specifics*.  Are you saying that your insurance company has dropped you after you were on there a month or are you saying that the insurer denied your script of Imitrex?
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Skullcrusher
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Re: medical neccessity
Reply #3 - Oct 12th, 2009 at 6:09pm
 
Medical coverage is a bit different here so I may not be any help. I have had problems in the past when I try and get too much meds at once and too often. I also like to switch it up. Use different meds, even if its as minor as Imitrex injections to Imitrex nasal spray(20 mg not the smaller size).
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Charlie
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Re: medical neccessity
Reply #4 - Oct 12th, 2009 at 7:36pm
 
Forget the politics of the thing. These are evil people with whom you are dealing. They have no interest your health.

Some drug companies will "help" you get drugs for a time. I applied for the anti-convulsant I have been stuck with for 15 years when I had a period of no coverage. It worked but the paperwork and deliberately complex and difficult telephone conversations nearly drove me over the edge. My doctor's office helped out but they were on the telephone for 45 minutes. They were great. Fortunately, I needed it only once.

Anyway, you might begin looking into it but you have to have the patience of Job.

Good luck!

Charlie
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« Last Edit: Oct 12th, 2009 at 7:37pm by Charlie »  

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jon019
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Re: medical neccessity
Reply #5 - Oct 12th, 2009 at 8:43pm
 
Hi Jay,

The title of your thread is actually the key. Get your Doc to write a letter of "medical necessity" indicating "intractable" headaches that require more than "approved" amounts. Your insurance co website or written lit should have more details of exact wording or details of appeal.

I went through excatly the same...it pissed my Doc off enough to write an emphatic letter...that, and the insurance broker going to bat for me...AND, dogged persistence by me in calling, writing and NEVER giving up.

You are right...it is tough duty when all you want is relief and they don't get it...or do, and just care more about the bottom line than you.

Fight it out...you can do it!.... clusterheads don't have the option of giving up...one beast at a time is usually enough. It became a crusade for me that really helped...I could focus on the bastard(s) that could be beat...

Best,

Jon
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Marc
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Re: medical neccessity
Reply #6 - Oct 12th, 2009 at 9:29pm
 
Random thoughts for any Clusterhead in trouble:

- Oxygen should probably be the number one choice to try to abort CH's. It is nothing short of miraculous for most - but not all. While you are fighting the battle to get Trex, get O2!

- Forced into the situation, I researched long and hard to discover that welding O2 is absolutely the identical product as "medical" oxygen. No prescription required and dirt cheap.

- Oxygen is not a preventative for CH's, but it surely can help ease the agony. For many of us, breathing pure O2 for a very few minutes can kill the attacks with startling regularity.

- Some people need to breathe oxygen at higher rates than others in order to be really successful. Others do well with much less. My point is to be sure and NOT give up if your first try doesn't provide the relief that you are looking for.

By all means, get your doctor and insurance to pay for oxygen if you can. While you are waiting, or if they won't cooperate: You could be in a whole lot less agony starting starting tomorrow morning with welding O2.

Read the "oxygen info" link first, then ask any questions that come to mind: Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or Register

Become totally proactive and take control of your situation. Read stuff in this site, read some more then ask away!

Marc



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« Last Edit: Oct 12th, 2009 at 9:33pm by Marc »  
 
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JustNotRight
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Re: medical neccessity
Reply #7 - Oct 12th, 2009 at 9:33pm
 
jon019 wrote on Oct 12th, 2009 at 8:43pm:
You are right...it is tough duty when all you want is relief and they don't get it...or do, and just care more about the bottom line than you.

Fight it out...you can do it!.... clusterheads don't have the option of giving up...one beast at a time is usually enough.
             focus on the bastard(s) that could be beat...

Best,

Jon


Couldn't have put it better myself, Jon. 

Keep in contact with your Doc Jay and don't give up!
Let us know what happens and which route you have to take as it maybe helpful to others.

PFDAN to you!
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catlind
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Re: medical neccessity
Reply #8 - Oct 13th, 2009 at 7:11am
 
Been there done that, had to go to 3rd level appeal (military insurance) and when they pissed me off real bad I threatened to show up in their head office with the most communicable disease I could find.  Course, ya can't do that in the days since 9/11, something about uttering terroristic threats - what a world we live in.

Jon's advice is best though.

Cat
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Potter
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Re: medical neccessity
Reply #9 - Oct 13th, 2009 at 10:53am
 
Marc wrote on Oct 12th, 2009 at 9:29pm:
Random thoughts for any Clusterhead in trouble:

- Oxygen should probably be the number one choice to try to abort CH's. It is nothing short of miraculous for most - but not all. While you are fighting the battle to get Trex, get O2!

- Forced into the situation, I researched long and hard to discover that welding O2 is absolutely the identical product as "medical" oxygen. No prescription required and dirt cheap.

- Oxygen is not a preventative for CH's, but it surely can help ease the agony. For many of us, breathing pure O2 for a very few minutes can kill the attacks with startling regularity.

- Some people need to breathe oxygen at higher rates than others in order to be really successful. Others do well with much less. My point is to be sure and NOT give up if your first try doesn't provide the relief that you are looking for.

By all means, get your doctor and insurance to pay for oxygen if you can. While you are waiting, or if they won't cooperate: You could be in a whole lot less agony starting starting tomorrow morning with welding O2.

Read the "oxygen info" link first, then ask any questions that come to mind: Multimedia File Viewing and Clickable Links are available for Registered Members only!!  You need to Login or Register

Become totally proactive and take control of your situation. Read stuff in this site, read some more then ask away!

Marc




Great post.

       Potter
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jayrobinson
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Re: medical neccessity
Reply #10 - Nov 9th, 2009 at 3:13pm
 
Hi everybody. Life is good and I am pr. I am wearing my "Together we fight shirt" right now so it is all good. I have manage to stockpile 66 dosages of injectible of 6mil apiece to date, I'm  having trouble converting to vials though. I hate to rock the boat right now. It was all I could do to get a 8 month script. My 02 therapy is in place. I am due this month to trigger so I can only hope that I am armed to the teeth and can function at work. Peace he with us
Jay
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LeLimey
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Re: medical neccessity
Reply #11 - Nov 9th, 2009 at 5:07pm
 
Wow! How did you manage to stockpile 66 doses in a month??! Thats info everyone could use!!!
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