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Title: Serious CH Topic...Need Your Help Post by Donna_D. on Dec 16th, 2004, 12:53am I am trying to put together some statistics on Insurance Carriers, Meds, and how much they allow per month What I need from as many of you as possible is to either list here or PM me the following information. It is for a little something I am whipping up for convention, et al. ALL information will be treated as confidential. What state do you live in: (Altered is NOT an acceptable answer, BTW ;) ) Do you have health insurance? Who is your current insurance Carrier: What CH meds do you take: How many are you "allowed" per month: Have you ever been able to get your insurance carrier to allow more? If so, how? I am trying to get some stats together that will help ALL of us...Please help DD |
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Title: Re: Serious CH Topic...Need Your Help Post by don on Dec 16th, 2004, 7:26am Other than confirming that the insurance companies suck, how will this data help? |
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Title: Re: Serious CH Topic...Need Your Help Post by JenniferD on Dec 16th, 2004, 7:42am I have no health insurance at this time. My doc GAVE me 2 bagfuls of meds- one preventive, one rescue. God I love that man! He will have a special place in heaven. |
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Title: Re: Serious CH Topic...Need Your Help Post by Donna_D. on Dec 16th, 2004, 7:45am I am attempting to put together letters that can be sent to the insurance carriers to appeal the number of abortives, etc. a CH'er is limited to each month. Also to get some states Medicare/Medicaid programs to pay for 02 for CH. I will compile all information and present everyone with a finished copy when I am done. DD |
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Title: Re: Serious CH Topic...Need Your Help Post by Biker on Dec 16th, 2004, 7:56am West Virginia No insurance------Veterans admin. hospitals Oxygen???? No way will they perscribe oxygen Verapamil???? They seem fairly liberal on the verapamil. Triptians??? Very limited. Just enough to abort 6 times in a 2 month period. Seems West Virginia Vets hospital has no neruo. I have to ride the bus to Pittsburg to see a neuro who knows very little about CH. Its very frustrating. Once at the Pittsburg neuro I was hit with CH. They saw me dance. All they did was wait till I could carry on a conversation. No oxygen, no triptians. |
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Title: Re: Serious CH Topic...Need Your Help Post by Rock_Lobster on Dec 16th, 2004, 8:05am on 12/16/04 at 07:26:38, don wrote:
It would be good to compile a list of CH-friendly insurers/HMOs. My current HMO is brutally CH-friendly, at least for my meds. If it were on your employers list I would give it 2 thumbs up. (Keystone Health Plan / PA) Of course, my employer is dropping it as an option for 2005. Being replaced with this guy: http://www.trapezeartist.com/trapeze/tallweirddude.jpg |
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Title: Re: Serious CH Topic...Need Your Help Post by Langa on Dec 16th, 2004, 8:35am New York. Blue Cross/Blue Shield. When in cycle, Depakote ER, Imitrex pills (100 mg). 9 pills per month. No. Thanks for doing this Donna... Langa |
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Title: Re: Serious CH Topic...Need Your Help Post by Sylvan on Dec 16th, 2004, 8:55am on 12/16/04 at 00:53:23, Donna_D. wrote:
Not sure if my info helps since i'm still very new to this - but thank you for compiling the info. Sylvan |
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Title: Re: Serious CH Topic...Need Your Help Post by nani on Dec 16th, 2004, 8:59am I'll let you know when I finally get my coverage on Jan 1st. I know it's going to be BC/BS PPO...no other info yet. Donna, can you keep bumping this? |
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Title: Re: Serious CH Topic...Need Your Help Post by Tiannia on Dec 16th, 2004, 10:49am What state do you live in: Nevada (Altered is NOT an acceptable answer, BTW ;) ) Do you have health insurance? Yes, never leave home without it (not with kids) Who is your current insurance Carrier:Health Plan of Nevada but also had Cigna here as well What CH meds do you take: Currently Imitrex NS and Replax Tabs (I have injections for Trex but that was a care package from a couple of angels) How many are you "allowed" per month: 6 NS for trex (for Cigna) 6 tabs for Replax (HPN) HPN does not cover Trex anymore so I pay for the NS myself so that I have them when I need them. the Replax I give to Shaun for his Migraines, they dont do shit for CH. But niether did the Trex tabs either. Think they just take too damn long to work. I did ask how many injections I could get if I got them prescribed and they said two cases (4 shots) Have you ever been able to get your insurance carrier to allow more? If so, how? Nope never. They tell me it cant be done. That medically it is not allowable to get more then the 6 a month because according the HPN the FDA does not allow more then that to be taken in a month time because it is dangerous. Guess I should be luck to be alive, cause I take a hell of a lot more then that. |
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Title: Re: Serious CH Topic...Need Your Help Post by marlin on Dec 16th, 2004, 11:04am Do you have health insurance? Who is your current insurance Carrier: Aetna What CH meds do you take: trex inject, pred, O2 (that's all I have bothered with past 8 years as they work) How many are you "allowed" per month: 8 trex shots/mo FREE. Can get an override (possibly) pred $10 copay O2 FREE home delivery Have you ever been able to get your insurance carrier to allow more? Don't need to. I'm episodic and I stockpile like a packrat. If so, how? I did once for trex with another insurer (Pacificare) 3 years ago. Wasn't easy. I had to see a neuro and he had to jump through flaming hoops with requests that got denied several times. Eventually got doubled from 6 to 12shots/mo. and boy did I stockpile then since I knew they were gonna be tough in the future. Got on a 3mo automatic delivery using mail order so I didn't even need to go to a pharmacy. That was sweet watching the stockpile grow 36 shots at a time!!!! |
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Title: Re: Serious CH Topic...Need Your Help Post by becky8 on Dec 16th, 2004, 11:07am Donna, John Deere Verapamil/lithium no problems(no limits) imitrex vials- 5vials a month 02 as much as I need and its totally free What was the last ? |
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Title: Re: Serious CH Topic...Need Your Help Post by byoung111 on Dec 16th, 2004, 11:07am What state do you live in: Colorado Who is your current insurance Carrier: Great West HealthCare HMO What CH meds do you take: Imitrex, O2 O2 coverd at 100% How many are you "allowed" per month: 2 auto-injector kits or 4-1ml vials. Have you ever been able to get your insurance carrier to allow more? If so, how? I'm in the process now of doing that. The Dr. has to call the insurance company and tell them why I need what I need. Then they accept or decline the request. Good luck we're all counting on you. |
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Title: Re: Serious CH Topic...Need Your Help Post by becky8 on Dec 16th, 2004, 11:13am Sorry about that, I live in Illinois and no they haven't allowed me anymore than what I said last post. |
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Title: Re: Serious CH Topic...Need Your Help Post by echo on Dec 16th, 2004, 11:19am on 12/16/04 at 00:53:23, Donna_D. wrote:
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Title: Re: Serious CH Topic...Need Your Help Post by purpleydog on Dec 16th, 2004, 1:25pm on 12/16/04 at 10:49:26, Tiannia wrote:
This is complete and total bullshit!!!!! My insurance will pay for 8 trex NS per month. A friend of mine gets 18. Why do the insurance companies try to feed you bullshit like this? If they have a policy against paying for more then 6, then they should just say so. As far as I know, the FDA doesn't not allow it. Christ, I can get as much as I want if I want to pay a fucking fortune out of pocket! Fucking insurance companies... I use way more than 6 a month too, and I'm still fucking here... Anyway... I live in Illinois Insurance carrier is Healthlink I use Imitrex spray and injections I can get 8 Imitrex NS per month or 6 Imitrex injections, and I get samples from the GP when they have them. Not this insurance. Letters have been written by my GP and neuro. They were denied with two appeals denied. My previous insurance carrier at my old job allowed me up to 30 Imitrex NS per month, after my neuro at the time wrote them a letter. |
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Title: Re: Serious CH Topic...Need Your Help Post by Gator on Dec 16th, 2004, 2:05pm Quote:
Tia, this is total BS. Neither the manufacturer nor the FDA have any such limitation. Insurance companies like to try this lie, but Teri Robert from About.com is a patient advocate who has fought this battle before. Read these three articles. http://headaches.about.com/library/weekly/aa-bc-trip-limits-a.htm http://headaches.about.com/cs/advocacy/a/trip_limits_2.htm http://headaches.about.com/library/weekly/aa-bc-error-a.htm Insurance companies piss me off soooo bad. As to your questions Donna: Oklahoma Yes (through my wife's employer) Aetna PPO Imitrex Injections in vials 10 vials per month No. I even had my neuro write a letter of medical necessity - no dice. Currently under appeal. Gator |
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Title: Re: Serious CH Topic...Need Your Help Post by becky8 on Dec 16th, 2004, 2:17pm I forgot to tell you guys this, but maybe it will help some of you get more trex injections. before I was using the vials of trex, I used the stat injector thing. Anyway I went to pick up my injectors and the pharm said my insurance wouldn't cover anymore for that month. SOOO 2days later after I saw the neuro I told him I wanted the vials of trex and I took the script to the same pharm and just because it was VIALS of trex instead of the stat injectors. I got them and it was 5 vails 6MG each. Seems just because it was in a different package I got more???? |
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Title: Re: Serious CH Topic...Need Your Help Post by RichardN on Dec 16th, 2004, 2:24pm Curious how much the cost of 02 varies from place to place. Might be of interest also. I pay $10 per tank (B,D,or E) Thanks again, Richard |
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Title: Re: Serious CH Topic...Need Your Help Post by Bethany1 on Dec 16th, 2004, 2:34pm Massachusetts Yes Group Insurance Commission Imitrex Injections Insurance allows 4 Boxes/ 8 shots per month ($20) I have never been able to get around it. 2x a year I can get it earlier than the 30 day mark. If you say your going on vacation. But a local pharmacy will give me a box and charge the insurance later if Im really in need for ($20). The guy that owns the store hates insurance companies so that works out ok. |
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Title: Re: Serious CH Topic...Need Your Help Post by Jeepgun on Dec 16th, 2004, 3:52pm Tennessee Blue Cross/Blue Shield Prevents: Verapamil Aborts: Injectable Imitrex I've never asked what the limit on Imitrex is. I tell my doctor I need it, she writes the script, and for a $10 co-pay, it is filled. She also gives me "samples" if she has them in her office. On the other hand, she won't prescribe O2. >:( |
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Title: Re: Serious CH Topic...Need Your Help Post by JeffB on Dec 16th, 2004, 4:02pm First of all I have Kaiser Permanente here in California(HMO), I'm getting trex in pill form, 50mg. I had to kick, scream, and shout for more than the 10 tablets they prescribe. I now get 20 (wow). 20 will last 4-5 days, my cycles are about 6 weeks long with about a 2 month break in between. I've been refused o2 since I have no breathing problems, and my nuero ( who I've seen once) can give a shit. Hope this helps. |
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Title: Re: Serious CH Topic...Need Your Help Post by Bandette74 on Dec 16th, 2004, 4:05pm on 12/16/04 at 00:53:23, Donna_D. wrote:
Florida Quote:
yes Quote:
Humana HMO Quote:
so far, just Relpax pills. However, I have a neuro appt. Monday & will try for O2. the Relpax pills were prescribed because they stay active in your system longer than injections and sprays, but they don't work quickly (usually 40 minutes), so i take when i feel heavy shadowing--not quite painful, and i usually don't get an attack. However, I went three days without the Relpax, and I got hit between a k7 and k8 a couple times each day and one the first day back on the Relpax. The Relpax does nothing at all for me if the CH is painful, and I cannot take Imetrex with Relpax in my system, so I have to sweat it out if I get it. Quote:
So far I have not been restricted beyond the two pills per day, but I haven't asked for many scripts. I called the insurace company, and asked a similar question, and they said that there "isn't a problem--i should be able to get whatever i need." whatever that means. Quote:
Quote:
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Title: Re: Serious CH Topic...Need Your Help Post by Margi on Dec 16th, 2004, 4:08pm on 12/16/04 at 16:02:34, JeffB wrote:
wow, Jeff, that's a LOT of trex to injest in 4-5 days. Please be careful. And please see about getting another neuro - this one obviously has anal vision. sorry you're hurting. |
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Title: Re: Serious CH Topic...Need Your Help Post by Sean_C on Dec 16th, 2004, 5:53pm What state do you live in: (Altered is NOT an acceptable answer, BTW ) LOL Massachusetts Do you have health insurance? Yes Who is your current insurance Carrier: Tufts What CH meds do you take: Imitrex nasal spray 12 doses per month Prednisone unlimited quantity O2 unlimited unlimited quantity How many are you "allowed" per month: see above Have you ever been able to get your insurance carrier to allow more? If so, how? My insurance carrier only allows 12 doses of Imitrex per month. My nuero wrote the carrier a letter stating my condition and the effects. Emphasised that I was under his care and that for them to reject additional quantities could result in ER visits 6 to 8 times daily for pain relief. In his opinion the Imitrex was the lesser of two evils. The insurance carrier wrote back to my nuero stating that they have given him permission for unlimited Imitrex doses as long as I am under his care and thanked him for the advise. Hope I was helpful D. Sean....................... |
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Title: Re: Serious CH Topic...Need Your Help Post by Bandette74 on Dec 16th, 2004, 5:58pm Sean, even I found that helpful. Thanks for letting us know how a neuro effectively dealt with an insurance co! :-* |
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Title: Re: Serious CH Topic...Need Your Help Post by Sean_C on Dec 16th, 2004, 6:02pm See, I'm not always a jerk ;;D Glad I could help, I try, its all interpretation ;;D Love to all Sean...................... |
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Title: Re: Serious CH Topic...Need Your Help Post by marlin on Dec 16th, 2004, 6:24pm on 12/16/04 at 17:53:46, Sean_C wrote:
That's a good one to know. I got a doubling of the allowable trex shots through a neuro - but unlimited - Now that's an accomplishment! |
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Title: Re: Serious CH Topic...Need Your Help Post by Sean_C on Dec 16th, 2004, 6:41pm Ultimately the ER visit is going to accomplish what you were looking for in the first place.................more trex, and I think the realization of that is what helped with thier decision. Unfortunately it probably had nothing to do with my health, it was surely about money. I hope that it works for you guys too. Its a scarey thought to be without your trex isn't it. I know it is for me ;;D Sean.............................. |
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Title: Re: Serious CH Topic...Need Your Help Post by ckelly181 on Dec 16th, 2004, 7:39pm >What state do you live in: Minnesota >Do you have health insurance? Yes - BC/BS >What CH meds do you take: Imitrex and O2 >How many are you "allowed" per month: 5 Imitrex boxes - 10 shots, unlimited 02 tanks >Have you ever been able to get your insurance carrier to >allow more? Nope - won't budge |
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Title: Re: Serious CH Topic...Need Your Help Post by eyes_afire on Dec 16th, 2004, 8:09pm Gee Donna, I really wish I could help you. My prescription plan is controlled by my employer (re-insurance). That means you can write Blue Cross all you want, but my employer still prohibits coverage of imitrex injections. You'd have to lobby my employer (and that's not likely to work). --- Steve |
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Title: Re: Serious CH Topic...Need Your Help Post by Tim_Z on Dec 17th, 2004, 12:34am What state do you live in: Minnesota Do you have health insurance? Yes Who is your current insurance Carrier: BCBS of North Dakota What CH meds do you take: Imitrex injections, verapamil, Depakote, pred, nuerontin, stadol. How many are you "allowed" per month: It's been two years, I think it was two scripts for six statdose kits a month, a total of 24 shots. Every time I see a medical person I ask for samples and if BCBS complains my pharmacist does the billing game with them. I still only get enough trex to barely get by. Have you ever been able to get your insurance carrier to allow more? If so, how? I never tried, see above. |
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Title: Re: Serious CH Topic...Need Your Help Post by Charlie on Dec 17th, 2004, 1:49am I live in New York State and have Community Blue ins. I get mine through the local Chamber of Commerce. So far it's been pretty good. Not cheap though. I never had trouble with drugs as the only one I ever took was Inderal which is also a beta-blocker. I suppose if I told them what I was using it for, I may have had trouble but I can't say. Charlie |
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Title: Re: Serious CH Topic...Need Your Help Post by Donna_D. on Dec 17th, 2004, 1:46pm Keep the answers coming, folks! Bumping for the afternoon crowd! DD |
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Title: Re: Serious CH Topic...Need Your Help Post by Melissa on Dec 17th, 2004, 2:13pm What state do you live in: Wisconsin Do you have health insurance? yes Who is your current insurance Carrier: Employers Health (Humana) What CH meds do you take: Depakote, Imitrex How many are you "allowed" per month: Whatever amount my Neuro writes the script for. Have you ever been able to get your insurance carrier to allow more? If so, how? Didn't need to. As long as I don't fill the script twice on the same day, I can refill when I need to. I am very fortunate. My Neuro writes the script for something like, 12 NS's and 6 injections X 8 refills, and I don't have to worry about being denied by the ins. co. (as long as we do the 20% co-pay for each refill, which amounts to $181.00 per fill) or the pharmacy questioning anything. mel |
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Title: Re: Serious CH Topic...Need Your Help Post by broomhilda on Dec 17th, 2004, 5:00pm I am in a bumping kinda mood, great idea Donna! |
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Title: Re: Serious CH Topic...Need Your Help Post by Tetris-addict on Dec 17th, 2004, 7:39pm Indiana Unicare Zomig 2.5 or 5 mg pills for $20.00 (cash) you can get 6 a month. so get the 5mg, cut them in half and have 12 doses. Supposed to only use 2 doses a week....hahahahahahahaha could be why I left my head at home.... Can't get more, but might get samples if your neuro doesn't have a family memeber who suffers from migraines or othr headaches.... hahahahahahaha GL. |
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Title: Re: Serious CH Topic...Need Your Help Post by Karla on Dec 17th, 2004, 11:18pm What state do you live in: WI Do you have health insurance? YES Who is your current insurance Carrier: Group Health Cooperative(GHC) a nonprofit HMO What CH meds do you take: Imitrix duragesic patch How many are you "allowed" per month: Most different insurance HMO's that I have been with have limited me to 6 per month. My current one included. The good news is I don't get any ch while on the duragesic patch. The dr gives me 10 a month/1 every 3 days to change. It definetly keeps the beast at bay. Have you ever been able to get your insurance carrier to allow more? If so, how? My dr documented all the preventatives i had tried that had failed and abortives I had tried and failed and explained that I needed imitrix several times a day for multiple different headaches and unlimited access to it. I got all the imirix I could ever dream of getting hit 8x a day. I had full coverage. It was when I went to the ha/pain specialist a year latter and he pointed out that taking that much imitrix is not good for the body and perscribed duragesic patch. It gave me my quality of life back and stopped the ha. |
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