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Topic: Serious CH Topic...Need Your Help (Read 1055 times) |
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Donna_D.
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Serious CH Topic...Need Your Help
« on: Dec 16th, 2004, 12:53am » |
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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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| « Last Edit: Dec 16th, 2004, 1:09am by Donna_D. » |
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don
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Re: Serious CH Topic...Need Your Help
« Reply #1 on: Dec 16th, 2004, 7:26am » |
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Other than confirming that the insurance companies suck, how will this data help?
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PollyPocket
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Re: Serious CH Topic...Need Your Help
« Reply #2 on: Dec 16th, 2004, 7:42am » |
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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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Donna_D.
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Re: Serious CH Topic...Need Your Help
« Reply #3 on: Dec 16th, 2004, 7:45am » |
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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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Biker
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Re: Serious CH Topic...Need Your Help
« Reply #4 on: Dec 16th, 2004, 7:56am » |
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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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Lobster
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Re: Serious CH Topic...Need Your Help
« Reply #5 on: Dec 16th, 2004, 8:05am » |
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on Dec 16th, 2004, 7:26am, don wrote:| Other than confirming that the insurance companies suck, how will this data help? |
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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:
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Langa
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Re: Serious CH Topic...Need Your Help
« Reply #6 on: Dec 16th, 2004, 8:35am » |
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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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Sylvan
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Re: Serious CH Topic...Need Your Help
« Reply #7 on: Dec 16th, 2004, 8:55am » |
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on Dec 16th, 2004, 12:53am, Donna_D. wrote:I am trying to put together some statistics on Insurance Carriers, Meds, and how much they allow per month
What state do you live in:
(Altered is NOT an acceptable answer, BTW )
NJ
Do you have health insurance?
Yes
Who is your current insurance Carrier:
Cigna Health Care HMO
What CH meds do you take:
Verapamil, Lithium, Indomethacin & hopefully O2 soon
How many are you "allowed" per month:
So far - whatever the Drs RX - as long as i don't try to exceed the dose on the RX - they will give a 30 day supply based on that.
Have you ever been able to get your insurance carrier to allow more? If so, how?
not yet
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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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nani
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Re: Serious CH Topic...Need Your Help
« Reply #8 on: Dec 16th, 2004, 8:59am » |
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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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Tiannia
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Re: Serious CH Topic...Need Your Help
« Reply #9 on: Dec 16th, 2004, 10:49am » |
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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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marlin
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Re: Serious CH Topic...Need Your Help
« Reply #10 on: Dec 16th, 2004, 11:04am » |
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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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becky8
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Re: Serious CH Topic...Need Your Help
« Reply #11 on: Dec 16th, 2004, 11:07am » |
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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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byoung111
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Re: Serious CH Topic...Need Your Help
« Reply #12 on: Dec 16th, 2004, 11:07am » |
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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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| « Last Edit: Dec 16th, 2004, 11:08am by byoung111 » |
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becky8
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Re: Serious CH Topic...Need Your Help
« Reply #13 on: Dec 16th, 2004, 11:13am » |
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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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echo
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Re: Serious CH Topic...Need Your Help
« Reply #14 on: Dec 16th, 2004, 11:19am » |
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on Dec 16th, 2004, 12:53am, Donna_D. wrote:
What state do you live in:
Kansas
Do you have health insurance?
Yes
Who is your current insurance Carrier:
Cigna -- changes to Harrington on Jan 1
What CH meds do you take:
Stydol as an abortive. Was on Tex injectors for awhile
How many are you "allowed" per month:
Two Stydol, One Trex
Have you ever been able to get your insurance carrier to allow more? If so, how?
No
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purpleydog
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Re: Serious CH Topic...Need Your Help
« Reply #15 on: Dec 16th, 2004, 1:25pm » |
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on Dec 16th, 2004, 10:49am, Tiannia wrote: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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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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| « Last Edit: Dec 16th, 2004, 6:36pm by purpleydog » |
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Gator
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Re: Serious CH Topic...Need Your Help
« Reply #16 on: Dec 16th, 2004, 2:05pm » |
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Quote:Posted by: Tiannia Posted on: Today at 09:49:26
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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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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becky8
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Re: Serious CH Topic...Need Your Help
« Reply #17 on: Dec 16th, 2004, 2:17pm » |
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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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RichardN
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Re: Serious CH Topic...Need Your Help
« Reply #18 on: Dec 16th, 2004, 2:24pm » |
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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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Bethany1
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Re: Serious CH Topic...Need Your Help
« Reply #19 on: Dec 16th, 2004, 2:34pm » |
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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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Jeepgun
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Re: Serious CH Topic...Need Your Help
« Reply #20 on: Dec 16th, 2004, 3:52pm » |
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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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| « Last Edit: Dec 16th, 2004, 3:53pm by Jeepgun » |
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JeffB
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Re: Serious CH Topic...Need Your Help
« Reply #21 on: Dec 16th, 2004, 4:02pm » |
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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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Bandette74
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Re: Serious CH Topic...Need Your Help
« Reply #22 on: Dec 16th, 2004, 4:05pm » |
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on Dec 16th, 2004, 12:53am, Donna_D. wrote: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 ) |
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Florida
Quote:| Do you have health insurance? |
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yes
Quote:| Who is your current insurance Carrier: |
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Humana HMO
Quote:| What CH meds do you take: |
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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:| How many are you "allowed" per month: |
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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:| Have you ever been able to get your insurance carrier to allow more? If so, how? |
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n/a
Quote:| I am trying to get some stats together that will help ALL of us...Please help |
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best of luck!!!
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| « Last Edit: Dec 16th, 2004, 4:06pm by Bandette74 » |
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Margi
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Re: Serious CH Topic...Need Your Help
« Reply #23 on: Dec 16th, 2004, 4:08pm » |
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on Dec 16th, 2004, 4:02pm, JeffB wrote:| ...I'm getting trex in pill form, 50mg. ... 20 will last 4-5 days....I've been refused o2 since I have no breathing problems... |
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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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Sean_C
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Re: Serious CH Topic...Need Your Help
« Reply #24 on: Dec 16th, 2004, 5:53pm » |
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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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