Hiya...coupla thoughts....I feel for you...went thru about 7 ins changes and it NEVER was easy..
but clusterheads are tough and WE DON'T GIVE UP...just keep repeating that cuz the insurance droids want you to. That is their purpose...they pay folks to sit in airless basements and make soulless decisions......and then reward 'em when you quit....DON'T!

You don't care...it's a game...play HARD...

...whatever the appeal rules are...do 'em to the "t"...don't miss deadlines...keep records of ALL correspondence AND conversations (get names, dates, comments)....note carefully WHEN (not if") they say they don't feel this is appropriate treatment/dosage/medication/whatever...then yu got 'em because THAT is practicing medicine...either without license, or without direct patient interaction..... ("we don't think" ) is malpractice

...nice try on the pre auth...that would of been the first road block but you got that covered. hopefully the busy neuro still has your back...now you need a letter of necessity...in his/her PROFESSIONAL medical opinion this is what YOU...HIS PATIENT.... needs (this worked several times for me). This REALLY puts 'em on the spot...relish it...it can be delicious....

...is this insurance through your workplace? If so you got a potential priceless advocate. FIRST get HR involved...hopefully they got yur back...then get the contact info for the DIRECT insurance broker (person) that bought the insurance policy on behalf of your company. Contact this person directly, tactfully, with all details and frustrations with the calm confidence you now have. THIS person is the customer of the insurance company...which only talks to YOU reluctantly and dismissively...but the broker is in fact their DIRECT customer...they gotta listen to that person. It really helps if the policy is coming due.....but that's just easier

...I'm a little rusty on this...just starting to get aggravated for you...will keep thinking....

Best

Jon

I had essentially the same problem with my insurance provider.  The issue, I was told, is that Triptans are not "approved" treatment for CH, they are prescribed for migraines.  Despite some good efforts from my neuro we could never persuade BC/BS of the medical necessity.  They would cover only 6 doses of Zomig/month.  The rest were out of pocket, and as you know, this stuff ain't cheap.  In 2014 I spent over $13k on Zomig alone (basically 1 snort/day).  From time to time the pharmacists (who I came to know quite well) would help by turning in multiple discount cards, and using samples, etc. but at the end of the day, the insurance company would not step up.  I hope you have better luck, and the advice above is spot on - run the details hard, double and triple check everything. 

You might also consider contacting the manufacturer to see if they can offer any help on out-of-pocket pricing if the insurance company lets you down.

Again, thanks all. Had BC/BS and got everything I needed. Work for a Canadian company here in the US so access can be a bit tedious. They just switched us to UHC on 12/1 and that reset everything. Just spoke with UHC myself and they apparently have an appeal process with an "urgent" category. Just overnighted a package request, neuro going to duplicate. Canadians shut down for 2 weeks at Xmas, so no contact until 1/4. Tried D3 regimen a couple of years ago with minor success, may have been coincidental. Ramping up to try again. I don't have to tell anyone here what life's like without meds, especially chronic and 3-6 per day. Plan B is to unenroll from company coverage and purchase BC/BS on my own. Not sure the budget can handle that for very long.

Again, thanks, great folks here!

That's awesome. I'll have to read the post! Continued success.