Imitrex and Insurance.

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Posted by drummer ( on January 16, 2000 at 20:02:05:

In Reply to: Imitrex and insurance posted by Chuck C on January 16, 2000 at 19:11:46:

Yes. There is a way around the “ignorance” or lack of education on behalf of Health Insurance Companies and their paying for Imitrex. (been there done that).

Unfortunately, you haven’t written what part of the world that you are located. I will assume that you are in the United States of America. You also haven’t written what State you are from nor have you listed which Health Insurance Company it is that you are having difficulty with.

All these things are important. Here’s why. I’m from New York and my Health Insurance Company is Blue Cross Blue Shield. With the help of my Neurologist; I have educated BC/BS of New York, (in my City only). BC/BS in my town had never heard of Cluster Headaches. They had no idea that Oxygen and Imitrex was used to help me medicate my Cluster Headaches. So, no matter how many times my Neurologist wrote a prescription for Oxygen and Imitrex; BC/BS would not pay.

So, here’s what I did. I asked my Neurologist to give me documentation that Oxygen and Imitrex “worked” as a medicative treatment for Cluster Headaches. My Neurologist gave me copies of medical books where Oxygen and Imitrex, (sumatriptan) is proven to be an effective treatment for Cluster Headaches. I gave this documentation to the Medical Director of BC/BS in my town.

I now get Oxygen for free from BC/BS and 7 kits of Imitrex injections per week for $20. Does this mean that BC/BS in Georgia is aware of this information? No, of course not. BC/BS in Georgia has a completely different Medical Director and completely different rules and regulations. A person with Cluster Headaches in Georgia needs to educate that particular BC/BS.

Now; what I have written takes time to do. I’ll assume that you don’t have a lot of time. There is another option that you may want to consider. However, it requires you and your doctor to use the “M” word. Personally, I hate the “M” word. I hate the “M” word because I have worked so very hard at educating people about Cluster Headaches. I have educated people that Cluster Headaches are a completely different syndrome than, (ok here comes the “M” word) Migraines.

You could have your doctor write your prescription for Imitrex under a condition known as “Migraine Variant”. Technically, this is not lying. Health Insurance Companies tend to recognize the “M” word more easily than the word “Cluster Headache” and you may find it easier to get the Imitrex that you so desperately need. Then, of course, in the meantime you can push through the paperwork to the Medical Director of your Health Insurance Company.

I hope this helps you. It helped me. Good Luck.

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