Migraine

Well, it may be too soon to tell, but I think I finally got some success with my insurance company and the imitrex. I had a long long call with a customer Service rep at Oxford today. She was very nice and helpful.

She researched the issue with the Imitrex and told me there's a limit of 9 pills in 23 days. I told her the pharmacy plan was only allowing me 4 pills in 30 days and I was paying out of pocket for the rest. She said my doctor can call in to the pharmacy plan and say I need the full pack of 9, and make it retroactive to November (which is when they started limiting me to 4). This means I can resubmit and get back the extra $350 I had to pay out of pocket since November. Also, with samples from the doctor and the fact that I now have a scrip for the injections, too, I'll have about 12 - 14 doses every 3 weeks or so, instead of 9 a month that I have to ration. It is still not necessarily enough, but it's much better.

She also helped me with a pile of claims that Oxford either wrongly denied or just ignored - I have a bunch of resubmitting and appeals to do but it sounds like I may have some real money coming to me. We pay so much for this self-employed insurance and I've gotten so little back up to now. This will really help. I put off dealing with it because it's tedious and frustrating, but I bit the bullet and spent almost 3 hours on it today. I'm proud of myself, and my bills will really appreciate it too!

- Megs

Megs, I am so happy for you and proud of you!! Good for you for sticking to your guns and talking to your insurance. You so deserve good coverage (we all do).

Reading this gives me hope I can successfully appeal my insurance company's denial of Botox coverage. So thanks for sharing your success! It may be too soon to tell but I'm still bringing some cake!!

Wow Millsy - that is helpful. You've really done a lot of work to get the coverage you need - most people tend to give up. I try to keep fighting the good fight but get very discouraged sometimes. I have not been very happy with Oxford, generally. But self-employed health insurance is very hard to find, especially in NJ. Oxford's requirement to get claims in within 3 months is very difficult, and they have lost a lot of things and made lots of mistakes. It's just nice to find an individual CSR who's willing to help and cut through all the problems. I will keep it in mind about the insurance commissioner - that's important to know!

The Imitrex does have a $50 co-pay, which hurts! (Better than paying the co-pay and then paying out of pocket for 5 pills!) But since I have severe medication allergies, the new neurologist wasn't willing to prescribe a different triptan. I told him I wasn't too worried because my anaphylactic allergies were to nsaids, different family of drugs altogether, but he wouldn't do it. Another reason I'm not happy with him - he really didn't give me the time to talk through the pros & cons with him.

I've got an appointment with Dr. Young at Jefferson in early June and hope to get more alternatives then, but may see if my PCP will prescribe me another triptan in the meantime. He's willing to have me try new meds in his office with life-saving equipment standing by, a lot of doctors won't for fear of liability. But in the short-term, at least I don't have to worry as much about using too much Imitrex and running out.

- Megs

That's good news on your success with your insurance.

What did you mean by pharmacy plan? Your insurance's pharmacy plan or your pharmacy's pharmacy plan?

Megs,
Congradulations!! Working through insurance like that is tedious. Wish they had a pat on the back I could give you.
Cindy

Good work, nutmegan! My insurance lets me have 12 Axert a month. I can't really argue with that, since my doctor doesn't want me taking more Axert than that in a month anyway--MOH concerns, etc. I just don't like the copay, which is $55.

The problem with the studies that say that "Triptan X" is the most effective is that it may be true for the "average" patient, but where is that average patient? Imitrex is certainly the best choice for some people. Other people can't tolerate it, or it doesn't work for them. I've tried Axert and Zomig. Zomig worked for me, but the side effects were a lot harder to tolerate than for Axert. So even though Zomig has a lower copay for my insurance, I stick with my Axert. I'm confident that at present, Axert is the "best" for me.

Nut I agree, it's hard to know what will work best for any individual. I'm going to run this by my PCP next time I see him and see if we can try a second triptan.

Deb I mean the pharmacy plan under my Oxford coverage - it has a separate administrator (Medco) and several times I got conflicting info from Oxford & Medco about the same thing. That's what was so good about this CSR - she actually called Medco and talked to them while on the phone with me to get the whole story.

Millsy that's interesting - I just got a mailer from BC/BS which seems to indicate they may have a cheaper plan. We were with them previously but they wouldn't offer us individual insurance at all (required 2 full-time workers in the business - we were running 2 separate businesses). As a certified coach I qualify for the American Counseling Association which has group plans but there was only one choice for us here in NJ - it was BC/BS and then they switched us to Oxford. Our deductible and premiums are sky-high. So I'll give BC/BS another look - maybe they've changed their requirements.

Thanks for all the info.

- Megs