[woody62]

Actually, unless an insurance company has written it's limitation directly into it's contract, they cannot refuse to pay for more. I am not saying that an insurance company would not attempt to restrict their exposure but they cannot restrict the amount. And very few insurance companies that have prescription coverage, restrict the amount. They can restrict your supply to thirty days, even when your doctor has written for a ninety day supply but that is the limit. Insurance companies, like state workers, tend to go over board in their denials but when confronted back down.

Woody

[RunnerRN]

Originally Posted by woody62

No, you are not drug seeking. But I have a few questions and suggestions. Has the insurance company said why they will only cover six a month? Unless you are receiving Medicaid, which can limit the number of prescriptions you can fill, no insurance company has any right to limit your medication. Check with your employer to see if they have opted to limit their employees, in any manner, in receiving the quantity of pills you can receive. If not, I would call back the insurance company and demand to speak to a supervisor. If she supports her/his adjuster, I would tell them I was going to file a complaint with your state's Department of Insurance. And I would, supplying them with a copy of your insurance and a copy of the part of your bill that sates the number you were given. And I would send a copy to the insurance company.

As for as your pharmacy is concerned, I would speak to the pharmacist and point out to him what the prescription was written for and what you received. In all likelihood he will give you the remainder.

Woody

Most insurance cos limit expensive medications. I know that my friend who had awful morning sickness during her first trimester had her Zofran limited. She was allowed to fill x number of pills every 2 weeks (I can't remember the exact number), and couldn't fill more until her 15th day. She had to call in sick many days because she couldn't even get out of bed without passing out. We're planning on getting pregnant early in 2008, and I already have a little Zofran stockpile

[Ariesbsn]

Originally Posted by woody62

no insurance company has any right to limit your medication. Woody

That one is news to me! My insurance limits Zofran tabs to 12 a month as well as several other meds. I can have my doctor send a letter of medical necessity, but the policy states that the insurance company can still deny giving me more of the medication.

[Susan9608]

Originally Posted by woody62
no insurance company has any right to limit your medication. Woody

I think woody meant that no insurance company can limit the amount of medication you receive, per your doctor's prescription, but they can limit how many they will pay for. If your doctor writes for 30 pills, but insurance will only pay for 15, then you can't be denied the other 15 unless you can't afford to pay for them out of pocket.

[oramar]

Originally Posted by elthia

I really scared myself today.

I've been having debilitating migraines, that last 5-10 days. Horrible, nasty migraines with dizziness, tinnitus, stabbing pains, photophobia, phonophobia, diarrhea, and intractable n/v. Yes, I have been taking my topamax. Yes, I have started seeing a neurologist, and he started me on elavil and doubled my topamax dosage. I am actually having almost daily migraines, and I take Axert, if the axert x2 doesn't work then the sucker last a week, give or take 3 days. Phenergan po or supp doesn't work, zofran po occasionally works, I've lost 8 pounds in the past month from n/v, I have NO paid time off left or sick leave left, I'm probably going to have to file FMLA if I want to keep my job.

Insurance only pays for 6 axert a month. that translates to 3-6 migraines a month. I am having almost daily migraines right now. So I got very panicky and had a complete meltdown when I ran out when my pharmacy was closed yesterday( my pharmacy has limited weekend hours). Axert is $21.00 a pill in the US. My script was written for 15 pills a month, insurance would only pay for 6, so the pharmacy only filled for 6, and when I called this morning and requested the other pills that I would pay out of pocket for, the tech said I would have to wait because it was 3 weeks too early to fill the scipt. At the time of the conversation I was having an aura, and I told her that. I called as soon as they opened. I almost had a panic attack, I couldn't get her to understand that if the script was for 15 and only filled for 6 then technically I was still 9 pills short for the month. Well I finally got the pharmacist, who allowed me to pick up 6 more pills, but too late. It took 45 minutes to get them, took one, then later took another. Went to work and had to leave early because I was dizzy and puking my guts out. My head is just killing me.

I was so terrified of having another full blown migraine, I didn't think I could lose my cool that way. I was almost yelling at the tech. I need to get off the computer, it's hurting my eyes, thanks for letting me vent

You poor thing, you sound so sick. I feel so bad for you. Is there somesort of physician speciality that deals with migraines? I hope so for you sake. Sounds like you have gone past the point where a family doc could help.

[Kunzieo]

So sorry, I misunderstood. I thought that she wanted the rest of the prescription without having to pay out of pocket. I had gathered that from the statements " I couldn't get her to understand that if the rx was written for 15, and I only got 6, that technichally I was still short and "the pharmacist allowed me to pick up 6 more." I missed the part in the middle when she had said that she would pay OOP costs.
my mistake. I do apologize.

[meownsmile]

Ive had migraines since i was 10 years old. The nausea, vomiting, photophobia is horrible. I have swollen eyes for a couple days afterward. I have learned how to try to control them and what typically triggers them thank god.
It will take a while but maybe you will too. Maybe start a acitivity diary and see if you can find a pattern of when, where you are when they start, what youve had to eat, what you are doing when they come on. I have a friend that would get headaches like yours for days on end and finally found out he was sensitive to peanut butter and was getting cluster headaches from it.
I learned that i have to take something for mine as soon as i feel it starting, if i get to the point i am yawning or getting nauseated and havent had anything it is usually the end of my day and i spend the rest of it in bed with a pillow wrapped around my head and the lights off.
Good luck and hop you feel better soon.

[NursingAgainstdaOdds]

Oh my gosh! You sound like you're suffering horribly.

I can really relate because I am a migraine sufferer as well. Thankfully I have been able to control them by squashing them when I start to have the aura.

I hope you find help soon.

[HM2Viking]

Originally Posted by elthia

I really scared myself today.

I've been having debilitating migraines, that last 5-10 days. Horrible, nasty migraines with dizziness, tinnitus, stabbing pains, photophobia, phonophobia, diarrhea, and intractable n/v. Yes, I have been taking my topamax. Yes, I have started seeing a neurologist, and he started me on elavil and doubled my topamax dosage. I am actually having almost daily migraines, and I take Axert, if the axert x2 doesn't work then the sucker last a week, give or take 3 days. Phenergan po or supp doesn't work, zofran po occasionally works, I've lost 8 pounds in the past month from n/v, I have NO paid time off left or sick leave left, I'm probably going to have to file FMLA if I want to keep my job.

Insurance only pays for 6 axert a month. that translates to 3-6 migraines a month. I am having almost daily migraines right now. So I got very panicky and had a complete meltdown when I ran out when my pharmacy was closed yesterday( my pharmacy has limited weekend hours). Axert is $21.00 a pill in the US. My script was written for 15 pills a month, insurance would only pay for 6, so the pharmacy only filled for 6, and when I called this morning and requested the other pills that I would pay out of pocket for, the tech said I would have to wait because it was 3 weeks too early to fill the scipt. At the time of the conversation I was having an aura, and I told her that. I called as soon as they opened. I almost had a panic attack, I couldn't get her to understand that if the script was for 15 and only filled for 6 then technically I was still 9 pills short for the month. Well I finally got the pharmacist, who allowed me to pick up 6 more pills, but too late. It took 45 minutes to get them, took one, then later took another. Went to work and had to leave early because I was dizzy and puking my guts out. My head is just killing me.

I was so terrified of having another full blown migraine, I didn't think I could lose my cool that way. I was almost yelling at the tech. I need to get off the computer, it's hurting my eyes, thanks for letting me vent

I would ask your doc to request an exception on your behalf from the insurance company. Sometimes insurance will grant an exception to the coverage guidelines based on the recommendation of a doctor. HTH

[elthia]

Thanks for all the replies.
It's 24 hours after I took the first axert and still have migraine. I'm taking phenergan and aleve right now, wearing sunglasses in the house, and have called in to work.

I guess I'm just sensitve, cause with the last migraine I had, I had to go to the ED twice, on day 6 and day 9, and the staff treated me like crap.

On day 9 I had been having n/v for 7 days straight (by the way I have fired by family practitioner as soon as I got my neurology consult) and was having esophogeal spasms that mimicked angina. It was true chest pain, just not cardiac, and boy did it hurt. Scared my husband to death. He ran into to the ED yelling we need help she's having chest pain, the staff handed him a w/c and said, "we're busy, you'll have to put her in a w/c yourself. " Wheeled me in, I was grabbing my chest, breathing heavy, diaphoretic, moaning, and alternately vomiting, after which I would grab my chest again.

Staff recognized me from earlier in the week, when I was in for status migraine with intractable n/v, and it took over an hour to even have my vitals taken, and 1 1/2 hour to have an EKG done, and this is a hospital that had an empty waiting room. It was me and one other pt in the waiting room! My husband was getting ready to take me AMA from the ED to other hospital in town. Finally after a big ruckus, with the nursing supervisor involved I was triaged, back in a room, "treated", but I never did recieve any pain meds, I did get treated for migraine. Literally. Left in a dark room, no call light in reach, husband out talking to supervisor, not on monitor or even blood pressure cuff. Of course once the compazine kicked in and I stopped vomiting, the esophageal spasms stopped and the chest pain eased up. the MD and the staff treated me like I was faking the whole thing to get fasttracked back to get treated for migraine, and never even wanted to discuss the chest pain. My ribcage and chest was sore for a week, especially after hiccuping. How do you fake diaphoresis when you are under constant survellance? The sweat was literally pouring off me, the EKG tech had a hard time getting the leads to stick. I even overheard one of the nurses say "no way is she getting morphine from me." I never have asked for narcotics at this ED. The only medicine I ever requested was ZOFRAN.

I'm terrified of having to go back to that ED ever again. At the time it was happening I was terrified that the prolonged vomiting had either led to an elyte imbalance and cardiac dysrythmia or an esophogeal tear. It hurt that bad. When we can, we are changing HMO's so that we can recieve care at the other hospital in town.