| BCBS Says Triptan Limit Was an Error | |
BCBS notified Ms. Brown that there is no limitation on triptans in her policy, said they "made a mistake."
Continued from BCBS Still Limiting, Declined Response
|
Analysis:
- One would think that, if this were a case of BCBS having made a mistake, that mistake would have been found prior to my February 28 article when I asked Mr. Luke to locate where the limits were stated in Ms. Brown's policy.
- Had a full review of the situation been performed when Ms. Brown first filed her grievance, this "error" should have been found during the first appeal phase. Instead, her appeal was denied.
- To put a patient with a serious neurological disease through this lengthy battle to get the medication her doctor prescribed is unprofessional and bad business at best.
- Saying that denying her access to her medication was a "mistake" does not explain Mr. Luke's first responses to me. He began by telling me that the limit was due to an FDA regulation. When given the information that I had it on record from the FDA that they have no such regulations, he came back to me saying that "experts" had advised them that Maxalt® is addictive. Again, not true. The FDA Legend, which is the FDA-approved label and prescribing information for Maxalt® clearly states that it is not addictive. In addition, true Migraine experts have assured me that Maxalt® is not addictive.
- It will be exceedingly interesting over the coming weeks and months to see what, if any, impact this has on the similar problems experienced by other BCBS subscribers as well as Migraineurs with other insurance coverage.
Summary:
Although Ms. Brown prevailed, this problem is far from being solved. She is but one of thousands of Migraineurs who are denied access to prescribed medications by their insurance company or managed care provider.One contributing factor that allows this problem to continue is that many Migraineurs don't understand their rights to appeal access limitations or have insurance through their employers and fear "rocking the boat."
Anyone who is encountering the problem of their insurance company or managed care provider limiting access to ANY medication should review their policy carefully. Look in the policy to see if it lists any limitations. Look for the process to appeal limitations or other determinations made by the company. Unfortunately, we live in circumstances when we, as patients, must know our rights and be willing to challenge those not respecting our rights and acting accordingly.
MAGNUM points out that it's important to note that due to this joint investigation with MAGNUM and About, we were able to ascertain that BCBS of Florida's general policy obviously does not limit triptans. Mr. Coleman said,
"Although the BCBS grievance supervisor noted the error when reviewing Ms. Brown's policy, it's important to notice that the triptan limiting issue was obviously a non-policy-specific issue. In addition, we at MAGNUM are grateful for BCBS for taking the time and initiative to cooperate with health advocates for determining appropriate policy interpretation toward false limits of triptans. Obviously, we all agree that the honoring the attending physician who makes the determination on the amount appropriate for the patient under his/her care when he/she prescribes medications. We commend BCBS for making sure their policy holders who are Migraineurs have access to the appropriate treatment as prescribed by their physicians."
What Can Be Done:
Each of us can make a difference in this unacceptable situation. As MAGNUM
advocates often point out to me, our legislators, our state officials, our
government officials are there for US, and the only way these public servants
understand where the problems lie is if we collectively do our part to make them
aware of the problems that limit us from access to the care we truly deserve.
For information on what you can do, please click HERE.
Please continue to the next page > YOU Can Make a Difference > Page 1, 2, 3
|
|
|
|
Chat Status: |
|
|
|
|
|
