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Ihelp: Insurance Approves Just Half My Nuvigil Dosage

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#21 raouf

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Posted 25 April 2014 - 04:35 PM

@ Hank, yes, it makes total sense.  My sister is an MD and tells me how little time they have to work insurance matters. I guess  I was just trying to help  and didn't know how to.  My file is still pending as of right now.

 

@purpley: I like your medical reps idea.  If Aetna denies the request again, i'll start gathering supporting data.  Although, what data would  convince an insurance  that refuses to accept a reputed Doctor's diagnosis and who knowingly puts a person in daily physical danger that could cause accidents and even death. 

 

Thank you all for the feedback.  

 

R



#22 purpley

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Posted 25 April 2014 - 05:10 PM

The insurance company isn't questioning your diagnosis (or your sleepiness), because they have to rely on your doctor's opinion for that. What they can do, though, is question the need for the higher than normal dose of the medication. Their argument will be that (1) there's no evidence there is any additional therapeutic value from Nuvigil in doses above 250mg daily, and/or (2) that 500mg exceeds the FDA guidelines or other guidelines for the use of the medication. The only ways to appeal that are to start out by saying that (1) you tried meds X, Y, and Z and they didn't work for you; AND (2) that Nuvigil 250 didn't work for you and 500 did. But if that doesn't work, which it probably didn't since your doctor probably said exactly that, you need to add (3) there's precedent in the literature for using doses of 500mg for some patients (and that the "some patients" should apply to you.). That's where the research part comes in, finding articles, case reports, anything at all that backs you up.

#23 raouf

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Posted 01 May 2014 - 01:59 PM

Monday  my doctor emails me saying its been Accepted!  Callled the insurance who had me contact the doctor to send a new prescription for 2*250mg.....I call in the next day and I am told the appeal was denied and the prescription they received was for 1 tab and not 2.    

 

This is turning into a nightmare... It looks like I am going to have to pay out of pocket or somehow manage the attacks. 



#24 raouf

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Posted 06 May 2014 - 01:30 PM

If anyone has any information or data that supports taking higher the benefits of taking higher Nuvigil dosages.  Thanks



#25 doinmdirndest

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Posted 06 May 2014 - 06:11 PM

can't say how much use a '96 article (before 'vigils' were fda approved) could be.  perhaps it could help; it cites examples on pg. 37 or so for three wakefulness promoting meds that are comparatively massive.   although comparisons between traditional stimulants and 'vigils' of which science does not know how they work may or may not be readily drawn by md's. 

 

prolly depends on the md.

 

likely it could help.  if 250mg/d desoxyn, 500mg/d pemoline (no longer available) and 1000mg/dmethlphynadate are good medicine for a few pwn, how can 500mg/d be ruled out as beneficial for you or any eds sufferer?

 

full text may be downloaded for free. (I'd insert link like others here do; treid googling up how-was confounded)

 

PHARMACOLOGICAL ASPECTS OF HUMAN AND CANINE NARCOLEPSY   by dr. Emmanuel mignot/ seiji nishino. 

 

incidentally, if robust wakefulness is essential for you nuvigil does not seem to perform it may be a sub optimal 'treatment tool'-from a good sized shed.  was for me.  my thought shortly after my md/me began it: "no wonder it's schedule IV, it's lame as f.  could be different for you, right treatment is for all of us, and by no means is limited to stimulants. 

 

good luck.  PS have in your hand hard copy of this article, provide it to your MD at your visit.  verbal approach  "doctor, there's an article that says...etc." = lead balloon.



#26 doinmdirndest

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Posted 06 May 2014 - 06:19 PM

BTW - @'geeks'/pc savvy: is there a youtube tutorial or something shows me how to put a link in a post to an article?  thanx.



#27 raouf

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Posted 09 May 2014 - 05:25 PM

Thank you , that was helpful information. 







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