My claim for
Zavzpret
was denied.Now what?
We know how frustrating, scary, and confusing this can be, but you’ve come to the right place. First and foremost, it’s important to know that you can appeal. It’s your right!
Didn’t go to medical school or work for a health insurance company? That’s ok. We did. Whether you’re trying to challenge a claim denial, prior authorization, or request a formulary exception, we are here to help.
Claimable can help you appeal. Why was your claim denied?
What is Zavzpret used to treat?
(also known as) can help . It's taken as . It works by .
How can help me?
What do doctors usually consider before trying ?
0
What are the coverage criteria for Zavzpret?
For Zavzpret to be approved for preventing , you need to have:If this describes your symptoms, and you do not have one of the excluded conditions, you may be a good candidate for Zavzpret approval. However, your treatment history matters. Often you will need to have tried other treatments before your insurance company will approve Zavzpret. The exact requirements can vary depending on the insurance plan, but below are the general guidelines: If you meet the above criteria, you will usually get an initial authorization, which will be active for on average. To continue receiving insurance coverage for Zavzpret it means:
What you can do to help your case?
Make sure your doctor is recording all different types of migraines that you suffer from. For instance, if you have migraines with aura and also have episodes without aura, make sure both are included in your records. Once you get a diagnosis of chronic migraine, however, that difference in coding becomes less important.
Track your migraines. Keep track of how often your headaches happen and their impact on your life (having to miss work or school, skip appointments, avoid driving, etc)
Track the drugs you’ve already tried. This improves your ability to say whether you can skip ahead in the process, especially if your doctor makes note of it.
Note if you have had headaches from your medications, or “medication overuse headaches”. Medications like Aimovig both help reduce headaches and do not cause an overuse headache, meaning they might be the best option for people with medication overuse headache.
Get help writing your appeal. These are complicated documents to write well. But we can take your details, cite the evidence, and improve your chance of turning that denial into an approval. We can help. Start your appeal today.
Learn more about Zavzpret
Claimable makes it easy to appeal denied claims
1
Upload denial letter
All we need to get started is your denial letter and insurance information
2
Answer simple questions
We’ll ask you a few questions about the events leading up to the denial
3
Generate expert appeal
We compose an evidence-based appeal, supported by medical history, clinical research and policy details
4
Submit & support
We mail your appeal and support you through the process
Patient success story
Diagnosis
Treatment
Denial reason
Health plan
Gender
Age
Health History:
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Appeal Summary
Appeal Successful
References
Ailani J, Burch RC, Robbins MS; Board of Directors of the American Headache Society. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7):1021-1039. doi:10.1111/head.14153
Ailani J, Burch RC, Robbins MS; Board of Directors of the American Headache Society. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7):1021-1039. doi:10.1111/head.14153
Ailani J, Burch RC, Robbins MS; Board of Directors of the American Headache Society. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7):1021-1039. doi:10.1111/head.14153
Ailani J, Burch RC, Robbins MS; Board of Directors of the American Headache Society. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7):1021-1039. doi:10.1111/head.14153
Choose a denial
reason to appeal:
No Prior Authorization (PA)
Your doctor did not submit the paperwork required by the insurer to show that you have tried other medications first.
Initial approval ended
The initial approval of Aimovig is sometimes only for a specific amount of time (such a 3 month period).
Why It's common for
Zavzpret
Some doctors and their staff do not know which insurance plans require Prior Authorization for which drugs.
How to appeal
Ask your doctor’s office to submit an initial Prior Authorization request to your insurance company. You can also try sending an appeal that details all the treatment options you and your doctor have already tried. That said, a doctor’s office might get a faster result.
Why It's common for
Zavzpret
Insurers want to see that the treatment is working after an initial trial.
How to appeal
Ask your doctor’s office to submit a Prior Authorization renewal to your insurance company. You can also submit your own request, though your doctor’s office might get a faster result. You have to include information on how the treatment has improved your symptoms. This usually means you have fewer migraine days AND you have a "significant clinical benefit" according to your prescribing doctor (sometimes that benefit can be self-assessed).
Why It's common for
Zavzpret
Insurers only want to pay for therapies that continue to work well and give you benefit.
How to appeal
Ask your doctor’s office to submit a Prior Authorization renewal to your insurance company. You can also submit your own request, though your doctor’s office might get a faster result. You have to include information on how the treatment has improved your symptoms. This usually means you have fewer migraine days AND you have a "significant clinical benefit" according to your prescribing doctor (sometimes that benefit can be self-assessed).
Why It's common for
Zavzpret
Insurers sometimes
Do not know your symptoms enough to see how you qualify
Are not following their own rules
Are not following the rules of your state
How to appeal
Document that you are no longer taking that medication.
On a drug that is not allowed at the same time
Some policies do not allow you to be on certain combinations of medications at the same time.
Medical necessity
Your insurance company does not have the information needed to show you meet their criteria. Or, your insurance company knows your history and still thinks you do not meet their rules.
Why It's common for
Zavzpret
5 Some doctors and their staff do not know which insurance plans require Prior Authorization for which medications.
How to appeal
Make sure your symptoms are clear: how severe, how often, and how they impact your life. Check them against the insurance company’s rules to make sure they’re applying their rules correctly. Check state law where you live to see if the rules are different for your area. Not sure where to start? See how we can create a personalized appeal for you in minutes.
Why It's common for
Zavzpret
Some doctors and their staff do not know which insurance plans require Prior Authorization for which medications.
How to appeal
Ask your doctor’s office to submit an initial Prior Authorization request to your insurance company. You can also try sending an appeal that details all the treatment options you and your doctor have already tried. That said, a doctor’s office might get a faster result.