Faces in the Crowd
The NHF asked its Facebook community how insurance coverage impacts their medication usage and received some passionate testimonials. Here’ s what you had to say:
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My insurance These insurance
Insurance only has denied multiple preventives the approvals tablets of Imi- people who do allows me nine for me. They have never had
trex or Zomig a say the medication is not a migraine.” month, which is not nearly intended for migraines— no – Cheryl W. enough when I have a crap— there really is not migraine every day. So I much that IS developed have to try to ration my meds, I have to ask myself for migraines. They need to be more accommodating with off-label use. It’ s a lot less expensive than inpatient treatment.” – Katie M.
meds for the worst headaches. This goes against what you should do.” – Patsy C.
I don’ t have insurance because I had to stop teaching due to my persistent daily migraines. Every time I need one of my rescue
if the pain is at a high enough level to deserve the expense.” – Sarah J. are generally covered through medical benefits. To make matters even more confusing, some medications given to migraineurs in the emergency room or in-office may be covered through medical benefits, not pharmaceutical.
Patrick-Lake learned of these classifications first hand after undergoing Botox treatments for her chronic migraines. Her insurance provider covered the $ 500 injection procedure fee, but the $ 1,500 drug got billed in an area of coverage that had a separate deductible, Patrick- Lake says.
2. Get to know your doctor
Headache patients need a physician who can do more than just diagnose and treat their illness; they need a true partner in care. Tackling both chronic pain and insurance authorizations demands a team effort.
“ It’ s about finding the headache specialist who will go to bat for you,” Patrick-Lake says.
Once you have located the right healer( chosen from a list of in-network doctors), it’ s important to get involved in the continuum of care, from diagnosis to follow-ups. A good place to start is where many migraine and headache sufferers square off with their benefit companies— over the prescription medications used to treat their conditions. Some patients find name-brand drugs more effective than their generic counterparts, while others don’ t get enough triptans to cover all of the migraine attacks they experience in a month. In these cases, patients can find themselves digging deeper into their pockets— sometimes to the tune of hundreds of dollars per month— for drugs their payers won’ t approve.
Merle L. Diamond, MD, headache specialist and president of the Diamond Headache Clinic in Chicago, says it’ s unfair to penalize patients who don’ t want to take generic drugs that might not work as well.
Tackling both chronic pain and insurance authorizations demands a team effort.
www. headwisemag. org | National Headache Foundation 37