Sticker Shock
“ We ’ re not Keebler cookies that all sit in the box and look the same ,” she says . “ Genetically , there are clearly distinctions in how patients respond to medication .”
Headache patients and their physicians , however , can often build a case for covering their preferred treatments . Not surprisingly , it ’ s all in the paperwork .
Both parties should ensure the medical records submitted to the insurance company properly reflect what ’ s going on . WellPoint ’ s Dr . Whitney suggests migraine and headache sufferers involved in complex care keep a detailed journal that meticulously documents the incidence and length of the medical issue , specific medications taken , other treatment interventions and side effects .
“ It helps the doctor and demonstrates the [ condition ’ s ] severity ,” he says , adding that the information can also be a valuable record of treatment when presented to an insurance provider .
And while it might be an uncomfortable conversation , patients need to speak openly with their physicians about payment and ways to save money on treatments if their coverage is limited or possibly denied .
Some offices even bundle treatments together to give patients more reasonable rates for care , though Dr . Diamond cautions “ not all offices are that creative or willing to do it .” Be sure to inquire about all possibilities .
If health care costs are crippling your finances , you ’ re not alone . Take a look at the unsubsidized cost of a single dose of these commonly used triptans based on national retail averages .
Relpax ( 20 mg ) |
$ 34 |
Frova ( 2.5 mg ) |
$ 37 |
Maxalt ( 5 mg ) |
$ 38 |
Amerge ( 2.5 mg ) |
$ 43 |
Imitrex ( 25 mg ) |
$ 39 |
Generic Sumatriptan ( 25 mg ) |
$ 24 |
Imitrex Nasal Spray ( 20mg ) |
$ 61 |
Generic Sumatriptan |
Nasal Spray ( 20 mg ) |
$ 44 |
Zomig ( 5 mg ) |
$ 38 |
Zomig Nasal Spray ( 5 mg ) |
$ 53 |
Source : Consumer Reports
3 . Study the rules of the game
Migraine and headache sufferers need to make every effort to understand how their care is evaluated so they can equip themselves to deal with unfavorable health care decisions levied by their insurance companies .
Most major health insurance plans base their policy decisions on credible scientific evidence published in peer-reviewed medical literature , Dr . Rosenberg says . Published clinical trials make a treatment more likely to be covered than one based purely on anecdotal testimonials .
But for patients with chronic pain , some physicians enlist a battery of treatments , such as acupuncture or magnets , that are not covered by a benefit plan .
“ Individual doctors may try a lot of things to see what works with migraineurs ,” Dr . Rosenberg says . “ But health care companies are looking for more systematic evidence to see that a treatment actually works better than the placebo .”
Even medications that have met benchmarks required by the FDA can be sidelined by providers until they are fully vetted . For example , Botox for migraine relief is classified as an off-label therapy by some providers because of the dearth of studies demonstrating its effectiveness .
Dr . Rosenberg suggests checking a benefit company ’ s website for its coverage and
38 HEAD WISE | Volume 1 , Issue 3 • 2011