Health Insurance for Migraine: Why so Complicated?

Health Insurance for Migraine: Why is it so Complicated?

Health Insurance for Migraine: Why is it so Complicated? Am I the only one who uses my free time talking to insurance, specialty pharmacy, or a doctor’s office?  I find that I spend a lot of time on the phone with these places.

Talking to my insurance company is a really frustrating situation.  It seems like no one seems to have exact clear answers.  I spend most of my time being transferred, re-explaining my situation, and receiving complicated documents.  Documents all seem to be labeled differently.  My insurance company wants to form ABC then I call my doctor’s office and they either don’t know what I’m talking about or respond with, “Oh, do you mean DEF form?”  I’m not a doctor nor in the insurance field so I am confused often and go in circles.

Health Insurance for Migraine

Along with the confusing verbiage, I’m in pain when speaking with these individuals.  I take notes when we talk so I can rearticulate to the next person but don’t always know what it means.

Even when I can clearly articulate my situation, my insurance company loves to claim my treatments as “experimental.”  Being that a variety of medications are used to treat migraine but specifically designed for other health impairments (such as seizures, depression, high blood pressure, etc.) insurance companies will not cover it.  Even if I have taken the medication and found success, it’s still “experimental.”  My response is “I have experimented and know it works.”  Yet this is not enough evidence to cover my costs.

So I spend time making more phone calls, filling out and gathering more forms, and appealing the denial.  Even when I appeal, I have never had a denial reversed.  So I pay out of pocket or don’t receive the treatment I need.

Pharmacy

I also receive many phone calls.  The pharmacy automated system calls me daily.  I know very few phone numbers by heart, but my local CVS is one of them.  Additionally, I also get reminder calls about an upcoming appointment or returned a phone call from a nurse. 

I spend so much of my free time on the phone often going in circles.  So I’m confused in pain, talking to people with inconsistent information or information that leads me to more phone calls. Health Insurance for Migraine: Why is it so Complicated? Also, Why is Healthcare So Unaffordable?

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Sarah Rathsack

I tell stories of My Migraine Life. Living life through Migraine consists of advocacy, treatment, prevention, and searching for health and happiness in a positive honest way. My kids, husband, dog, family and friends motivate me to make a difference in the Migraine World.
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4 Comments

  1. Migrainista on August 26, 2016 at 9:51 am

    I go through this as well. The doctor’s office, insurance companies and testing facilities all telling a different story. Me not privy to any of the actual facts. It’s an impossible situation.



  2. mymigrainelife on August 26, 2016 at 10:07 am

    So frustrating!



  3. Nicole (Nikki) Seefeldt on September 5, 2016 at 1:08 pm

    I’ve been on both sides. I was a rep at a health plan for a few years, then got promoted but had to take disability until transplant (still waiting for it), but yes, even with all the inside tips I picked up myself, I spend a fair amount of time trying to sort things out. It gets confusing for me. It’s like a huge bureaucratic puzzle sometimes to get at the correct answer or find a deeper explanation in the policy. And even with someone confirming with a higher up, I still get bad info occasionally. You’re not alone.



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