Migraine, Other Health Issues, and Insurance

Mime-Pleading-150In the late 90's, my Migraines became chronic, leaving me with a debilitating Migraine five or six days a week. Those Migraines cost me my job and left me with pretty much no life. When I learned about true Migraine specialists and began treating with one, things started to turn around. Now, 15 years later, Migraines strike one or two days a week. Because of a great treatment regimen, a Migraine seldom takes me down for more than an hour or two.

Taking daily medications is something I'm never going to like, but those medications make it possible for me to function and to have a pretty good quality of life. There are other conditions for which I need medications too - diabetes, heart disease, glaucoma, and a couple of others. So I count on my medications and being able to get them when I need them.

My husband worked for DuPont for 30+ years. One of the reasons he stayed with DuPont during the last years of his career was for the benefits that would continue through his retirement, including medical and prescription insurance. Our insurance isn't "free" for us. We pay significant premiums to keep the insurance, but if it works the way it should, it's well worth it.

Therein lies the problem. My prescription drug coverage, which is through Express Scripts is so messed up right now that I can't order anything through their mail order service, and if I were to take a new prescription to a local pharmacy, I'm not sure it would be covered.

We first discovered there was a problem when Dr. Watson's (my Migraine specialist) nurse called Express Scripts for a coverage review to get Axert covered. She called me to tell me that Express Scripts said my coverage had ended December 31. John (my husband) called DuPont and was told that they'd sent me a new drug coverage card with a new account number for this year. I had received nothing from them, but John had received Express Scripts insurance cards in the mail. Since he's older and on Medicare, he'd just thrown the cards away because his drug coverage isn't through Express Scripts. After John spent two and a half hours on the phone with DuPont and Express Scripts, we thought the issue was settled. We got logged onto my Express Scripts account online and changed the ID number as directed.

All was well - we thought. Then we discovered that all of my prescription refills had disappeared. I asked Dr. Watson's nurse to do the coverage review for Axert again and send in all new prescriptions. She got the approval for Axert and sent in all new prescriptions for me. Whew! Again, all was well - we thought. BUT, I received yet another new set of Express Scripts insurance cards with yet another new ID number. John called again. He was told that the new number is to go into effect on May 4 and that all of my prescriptions would be transferred to it. I cannot, however, log onto the Express Scripts site to see that account until May 5. When I log onto what's supposed to be my current account, all of my prescription refills are gone - again.

Now, do you want to know the truly confounding issue? Nobody at DuPont or Express Scripts can tell John why all of these changes are being made to my account. Changing ID numbers in the middle of the year is totally unprecedented, and nobody at either company can give us any answers.

I wear two hats in this situation:

  1. The patient who's being stressed and so negatively impacted by the situation.
  2. The patient advocate who helps others but doesn't seem to be able to do anything to help myself with this situation.

To summarize the situation:

  • DuPont and / or Express Scripts keep changing my ID number with no explanation. When new Express Scripts cards come in the mail, all I get is the cards with a "Welcome to Express Scripts" letter. No information about what's changing or why.
  • Hours spent on the phone have resulted in no answers on the what or why.
  • I've had to get all new prescriptions once and may have to do so again.
  • There seems to be nothing we can do other than wait and see what happens next week when yet another new ID number goes into effect.

There's absolutely no excuse for nobody being able to answer our questions. I can say with absolute confidence that if I performed my job so poorly, I'd be fired. John worked for DuPont for 30+ years with the guarantee of benefits through retirement until each of us reached the age where Medicare took over. We've paid significant monthly premiums for my coverage since he retired 15 years ago. There's no possible excuse for all of the inefficiency here or the plain old stupidity involved. It's not even as if DuPont and Express Scripts are giving me this coverage out of the goodness of their hearts. John worked for it for over 30 years, and we're PAYING for the coverage.

On top of the impact of Migraine and my other health issues on my physical health, I now have all of this stress impacting both my physical and mental health. Insurance should be there to help us with our health issues, not make them worse.

Live well,

PurpleRibbonTiny Teri1
 

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© Teri Robert, 2015
Last updated April 29, 2015.


Aetna and Botox for Chronic Migraine - What a Farce!

StupidityIncompetenceHave I said that I'm thrilled not to have to depends on Aetna to cover my treatment for Chronic Migraine? No? Well, I am truly thrilled that my insurance coverage changed from Aetna to Cigna the first of the year. Back in December, I shared my frustration that Aetna had denied coverage on Botox treatment for me for Chronic Migraine? Why? Essentially, because it was working too well. Since Botox had reduced my Migraine and Headache days to fewer than 15 per month, they had cut off coverage. (See Aetna Denied Botox for my Migraines - What?!) In the end, they paid it, but by the time they did, I was honestly beginning to wonder if anything was worth all the arguing and stress.

Today, I'm writing about a pathetically sad situation another patient is in with dear old Aetna. First, they questioned if the patient met the part of the Chronic Migraine definition that says the Migraines and headaches last at least four hours per day. Mind you that the doctor had charted that the patient had "continuous" Migraine with no breaks. Do you think that means four hours or more? Duh!

Then the doctor and the Aetna rep came to an Aetna requirement for Botox. The patient must have failed at least one preventive from each of three different classifications of medications. She's tried antidepressants, and they failed to help. She's failed two anti-epileptic meds, and they failed. The woman is beyond chronic, and the doctor feels it's time to try Botox. But, oh, no! Aetna insists that she try anti-hypertensives first, regardless of the fact that several of them are contraindicated for her due to other health issues.

Now here's where I just want to scream, "Stupidity and incompetence should be illegal!" Enough is enough. This poor patient has tried preventive medication after preventive medication, but they want her to try more, MOST of which have a might higher potential side effects profile than Botox does.

Anyone who's being honest will admit what's going on here. It's about the $$. Aetna doesn't want to pay for the Botox treatment. SHAME ON THEM?! If they don't want to pay for Botox, they should simply put it in their contracts and not cover it. People whose Migraines are bad enough to need Botox treatment don't need all the useless, idiotic, asinine red-tape run-arounds.

Seriously?! I repeat, stupidity and incompetence should be illegal!

Live well,

PurpleRibbonTiny Teri1
 

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© Teri Robert, 2014
Last updated September 23, 2013.


Migraine and Health Insurance

Are you trying to deal with Migraines without health insurance?I saw this on television today, and it offers some great information for people with no health insurance:

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© Teri Robert, 2011
Last updated September 30, 2011