Migraine

Why is it that when I comes to insurance we are always the loser. I haave been dealing with migraines most of my life but was not diagnoised until I was 40 years, that was 13 years ago. I have been dealing with same neurology office during those 13 years for there is not another one in town.
I finally had enough going around in circles and asked for a referal to Philly. Everytime I change jobs(yes I still work because I have to) my insurance gets worse and worse. The company I am with now which is national known will not give me the referal because I have no out of state coverage. There is not a headache speciality in the state of virginia so I'm stuck. ugggggggggh!!!!!!!!!!
Ineeed a referal just to go to an urgent care and it cost half a paycheck just to go to the ER. The ER just gives me an anti-inflamatory and sends me home with my headache still at a 6+. For this I pay $250.00 a visit.
I just want to cry but of course that makes the head worse and this springs weather has not help much either. Just needed to vent.

At a lose in Virginia

Hytymes,
We are the losers with our employers and the policies they provide for us. The insurance companies give them what they will pay for. My company offers 3 plans, each more expensive. I can only afford the HMO plan (least expensive) as I have my self and 2 children to insure. I still pay $300/month. For that, like you, I have really only local coverage and have to stay within a certain group of doctors. I have gotten extremely lucky that the neurlogist I see that is within my group is great. But that is just dump luck. Each year our premiums go up a bit and our deductibles for ER, Outpatient Surgury and Inpatient Care go up. The other two plans that would allow me to go basically anywhere and not need referral, I can't afford those plans.

My company is fairly large I guess (500-600 employees)so they have fairly large buying power. Most companies don't have that. My ex-husband and his wife have much worse coverage due to the fact that their companies are smaller and have much less buying power being is smaller groups. That's why I insure the kids.

It's awful what they can offer employees due to the cost. The prescriptions are the worst. I was doing my flexible spending account last night and being reminded of the cost my drug costs. I find it so hard to believe that Topamax is really roughly $300 for 75 mg/month. Or the 9 tablets of Imitrex being around $300 also. So hard to believe that's what really needs to be charged.

The referral's are a mess. The pool of specialists is so small for any specialty group that to be so limited is awful. Just like neurlogoly, some orthopedist don't see all types of orthopedic injuries. It seems like there should be a better way to deal with it.

I would guess you have a medical group you deal more directly with than the insurance company? If so, call the insurance company and explain what is going on. They might have a process to get an out of area specialist approved, but the catch will be your primary care doctor will have to write the referral and support it.

Guess I had to vent too!!

Take care,

Cindy

Hi, hytymes, and welcome to the forum!

That really, really bites about your insurance. I think it's really sad that premiums and the like keep going up and up while at the same time services get cut. It wouldn't seem quite so bad if they at least kept services intact. Our insurance for our school district is self-funded, and it gets kind of scary whenever negotiations roll around and they talk about costs and cuts. We've tried for years to get the state to set up a state-wide insurance pool for school districts to help even up some costs, because catastrophic claims are eroding the smaller plans like we've got, but it's never been done. It always dies.

I agree with Cindy's idea to get your primary provider involved. Letters from your doctor, backing up their referrals, can go a long way in appealing rejections. Your doctor can attest that you need more specific care from a true specialist, and that in order to receive it, you'll need to go out of area. It's worth a try. You might be able to talk them into partial coverage, if nothing else.

Thank you for the warm support and please forgive my typos lol. I too spend $300.00 a month for health insurance which does me little good in my humble opinion. After researching insurances for myself I could have paid almost the same thing to just a little more with better coverage but since I can get cover through my job I am denied the chance for better insurance. I wish that we can just make the decide how to treat our insurance and not be dictated by the companys that sells the insurance. I realize that it is costly to insure someone like myself but we pay for the benifits and we should at least have a say in the type of plans we pay for! Again thanks for the support and wishing the best with your plans.

Lynn in Virginia

hytymes,

I'm not sure if I've said hello yet, so welcome!!

I don't know if your area hospitals are charity hospitals or not, but check and see if they have a program called "healthcare for the uninsured" or "charity care".

It's also known as "hospital care assistance" and is available to help cut the cost of hospital services for those who cannot afford it.

Also as far as perscription coverage - not sure if you are good on that or not - but check out http://www.pparx.org - even with decent medical coverage you may qualify for a discount card though this plan. I qualified for a few different cards and just need to find the time do the rest of the online work on it.

good luck!

hytymes,
I have a suggestion that may or maynot work for you. I recently was faced with my neuro and primary care not being in the same network of doctors. I very quickly made the decision I would change my primary care to keep my neuro.

The suggestion is to find on your insurance the neuro you want to see and than find a primary care that is in the same network of doctors if possible to get the referral. That may not work for you if the neuro you want to see if too far away. As you would be left with a primary care too far away also. Is there a neuro closer than Philly you would be willing to try? There are some of use who have had good care from specialist not on the forum's list. I'm one of those. It is hit and miss. But sometimes I think that even the best doctor, if I as a patient don't click with the doctor, it still won't work.

Anyway, it was something I thought of that might help you. I do understand your frustration.

Take care,
Cindy