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A Health Insurance Rant

health-insurance-rantTearing up over a headline on the cover of People magazine, which I happened to glance at when I walked past it at the pharmacy, was the telltale sign that depression symptoms had returned. I was already pretty sure they were back, it’s why I was at the pharmacy.

Although I was perfectly mostly happy with Wellbutrin, I had to reduce my dose because, thanks to a migraine attack, my brain is now so sensitive to Wellbutrin’s side effects that I am massively dizzy on the dose that manages my depression. Cutting my dose back, the dizziness finally became manageable (though still present) on Monday… at the same time it stopped keeping the depression at bay.

I’m already frustrated by the needs of my ever-changing brain, but I was hopeful a new antidepressant would help me balance all my competing needs. Or I was until my insurance denied coverage. Now my doctor has to jump through constantly moving hoops to prove that, yes, this is the drug I need.

While I wait to see if her appeal will be approved, I can either be so dizzy that I can’t move my head and can’t look at the computer or I can let my depression symptoms build so that I have no motivation to get out of bed and cry at everything. Either way, I can’t work, can’t run errands, and can’t do anything around the house. I could try another yet another generic antidepressant, though I’ve already tried many, and would have to decide which I prefer, potentially gaining a ton of weight or losing interest in sex.

I don’t have much faith in my doctor’s authorization being accepted. Since the first of the year, Hart’s been working on a getting a doctor’s authorization approved for a drug that I was told would definitely be covered under our plan. It’s a drug he’d been taking for months, paid for by the same insurance company, until the rules changed with the turn of the calendar page. Now he’s without a drug he needs. There is a replacement, a replacement that he’s already tried. Last time it increased his migraine frequency so much that I lost sleeping worrying that he was developing chronic migraine.

I miss the days when my doctor and I got to weigh all the relevant medical factors and decide which medication was right for me. Yes, I could pay for these drugs out-of-pocket (assuming I could afford them), but I already pay a small fortune for health insurance each month. Being told a service will cover what I need, tethering myself to that service for a year, and still having to wheedle and cajole to get what that service supposedly includes is absurd. Especially when all that time spent on the phone and submitting paperwork is unlikely to result in me getting the coverage I thought I was paying for. Tell me up front whether the treatment I need will be covered so I can make a fully informed decision, don’t lock me into something then change the rules.

That’s what I’m angriest about. I understand why insurance companies don’t cover certain drugs or treatments. Yet I did everything I could possibly do to make an informed decision, including 17 hours of research, questions for my insurance broker, and hours on the phone with the insurance company. Now I have a yearlong commitment to a health insurance plan that’s not providing the coverage I was assured they would provide.

I get that health insurance is a mess right now. I get that companies are scrambling to make a profit now that they have to provide coverage to people like me. And I am grateful to be able to have any insurance coverage for my entrepreneur/freelancer household. But how is that companies are able to provide only basic information for a consumer to use to choose a plan, give half-truths (or lie outright) when asked questions, then delay coverage for months? I can’t think of another consumer service that operates this way successfully. Certainly not one that requires a commitment to paying thousands of dollars over the course of the year, then telling the customer, “Oh, wait, we’ve changed our minds.”

How is this OK? How can that happen without repercussions?

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Hormonal Birth Control for Menstrual Migraine & Insurance Denials

Despite the Affordable Care Act’s required coverage of birth control, some insurers are denying coverage of the birth control patch or NuvaRing, NPR reports. There are a few exceptions to the rule, but nearly all health plans are required to cover all FDA-approved birth control. If you have been denied coverage, NPR recommends appealing the denial and contacting your state insurance board.

How is this relevant to headache/migraine/chronic illness? Hormonal birth control is one method of managing menstrually associated migraine attacks, which tend to be more severe than the migraines a woman has other times of the month. The patch and the ring provide a steadier dose of hormones than a pill does, which makes them more effective for this purpose.

I’ve been using NuvaRing continuously (with one-week breaks every three or four months) since January 2010 and it has been tremendously helpful. Now, the most severe migraines I get happen the few times a year I have to stop the ring for a withdrawal bleed. (You can learn more about skipping periods on The Well-Timed Period.)

This method is generally not recommended for women who have migraine with aura, who are at greater risk of stroke if they use hormonal birth control. However, I recommend talking it over with your headache specialist to decide if it is a good option for you, whether you have migraine with or without aura. Given the frequency and severity of my migraines, my headache specialist said he’d advise me to continue using the NuvaRing even if I did have migraine with aura.

(If you don’t want to/can’t use hormonal birth control for some reason, triptans can be used to prevent menstrual migraine attacks.)

I always love to read your comments, but I’m on vacation and won’t be able to reply until the week of Sept. 8. Please don’t think I’m ignoring you!

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Tips for Getting Onto the Federal Health Insurance Marketplace

After years of eagerly awaiting the Affordable Care Act’s insurance marketplace, technical glitches weren’t going to deter me from finding out which plans would be available to me next year and how much they’ll cost. Tips for Accessing HealthCare.gov’s Federal Insurance Marketplace on Migraine.com outlines how I finally succeeded in reviewing health insurance plans after literally spending hours each day last week trying to access HealthCare.gov.

The most important tip? Use Internet Explorer! Despite trying Firefox, Chrome and Safari, Internet Explorer is the only browser that allowed me to access and complete the application and review health insurance plans.

If you’re chomping at the bit to learn what your health coverage might look like next year, check out all my suggestions on Migraine.com.

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Health Insurance Stressors

Before our COBRA coverage ended last month, Hart and I spent months scrambling to find health insurance to cover us until the pre-existing condition coverage of the Affordable Care Act goes into effect in January 2014. Our experience was even more complicated than expected and brought home just how faulty the current health care system is.

Having been denied coverage by every health insurance company in Arizona, private health insurance isn’t an option. We couldn’t even get a high-deductible plan.

After tons of research, it looked like we were down to two options: joining a small business organization’s group plan and spending more than $1,000 a month for a plan with a $10,000 deductible per person and high co-pays or enrolling in classes at a community college and paying for student health insurance.

The first option tied our stomachs in knots. That’s a major financial burden even if we are both perfectly healthy for the next six months. And spending that much money for mediocre coverage wasn’t palatable.

The student health insurance is far more appealing, but coverage doesn’t begin until August. Hart and I both like to have our ducks in tidy rows when it comes to this sort of thing. The thought of going even a month without insurance would have us both losing sleep. Even though the chances of getting injured in an accident, having a stroke, or having a heart attack are small, they risk is enough to worry both of us.

More distressing is that the plan is being rewritten to comply with the Affordable Care Act and details have yet to be released. We have no idea how many credit hours we’d have to take, what the coverage would be, or how much it will cost. All we know is that it will look different than previous years’ plans.

Then an entrepreneur Hart knows mentioned that she had short-term health insurance that didn’t cover pre-existing conditions, but does cover new diagnoses or accidents. We didn’t qualify for some plans, but did find one company that would provide us six months of coverage at less than $250 a month. Migraine’s not covered for either of us, of course, but we’re less likely to go bankrupt if one of us has a catastrophic health problem in the next six months. It isn’t an ideal solution, but it is way less expensive than the alternatives (and than what we paid for COBRA) and, fortunately, Hart and I both currently have prescriptions for only generic drugs.

We’re now on the short-term insurance, so we’re covered until four days before Obamacare goes into effect — assuming politics don’t derail it. (We’re planning to spend the last four days of the cooped up at home, doing nothing so dangerous as using a ladder.) Some sort of health coverage is guaranteed come January, though we won’t know until October what our coverage options will be or how much we will have to spend.

Last June, Hart and I both fretted while we waited for the Supreme Court’s ruling on the Affordable Care Act. Then we worried that if Romney won the presidential election and succeeded in repealing Obamacare, we’d have to abandon TheraSpecs so Hart could get a corporate job with health insurance. Whatever your politics, its undeniable that a system that won’t provide health coverage to people who are willing to pay through the nose for it is defective. Especially considering that, while we aren’t in perfect health, neither of us has a disease that’s particular expensive to treat. Triptans aren’t cheap, but they cost pennies compared to chemotherapy or $15,000-a-month injections for MS.

The costs and benefits of the Affordable Care Act/Obamacare won’t truly be known for years. It may not be an ideal solution, but the system that’s concentrated in for-profit companies and ties health coverage to employment is way out of whack. The next few years — or even decades — could be rocky, but I’m hopeful we’re on the way toward improving the impoverished approach we currently have.

And I’m grateful that Obamacare’s existence means we can keep TheraSpecs, a company that seeks to improve the lives of people in pain, going.

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Migraine, Careers, Weather, Happiness, Love

My husband left the best job he’s ever had so we could move to Phoenix for my health. He telecommuted at first, but it quickly became apparent that it wasn’t going to work. This is old news for me, but I haven’t shared it with you. I thought I was OK with how things were working out. Although Hart no longer has the job that he loved, he is starting his own company (yay, TheraSpecs!), which is something he’s always wanted to do. We’re both stressed about bills and the looming end of COBRA health coverage, but I thought I was taking it in stride.

Then Hart’s boss from his best job ever, in Boston, called to fill him in on the future direction of the company. It is exciting stuff; stuff Hart wanted to be a part of. Jobs and careers aren’t more important than people, of course. However, my husband having a job that doesn’t bore him and doesn’t overwork him, that paid well and had health insurance is worth a lot. I cried when he told me about the phone call. He gave up so much for me and the move to better weather only improved my migraines a bit.

I had felt significantly better on vacations to Phoenix, so we left Boston thinking we’d have a full life here. That we’d be able to go out frequently, have parties, take weekend trips. Instead, the migraines caught up to me after I’d been here two months. It was the weekend after we closed on our (adorable, fantastic) house and my mom dislocated her shoulder and broke a bone in it to boot. Real life came crashing down. My body realized it was no longer on vacation and the migraines were back. Not as bad as they were in Boston, but still regularly disabling.

I am much, much better now than I was my first year back in Phoenix, thanks to magnesium and cyproheptadine (which I’ve been on for seven weeks and still need to tell you about), but I’m still pretty wrung out by the migraines. I feel like my health will continue to improve. I just need to work out some kinks, like dosage and timing, and get myself on a regular schedule. That process is never as easy or as quick as I think it will be, but I still believe the life in Phoenix that Hart and I planned is close to becoming reality.

I’ve spent the last three days wondering if I could get myself well enough to move back to Boston so Hart could work for that company again. (I’m fully aware of how absurd that is — if I had that much control over my health, I’d have healed myself decades ago.) Never mind that the company may not need him anymore and that he’s in the (scary, uncertain, exciting) depths of doing what he’s always wanted. My mind grabbed onto the notion that there was only one solution and gnawed on it for days.

Finally it occurred to me that if I were healthy enough to move to a less stable climate, I’d be healthy enough to get a job for health insurance myself. I’d be healthy enough to be the woman Hart married, the one who’s always ready for an adventure. I know he wouldn’t trade that for any job.