Miss Migraine: Shopping for health insurance

Posted on by Kelly Lynn Thomas
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The Adventures of Miss Migraine is an ongoing column about my life with chronic migraine. A version of this post appeared first on my blog of the same name on September 6, 2012. I’ve updated it with reflections and more experiences.

When I was 26, my partner was laid off and we lost our health insurance. It was 2012, and the ACA exchanges weren’t up and running yet. So, I had to shop for health insurance on my own, to ask questions like “What kind of formulary does this plan have?” and “What would the prescription co-pays be for venlafaxine, topiramate, verapamil, Maxalt, Migranal?”

Caduceus and headlight

“Caduceus and Headlight” by Flickr user takomabibelot. Used under Creative Commons license.

I had to check and double check for things like spinal manipulations and mental/behavioral health coverage. I had to weigh specialist co-pays against deductibles and monthly premiums, generic prescription co-pays against brand-name prescription co-pays and mail order pharmacy co-pays.

At the time, a colleague of mine, similar age, same career goals (writer), said this to me: “Yeah, I had health insurance in grad school. It was a decent plan. But I never used it.”

I use my insurance at least once every week. To refill prescriptions, to see my chiropractor, my therapist, my migraine specialist. To get another test done. So many tests. Yearly blood work, at least, but throw in a nearly annual visit to the ER and we’re talking CT scan or MRI on top of that, which always come out of the deductible.

The specialist visit co-pays mean more to me than the regular office visit co-pays. I hardly even looked at that column. I see my PCP once or twice a year. I see my migraine specialist every three months. But even more important, it’s the prescription co-pays I have to watch out for. Right now a generic version of my abortive drug, almotriptan, costs me $80 for 12 pills. A generic.

My friends, my colleagues, most of them don’t even know what their specialist co-pays are. I’m painfully aware of mine. I envy them, my friends who look at health insurance as a bonus, an unnecessary extra.

In 2012, a health care plan for two people with a $5,000 deductible cost us $500 per month. Honestly I don’t know how we afforded it, except that we couldn’t afford not to. I’ve been on several different insurance plans since then, some good, some bad.

On each one, though, I’ve had to fight for the coverage I need. Migraine isn’t a deadly disease in most cases, but it can be deadly in indirect ways. It can make you so miserable you just want to find relief in any way possible. It can make you desperate. And health insurers? They don’t care. They are only thinking about the bottom line. The ACA didn’t change that. Sabotaging the ACA didn’t change that.

But you know what will? Universal health care. I’m not going to debate the ins and outs of it or exactly what form it should take. Greed is literally killing people. Universal health care won’t solve all the problems of our health care system, but it could save lives. I hope one day I can talk to a teenager and tell them the crazy story of how you used to have to shop for health insurance.

For now, though, it’s open enrollment season with our current insurance provider, and I need to get back to the books to figure out which plan will be the least frustrating.

 

#FridayReads: Shirtless Bear-Fighter

Posted on by Kelly Lynn Thomas
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I was over at a friend’s house to watch hockey, and on my way out after the game I saw a copy of a comic called Shirtless Bear-Fighter. The cover depicts a shirtless man in raggedy pants with exaggerated masculine features (seriously, his feet are huge). I paged through it and saw that this was, yes indeed, a comic about a man who fights bears while decidedly not wearing any clothes (his junk is pixelated so it remains PG-13, sort of). Curious reader that I am, I checked out Shirtless Bear-Fighter from the library via Hoopla and read it in under an hour.

Cover for the first issue of Shirtless Bear Fighter

I have several takeaways:

  1. WHAT IS THIS COMIC I DON’T EVEN KNOW
  2. BUT IT’S REALLY FUCKING FUNNY
  3. “Bear” is not limited to the large omnivorous mammal
  4. There are a lot of toilet paper and poop jokes (WHICH ARE HILARIOUS)
  5. The whole thing can be read as a fable about environmentalism and toxic masculinity
  6. ALSO IT’S REALLY FUCKING FUNNY
  7. Magic bacon.

First, if you find crude humor beneath you, don’t bother with this book. Second, if you can’t tell the difference between straight tropes and the skewering of said tropes, also probably don’t bother with this book. Still with me? GREAT.

Shirtless Bear-Fighter tells the story of a man named Shirtless, who was raised by bears in a lush mountain forest. The bears betrayed him when they killed his lover, and after that he vowed to fight every bear. Now, enraged bears are attacking major cities across the US, and the FBI calls in Shirtless to handle the problem. In the process he discovers that past events weren’t what they seemed and uncovers a plot by a greedy toilet-paper-company logger to turn the whole forest into TP. On the way Shirtless has to deal with multiple betrayals, bears high on magic bacon, and the fact that he probably definitely has a thing for Silva, the female FBI agent.

The creative team (Jody Leheup, Sebastian Girner, Nil Vendrell, and Mike Spicer) do not take anything seriously. Shirtless is a hyperbole of our culture’s idea of what men should be, and that’s exactly what gets him into trouble. The issue of Shirtless’s dead lover reveals the cavalier way men treat women and highlights exactly why that is terrible and we should maybe stop doing that right now. Silva is not hyper sexualized and proves herself to be smart and resourceful–without her, Shirtless would fail his mission to save the forest.

So, here’s a comic that takes the most exaggerated masculine tropes and handles them in a subtle, brilliant, hilarious way. I’m definitely on board for a second volume (though it seems the creators are working on other projects right now, but a girl can hope).

Miss Migraine Gets Angry

Posted on by Kelly Lynn Thomas
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The Adventures of Miss Migraine is an ongoing column about my life with chronic migraine. This post appeared first on my blog of the same name on November 21, 2012.

When my husband got laid off in September 2012, we had to purchase our own health insurance (Note: This was pre-ACA). This was not an easy task. I had to make sure to get a plan that had reasonable specialist co-pays, that covered all of our medications, that included chiropractic and behavioral services, AND that didn’t cost a million dollars. Overall, I’m pretty satisfied with the insurance. It’s not cheap and it’s not as good as what we had under my husband’s job, but it does what we need it to do.

Except when it comes to my abortive medication, namely, Maxlt.

Oh, sure, the insurance company says, we’ll let you refill that–but you only get nine pills (yes, we know your doctor prescribed you twelve pills per month) and we’re going to charge you $280! But wouldn’t you rather just take Imitrex? I mean, we’d really like you to take Imitrex. We think it’s way better than Maxlt. And you can trust us, even though we aren’t doctors or nurses. We’re an insurance company! We know what we’re doing!

(In case it wasn’t clear, the above paragraph was sarcasm.)

I knew that when I started this blog, and decided to sub-title it “A Girl’s Adventures in the United States of Pain,” that I was eventually going to have to talk about how ridiculous and (pardon my French) fucked up our healthcare situation is.

The Affordable Care Act is making things better for a lot of people, me included. Making insurance companies provide birth control with no copay is a huge thing. But what the Affordable Care Act does NOT do is force insurance companies to cover non-birth control prescriptions at a reasonable co-pay.

Let’s just say I’m furious.

I was even more furious when I called the insurance company and asked for the reason for the quantity limit. FDA regulation, they told me. Well, that’s blatantly false! Teri Robert covers this issue in her book Living Well With Migraine Disease, but basically, the FDA suggests a max of 3 pills per week to avoid rebound headaches. That works out to 12 pills per month.

My doctor’s office has clearly run into this problem many times. When I called them, they said they would send a form over asking for coverage and a quantity increase, and that it was almost always granted. This is definitely good news, but just because I will probably get the medication I need doesn’t mean I’m going to stop fighting this.

Living with migraines is a kind of hell. No one should have to suffer through more hoops and stupid red tape because an insurer wants to save a few bucks. On Monday, I’m going to be making a few phone calls.

Post script: This has since happened to me many more times. Now my co-pay for my abortive medication is $80 for 12 pills, and my new insurance company also tried to limit me to 9, citing the same “FDA regulation” as the previous one. Sigh.