Miss Migraine: Shopping for health insurance

Banner that says "The Adventures of Miss Migraine"

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.

 

Miss Migraine Gets Angry

Banner that says "The Adventures of Miss Migraine"

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.

Miss Migraine: Freeing Yourself From Anxiety by Tamar E. Chansky

Banner that says "The Adventures of Miss Migraine"

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 September 4, 2012.

Freeing Yourself From Anxiety, Tamar ChanskyTitle: Freeing Yourself From Anxiety
Author: Tamar E. Chansky, Ph.D.
Publisher: Da Capo Lifelong Books
Format: Trade Paperback
ISBN: 978-0738214832
List Price: $16.00

Freeing Yourself From Anxiety isn’t the kind of book I look for (as the possibility of it featuring explosions in space is right around zero). But my library, the Carnegie Library of Pittsburgh, recently released a smart phone app that lets you download and listen to electronic audio books on your phone, among other cool features. As an unabashed book junkie, I have been, pardon my French, using the shit out of this app.

The app’s only flaw is that it presents you with a list of every audio book currently available for check out and download (2018 update: This is now fixed). You can search for a specific book, but can’t, say, browse for science fiction books. So one day, Dr. Tamar E. Chansky‘s book came up on the first page of the long list of books available for download, and I thought, what the hell, stress is a huge migraine trigger for me, maybe this will help.

Although I felt the book could have been organized better, the information and strategies for dealing with anxiety, stress, and “negative” emotions more than made up for that shortcoming. At the book’s heart are four steps to help the reader overcome anxiety. These steps work both in the moment of anxiety and as a daily practice to help reduce the overall incidence of anxiety.

And here is the book’s real strength: Chansky doesn’t simply provide direction for calming the mind and body down when anxiety grips both, but direction and ideas for daily practice to train the body not to overreact to ordinary stressors and stimuli. Examples include instituting a time for regular, deep breathing to calm the body, keeping a gratitude journal to remind us of good things, and creating positive moments of joy (like playing with a pet) instead of waiting for them to simply happen.

Throughout the book, Chansky focuses on “possible thinking.” She actually advocates against false positive thinking, because studies have shown that telling yourself things are okay when they are not is just as bad as thinking negatively. Instead, she suggests re-focusing on reality: What is the actual situation? What do you truly believe will happen? Then, we can prepare ourselves for that situation instead of becoming stressed about out unlikely possibilities.

Admittedly, I haven’t been as dedicated in applying these strategies to my life as I should be (again, because stress is a huge migraine trigger for me), but even in my casual application I’ve seen a reduction in my stress and anxiety levels, at least in the moment. Just making myself pause and ask, “Kelly, do you really think that will happen?” is enough to calm me down. This book is overflowing with strategies, so I imagine almost every reader could find several that would work for him or her.

If you suffer from migraine or another chronic illness, and stress or anxiety trigger symptoms — or if you suffer from an anxiety disorder or simple depression — this book will provide you with something to fall back on when it feels like the world is slipping away from you, fast. I would, however, suggest reading a paper copy, because I often found myself wishing I could go back and re-read sections that I liked, and that’s a little more difficult with an audio book. This is an unpaid, unsponsored review.

How do you deal with stress and anxiety?