Headaches and Insurance

On Tuesday, I had an appointment with the Headache Clinic at Dartmouth. I first went about six months ago, so for the past six months I have been taking monthly Emgality injections, which are very painful, by the way. Anyway, before I started taking the Emgality, I was having a headache seven days out of the week. Since the medicine kicked in, it took almost two months to begin working, my headaches have dropped to about four a week. Obviously, this is an improvement, but not the kind of improvement the clinic wants to see. In my appointment on Tuesday, the nurse practitioner who does all the follow-up visits talked to me about switching to Aimovig and/or Botox injections. Aimovig is another auto injector like Emglaity, but supposedly easier to use, not that Emglity was hard to administer. She asked which I would prefer. I have never been too keen on the idea of injecting poison into my body, so Botox is not something I really wanted to consider. Also, it’s thirty-one shots in the head, and I don’t like needles. However, I am getting desperate. I have dealt with headaches my entire life, and I just want some relief. I asked the nurse if I would be taking Aimovig and Botox or just one or the other. She told me that they would prefer that patients try both at the same time. Though research is being done on the combined effectiveness and not much information exists about this yet, it is believed that they work well together to prevent migraines. Here comes the caveat: very few insurance companies will pay for both treatments at the same time. She advised that I call my insurance provider and ask if they would cover both simultaneously.

Let me begin by saying that I hate insurance companies. They are crooked and cheap. They are always trying to cut corners and not pay for treatments advised by doctors. While my friends in other countries will say that the United States needs universal healthcare, and I am not going to argue with that, the US government is so colossally incompetent and corrupt that I am afraid it would actually be worse than the current situation. Considering that a large number of people were stupid enough to elect Donald Trump, how can I have faith that they would ever support truly universal healthcare? I just don’t believe it is possible in the greedy, capitalistic economy of the United States.

Now that I have given my rant about insurance companies, I will tell you what happened when I took the nurses advice and called my insurance company. Right off the bat, I got am idiotic computer giving me vast amounts of useless information that I did not ask for. So, I finally asked to be connected to an operator. I was given their pharmacy department. Finally, a live person! So I told her about my neurology visit and what had been recommended and asked would they cover both treatments. That’s when I began to get the runaround. I was told by the customer service representative that they had not received a preauthorization  request for the Aimovig and therefore could not tell me if they would cover it or not. I already knew they would probably cover one or the other, but I wanted to know if they would possibly cover both. The reason I knew they would cover Aimovig or Botox is because when I was first prescribed Emgality, their reason for the initial denial was that I had not tried Aimovig or Botox first. Then she proceeded to tell me that Botox is a medical procedure and does not fall under her department, and I would have to talk to a representative from the medical department. So, she transferred me over there. I went through my explanation again. Again, I was told that he could not tell me if Botox would be covered because they had not received a preauthorization request. So I explained to him again that I was not asking if they would just cover Botox, but would they cover both treatments simultaneously. Again I was given the spiel about the Aimovig was covered by the pharmacy division and Botox was covered by his divisions, and he had no way of knowing if they would cover both since they would have to be requested separately. He told me to have the Headache Clinic request a preauthorization for both treatments.

At this point, I gave up on talking to the insurance company since they were obviously not going to tell me anything. So, I did as he suggested and called the Headache Clinic. This is when I got really annoyed. I was given a clerk to speak to and explained what I was calling about. I told her I needed them to request both treatments before they could tell me if both would be covered. She took down the message, and then had a nurse call me back. This was not the nurse practitioner I had spoken to earlier that morning. The nurse reviewed my chart and told me that it did not mention the Botox treatment and therefore the nurse practitioner must have decided against that course of action. I tried to explain that before she would order the Botox and the Aimovig simultaneously, that she wanted me to talk to the insurance company. I was basically told the since it was not in the chart, I needed to forget about it for now. When I tried explaining again, she finally said she would make a note of my call and ask the nurse practitioner, who would call me back. Do you think I have gotten a phone call back? No. While I like the people at the Headache Clinic, they are really bad about returning phone calls.

As it stands now, it appears that I will only be taking the Aimovig. Here’s what worries me, I was told by the pharmacy that by changing medications, it would take two to three months for the new medicine to begin working. If they had been able to schedule the Botox, the effects would be immediate and the botox would be working its magic while I waited for the Aimovig to begin working. I had been told that a Botox appointment would not take long to get scheduled because with the pandemic, they had a lot of appointments open. I am writing all of this because I had a major debilitating headache yesterday and was really hoping for a treatment that would work. Now, I wait.