Posted by drummer (208.157.153.149) on June 21, 1999 at 11:23:07:
In Reply to: Insurance denials-please help-OUCH research posted by Paul on June 21, 1999 at 09:05:17:
Hi Paul,
Drummer here. Please be careful about “tearing the FICO’s apart”. Yes, it is frustrating. I have asked my wife to respond to OUR concerns and frustrations. I hope it will shed some light on the difficulty that WE all face with this illness called Cluster Headache. I have no doubt that O.U.C.H will help US overcome the many hurdles that WE currently face. I think it is important that WE all make a commitment in OUR local areas to make some changes. I firmly believe that seeking understanding from not only the FICO’s but also doctors and headache research professionals is extremely important. I live in the state of New York. I have placed a call to the University of Rochester. I am awaiting a response from a doctor there that is researching headaches. I am going to ask him for direction in my quest for understanding of Cluster Headaches. I wish you great success in your local area. Here is my wife’s response to your post:
I work for a major health insurance company. The reason the company I work for does not cover Oxygen for the treatment of Cluster Headaches is because of our Corporate Medical Policy. Our Corporate Medical Policy only covers Oxygen for respiratory problems. All this means is that there is not an awareness or documentation on the use of Oxygen for Cluster Headaches. People that suffer from Cluster Headaches KNOW what works for them and their doctor’s experiment to find what works. It is very difficult to expect a Health Insurance Company to be aware of KNOWN treatments when the Company is unaware of such treatments. Documentation from a Medical Professional is the key.
Let me Explain. I spoke to our Medical Director and was told that he would like to have more information (ie…documented information from a prescribing Neurologist on the treatment of Cluster Headaches). It is possible that our company is not aware that people are suffering unintentionally from our ignorance. If there are KNOWN treatments for them, we need to look at the documentation and move forward with it. You may want to speak to your insurance company and find out if this is the case. Anyone can request a change in the Corporate Medical Policy of a Health Insurance Company. Be sure to ask them how often it is reviewed and how much information they need to get the ball rolling. Be aware though; it is probably not a quick process from the customer’s viewpoint. It can sometimes take longer than a year. That is not a long time to an insurance company, who is trained to cover their ass, then cover it again. Be patient though; it will happen!
I have placed a call to my husband’s Neurologist to ask him to document my husband’s progress with Oxygen. The Neurologist will forward this documentation to the Medical Director of my Health Insurance Company. It will then be the Medical Director’s responsibility to follow up and pursue any possible treatments that the Neurologist documents. I am not going to “go into battle” with my Health Insurance Company. I am, however, going to follow through and educate my Medical Director with the help of my husband’s Neurologist. Your Neurologist’s assistance is critical in explaining and educating your Health Insurance Company.
Believe me, I know your frustration. I see it from both sides of the table. I know how to effectively follow the “rules” of a Health Insurance Company and at the same time change their policy to help my husband and others with Cluster Headaches.
The answer to your question 1). Oxygen is the most denied treatment for Cluster Headaches. (The only reason I say Oxygen is because usually drugs don’t require a Diagnosis; they tend to “go through” and get paid). Oxygen falls under Durable Medical Equipment and requires a diagnosis; which is separate from your drug benefit.)
The answer to your question 2). **Not a covered service for this condition.
Please feel free to E-mail if you have any further questions at davedrum@eznet.net.