Tis the Season for Open Enrollment . . . Which is the Best Insurance for the Headache Sufferer

Over the years I’ve noticed a big difference among the insurance companies when it comes to respecting and caring for the headache sufferer.  This is best defined by the insurance companies willingness to listen the us, the providers and the patient on what treatments work.  So, if headache is your major health problem, I will make some suggestion.

We have had very good luck with Regence and BlueCross/Shield. They are willing to bend the rules when it comes to their patients.  In other words, if X, Y and Z fail, they will pay for and support things that they don’t usually cover.  If you have one of these insuers, count yourself lucky and let them know how much you appreciate their honest concern about you, their subscriber. I am proud to do business with them.

I think I could make the same statement for Atena. They have been very responsive to the special needs of headache patients.

So those are my top three and I will give my bottom three.

In my opinion, Molina is the worse.  They will not pay for most things that headache patients need.  I’ve had patients who completely failed the few things they cover, but then have a 100% success rate with something that isn’t covered (be it a medication or even things like acupuncture) and Molina will never pay for it, even it is a relatively cheap treatment.

Of course DSHS pays poorly for most things. They too make very few exceptions even if it greatly improves the quality of life for the patient.

I had been somewhat of a fan of Group Health because they did pay for things like Botox. But after our recent discussion with them (see the other news item about Group Health) I am very disappointed in them. They communicated to me that they did not consider headache to be a serious problem and for that reason they will not allow patients to seek specialty care even if the person is suffering tremendously. They also have a narrow pharmacy formulary and will not make exceptions if you life depended on it. So I don’t recommend headache sufferers picking Group Health if they have an option.

I will add one more comment about Tri Care. Those who have Tri Care, usually have no choice. While we must see Tri Care patients for free (it cost us more to process the claim than we get from them) they do, at least, pay for the medications that the patient needs, usually much better than the private insurers.