I changed jobs in May, and my health insurance from my previous job expired on 4/21/13, and my new insurance went into effect 7/1/13. At the end of September, I was forced by my doctor to make an appointment and go see him during a migraine before he would authorize a refill for my sumatriptan. I say “forced” because #1-I see him regularly, about every 3 months for ongoing follow-up for my migraines and fibromyalgia, #2-I had just seen him at the end of July after my new insurance went into effect, and #3-I have always used sumatriptan as treatment and only got 9 per month-not like I was asking for an excessive amount for a refill of 9 after two months. So, I felt it was unnecessary for me to leave work and drive over there to the doctor’s office in the middle of a horrendous migraine episode just to get him to send in a refill of the medicine we both already knew would abort the episode, so I could waste more time away from work to go out by my house to pick it up, so I could function well enough to then go back to work. I could have just taken my lunch hour, gone straight to the pharmacy, and been back well within my allotted 30 minutes if he had just approved the refill. Instead I was gone from work for over 3 hours, and they told me not to bother coming back that day. They were not happy, nor were they sympathetic.
Anyway, the point of this is, when they submitted the visit to my insurance, I assume they put down “migraine” as the reason for my visit, and now the insurance company is refusing to pay the bill – and refusing to pay for my migraine meds any more – because they “suspect it is a pre-existing condition.” I am 46 and have been suffering from migraines for over 32 years – heck yes, it’s a pre-existing condition. It seems stupid to me for them to apply that term to migraines, and even more so for them to use it as a reason to get out of paying claims. Does this mean they will only pay for migraine treatment if I only started having them after July 1, 2013? They sent me a questionnaire to fill out, where I had to answer whether I had been treated for “this condition” prior to July 1, 2013, (when my insurance went into effect.) I said NO – my rationale being, “No, I was not treated for THIS migraine before July 1, only on Sept. 27th.” If they want to deal in semantics, I can do semantics. We’ll see if they buy it or not. I’m betting not, and then I will be stuck paying $300 for my minimum supply of sumatriptan every month…and the neurologist my PCP wants to send me to? Forget that! This may be the end of any treatment for my migraines beyond OTC stuff that very rarely works.
Has anyone else been through this with insurance before – determining that your migraines are a pre-existing condition so they don’t have to pay?