When your migraine treatment (or a part of it) is denied it can derail any progress you made. To fight back against such denials you might need something like, “The Guide to Filing an Insurance Complaint for Headache Disorder Patients & Providers”, provided by The Headache and Migraine Policy Forum. This can help you file state insurance complaints against your insurer.
The following information about filing state insurance complaints can be found at the Headache and Migraine Policy Forum’s website. It is reproduced here in similar language.
People who live with headache disorders have more treatment options than ever before, including new and innovative medications. For some patients, the use of multiple preventive or rescue medications at the same time yields the best outcomes. Despite this, insurance companies are denying patients access to some of these prescribed medications. This limitation on migraine treatments adds to the stress, anxiety and stigma of living with the disease. Patients—and their providers—can get help in appealing their insurance company’s denial. Every state provides oversight of insurance companies, commissioners through whom you may file a state insurance complaint. Aside from their regulatory role, states also provide liaison services between insurance companies and the consumers they serve.
If you or your patient has been denied access to treatment, you have the right to file a state insurance complaint.
STEP 1: Try to Resolve the Issue Directly
Before you file a request for assistance or complaint with your state’s consumer services office, you should first contact the insurance company to try and resolve the issue. If you do not receive a satisfactory response, then contact your state’s consumer services office.
STEP 2: File an Official State Insurance Complaint
Aside from the reason for your complaint, be prepared to provide the following information regarding your situation:
- Name and contact information of the patient or provider filing the complaint;
- Name of insurance company, type of insurance and state where the plan was purchased;
- Claim information, including policy and claim numbers, and dates;
- What you consider to be a fair resolution. Most states are required to follow up in a defined period, usually 30-45 days.
STEP 3: Share a Copy of Your Complaint
The Headache and Migraine Policy Forum is tracking complaints related to care and treatment denials to help follow-up on systemic access challenges. Sharing your story will help other patients get access to treatment. Please email a copy of your complaint to: firstname.lastname@example.org
The Alliance for Patient Access (AfPA) Headache and Migraine Disease Working Group is a unique network for clinician advocates interested in public policy related to access to therapies for headache and migraine disease.
The Coalition For Headache and Migraine Patients (CHAMP) provides support to people with headache, migraine and cluster diseases who are often stigmatized and under-served. CHAMP brings together organizations and leaders in the migraine community to enhance communication, coordination and collaboration to more effectively help people wherever they are on their patient journey.
The Global Healthy Living Foundation (GHLF) advocates for improved access to care at the community level, amplifying education and awareness efforts within its social media framework including the 50-State Network, a grassroots advocacy network of patients who engage with policymakers and the community on barriers to access to treatment.
The mission of the Headache and Migraine Policy Forum (HMPF) is to advance public policies and practices that promote accelerated innovation and improved access to treatments for persons living with headache disorders and migraine disease.
We at Patients Rising certainly hope you never have to use tools like these, but if you do, we’re proud to collaborate with organizations like The Headache and Migraine Policy Forum, The Coalition for Headache and Migraine Patients, and the Global Healthy Living Foundation. Again, you can find the original PDF version of this information at https://www.headachemigraineforum.org/complaint.
It is easy to feel powerless against collossal insurance companies, but filing a state insurance complaint can give you some power back.
And if you would like to learn more about what migraine treatments or what migraine patients are going through you can read the following:
“How Step Therapy Resulted in Untreated Migraine” by Eileen Brewer
“Migraine: Take More Control With This One Vital Tip” by Lisa Smith