Letter to Insurance company

[Ricardo]

Thought I would share...

Dear Health New England,

     I am writing to you because I have been extremely dissatisfied with the level of service that your company has provided me.  I am a chronic cluster headache sufferer.  Cluster headache has been deemed the “most painful condition known to man” and I get them every day.  Every day of every month of every year I get these “headaches”, although calling them headaches does no justice to the sufferers who are afflicted with this disease.  The most accurate way that I can describe it is to imagine that someone has your eye in their hand and is squeezing it, trying to pop it like a grape. 

            The first thing that your company has done that is inexcusable is not paying for a doctor that is qualified to treat me.  I know that you have said that you have headache specialists within your plan, but none of them have ever proven that they actually know what they doing.  The only way that they can do this is by going through the United Council for Neurologic Subspecialties.  This is the only certification that a physician can do to show that they actually know what they are talking about when it comes to headache medicine and you have no doctor that has gone through this.  All it takes is a quick talk with most headache specialists to find out the unfortunate truth about Cluster Headaches, that even headache specialists only get taught a good 10 minutes of cluster headache information while they are being trained.  Maybe you have a doctor who is different, but you have no way of proving that and I do not feel like taking the gamble to see if your doctor who has in no way proven his ability to treat patients like me can actually treat me effectively.  I have a Neurologist that has gone through this certification but you refuse to pay for him, because you put profits ahead of actual care.  Luckily he is a compassionate person who gives me a break on his fees because he knows how horrible this disease is and also now knows the truth—that before I was going to him I was in the Emergency room once a month and that now, almost 4 years later I have not had to go once. 

     The second thing that your company has done that I find completely inexcusable is that you refuse to pay for the proper amount of medication that my doctor has prescribed.  The medication is Sumatriptan injections and I have been prescribed 6 shots every month, but your company will only pay for 4.  I get 30 days a month of pain and I only ask for what my doctor has prescribed, 6 days of relief for the times when these headaches get unbearably bad.  Your company has insisted that they know the situation better than my neurologist and say that I should be on a different medication, one that costs your company much less than the medication that has been prescribed.  The idea that your company has tried to force down my throat is that I should be on “preventative” medication instead.  That would be a great idea if they had a good reputation for working and would not be very bad for my overall health and wellbeing.  These options range from toxic anti-psychotics like Lithium or Zyprexa to blood pressure medication like verapamil. (although I should not neglect to mention that you have made it very clear that you will pay for as much addictive narcotic medication that I can get a doctor to prescribe)  The thing is, IÂ’m not psychotic, and I donÂ’t feel like I should have to go on a toxic medication that will zombify me and make it so that I have to continuously be checked to make sure that my kidneys are not failing.  ThatÂ’s just the Lithium though, the Zyprexa can theoretically give me long lasting Tardive Dyskinesia from just one dose along with a slew of other horrible side effects.  There is also that Verapamil blood pressure option that has been repeatedly recommended by your company “doctors” (I dispute the claim that they are true doctors because real doctors have taken an oath to “do no harm” not “do no harm unless itÂ’s going to profit the company that I work for”) but the thing is that I do not have high blood pressure, I have almost low blood pressure.  A cardiologist I met with said that he could not put me on a high dose of it because with my blood pressure it would end up making me very very tired.    IÂ’m sure you could come up with a bunch of more options that would do me no good but would be good economically for your company but I donÂ’t feel like being your companyÂ’s guinea pig and I actually want to keep myself productive and live my life fully. 

     All I have asked for is for you to pay for what my qualified neurologist has recommended—6 shots of Sumatriptan a month, but you will only pay for 4.  This makes it so that I have to pay out of pocket $175 for the extra 2 shots and this is not ok.  Truthfully I do not understand how people that make these decisions sleep at night, you are ruining lives and most definitely giving inadequate care to people that severely need it.

     I would say I look forward to your response, but it would not be true.  I have explained all this to your company in detail and have only been met with a stonewall resistance to treat my condition effectively.  At this point I want as little to do with your company as possible and as a business owner who will be very shortly looking into health insurance options for our employees this will most definitely be taken into consideration.  I will also be making this an open letter that will be posted on my Facebook page to make sure that as many people as possible are aware of this situation.

Ricardo  (edited because I accidentally "outed" myself...as in no, my name is not actually Ricardo )

Cluster Headache Sufferer