Tips for insurance appeals

I want to share some tips for insurance appeals. I'm not sure if they all help but I'm sure they can't hurt.

First of all, I don't know if this is true, but it seemed true for me. I was told that an appeal coming from a patient is often more successful than a doctor appeal. Your doctor should be able to appeal 3 times, and if all of those are denied, it becomes the patient's turn to appeal. What I did with mine was just overwhelm them with info. I wrote like a 6 page letter giving them a history of my headaches for the last 15 years, telling them all the things I tried,how it had affected my life, and why the stimulator was the last option. I wrote it as an essay so maybe it would make them think of me as a person instead of a number.

I also included references to current research articles. I suggest using Google Scholar to look for professional articles. I have a list of them that I'd be happy to share but I'm sure there are some more up-to-date articles available as well.

I also did a simple cost-benefit workup. I'm not much with numbers but I basically added up my costs for the past year, and estimated how much of that could be cut out if the stimulator works (75% of prescriptions, ER visits, urgent care visits, etc.) and compared it to the stimulator to show that them paying for the surgery would be to their financial benefit within as short as a year.

And lastly, I'm also it's told the diagnosis and procedure codes are important. For example, if your diagnosis is coded as "migraine" it won't be as successful as if it's coded as something more specific like "occipital neuralgia." I already posted the codes that were successful for me on here somewhere but if you can't find them, I would be happy to post them again.

Those are my tips. I hope they help. If anyone has anything to add, please do!

 Also, as previously posted, we've got a great group going regarding occipital nerve stimulation on Facebook so please join us! http://www.facebook.com/groups/232392623486874/

Facebook

Yeah, I'm a nerd, I'm on Facebook a lot.  As I was browsing around, I realized there are several groups for migraines and nerve stimulators in general, but none specifically dedicated to occipital nerve stimulation.  I've found these groups to be great sources of information and a great way for people to communicate.  Blogs are good too but they are obviously rather one-sided.  So please consider joining the group.  Sometimes the discussions are a little slow to get going but feel free to invite friends or anyone you know who may be interested.

Here is the link to the group:

http://www.facebook.com/groups/232392623486874/

Hope to see you there!

Two New Blogs

I have two new blogs to share with you related to occipital nerve stimulators.

The first is from Tara who has been diagnosed with hemicrania continua and is looking into getting a stimulator to help manage her pain.  You can find her blog at: http://hemicranialady.blogspot.com

The second is from "Ms.J" who has been diagnosed with occipital neuralgia and although she's been suffering for years, she is just starting her journey into the world of ONS.  You can find her blog at: http://on-neurostim.blogspot.com

I'm still way behind on getting my list of doctors updated, although since I've heard it has actually helped people find a doctor, I know it's an important thing to do.  I also need to update my links and labels.  I've been pretty lax about keeping up with this blog lately but updating it is at the top of my list, I swear!

If anyone has a blog that relates to occipital nerve stimulation that you want to have linked to on this site, let me know.  As always, my email is always open.

New ONS Blog

I don't often have much to post anymore since my stimulator is in and working well.  It's hard enough to find the info that people want on this blog so I've vowed not to bog it down with a bunch of useful posts just to keep it active.  Consequently, I now go months without posting.  But even if I'm quiet, I'm still here and check my email daily so you can get in touch with me.

A fellow headache sufferer and blog reader has decided to blog about her experience getting a stimulator.  I want to share it so that people can hear a more current and different story than mine.  Because resources regarding occipital nerve stimulators seem to be so hard to come across, I'm really excited that "nutmeg04" has decided to document her experience.

Her blog can be found at:
http://stimulationsurgery.blogspot.com/ 

She just got her trial stimulator put in TODAY so show her some support and have a look!

List of ONS Doctors--Updated

I have just updated the list of doctors that are known to use occipital nerve stimulators for headache treatment from names readers have submitted to me.  If you have any to add, please e-mail me.  And thank you everyone for helping me compile this list.  I've been told by several people that it has been a great resource for them.

This list can always be found on the righthand side of the blog for easy access (you may have to scroll down a bit to see it).  Also, as one reader suggested, you can try contacting your local university pain management center.  Most of them implant nerve stimulators for many indications, possibly including headaches. But in the meantime, here is the current list:

NOTE: I cannot, and do not, vouch for any of these doctors, except Dr. Elborno as he is the only one I personally have any experience with.

Dr. Ahmed Elborno
Midwest Academy of Pain & Spine
Chicago, IL

Dr. Robert Narotzky
Central Wyoming Neurosurgery
Casper, WY

Dr. Miles Day
Lubbock, TX

Swedish Pain and Headache Center
Seattle, WA

Mayo Clinic
Scottsdale, AZ

Elliot Pain Center
Manchester, NH

Dr. Thimineun
Comprehensive Headache & Pain Center
Derby, CT

Dr. Nagy Mekhail
Cleveland Clinic
Cleveland, OH

Dr. Linqui Zhou
Woodbury, NJ

Dr. Peter Pahapill
United Neurosurgery Associates
St. Paul MN

Dr. Ashwini Sharan
Jefferson Medical Center
Philadelphia, PA

Dr. William Witt
Cardinal Hill Rehab Hospital
Lexington, KY

Dr. Ramsin Benyamin
Millenium Pain Center
Bloomington-Normal, IL

Dr. James North
Winston-Salem, NC

Drs. Didier Demesmin and Jeffery Gehret
University Pain Management Center

Somerset, NJ

Dr. Hammam Akbik
UC Pain Management Center

West Chester, OH

Precision Neurosurgery
Melbourne, VIC--Australia

Dr. Andrew Parent
London, Ontario--Canada

According to Medtronic, other doctors also available in Montreal and Vancouver

Residual Effects

I've had my stimulator for a  year and a half now, and I find that as time goes on, I use it less and less.  When I initially got it, I had it on all the time.  Now I only turn it on when I need it.  My surgeon's head nurse told me that this is pretty common, and in fact some people get to the point where they no longer need the stimulator.  She said they removed a woman's this fall because she no longer used it!  I still find it hard to imagine getting to that point, but the idea that it is possible is so uplifting.  Now, I have zero medical background, but I'll try to explain it the way the nurse explained it to me.

She said when people have chronic pain, the nerves get used to firing  at a certain location.  The more they do this, the more that becomes almost like a normal process for your body.  Part of breaking the pain cycle is to block that "easy" path that your nerves have gotten used to.  The stimulator helps to disrupt this pain path and make your nerves sort of re-circuit.  If there is a bigger problem causing the pain, your body may find new paths to use.  However, if the pain is partially caused by nerves that are damaged from so much firing, the stimulator may help to give them a break and allow them to heal (yes, nerves can/do regenerate).  I'm sure it's all much more complicated than that, but that was a basic explanation that I got that I thought was worth sharing.

I hope everyone had a wonderful holiday season.  Best wishes to all for a pain-free (okay, let's not get greedy...pain-reduced) New Year.

Breakthroughs

There are a couple of exciting breakthroughs I want to mention for anyone who is interested.  The first doesn't have to do with occipital nerve stimulation, per se, but it's a breakthrough in migraine treatment.  The FDA has recently approved the use of Botox for migraine treatment.  My excitement from this approval is that it shows that there IS hope for new treatments to be approved!

But more importantly, supposedly there will be a nationwide medical trial conducted on nerve stimulators in regards to headache treatment in 2011.  What this means for you:  If you can't get your insurance to cover the stimulator, you can get it paid for under the medical trial if you get accepted.  I, unfortunately, do not have much information regarding the trial.  I do know that the Mayo Clinic has accepted several people but am not sure if the opportunity is only being offered through specific doctors/clinics, or is available all over.  I asked my doctor about it, and she hadn't heard anything about it.  She said she'd do some research and get back to me.  My suggestion would be to discuss the possibility of joining the trial with your doctor ASAP.  If any of you readers have more information regarding this trial, please let me know so I can share it with everyone.