Are You Getting Substandard Migraine Care Too?

Nancy Harris Bonk Health Guide
  • On April 13, the most appalling study was released confirming something I had suspected for a long time. The study is the "Impact of insurance status on migraine care in the United States."1  Migraineurs (and patients in general, in my opinion) who are uninsured or insured with Medicaid and/or Medicare get substandard medical care. Yes, you read that correctly. Teri has written an excellent article about this study you can read in the article, No Insurance Often Means Substandard Migraine Treatment.


    I've often wondered about this very subject when waiting in a small sign-in line at my neurologist's office. This doctor sees people who have MS, are in chronic pain, who have limbs in casts, who have necks in braces, people using crutches, and Migraineurs too. It seems that when someone who has Medicaid steps up to the window I can almost hear an audible a sigh from the receptionists - "ugh, here is another one of those people." It's the smallest change in her tone of voice, posture and attitude. Her voice is a bit crisper; she's not as pleasant or accommodating as she was to the last patient. So what's the difference? One patient has private pay insurance and the other has Medicaid.

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    This doesn't just happen at this particular doctor's office; I've seen it happen at other doctors too. How do I know this, because I am now one of these people. As someone receiving Social Security disability benefits, I am on Medicaid and Medicare. At the offices of some of the doctors I'm seeing, this really isn't an issue for me. Having been a long-time patient with these doctors, I've established a relationship with the staff, so they know me and understand my current circumstance and know my health insurance has changed. But when I go to a different doctor as a new patient and pull out the dreaded Medicaid card, it's whole different ball game. It seems not to matter how pleasant or helpful I am, once that card is out, I am pegged as "one of those" patients.     


    And it doesn't stop there. After you get through the receptionist desk, you've probably been "flagged," "tagged," or whatever clerical word they put in your file so everyone now knows you are a Medicaid and/or Medicare patient. But now, any time I see a new doctor, (and sometimes the "old" ones) things are definitely different. For example, when I had private insurance, there was never a question regarding my IV infusion treatment. These are treatments I receive when I get into a Migrainous cycle that lasts too long, and I can't break it. Now, there seems to be a discussion about the treatment. "How about we do two shots of dilaudid to see if that will break it?" "Let's not start an IV this late in the day." (Wait, it is two o'clock in the afternoon and the office doesn't close until five. That isn't late in the day!!)  This has happened during two IV infusions during the last four months, and I honestly believe, it was because I am now one of "those" patients (Medicaid).


    With all the health care changes going on, how do we change the attitudes of people working in this area? Don't patients who have Medicare and / or Medicaid deserve the same treatment as private pay patients do? Do we not get it because there is too much paper work to fill out, or doctors aren't reimbursed enough per patient? Whatever the reason, it does not excuse treating people who are uninsured or have Medicaid poorly. We are patients with health issues coming to you for help, not attitude.


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    1 Wilper, Andrew, MD, MPH; Woodhandler, Steffie, MD, MPH; Himmelstein, David, MD; Nardin, Rachel, MD. "Impact of insurance status on migraine care in the United States." Neurology® 2010;74:1178-1183.  






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    © Nancy Harris Bonk

    Last updated April 18, 2010.

Published On: April 18, 2010