Health Insurance: Managing the Changes that Unexpectedly Happen While Your Child is Seeking Help for Their Medical Condition

Being a parent of a child living with chronic migraine comes with its share of numerous obstacles. Between getting the referrals from the primary care physician to seek a proper diagnosis from a neurologist or headache specialist then figuring out with treatment options are suitable for your kid so they can attend school more often than not; you barely have time to worry about much else.

You should be able to rely on your child’s provider and health insurance to help make each medical related issue run smoothly. For the most part, it will be an effortless feat. That’s when you can’t help but be thankful for having an incredible medical professional taking care of your kid and the right type of coverage that gets your son or daughter feeling more like themselves.

Regrettably, there will be times when you are on the phone for hours on end or standing in front of your child’s provider asking for guidance on how to not lose your sanity when disputing a denial for treatment or tests that could benefit your kid.

In the past five years of seeking treatment for my son’s chronic migraine diagnosis, our two major dilemmas were having his first neurologist relocate to a different state and his second neurologist name not be on the new health insurance company’s list of providers my ex-husband’s company switched over to.

I’ve learned if you are unprepared to deal with these new developments, it’s relatively easy to become overwhelmed with decisions that require a resolution in a very time sensitive manner.

It’s because of those unexpected developments; I want to share how I was able to successfully navigate through switching providers and have a positive experience while doing so.

Transitioning from one provider to another; especially when things are going so well, does not seem ideal to most people. The last thing we wanted to hear is if my son wanted to keep seeing his neurologist, we’d have to travel halfway across the United States to her new office. She’d still be covered under our insurance, but there were the added expenses that just didn’t seem feasible at that time.

A common factor some people are forced to take into consideration is would you be able to afford the extra expense of continuing to do office visits with that provider? You’ve entrusted your child’s health with this medical professional for months, possibly years and seen a vast improvement in your kid’s overall well-being. However, the financial impact has the potential to lead to more expenses than your budget allows.

I ran into this issue 2 years into my son Colton’s initial migraine diagnosis. We learned his neurologist was relocating to another state. The paranoia immediately stepped in leaving me unsure of what to do next. Even with the existence of virtual visits, going for in-office visits twice a year wasn’t going to work within our budget.

Thankfully, my child’s neurologist offered to help us with finding a new provider. Ones she felt were very knowledgeable about Colton’s other migraine diagnosis: abdominal. The nice part about her recommendations is these neurologists were located in the same office she had practiced at.

Soon after choosing a suitable provider to treat my child, a consult followed so that we had a chance to exchange vital information that was relevant to my son’s health progress before his next follow-up appointment. This opportunity gave our family a chance to get familiar with one another and left Colton a bit more at ease especially since a proper introduction given by his current neurologist.

We then spent the next two years working as a team with Colton’s new neurologist. At the beginning of his first recommended treatment regimen, there was a significant amount of improvement with his health. He was
rarely missing full days of school. The best part was that he joined the middle school’s football team and was experiencing a better quality of life as a teenager.

The school year started great. Colton managed to attend all of his freshman
classes and played in each of his JV high school football games. If he did get a migraine attack, it was quickly aborted with non-prescription methods. I continued to remain hopeful, and so did he. That moment was temporary. We found ourselves back to his neurologist, grasping at straws trying to find a better treatment option than the last.

For the next four months, we made no progress. Colton’s health was at a complete standstill. I know the changes in the environment like the barometric pressure and humidity play a huge role in how frequent my teen’s migraine attacks hit him. It was a brutal winter, but there had to be something more we could do to help him.

During this time another unexpected change of events took place with our insurance provider. My ex-husband’s company was bought out, and with all of the modifications, we learned the health insurance we had for the past 15 years, was no more.

I had no clue what was in store for us with the new insurance provider, but I made it my priority to get as much as information I possibly could starting with the list of providers in their network.

When I didn’t see my teen’s current neurologist listed as in the network I temporarily went into panic mode. We already switched neurologist once before. Was it necessary to do it again?

There are a few options available when your provider is no longer in your network. You could continue to be that provider’s patient and pay the full cost for every visit out of your pocket. Another option would be to call your insurer directly to ask if they’d consider adding your kid’s provider to their network. You could even take that a step further by convincing your child’s doctor to join your insurer’s network.

Lastly, there’s always the option of finding a new provider. Again, this option may not be one you are ready to choose for your son or daughter. I will tell you with all of my battles with the insurance company; this one can be a somewhat frustrating and difficult one. If you are adamant about keeping your kid’s provider, it is possible to break through those insurance barriers by submitting an appeal. I will tell you that there is a lot of work to be done on your end. It is not an easy process, but it doesn’t mean it won’t be worth all of your time and effort.

Yes, we had a good relationship with Colton’s neurologist, but we also were struggling to get him to school on a daily basis. With no improvement in months, I knew the longer we waited to seek out another suitable provider, my son’s health would continue to be in limbo.

This time, I contacted our new insurance company and requested a list of neurologist and headache specialist that focused on migraine in teenagers. After researching the list of potential providers, I found one that I felt would be a good fit for my son and called the office to get the new patient registration started.

No matter what age your child may be, I feel it is important to discuss any new changes that are relevant to their healthcare. This kind of openness could make the transition between physicians a little less intimidating for your kid and will give you a chance to address any concerns or questions they may have before their first appointment.

Our first office visit to Colton’s 3rd neurologist could not have gone any more smoothly. Not only did his new provider know all about abdominal and chronic migraine, but he also gave my son assurance that we would find a way for him to experience a better quality of life. As a mom, that is all I could ask for my child. Someone that gives my teen hope he’ll be a full-time student that gets to play high school football just like all his other classmates.

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